Start with the plan name and coverage dates. Then check the deductible, out-of-pocket limit, and what you pay for care you expect to use. Compare the Summary of Benefits and Coverage with your payroll deduction sheet, provider directory, and prescription drug list before you enroll.
During open enrollment, your employer may give you a Summary of Benefits and Coverage, often called an SBC, for each option. It uses a standard format so you can find the same information in each plan. Pull up the documents side by side, then work through the sections below.
Confirm you have the right plan and coverage period
Check the plan name, dates, and plan type at the top. An employer can offer several options from the same insurer, each with its own costs or provider network. Use the SBC for the upcoming coverage period and match it to the plan name on your enrollment form. Get your premium or per-paycheck cost from your employer’s rate sheet.
Read the deductible and out-of-pocket limit first
- Deductible. Check what you pay for services that are subject to it, which services the plan helps pay for before you meet it, and whether prescriptions have a separate deductible.
- Out-of-pocket limit. Check the most you could pay in a plan year for qualifying in-network costs. Premiums and charges for services the plan excludes fall outside that limit.
- Family coverage. If you’re enrolling dependents, look for both individual and family amounts. Read the explanation of whether one person can meet an individual deductible or limit within family coverage.
- Network and referrals. Check how costs differ outside the network and whether your plan requires a referral to see a specialist.
Find the services you expect to use
In the common medical events table, find the rows for your likely care, such as a specialist visit, an MRI, or a prescription. Read across to the in-network cost and the limitations column. A single event can have separate rows for a facility and a clinician. If you expect an outpatient procedure, compare both.
Note whether you pay a copay, which is a set amount, or coinsurance, which is a percentage of the allowed cost. For an illustrative service with a $300 in-network allowed amount, 20% coinsurance after the deductible would be $60 once the deductible has been met. If the deductible still applies, your share can be higher. Check the row for any conditions on when that amount applies.
Review exclusions and use coverage examples to compare plans
The exclusions and other covered services sections flag services the plan may exclude or limit. If you rely on a particular treatment, ask the plan about visit limits, referrals, or prior approval and confirm the details in the full plan documents.
At the end, coverage examples show how the plan would handle standardized situations, such as managing type 2 diabetes. Compare the same scenario across your options to see how the cost sharing differs. For care you already expect, ask the plan or provider for an estimate based on your own services and network.
Check what the SBC leaves to other documents
Use the plan’s provider directory to check the network for your doctors and facilities. Check the drug list for the exact medication and any approval requirements. Get the employee contribution by coverage tier and the election deadline from your employer. If you’re considering keeping your current option, use this open enrollment renewal checklist to compare the two plan years.
Sources & publication notes
Sources checked November 13, 2026. Figures identified as examples are original illustrations, not quotes or client results.
- CMS Summary of Benefits and Coverage
Standard materials and instructions for the SBC and uniform glossary.
- CMS sample completed SBC
Examples of the important questions, service cost-sharing table, limitations, and standardized coverage examples.
- HealthCare.gov uniform glossary
Definitions of common coverage and cost-sharing terms.
This educational guide is not a plan document or individualized tax, legal, or insurance advice; confirm requirements for your employer and coverage before acting.