SBC Disclosure

Summary of Benefits and Coverage and Uniform Glossary (CMS-10407)

OMB: 0938-1146

IC ID: 199007

Documents and Forms

Document Name Document Type
Maternity-Care-Narrative-05-05-22.pdf Other-Maternity Care Narrative
SBC_Diabetes-Narrative-051222 508.pdf Other-Diabetes 2 Narrative
Uniform-Glossary-051222 508.pdf Other-Uniform Glossary Anchor
English_Why This Matters NO Answers_Final_11.01.24 (clean).docx Other-What the Plan Covers and What You Pay (No Answers)
English_Why This Matters YES Answers_Final_11.01.24 (clean).docx Other-Why This Matters for SBC (Yes Answers)
Group-Instructions-051222 508.pdf Instruction
Individual-Instructions-051222 508.pdf Instruction
English_Sample_Completed_SBC_Final_01.28.25 (clean).docx Other-Completed SBC Template
English_Sample-Completed-SBC-Accessible-Format_Final_11.01.24 (clean).docx Other-SBC Template
Foot-Fracture-Narrative-051222 508.pdf Other-Foot Fracture Narrative
Coverage-Examples-Calculator-Instructions-051222 508.pdf Instruction
Coverage-Examples-Calculator-Instructions-051222 508.pdf Other-Coverage Calculator
Having-a-Baby-Guide-051222 508.pdf Other-Template
Managing-Type-2-Diabetes-Guide-051222 508.pdf Other-Diabetes Guide
Uniform-Glossary-051222 508.pdf Other-Glossary Anchor
Simple-Fracture-Guide-051222 508.pdf Other-Template
English_AIAN-Limited-Cost-Sharing_Final_01.28.25 (clean).docx Instruction
English_AIAN-Zero-Cost-Sharing_Final_01.28.25 (clean).docx Instruction
English_Uniform Glossary_Final_11.01.24 (clean).docx Other-Uniform Glossary
CMS-10407 SBC Template SBC-Template-Accessible-Format.pdf Form
Carolinian_SBC-Template-Standard-Format_Final_11.01.24 (clean).docx Other-SBC Template - Carolinian
Carolinian_Uniform Glossary_Final_11.01.24 (clean).docx Other-Uniform Glossary - Carolinian
Carolinian_Why this Matters NO Answers_Final_11.01.24 (clean).docx Other-Why This Matters NO Answers - Carolinian
Carolinian_Why this Matters YES Answers_Final_11.01.24 (clean).docx Other-Why This Matters - Yes Answers - Carolinian
Chamorro_SBC-Template-Standard-Format_Final_01.28.25 (clean).docx Other-SBC Template - Chamorro
Chamorro_Uniform Glossary_Final_11.01.24 (clean).docx Other-Uniform glossary - Chamorro
Chamorro_Why this Matters NO Answers_Final_11.01.24 (clean).docx Other-Why This Matters No Answers - Chamorro
Chamorro_Why this Matters YES Answers_Final_11.01.24 (clean).docx Other-Why This Matters YES Answers - Chamorro
Chinese_SBC-Template-Standard-Format_01.28.25 (clean).docx Other-SBC Template - Chinese
Chinese_Uniform Glossary_Final_11.01.24 (clean).docx Other-Uniform Glossary - Chinese
Chinese_Why This Matters No Answers_Final_11.01.24 (clean).docx Other-Why This Matters NO Answers - Chinese
Chinese_Why This Matters Yes Answers_Final_11.01.24 (clean).docx Other-Why This Matters Yes Answers - Chinese
Pennsylvania Dutch_SBC-Template-Standard-Format_Final_11.01.24 (clean).docx Other-SBC Template - Pennsylvania Dutch
Pennsylvania Dutch_Uniform Glossary_Final_11.01.24 (clean).docx Other-Uniform Glossary - Pennsylvania Dutch
Pennsylvania Dutch_Why this Matters NO Answers_Final_11.01.24 (clean).docx Other-Why This Matters No Answers - Pennsylvania Dutch
Pennsylvania Dutch_Why this Matters YES Answers_Final_11.01.24 (clean).docx Other-Why This Matters YES Answers - Pennsylvania Dutch
Samoan_SBC-Template-Standard-Format_Final_11.01.24 (clean).docx Other-SBC Template - Samoan
Samoan_Uniform Glossary_Final_11.01.24 (clean).docx Other-Uniform Glossary - Samoan
Samoan_Why this Matters NO Answers_Final_11.01.24 (clean).docx Other-Why This Matters No Answers - Samoan
Samoan_Why this Matters YES Answers_Final_11.01.24 (clean).docx Other-Why This Matters Yes Answers
Spanish_SBC-Template-Standard-Format__Final_11.01.24 (clean).docx Other-SBC Template - Spanish
Spanish_Uniform Glossary_Final_11.01.24 (clean).docx Other-Uniform Glossary - Spanish
Spanish_Why This Matters No Answers_Final_11.01.24 (clean).docx Other-Why This Matters No Answers - Spanish
Spanish_Why This Matters Yes Answers__Final_11.01.24 (clean).docx Other-Why This Matters Yes Answers - Spanish
Spanish_Why This Matters Yes Answers__Final_11.01.24 (clean).docx Other-Why This Matters Yes Answers - Spanish
Tagalog_SBC-Template-Standard-Format_Final_11.01.24 (clean).docx Other-SBC Template - Tagalog
Tagalog_Uniform Glossary_Final_11.01.24 (clean).docx Other-Uniform Glossary - Tagalog
Tagalog_Why This Matters No Answers_Final_11.01.24 (clean).docx Other-Why This Matters No Answers - Tagalog
Tagalog_Why This Matters Yes Answers_Final_11.01.24 (clean).docx Other-Why This Matters Yes Answers - Tagalog
Navajo_SBC-Template-Standard-Format_Final_01.07.25 (clean).docx Other-SBC Template Standard Format - Navajo
Navajo_Why This Matters NO Answers_Final_01.07.25.docx Other-Why This Matters NO Answers - Navajo
Navajo_Why This Matters YES Answers_Final_01.07.25.docx Other-Why This Matters YES Answers - Navajo
Navajo_Uniform Glossary_formatted_Final_01.07.25.docx Other-Uniform Glossary - Navajo