Summary of Benefits and Coverages (SBC)

INsurInsurance companies and group health plans are required to provide consumers with a concise document detailing, in plain language, simple and consistent information about health plan benefits and coverage. This summary of benefits and coverage document (SBC) will help consumers better understand the coverage they have and, allow them to easily compare different coverage options. It will summarize the key features of the plan or coverage, such as the covered benefits, cost-sharing provisions, and coverage limitations and exceptions.

Qualified High Deductible Health Plan (QHDHP)

Insurance Service
Member Services Phone
Group Number (Town)
Group Number (School)
SBC Document
Fallon SelectCare


800-868-5200


N/A
55508685550855SBC (PDF)
Fallon DirectCare


55508655550854SBC (PDF)
Harvard Pilgrim


888-333-4742189920008189920006SBC (PDF)
Blue Cross Blue Shield


800-262-BLUE00-406272600-4064459SBC (PDF)
Tufts Health Plan


800-462-022457527-11457527-194SBC (PDF)
Fallon SelectCare


800-868-5200



N/A
55507555550753SBC (PDF)
Fallon DirectCare


55507515550749SBC (PDF)
Harvard Pilgrim


888-333-4742288480016288480017SBC (PDF)
Blue Cross Blue Shield


800-262-BLUE00-4053585T00-4053585SBC (PDF)
Tufts Health Plan


800-462-022445843-11445843-194SBC (PDF)
Harvard Pilgrim


800-782-3675N/A
N/A
SBC (PDF)

For more information on plan offerings please visit the West Suburban Health Group website.