Summary of Benefits and Coverage

This document is about a Summary of Benefits and Coverage (SBC) for a health insurance plan offered by Insurance Company 1. It provides details on the plan's coverage, including the deductible, copayments, coinsurance, and out-of-pocket limits. The SBC also outlines the services covered before the deductible is met, such as preventive care, and the requirements for referrals to see specialists. It explains the differences in costs for in-network and out-of-network providers, and lists the services that are not covered under the plan.