Summary of Benefits and Coverage

This document is about the Summary of Benefits and Coverage (SBC) for a health plan offered by Insurance Company 1. The SBC provides information on the plan's coverage, including what services are covered, how much the plan pays, and what the individual's out-of-pocket costs may be. It includes details on the plan's deductible, out-of-pocket limits, and network provider requirements. The document also outlines the plan's coverage for various medical events, such as doctor visits, hospital stays, and prescription drugs, and highlights any specific exclusions or limitations.