sbcbuilder

Network tiers
deductibleoop max
individual
family
deductibleoop max
individual
family
Benefits
If you visit a health care provider's office or clinic
Primary care visit to treat an injury or illness
In-network
Out-of-network
Specialist visit
In-network
Out-of-network
Preventive care / screening / immunization
In-network
Out-of-network
If you have a test
Diagnostic test (x-ray, blood work)
In-network · X-ray
In-network · Blood work
Out-of-network · X-ray
Out-of-network · Blood work
Imaging (CT / PET scans, MRIs)
In-network
Out-of-network
If you need drugs to treat your illness or condition
Generic drugs
In-network
Out-of-network
Preferred brand drugs
In-network
Out-of-network
Non-preferred brand drugs
In-network
Out-of-network
Specialty drugs
In-network
Out-of-network
If you have outpatient surgery
Facility fee (e.g., ambulatory surgery center)
In-network
Out-of-network
Physician / surgeon fees
In-network
Out-of-network
If you need immediate medical attention
Emergency room care
In-network
Out-of-network
Emergency medical transportation
In-network
Out-of-network
Urgent care
In-network
Out-of-network
If you have a hospital stay
Facility fee (e.g., hospital room)
In-network
Out-of-network
Physician / surgeon fees
In-network
Out-of-network
If you need mental health, behavioral health, or substance abuse services
Outpatient services
In-network · Mental / behavioral health
In-network · Substance use disorder
Out-of-network · Mental / behavioral health
Out-of-network · Substance use disorder
Inpatient services
In-network · Mental / behavioral health
In-network · Substance use disorder
Out-of-network · Mental / behavioral health
Out-of-network · Substance use disorder
If you are pregnant
Office visits
In-network
Out-of-network
Childbirth / delivery professional services
In-network
Out-of-network
Childbirth / delivery facility services
In-network
Out-of-network
If you need help recovering or have other special health needs
Home health care
In-network
Out-of-network
Rehabilitation services
In-network
Out-of-network
Habilitation services
In-network
Out-of-network
Skilled nursing care
In-network
Out-of-network
Durable medical equipment
In-network
Out-of-network
Hospice services
In-network
Out-of-network
If your child needs dental or eye care
Children's eye exam / glasses
In-network
Out-of-network
Children's dental check-up
In-network
Out-of-network
  • Bariatric Surgery
  • Cosmetic Surgery
  • Dental Care (Adult)
  • Infertility Treatment
  • Long-Term Care
  • Non-Emergency Care When Traveling Outside the U.S.
  • Private-Duty Nursing
  • Routine Eye Care (Adult)
  • Routine Foot Care
  • Acupuncture
  • Chiropractic Care
  • Hearing Aids
  • Weight Loss Programs

What is sbcbuilder?

sbcbuilder is a free Summary of Benefits and Coverage (SBC) builder and editor. Set health plan benefits by hand (deductibles, out-of-pocket maximums, copays, coinsurance, prior authorization and visit limits across as many named network tiers as you need), or upload an existing SBC PDF and it gets parsed back into editable fields. Then export a clean CMS-style SBC document as a PDF.

CMS template layout

The exported document follows the federal SBC template: coverage questions, the common-medical-events chart, excluded and other covered services, and the Peg, Joe and Mia coverage examples computed with the official calculator logic.

Edit any SBC

Drop in a plan's existing SBC PDF to extract its benefits into the editor, tweak what's changed, and export a fresh document, useful for renewals, drafts and plan comparisons.

Private by default

No account, no server-side storage; plans autosave to your browser and can be saved or shared as JSON files.

sbcbuilder.com - free SBC builder. Always confirm exported documents against the official CMS SBC template and instructions before distributing.