The plan design you need for a creditable coverage determination is already written down. It is in the Summary of Benefits and Coverage, a document every plan is required to produce in a standard format.
So we stopped asking people to retype it.
Upload, don't transcribe
Drop the SBC in. Creditable reads the deductible, the tiers, the copays and coinsurance, and the out-of-pocket maximum, and shows you what it found before it calculates anything.
Why the SBC and not the carrier file
Carrier files vary by carrier, by year, and sometimes by account. The SBC does not — its format is prescribed. Reading the prescribed document is the only approach that works the same way for every plan you handle.
What you get back
| Output | What it is for |
|---|---|
| Actuarial value | The number behind the determination |
| CMS comparison | The standard Part D benchmark it is measured against |
| Determination record | A dated, exportable record of the inputs and the answer |
Availability
SBC reading is live for all plans on the platform. There is nothing to enable.
A determination you cannot show your work on is a guess with better handwriting.
