What is an Explanation of Benefits?

An EOB is a statement from your health insurance plan describing what costs it will cover for medical care or products you’ve received. The EOB is generated when your provider submits a claim for the services you received.

The insurance company sends you EOBs to help make clear:

• The cost of the care you received

• Any money you saved by visiting in-network providers

• Any out-of-pocket medical expenses you’ll be responsible for

How do EOBs work?

• A health care provider will bill your insurance company after you’ve received your care. Then you’ll receive an EOB. Later, you may receive a separate bill for the amount you may owe. This bill will include instructions on who to direct the payment to--either a health care provider or your health insurance company.

• EOBs are a tool for showing you the value of your health insurance plan. You see the cost of the services you received and the savings your plan helped you achieve. EOBs also help you gauge how much money you may have left in accounts related to your plan. For some plans, EOBs also show you how close you may be to meeting your annual deductible. Once your deductible is met, your plan begins to help you pay for services.