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Understanding Explanations of Benefits

After you receive a treatment or procedure and there is a cost share (copay, deductible, coinsurance), you’ll receive an Explanation of Benefits Statement, or EOB. This document gives you a detailed look at those health care services and shows:

  • What was covered by your health plan
  • How much was covered
  • Any out-of-pocket costs you are responsible for

An EOB is not a bill.

Here’s an example of how the process works:

  1. You pay your monthly plan premium.
  2. You head to the doctor.
  3. Depending on the service and your benefit plan, you may have to pay a copay.
  4. You receive an EOB. You can receive it by mail or electronically. It is not a bill but it will give you an idea of how much you may have to pay the doctor.
  5. You receive a bill from your doctor.
  6. You pay your bill directly to the doctor’s office.

To view a detailed record of your EOBs, log in to your online member account. Click on “My Claims.”

Need help accessing or understanding an EOB? Contact us.