How to read your Explanation of Benefits (EOB)


What is your EOB?

Each month you use your plan for medical services, you receive an Explanation of Benefits (EOB). Your EOB is a list of the services you received. It shows you how expenses are divided between your doctor, your plan, and your copay, but it’s not a bill. You don’t need to send any payments or take any action. Your EOB makes it easy to keep track of the medical services you received and their costs.

How to read your EOB

Your EOB includes multiple sections—the main section of your EOB provides details for your claims, including the provider who performed the service, the date, type of procedure, and the costs:

  1. Provider—The name of the doctor or specialist who provided the service.
  2. Service/Procedure—The type of service you received.
  3. Total Cost—The amount we pay for the ser­vice. It may be less than the amount the provider charged.
  4. Not Covered—The amount of the service not covered (this usually only occurs if the service is denied).
  5. Deductible—If there is a deductible for the service, you would need to pay this amount before we pay our share.
  6. Copay/Coinsurance—The amount you pay.
  7. Other Patient Responsibility—Any other costs you may need to pay for the service (usually, this only occurs if the service is denied).
  8. Plan’s Share—The amount we pay for the service.
  9. Total Your Share—This is the total amount you pay for this service. The EOB is not a bill. You may have already paid the total amount shown.