HR, Payroll and Benefits News

What is an Explanation of Benefits (EOB)?

An Explanation of Benefits (EOB) is a statement that provides details about your health and dental insurance claim(s). An EOB is created by your insurance carrier to show you how much services cost, what portion of your claim was paid by insurance, any amount(s) “written off” as a discount for obtaining services within an approved network of providers and the amount that is your responsibility to pay. Your EOB will also show how much of your deductible and out-of-pocket has been met for the calendar year.

Review the following samples for what to expect on an EOB:

When should I expect an EOB?

You should expect an EOB every time you visit your doctor or dentist. It’s important that you show your health or dental insurance ID card at each visit. It may take a few weeks for your doctor or dentist to send your claim to your insurance carrier. It typically then takes a few weeks for your insurance carrier to process your claim(s) and send you your EOB.

Do I need to submit payment to my doctor’s office or dentist’s office when I receive my EOB?

No. You should not submit payment when you receive an EOB. An EOB is not a bill. Your doctor or dentist will send you an invoice after they have receive payment from your insurance.

What should I do with my EOB?

Review your EOB upon receipt for accuracy and save it in a secure place as it contains personal health information. Additionally, EOBs may be used as follows:

  • If you are enrolled in a Health Savings Account (HSA), your EOB is an ideal document to:
    • Estimate how much to contribute to your HSA from your paycheck. Since an HSA is a component of your High Deductible Health Plan, it is important to be financially prepared to pay 100% of most services* before you meet your deductible. If unforeseen circumstances arise, you may increase or decrease your HSA contribution at any time.
      * Preventive and telehealth services are covered at 100% by your insurance even if you have not met your deductible.
  • If you are enrolled in a Flexible Spending Account (FSA), a copy your EOB is an ideal document to use to:
    • Substantiate your claims. An EOB may be submitted to the FSA administrator to show the money is being used for eligible expenses per IRS regulations.
    • Estimate how much to put into your FSA on an annual basis. Since the FSA is a “use it or lose it” account** it’s important that what you put into your FSA, you plan to use.
      **The Health Care FSA allows for up to $550 to carryover from 2020 to 2021.

How do I access my EOBs?

You may access your EOBs by logging into your account online. The website information is provided on your health or dental insurance ID card.

Who should I call with questions regarding my EOBs?

You should contact your health or dental insurance plan carrier if you have questions regarding the information on your EOBs. Contact information may be found on your EOBs and on your insurance ID card(s).

Source: UW System Human Resources