HR, Payroll and Benefits News

What is an Explanation of Benefits?

An Explanation of Benefits (EOB) is a statement that shows claims information about the services provided during your health and dental appointment visits. 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 discounts (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:

How do I access my EOB and who should I contact with questions?

You may access your EOB by logging into your health or dental insurance plan carrier’s website. If you have questions about the information on your EOB, you should contact your health or dental insurance plan carrier. The website and contact information may be found on your EOB or your insurance cards.

When should I expect an EOB?

You should expect an EOB every time you obtain medical or dental services. It is important that you show your health or dental insurance ID card whenever you receive services. It may take a few weeks for your insurance carrier to send you your EOB.

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

An EOB is not a bill. Your doctor or dentist will send you an invoice after they receive payment from your insurance. The invoice sent to you by your doctor or dentist should match the amount indicated as your responsibility on your EOB.

What should I do with my EOB?

Review your EOB for accuracy and save it in a secure place since it contains personal health information. Remember that EOBs may be used for the following:

  • 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. 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, except preventive services, before you meet your deductible.
  • If you are enrolled in a Flexible Spending Account (FSA), your EOB is an ideal document to:
    • Substantiate your claims with the FSA administrator
    • Estimate how much to put into your FSA on an annual basis

Reminder: Save your EOBs as documentation to show you are using your funds for IRS eligible expenses.

Source: UW System Human Resources