Explanation of Benefits

April 2017

An Explanation of Benefits, EOB for short, can help you understand what happens to your claims. And it can help you manage your health care spending. It's loaded with useful information.

After you've visited a doctor, clinic, or hospital, an EOB tells you and your provider what portion of the provider's charges are covered under your insurance plan.

You can instantly view, print or download EOBs anytime by going to your secure member website.

This sample EOB from Aetna is broken into seven sections. The first includes personal info like your member ID and group number.

The second section contains the nuts and bolts:
 - Spending: What you owe and the payments already made for the claims listed.
 - Savings: How much you've saved by using a provider in your network.
 - Deductibles: How much you have to pay before your health plan kicks in. These are out-of-pocket expense.

The final three sections show you:
 - How much we've paid and how much you've paid on a claim.
 - Your claims up close: a detailed description of your claims.
 - Your benefit balances for the year, like how much of the network deductible you've used.