How does my employee read their medical EOB (Explanation of Benefits)?


Since an EOB isn’t a bill, the “what you pay” section is for your employee’s information only.  If the employee or dependent owes the doctor or hospital, they will send your employee or dependent an invoice. Comparing the EOB and the invoice is a good way to make sure they are getting billed correctly by the doctor or hospital.

Not all claims generate an EOB. For example, employees will not get an EOB for a prescription. EOBs show you the costs associated with the services your employee received, including:

  • Claim Details, each service or procedure from each provider is explained
  • What the provider charged
  • What the allowed charges are (this is the contracted amount in which an in-network PPO provider agrees to accept as payment)
  • Any non-allowed charges (discount or amount billed over the contracted amount for this service)
  • What the Plan pays
  • Total covered
  • What the employee or dependent pays (summary of Deductibles, copays, and coinsurance)