How to read an Explanation of Benefits (EoB)

An Explanation of Benefits (EoB) is a document that plan participants may receive from their health insurance carrier after a claim for services has been processed under your plan. The information in the EoB can be helpful in monitoring expenditures and services.

While the information varies per carrier, a typical EOB may include the following:

• Patient: The service recipient. May refer to the plan holder or a dependent.
• Insured ID Number: Assigned by the insurance carrier, this number helps to identify the insured party, and should also be represented on the issued insurance card.
• Claim Number: Assigned by the insurance carrier, this helps to identify or refer to a specific claim.
• Provider: Refers to the provider of the healthcare service. (e.g. A Doctor, Hospital, or Laboratory).
• Type of Service: A code and description of the service received.
• Charge / Billed Charges: Total amount billed from the provider for the service.
• Not Covered Amount: Amount billed that was not covered by the insurance carrier. This may include a code representing the reason why the amount was not covered; corresponding code descriptions may be located on the bottom, back, or attached to the EoB.
• Total Patient Cost: The amount owed by the patient. This is dependent on plan requirements such as deductible, co-payments, co-insurance, and uncovered services.

Additional information may include total payments made to the provider so far and the balance remaining on your annual deductible.

Download a copy of this article to share with your employees for their reference.

For questions regarding Explanation of Benefits, please call our Employee Advocacy Center at (855) 322-1237 (855-EAC-1ADP) or email to: employeeadvocacycenter@adp.com.