Your explanation of benefits

Here's a guide to help you better understand key points on your
explanation of benefits (EOB).

 

Page 1 of your EOB

1
Annual out-of-pocket maximum: Individual and family out-of-pocket expenses, year to date. Out-of-pocket costs include copayments, deductibles and coinsurance. This is the most you have to pay for covered services in a plan year.


2
Annual deductible: Summarizes individual and family deductibles, year to date. This is the amount to pay in a plan year for specific covered services before your plan starts paying benefits.
Explanation of benefits cover page

Page 2 of your EOB

3
Patient information: Shows member of your family plan that received care. All information on the EOB refers to this person.

4
Your claim payment summary: A view of your claim information, shows the amount saved, amount paid by Sharp Health Plan, and amount you may owe your provider.

5
Date & service: Date of your health care service, description of the service, and code for the service.

6
Provider billed: Amount your health care provider charged for your service.

7
Amount allowed: Amount that Sharp Health Plan will pay for a covered health care service with that provider.

8
We paid: Amount Sharp Health Plan paid the provider towards each service.

9
Not covered: Portion of the amount billed not covered or eligible under your plan.

10
Deductible: Amount you need to pay in a plan year for specific covered services before your plan starts paying benefits.

11
Copay/Coinsurance: Copay is a fixed amount you pay for covered health care services after paying your deductible. Coinsurance is a percentage of costs you pay for covered health care services.

12
Notes: Provide general information about the claim and may provide specific explanation of the activity that occurred.

EOB-page2-rev

Still have questions?

Check out our frequently asked questions regarding claims, explanation of benefits, deductibles, reimbursements, and more.