Your explanation of benefits

This guide will help you better understand the key points on your explanation of benefits.

An explanation of benefits (EOB) is a statement that summarizes the costs we cover for the medical care or products you've received. Members who have an individual deductible on their plan receive EOB’s. You can find your individual deductible amount on your member ID card.

 

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.
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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.
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Still have questions?

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