Understanding Your Explanation of Benefits (EOB) Statement

Important Definitions You Should Know, Understand and Remember

Your Explanation of Benefits (EOB) is designed to help you understand costs associated with your health care visit.

We want you to get the most out of this information. Below are terms you should know in order to put your EOB to best use:

  • Amount allowed by your plan: The maximum amount we pay under your plan for the service(s) you received. This amount may be less than the amount submitted.
  • Amount billed: Same as “amount submitted.”
  • Amount submitted: The amount the provider billed for the services you received.
  • Amount we paid: The amount we are sending to you or your provider.
  • Benefits we paid toward this claim: Same as “amount we paid.”
  • Coinsurance: A percentage of the cost of the service we require you to pay.
  • Combined copay/coinsurance: The total copay/coinsurance you or your dependents must pay.
  • Combined deductible: The total deductible you or your dependents must pay.
  • Combined total out-of-pocket expense: The total dollar amount you or your dependents must pay.
  • Copay: A fixed dollar amount you must pay a provider each time you obtain care for a covered service.
  • Deductible: The amount you must pay each year before we will begin to pay for covered services.
  • Member: A person, including a covered dependent, who has health coverage.
  • Subscriber: A person who has a health coverage contract in his or her name, or an employee who is covered under an employer’s group health coverage contract.

Understanding your EOB will allow you to become a better health care consumer.

Unless you decide to go paperless, your EOB will be mailed to you. This information is also available under your "Claims" when you login to myEmblemHealth to get your personal health information.

Still have questions about your EOB? Answers are only a call or click away.