Insurance Glossary

Insurance Term - Explanation of Benefits (EOB)

A document sent to an insured when the insurance company handles a claim. The document explains how reimbursement was made or why the claim was not paid, as well as any additional information if required for satisfying the customers. The appeals procedure has been streamlined to advise the insured of his or her rights in case there is dissatisfaction with the decision delivered by the insurance company. It lists the services for which the policyholder or his/her healthcare service provider has sent claims for reimbursement processing. These forms are not bills, but explain the results for each service submitted. In short, it is a statement sent by health plans to individuals who have experienced a claim under the health plan. The explanation of benefits (EOB) details the charges for the healthcare services received, the amount the health insurance company will pay for those services, and the amount the insured person will be responsible for paying.

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