Understanding Your Explanation of Benefits (EOB)

What is an EOB?

An Explanation of Benefits (EOB) is a statement from your health insurance company. It explains what medical care you received, what your health plan paid, and what you may owe.

When you visit a doctor, or get a treatment or prescription, your provider sends a claim to your health insurance company. After the claim is processed, your insurer sends you an EOB.

The insurance company sends you EOBs to help make clear:

• The cost of the care you received
• Any money you saved by using in-network providers
• What you might need to pay out of pocket

Note: this page gives you a general overview of an EOB and is not specific to Cigna Healthcare^®. If you're a Cigna Healthcare customer, you can log in to myCigna to view the EOBs for your plan.

Is my explanation of benefits a bill?

No. An EOB is simply a statement of the medical services you received and details on how you and your plan will share costs. You will not use this to pay any outstanding bill.

How do EOBs work?

Here's the general process:

1. You receive care from a provider, doctor, or medical facility.
2. The provider sends a claim to your health insurance company.
3. Your insurer reviews the claim and applies your health plan benefits.
4. You receive an EOB showing what was covered and what you may owe.
5. If you owe money, you’ll get a separate bill later. That bill will include instructions on who you should pay (either a health care provider or your health insurance company). 

How do you get an EOB?

EOBs typically come in the mail. They may also be found in your online member portal. Cigna Healthcare customer can log in to myCigna to view EOBs for your plan.

How do you read an EOB?

Remember that EOBs state the costs associated with your care, but they are not bills. Most EOBs have similar sections, but the information may change depending on your health plan. Here's generally what you'll find on an EOB:

Page 1: Summary

• Your name and details
• Medical services you received 
• Who provided the medical services
• Amount billed (cost of those services)
• Discounts (any money you saved by getting in-network care)
• Amount paid by your health insurance plan
• Amount not covered (costs your health plan did not cover)
• Amount that may have been paid from spending accounts, such as a health reimbursement account (HRA), if applicable
• Any additional costs you need to pay

Page 2: Glossary and Appeal Information

• Glossary of the terms and definitions included on your EOB
• Instructions for how you can appeal a claim, if necessary

Page 3: Detailed Breakdown and Additional Information

• Specific details about the cost of the care you received
• How much of your out-of-pocket medical costs count toward your annual deductible 
• Language assistance instructions
• Specific details about filing an appeal in your state of residence

Why do EOBs matter?

EOBs show you the value of your health insurance plan. You see the cost of the services you received and the savings your plan helped you achieve. EOBs also help you understand how much money you may have left in accounts related to your plan.

For some health plans, EOBs also show you how close you may be to meeting your annual deductible. Once your deductible is met, your plan begins to help you pay for services.

If you have questions, or something on your EOB doesn't look correct, be sure to contact your health insurance company or provider.