What is an EOB?

The Explanation of Benefits (EOB) shows you the details of your medical and pharmacy expenses and how health insurance covers each. It is a summary of your claims activity that includes:

• Total charge: The total amount a provider charged for services
• Member discount: We negotiate discounts with providers for you. As a member, you get the benefit of these discounted rates and if you use an in-network provider, they agree not to bill you for any covered service above your deductible, copay and coinsurance. However, out-of-network providers may bill you for any part of the total charges not paid by your plan.
• Your plan(s) paid: The amount we paid based on your coverage and the contractual agreement with the providers
• Your responsibility: Providers can bill you for this amount if you have not paid

You may have paid your responsibility already. If not, this is the amount you can expect to be billed from your healthcare provider at some point. You will not receive a bill from us.

EOBs are sent every two to four weeks—if you have received medical care, depending on your plan type. Each EOB will include any medical or pharmacy claims we processed for you within that time. You may be able to see information about a claim before your EOB is ready when you sign in to Blueprint Portal, our member dashboard.

You can choose to go paperless with EOBs by selecting that preference in the member portal. If you go paperless, you’ll receive an email when a new EOB is available to view.