Explanation of Benefits definition

Explanation of Benefits means a statement a health plan sends to a Participant which shows charges, payments and any balances owed. It may be sent by mail or e-mail. An Explanation of Benefits may serve as an Adverse Benefit Determination.
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Explanation of Benefits means claim processing advice or notification of action on claims.
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Explanation of Benefits means the document that lists benefits paid and/or denied for claims submitted to the insurance carrier (commonly referred to as “EOBs”);
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Examples of Explanation of Benefits in a sentence

  • Contractor shall send each Enrollee an Explanation of Benefits to Enrollees in Plans that issue Explanation of Benefits or similar documents as required by Federal and State laws, rules, and regulations.

  • Explanation of Benefits (EOB) – A statement sent from the Contractor to an Enrollee listing services provided, amount billed, eligible expenses and payment made by the Plan.

  • The Explanation of Benefits and other documents shall be in a form that is consistent with industry standards.

  • Such proof may include, among other things, the Insurance Company’s Explanation of Benefits, the examining physician’s bill/receipt.

  • Cost shared Employee paid Employer paid Explanation of Benefits (for above list): Reimbursed Benefits: Diagnostics Preventative Minor Restorative tics Periodontics Minor Prosthodontics Surgery Adjunctive Services Reimbursed Benefits: Major Restorative Major Prosthodontics Orthodontic applies for Employee, spouse, and eligible dependents under age or age to if in full-time attendance in school or school.


More Definitions of Explanation of Benefits

Explanation of Benefits or “EOB” means a document a carrier issues to a covered person in response to the submission of a claim for services or supplies under a health benefits plan. The EOB identifies both the billed and allowed charges and explains whether services and supplies are covered, the application of cost sharing, the amount paid by the plan, and the reason(s) for any denials or reductions in the benefits paid.
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Explanation of Benefits or "EOB" means a statement sent to covered individuals explaining what medical treatments and/or services were paid on their behalf.
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Explanation of Benefits means a computer-generated statement from Delta Dental that You will receive after We process a Claim for You or a Covered Person describing how Delta Dental determined the Benefit for the Dental Services submitted on the Claim or telling You the information Delta Dental requires before a Benefit determination can be made.”
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Explanation of Benefits means a form provided by a carrier that explains the amounts covered
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Explanation of Benefits means a statement from a medical or dental plan or health maintenance organization concerning benefits provided to an individual.
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Explanation of Benefits or “EOB” means a statement to a Beneficiary providing details about a Provider Payment made on a Provider Claim, and explaining what portion of services were paid by the Benefits Plan and the portion the Beneficiary is responsible for paying.
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Explanation of Benefits. (EOB) means explanation of benefits used by an insurance carrier to explain the payment or denial of services for an individual insured. Final Jun 6-01 Effective 7-01-01 Page 5 -------------------------------------------------------------------------------- [LOGO] Community Partnership FEE FOR SERVICE and RISK-BASED of Southern Arizona SUBCONTRACT AGREEMENT Regional Behavioral CHILDREN SERVICES Health Authority The Providence Service Corporation ------------------------------------------------- CONTRACT NUMBER: A0108 FY 01/02 --------------------------------------------------------------------------------
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