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What is the summary of your health insurance benefits and coverage?

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This list of your benefits and coverage details must be written in easy-to-understand language. The summary among other things should have:

The summary should include:

  • Your appeals and grievance rights and procedures
  • Instructions for how to get information in other languages
  • Your deductible
  • Your cost-sharing amounts -- the portion of the treatment or service that is your responsibility
  • Your out-of-pocket limit
  • Whether the plan has a network of providers you must use and the difference in cost-sharing if you use an out-of-network provider
  • Whether you need a referral to see a specialist
  • Any services or treatments the plan does not cover
  • The plan’s coverage for common medical events like visits to primary care doctors, lab tests, and hospital stays

From: Your Guide to Health Insurance Paperwork WebMD Medical Reference

SOURCES:

AARP: "What You Can Learn From Your Explanation of Benefits Statement."

American Academy of Family Physicians: "Understanding Your Medical Bills."

American Cancer Society: "Health Insurance and Financial Assistance for the Cancer Patient."

FamilyDoctor.org: “Understanding Your Medical Bills.”

American Cancer Society: “Covering the costs of cancer treatment.”

Reviewed by Sarah Goodell on September 18, 2018

SOURCES:

AARP: "What You Can Learn From Your Explanation of Benefits Statement."

American Academy of Family Physicians: "Understanding Your Medical Bills."

American Cancer Society: "Health Insurance and Financial Assistance for the Cancer Patient."

FamilyDoctor.org: “Understanding Your Medical Bills.”

American Cancer Society: “Covering the costs of cancer treatment.”

Reviewed by Sarah Goodell on September 18, 2018

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What is a health insurance explanation of benefits (EOB)?

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