Your Explanation of Benefits, or EOB, is a detailed financial statement of how one or more of your medical claims has been processed. It outlines what the State Health Plan has paid and what is your responsibility. It’s not a bill, but it can help 70/30 Plan and 80/20 Plan members track their health care costs.
Your EOB was recently redesigned to include detailed explanations of your claims, helpful terms, and the status of your payments. It’s also brighter, more colorful, and easier to read. Use your EOB to help control your health care costs and keep the Plan financially healthy, too.
Your EOB is sent in the mail after you access health care services. Please note that when you experience just a copay for a service, an EOB will not be sent to you.
Your EOB is also online! Log into eBenefits, the Plan’s enrollment system on the State Health Plan’s website. You’ll find the link at the top of this page. Once you have logged into eBenefits, look for Blue Connect on the left under Quick Links. Through Blue Connect, you can access your EOB as well as many other health and wellness resources. Your new EOB features include:
- Overview: this is a summary of recent claims processed by Blue Cross NC. You’ll see the total amount charged, the amount the Plan has paid, your savings – for example, by using an in-network provider – and the amount that providers may bill you.
- Helpful Terms: this glossary includes helpful terms described in an easy-to-understand way to help you become an educated health care consumer.
- Claim Details: this is the heart of your EOB. You’ll find your health care service provider, the date of your visit, your claim number and more. This includes the service provided, what the provider charged, the charge amount allowed, the in-network discount, if any, and what the Plan paid. Also shown are how much was applied to your deductible, the copayment and coinsurance amount. You’ll also see claims broken out by subscriber and any member dependents.
- Alert Codes: these codes explain specific charges. Alert codes are explained at the end of the claims section.
- Your Plan at a Glance: this section includes a year-to-date payment overview of your health care costs under the Plan. You’ll see your deductibles and out-of-pocket limits, both in- and out-of-network. Some providers do not file claims right away, so this may not reflect all recent services.
Remember, to control your costs and help protect the Plan, take these four simple steps:
- Compare what’s in this EOB with any bills sent by your provider. Make sure everything is correct and you aren’t overcharged. If you have questions, call Customer Service at 888-234-2416
- If you suspect fraud, abuse or improper billing, call our confidential hotline at 800-324-4963
- Educate yourself on benefits and get a closer look at claims through Blue Connect. To access Blue Connect, visit www.shpnc.org, click eBenefits, then scroll down to click the gold button for your enrollment system. Blue Connect offers great online resources and even includes health and wellness discounts!