This article is for Participants who are required to submit an Explanation of Benefits (EOB) as documentation for claims. This is most common with a GroupHRA, where your HRA is a supplement to your company's group health insurance policy.

Why is an Explanation of Benefits (EOB) required as documentation?

Your company designed your HRA to reimburse you for out-of-pocket medical expenses that are also covered by your health insurance plan. In other words, they want to help you with your deductible and co-insurance expenses. 

What is an Explanation of Benefits (EOB)?

An Explanation of Benefits (EOB) is a statement your health insurance carrier sends to you listing the amount the insurance covers and the amount of your patient responsibility. Often it will say "Explanation of Benefits" or "This is Not a Bill" at the top.

Please Not: EOB's will be on the insurance company's letterhead, not from the medical provider. 

What amounts should I submit for reimbursement on the EOB?

When your plan is designed to require the EOB, you can request reimbursement for amounts applied to your co-insurance and/or deductible amounts only.  Co-pays, billed amounts and non-covered amounts are not approvable for reimbursement. 

How can I tell if I need to submit an Explanation of Benefits (EOB)?

The easiest way to see what expenses require an EOB is to log in to your Participant account at Listed on your homepage (under Eligible Expenses) it will note which type of expenses require an EOB.

Please Note: In some cases, you may need to submit an EOB for some types of expenses and not others.

How do I get an Explanation of Benefits (EOB)?

Your insurance company provides you with an Explanation of Benefits (EOB) for each medical service or expense via a mailed statement or through an online account.  

Tip: If your insurance carrier offers an online account or smart-phone app, this is usually the quickest way to receive your EOB. 

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