Explanation of Benefits

The insurance company’s written explanation to a claim, showing what they paid and what the client must pay. Sometimes accompanied by a benefits check.

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Related Terms

Admitting Privileges
Benefit
Carrier
Certificate of Insurance
Claim
Co-insurance
Co-payment
Deductible
Denial of Claim
Dependents
Effective Date
Exclusions
Group Insurance
Health Maintenance Organizations (HMO)
HIPPA
In-network
Indemnity Health Plan
Individual Health Insurance
Length of Stay (LOS)
Lifetime Maximum Benefit
Limitations
Long-term Care Policy
Managed Care
Maximum Dollar Limit
Medigap Insurance Policies
Network
Open-Ended HMO
Out-of-network (Out-of-plan)
Out-of-pocket Maximum
Outpatient
Pre-admission Certification
Pre-admission Review
Pre-admission Testing
Pre-existing Conditions
Preferred Provider Organizations (PPO)
Primary Care Provider (PCP)
Provider
Reasonable & Customary Fees
Rider
Second Opinion
Second Surgical Opinion
Short-term Disability
Short-term Medical
State Mandated Benefits
Stop-loss
Usual, Customary, & Reasonable (UCR) or Covered Expenses
Waiting Period
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