Skip to main content
Help Center FAQs

What is an Explanation of Benefits (EOB)?

Your EOB or Explanation of Benefits gives you an overview of the claim, including who provided the care, how much was billed, how much your plan covered, and how much you may owe.

After you visit a doctor, other health care professional, laboratory or hospital, an EOB is generated for you. If your health care provider participates in Horizon’s networks, the claim is submitted to Horizon for you. But if you go to an out-of-network health care provider, you may need to submit the claim yourself.

An EOB is not a bill. It tells you what costs are covered for medical care or services you’ve received.

You can sign in to view your EOBs, 24/7, or view them with the Horizon Blue app.

Understanding Your Explanation of Benefits

Video Transcript

[“Understanding Your Explanation of Benefits” title and Horizon Blue Cross Blue Shield of New Jersey logo]

Each time you use your health plan to get care, you’ll get information about the claim your doctor submitted.

This information is called an “Explanation of Benefits” or EOB.

Your EOB gives you an overview of the claim, including who provided the care, how much was billed, how much your plan covered, and how much you may owe.

Your EOB also gives you detailed information about your claim.

This section lists additional information, including other insurance plan payments, if you have other coverage, and how much you are responsible for paying as a copay, coinsurance or deductible.

It also lists any “Amount Not Covered,” which may be costs billed by your doctor that are not covered by your plan.

All of these amounts are included in “What You Owe.”

Remember: Your EOB is not a bill, so don’t take out your checkbook just yet. Wait until you get a bill from your doctor to pay exactly what you owe.

You can view your EOBs, 24/7, by signing on to or the Horizon Blue app.

If you have a question about your benefits or your EOB, sign in to to email your question or chat with us, or give us a call. [1-800-355-BLUE (2583)]

To learn more, visit “What Happens After My Appointment” at []

[Horizon Blue Cross Blue Shield of New Jersey logo and disclaimer]

Sample Explanation of Benefits (EOB)

Explanation of Benefits sample

Terms used in an EOB

A. Date of Service: The date you received your care.

B. Type of Service: The service or care given to you by the provider.

C. Amount Billed: The amount charged by the provider for each service on the claim.

D. Allowed Amount: The amount the provider agrees to be paid for a specific service. It may include a deductible, coinsurance and/or copay.

E. Your Plan Paid: The total amount paid by Horizon BCBSNJ to you or the provider for the services that were covered by the plan.

F. Your Other Insurance Paid: The amount paid by another insurance carrier, if you are covered under another health insurance plan.

G. Copay: A copay is a fee that you pay each time you go to the provider. You pay the copay at the time you receive the care or service.

H. Coinsurance: The coinsurance is the amount you pay out-of-pocket after you have paid your deductible, if any. You pay the coinsurance amount directly to the provider.

I. Deductible: The amount you must pay before your plan pays for covered services. You are responsible for paying this amount directly to the provider.

J. Amount Not Covered: The fee charged for care that is not covered by your plan. You may be responsible for paying this amount in addition to any deductible, coinsurance and/or copay.

K. What You Owe: The total amount you owe the provider. The total amount includes:

  • Any copay, coinsurance and/or deductible
  • Costs for services you receive that are not covered by your plan
  • The difference between the billed and paid amounts for out-of-network services

L. Claim Detail: These codes refer to specific messages for each claim that help explain how we processed your claim and calculated any payment.

Was this helpful?

24 votes with an average rating of 4.1.

Last updated:

Apr 19,2023