When you are using the health plan, the Explanation of Benefits (EOB) is the most important document when it comes to the billing side of your care. You either receive the EOB in the mail or you have access to them through the PEHP online portal. You elect how you receive this document.
Once you receive this document, match it up with a bill you receive from your provider and pay what PEHP states is "Your Responsibility". It may not match what your provider's bill is showing but your provider receives the same information from PEHP. If there is a portion that is not being covered it could be that PEHP needs additional information or your provider needs to write off the balance.
- Billed Amount - The medical provider’s (e.g., doctor, hospital, or clinic) bill for your service.
- Allowed Amount - The maximum fee allowable for a given procedure, test, device, or medication established by PEHP and accepted by In-Network Providers. Also referred to as “In-Network Rate.”
- Amount Eligible - This is PEHP’s In-Network Rate. This is the most we allow in-network providers to charge for this service. However, out-of network providers may charge more than the In-Network Rate. Avoid paying more by using only providers in your network (go to www.pehp.org).
- Deductable - The set amount you pay for eligible charges in a plan year before cost sharing takes place.
- Coinsurance - The percentage of the cost you must pay under your plan. You may already have paid this amount when you received services. If so, the provider’s bill may be lower than what’s shown on the EOB.
- Copay - The fixed dollar amount you must pay under your plan. You may already have paid this amount when you received services. If so, the provider’s bill may be lower than what’s shown on the EOB.
- Plan Payment - The part of the bill PEHP paid.
- Claim Number - Keep this number as reference if you call PEHP about your claim.
- Your Responsibility - The amount of the bill the provider expects you to pay. This is between you and the provider.
Please contact Insurance Services with any questions or concerns 801-567-8285 or insurance@jordandistrict.org