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For example, your car insurance pays you the value of your car if it's totaled in a crash, and your health insurance covers the cost of your hospital stay if you're injured in that crash. In an insurance plan, the insurer carries the risk. A benefit plan, on the other hand, is only set up to cover certain costs.
Almost 80 percent of claims are received within 30 days from the date of service. In some cases, it can take up to 60 days before your doctor or hospital submits a claim. How quickly we process the claim once it's received. More than 90 percent of claims are processed within 7 days of receiving them.
Make a direct, specific request for the explanation of benefits. For instance: "I would like to know what this bill was for and why it was not covered by my policy. I would like a detailed explanation of benefits sent to me at the address listed at the top of this letter."
The SBC is a snapshot of a health plan's costs, benefits, covered health care services, and other features that are important to consumers. SBCs also explain health plans' unique features like cost sharing rules and include significant limits and exceptions to coverage in easy-to- understand terms.
Where can I find a Summary of Benefits and Coverage? You'll find a link to the SBC on each plan page when you preview plans and prices before logging in, and when you've finished your application and are comparing plans. You can ask for a copy from your insurance company or group health plan any time.
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A summary gives information regarding the coverage limitations, conditions as well as the total premiums that will be charged. The policy summary might be given out to a policy holder, on virtually every transaction.
An easy-to-read summary that lets you make apples-to-apples comparisons of costs and coverage between health plans. You can compare options based on price, benefits, and other features that may be important to you.
What Does Policy Summary Mean? A policy summary is an abbreviated overview of the key aspects of a life insurance policy. This can include the premium amounts, coverage limitations, conditions, and other details.
EOBs are usually mailed once per month. Some plans give you the option of accessing your EOB online.
After you visit your provider, you may receive an Explanations of Benefits (EOB) from your insurer. This is an overview of the total charges for your visit and how much you and your health plan will have to pay. An EOB is NOT A BILL and helps to make sure that only you and your family are using your coverage.

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