Health Care
Paying for Health Care Services and Filing Claims
| Step 3: Reviewing Your Explanation of Benefits Form |
Explanation of Benefits (EOB) forms summarize how your health care claim was paid by the plan. It’s important to understand
the EOB form so you can verify that your and your family’s claims were processed and paid correctly. If you participate in the
Kraft National Network Medical Plan and/or Dental Plan, you can register through Aetna Navigator for access to your EOBs online.
The EOB form may include such information as:
Service provider (e.g., doctor, hospital)
Date of service
Type of service (e.g., medical, diagnostic, surgery)
Amount that was billed by the provider
Amount allowed for the charge — the negotiated rate for in-network providers
Amount in excess of the reasonable and customary charges — for out-of-network providers, this is the amount that is not
covered by the plan because it exceeds the specified percentage of the average charges by similar providers in the same geographic
area for the same service
Amount that applies to your annual deductible (which you have to pay), your total annual deductible paid for the calendar year
and your family deductible paid for the year
Co-insurance level and amount of co-insurance paid by the plan for the claim
Total amount paid by the plan
Amount that was paid directly to the provider
Total amount due from the insured/patient (you).
Your EOB will track the deductible and out-of-pocket amounts you have paid for each family member during the year. Once the individual
or family deductible has been met, you pay for services at the appropriate co-insurance level. And when the individual or family
out-of-pocket limit has been met, the plan pays 100% of covered expenses for that individual or family for the rest of the calendar
year.
Check Your EOB Forms Carefully
Check your EOB forms for correct processing of your claims. If you find a mistake, call Member Services. They will let you know if
they need additional information to review the claim.
Also consider …
Step 1: When You Receive a Service or Make a Purchase
Step 2: Filing Claims