Insurance Basics: Home

Explanation of Benefits (EOB)

After you get care, your provider sends a bill, or “claim,” to your insurance company. Your insurance company handles the claim and sends you an Explanation of Benefits (EOB).

Explanation of Benefits (EOB)
In-Network and Out-of-Network Care

Your plan contracts with a wide range of doctors and other practitioners, as well as hospitals, labs, radiology facilities, pharmacies and other providers. These are the providers in your “network”. Each of these providers has agreed to take your plan´s contracted rate as payment in full for services.

In-Network and Out-of-Network Care
Protections for New York Consumers: Understanding Your Out-of-Pocket Costs

By law, consumers living in New York State have certain protections when shopping for and using their health insurance. Your insurer must provide up-to-date information about who is in your network.

Having More Than One Health Plan

Being covered under two health plans doesn't mean the two plans will pay the same amount twice for the same doctor visit. Instead, the plans follow rules about which plan pays what, known as "coordination of benefits."

When Out-of-Network Care Can be Covered In Network

Receiving care from a provider in your health plan´s network usually costs you much less than going to an out-of-network provider.

Wellness Programs: Coverage for Promoting Healthy Living

Healthy lifestyle behaviors include regular exercise and nutritious eating. Are you looking to carry out such behaviors but unsure how to start? If so, you may want to explore the wellness programs offered by your employer or health insurance plan.

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