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Plan Enrollment
After enrollment into a Covered CA plan, the client becomes a member of the health plan selected. Each health insurance company may have differences in how and when they communicate with their new members. Generally, members receive a new member kit that provides an overview of how to navigate the plan. Members also receive several documents that should be kept for their record including:
Summary of Benefits
The Summary of Benefits helps consumers understand their coverage. It provides a description of coverage including any amounts the member has to pay (deductibles, coinsurance, and copayments).
ID Card
The ID Card provides important information:
- The health plan and health insurance company name
- The plan type and group or policy number
- The name of the primary care physician (for HMOs)
- Information for the doctors and hospitals
- Copay or coinsurance information
Evidence of Coverage
The Evidence of Coverage (EOC) is a contract between the client and the insurer. The EOC contains the following information:
- Details on what is covered under the client's policy, as well as any exclusions or limitations to coverage
- Benefit descriptions, premiums, and cost-sharing amounts
- Information on how to file a complaint or grievance
- Member rights and responsibilities
- Information on how to access care and services
Explanation of Benefits
After the client receives care from a doctor or hospital, the health insurance company sends an Explanation of Benefits (EOB). The EOB describes the payment between the health insurance company and the doctor, hospital or other provider of services. The EOB is not a bill. The client may receive a bill separately for any payment due directly to the doctor, hospital, or other provider (i.e. copays).
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