Understand your health plan documents and coverage

Plan types, documents, acronyms — it can seem like there’s a lot to figure out about your health coverage. If you’re shopping for a plan or learning about your plan’s benefits, it’s good to know the main documents that will help you understand what’s covered and how much you’ll pay for care. There are also tools you can use to help you research costs and make the most of any plan you choose. 

EOC, SBC, EOB — what’s the difference? 

There are a few common health plan documents that explain information about the plan, like what services are covered and how billing works. Some give a brief overview of the plan, and some walk through the entire plan in detail.

If you’ve already signed up for a health plan or gotten care, you’ll likely have been given one or more of these documents. If you’re shopping for a plan, they can be helpful for comparing plan terms and benefits. 

• Evidence of Coverage (EOC) — Your fully detailed plan document.
  • What it does — Outlines the coverage details of a health plan’s covered services and prescription drugs. It also explains the plan’s terms and limitations, and how to use all the services available to you. The Evidence of Coverage is like a contract between you and your health plan. 
  • How to use it — You can refer to your EOC to find your plan details, your provider’s contact info and obligations to you, and how to file a complaint if you’re not satisfied with a service or treatment. 
• Summary of Benefits and Coverage (SBC) — Your summarized plan document.
  • What it does — Summarizes your health plan benefits and coverage in plain language, and in a standard format that’s used throughout the health care industry. 
  • How to use it — You can use SBCs to get a quick overview of your plan, or to compare the benefits of different plans.
• Explanation of Benefits (EOB) — A statement of care you’ve received. 
  • What it does — After you see a care provider for a health service, you will likely get an EOB. This statement summarizes the care you’ve gotten in a given time frame (like your monthly credit card statement). EOB statements aren’t bills, and you don’t need to send any payments until you get a bill. 
  • How to use it — You can check your EOB statements to see the services you’ve gotten, how much the provider will cover, and how much you’ll owe as part of your copay or deductible.

When reviewing health plan documents, it’s helpful to be familiar with terms like copay, coinsurance, and deductible. You can use Kaiser Permanente’s health care glossary to find definitions for many of these common terms. You can also take a deeper dive into key terms for health plan costs and coverage.

Where to find plan documents

Important documents like your Evidence of Coverage, Summary of Benefits and Coverage, and Explanation of Benefits should be available on your health plan website or in your member portal. You can also often request a copy by contacting the plan provider’s customer service.
 

Finding your plan documents at Kaiser Permanente

Evidence of Coverage (EOC) — If you’re a Kaiser Permanente member with an individual or family plan, you can find your plan’s Evidence of Coverage on the Individual & family plan documents page on kp.org. 

If your plan is through your employer, your Evidence of Coverage should be available through your employer’s website or human resources department.

Note: Some plan types use a name other than Evidence of Coverage for this document. Other names might include Certificate of Insurance, Summary Plan Description, Certificate of Coverage, or Member Handbook.

Summary of Benefits and Coverage (SBC) — For Kaiser Permanente individual and family plans, you can find and compare different Summary of Benefits and Coverage documents on the Individual & family summary of benefits and coverage page on kp.org. 

If your plan is through your employer, your Summary of Benefits and Coverage should be available through your employer’s website or human resources department.

Explanation of Benefits (EOB) — At Kaiser Permanente, your Explanation of Benefits shows you all the health benefits you’ve gotten under your plan. To find your Explanation of Benefits, sign in to kp.org, navigate to the "Benefits" section, and select "View benefit summary" or "Coverage documents.” 

You can also contact Kaiser Permanente Member Services at 1-800-443-0815 for more information about any of these documents.

Estimating costs for care as a Kaiser Permanente member

Along with your health plan documents, there are online tools you can use to estimate your costs for different types of services. 

• Kaiser Permanente treatment cost calculator — For Kaiser Permanente members, this calculator uses your actual health plan details, including your remaining deductible and out-of-pocket costs for the year, to estimate what you’d pay for a wide variety of services. You can browse by service categories or search for specific services. (You must be signed in to your kp.org account.) 
• Kaiser Permanente treatment fee tool — The treatment fee tool is helpful for managing costs under a deductible health plan. You can include your covered family members to see what costs you can expect for the services you’re likely to use. This tool uses treatment cost averages in your area to calculate estimates. Note that it doesn’t take your personal information into account. 

Additional support

Current and prospective Kaiser Permanente members can visit the Support Center to get answers to questions about plans, coverage, bills, and more, or to connect with a Member Services representative.