Sick of spending hours on hold to get simple answers about your health insurance? Outfox Health gives you accurate answers in seconds thanks to our AI.
But for Outfox to answer your questions, you need to submit your plan’s Evidence of Coverage (EOC) or its Summary Plan Description (SPD).
Which document should I find?
There’s two specific documents that help us give you the best answers.
The first is the Summary Plan Description or SPD, also called a Benefits Plan Description. It’s a lengthy document provided by employer-sponsored plans detailing the general terms of the plan, including eligibility, benefits, and administrative information.
The second is the Evidence of Coverage or EOC, also called a Schedule of Benefits. It’s a comprehensive document that outlines specific details of your coverage.
These documents are typically well over 150 pages long, making them difficult for humans to quickly understand – but perfect for Outfox Health’s AI.
What about all the other documents?
Confusingly, health insurers offer other similarly-named policy documents which are less helpful.
A Summary of Benefits & Coverage (SBC) is a much shorter guide which is good for quickly comparing insurance options. An Explanation of Benefits (EOB) is typically used after you get healthcare.
Neither of these are useful for thoroughly explaining your insurance policy. Refer to this guide below for the correct document to submit to Outfox Health:
How to find your insurance policy
Log in to your healthcare portal: Whether it’s your insurer, employer, or union, login to the online portal where you access healthcare. Follow these steps:
- Go to your insurance administrator’s website. This can be your health insurance itself but it could also be your employer or your union.
- Log in to your account using your username and password.
- Navigate to the “Documents”, “Plan Information” “Coverage Details”, “View Certificate Booklets”, or similar section.
- Look for a download option for your EOC or SPD.
Here’s one example of where to find your SPD. In this case, an Aetna member clicks on “Benefits” and then downloads their “Benefit Plan Description” on the right hand side of the screen:
Here’s another example. In this case, a person logs into their union’s healthcare plan portal and goes to the “Documents” tab, then clicks the “Summary Plan Description” (SPD) folder:
Other methods for finding these documents include:
- Contact Customer Service: If you cannot find your EOC or SPD online, contact your health insurance provider’s customer service and ask. Have your member ID ready for faster service.
- Check Your Mail: Some insurance companies still send out physical copies of the EOC or SPD by mail, so don’t forget you may have a physical copy rather than a digital one.
- Check Your Welcome Packet: When you first enroll in a health insurance plan, you typically receive a welcome packet which could include your EOC / SPD.
Public sources of insurance policies
Some insurers post their EOC / SPDs documents publicly. You just need to know your specific plan and search for it on the insurer’s directory.
Below are links to EOC directories provided by major US health insurers:
- Anthem Blue Cross, Blue Shield: EOC Document Posting Site
- Aetna: Find EOC (Medicare)
- Cigna: EOC Plans (Medicare)
- Clover Health: Plan Details
- Kaiser Permanente: Individual and Family Plan Documents
Unfortunately, most insurers do not post their policies publicly yet. Unless you have insurance from one of the above providers, your best bet is still to login to your portal.
No personal health data included
The EOC / SPD is a generic policy document that outlines the terms and conditions of your health insurance plan. It provides detailed information on coverage, benefits, and your rights and responsibilities.
These documents does not contain any sensitive health data related to you, such as which illnesses you have or your last insurance bill. Instead, these serve as guides to help you understand your health insurance plan without revealing any personal health information.
This ensures your privacy is maintained while still providing you with essential information about your coverage.
Still can’t find your insurance policy document?
In some cases, employees may have to ask their HR departments directly in order to get their policy documents. We’ve created a template below that you can use to request it:
Subject: Request for Explanation of Coverage (EOC) or Summary Plan Description (SPD)
Dear [HR Representative’s Name],
I hope this message finds you well. I am writing to request a copy of my Explanation of Coverage (EOC) or Summary Plan Description (SPD) for my health insurance plan. I was unable to locate these documents using the instructions provided on our internal resources.
The EOC and SPD are detailed documents that describe the benefits, coverage, and rules of our health insurance plan. They typically exceed 100 pages in length, containing comprehensive information about the plan’s terms and conditions. These documents are legally required to be provided to participants under the Employee Retirement Income Security Act (ERISA).
Could you please provide me with these documents or guide me on how to access them? Additionally, if there are any specific steps I need to follow, please let me know.
Thank you very much for your assistance.
Best regards,
[Your Name]
[Your Position]
[Your Contact Information]
