To view and print PDF documents on this website, download the latest version of Adobe Reader for free.
Essence Washington Part D Medicare Prescription Drug Plan
Explanation of Benefits
The Explanation of Benefits (EOB) is a document you will get each month you use your prescription drug coverage. It will tell you the total amount you have spent on your prescription drugs and the total amount we have paid for your drugs. You will get your EOB in the mail each month that you use the benefits provided by us. You will not get an EOB if you don't use any benefits that month.
The EOB is not a bill. It is sent for informational purposes only. No action is necessary on your part.
Your Explanation of Benefits will contain the following information:
- A list of prescriptions you filled during the month, as well as the amount paid for each prescription.
- Information about how to request an exception and appeal our coverage decisions.
- A description of changes to the formulary affecting the prescriptions you filled that will occur at least 60 days in the future.
- A summary of your coverage this year, including information about:
- Annual Deductible - the amount you and/or others pay before you start receiving prescription coverage.
- Amount Paid for Prescriptions - the amounts paid that count towards your initial coverage limit.
- Total Out-of-Pocket Costs That Count Towards Catastrophic Coverage - the total amount you and/or others have spent on prescription drugs that counts towards your qualifying for Catastrophic Coverage. This total includes the amounts spent for your co-payments and co-insurance, and payments made on covered Part D drugs after you reach the initial coverage limit. (This amount does not include payments made by your current or former employer/union, another insurance plan or policy, government funded health program, or other excluded parties.)
Please Note: Items/services appear on the EOB when a claim is processed, not necessarily for the month in which you received the item or service.