How Health Insurance Works

If you want to get the most out of your health plan, it's important to understand how health insurance generally works. This graphic gives you a basic overview.

Select and enroll in a health plan

Receive your member ID card

Find an in-network primary care physician (PCP)

Get the care/ services you need

For example, you visit your PCP for strep throat.

After your appointment, your PCP submits a claim to your insurance for payment for the care/services they provided.

Your insurance processes the claim and pays your PCP its portion; they will also send you an explanation of benefits (EOB).

Receive an EOB

Repeat

Essentially, this is how health insurance works every time you get care from an in-network provider.

What Is an EOB?

An EOB is an explanation of benefits, which summarizes how your benefits were applied after receiving care. To learn more about what they are (and are not), tour CareFirst’s explanation of benefits.