What is an Explanation of Benefits (EOB)

October 2, 2025

Answer:

An Explanation of Benefits (EOB) or claim statement, is provided to you after you or your provider have submitted a claim for a health or dental service or product. It is also provided if you have submitted an estimate for a pre-determination of benefit for a health or dental service or product covered under your plan.

The EOB can show:

• What health or dental services were paid for under your OSSTF benefits plan.
• What health or dental services will be eligible under your OSSTF benefits plan.
• How much you are responsible for paying ‘out-of-pocket’.

How to find your claim statement or EOB

After you have logged into the OTIP member site, you can review your claim statement or EOB in Claims History in My Claims. Your claim statement or EOB will also be mailed to you if you have not consented to the electronic transfer of funds.

Beside each claim, you can click on the document icon under the Statement column to review:

• Your plan details including your plan and claim number.
• The details of the claim or estimate, including the date of expense if applicable, the specific services or products and the amount that was charged or will be charged for those services or products.
• The eligible amount, the percentage paid and the benefit amount that your plan reimbursed or will reimburse for those services or products. EOBs issued on estimates may also advise you how much of a benefit you have used out of your plan maximum.
• If the amount is not paid, the EOB will note other information required, such as a request for additional supporting information to determine eligibility of coverage under your plan.

In addition, your claim statements or EOB can also be used when claiming unpaid portions of health or dental expenses on your income tax return. Read more about EOBs here What is an Explanation of Benefits? | OTIP RAEO

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The information in this document is provided by OSSTF Benefits for general information only. OSSTF Benefits endeavours to have all information current and accurate. We make no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, or suitability of the information included. All information is subject to change without notice.

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