What Is an EOC?

EOC is an acronym for Evidence of Coverage, a document that details plan coverage, a member’s rights and responsibilities as well as the associated costs each year. Healthcare providers are required by US regulations to provide the EOC, also referred to as a certificate of coverage, to each and every member. The aim of the EOC is to provide healthcare subscribers with accurate information and adequate time to assess their healthcare options before the new year of coverage begins in January.

Under current US regulations, healthcare providers in the US are required to clearly outline coverage, including limitations and exclusions of that coverage, and associated costs to members in the EOC document, which must meet exacting specifications and be delivered to members in September.

US healthcare communications are highly regulated, so data collection, formatting and delivery requirements are subject to change. Healthcare providers are expected to be aware of these changes and meet all current, relevant EOC compliance requirements.

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