Health insurance basics
Understanding your Personal Health Statement(PHS)
Your Personal Health Statement (PHS) is designed to help you better understand your recent medical and prescription claims including:
- Total amounts charged
- Your discounts just for being a member
- What your health plan paid on your claims
- And what you owe, or may have paid, to your medical provider
BlueAdvantage Administrators of Arkansas is providing you with this information so you can be a more informed member when it comes to paying for healthcare costs. You can also view your PHS information inside Blueprint Portal.
Sample PHS
PHS description
The following is a description of the items listed on the PHS. The field numbers referenced within the sample PHS pages correspond with the field names and descriptions provided below.
| FIELD NUMBER | FIELD NAME | FIELD DESCRIPTION |
|---|---|---|
| 1 | Patient's Name | The name of the person who received the service. This could be the policyholder, covered spouse or a covered dependent child. |
| 2 | Date Span for PHS | This date span is the week(s) from when the last PHS ran to the current PHS run representing our accumulation period. |
| 3 | I.D. Number | The member number of the person that received the services billed on the PHS. |
| 4 | PHS Statement Number | The number BlueAdvantage assigned to the PHS for tracking purposes. |
| 5 | Contact Information | All contact information for BlueAdvantage Administrators of Arkansas. |
| 6 | Span for Benefits | Current contract span for the claims listed on the PHS. |
| 7 | HRA | The total HRA accumulation during the contractual year. If the member has an Health Savings Plan then this field will have HSA verbiage in place of the HRA graph. |
| 8 | Deductible | The total deductible accumulation during the contractual year. |
| 9 | Coinsurance | This indicates the rate of coinsurance at which BlueAdvantage and the member pays for the services on the PHS (if applicable). |
| 10 | Out-Of-Pocket Max | The total out of pocket accumulation during the contractual year. Once the out-of-pocket is met BlueAdvantage will pay 100% of allowed services. |
| 11 | Payment Summary | A brief summary of the way the claims on the PHS processed. |
| 12 | Your Health Matters | Helpful information to help the member better manage their health. |
| 13 | Provider | The healthcare professional or facility that provided services to the patient. |
| 14 | Claim Number | The number BlueAdvantage assigned to this claim for tracking purposes. |
| 15 | Procedure Description | A description of the type of service for each claim. |
| 16 | Service date | The date the service was performed. |
| 17 | Claim Received | The date BlueAdvantage received the claim. |
| 18 | Provider Billed | The amount the provider charged for the service. |
| 19 | Member Discount | The difference between the amount the provider billed and the net amount charged. |
| 20 | Net Amount Charged | The amount billed after the member discount is deducted. |
| 21 | HRA Paid | The amount of HRA dollars used on this service line. If the member has a Health Savings Account then this field will always have a dash on each service line. |
| 22 | Your Health Plan Paid | The amount BlueAdvantage paid based on the benefit coverage and the contractual agreement with the provider. |
| 23 | Explanation Codes | This is an explanation of activity that occurred on this claim/service and describes how the claim was processed. |
| 24 | Other Insurance Paid | The amount paid by the members other primary insurance carrier (if applicable). |
| 25 | Copay/Excluded Services | A copay is a fixed amount you pay for a healthcare service, usually when you receive the service. Excluded services are services that are not covered under the benefit plan. |
| 26 | Deductible | The amount the member pays to providers for services each benefit period before BlueAdvantage starts paying a portion of the coinsurance. |
| 27 | Coinsurance | The percentage of allowable charges the member pays to the provider for covered services for which the member is responsible. |
| 28 | Total | The amount the member pays to the provider for each line of service. This includes any non-covered services, deductible, & coinsurance. |
| 29 | Totals | Accumulates the totals for each column. |
| 30 | Total Charge After Discount | Total charge after the member discount is applied for all claims on the PHS. |
| 31 | Your Health Plan(s) Paid | Total BlueAdvantage paid for all claims on the PHS. |
| 32 | You Owe or May Have Paid | Total the member owes for all claims on the PHS. |
| 33 | Total member responsibility | This amount is the same amount from Box #32. |