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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

Example of a personal health statement.

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.

1Patient's NameThe name of the person who received the service. This could be the policyholder, covered spouse or a covered dependent child.
2Date Span for PHSThis date span is the week(s) from when the last PHS ran to the current PHS run representing our accumulation period.
3I.D. NumberThe member number of the person that received the services billed on the PHS.
4PHS Statement NumberThe number BlueAdvantage assigned to the PHS for tracking purposes.
5Contact InformationAll contact information for BlueAdvantage Administrators of Arkansas.
6Span for BenefitsCurrent contract span for the claims listed on the PHS.
7HRAThe 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.
8DeductibleThe total deductible accumulation during the contractual year.
9CoinsuranceThis indicates the rate of coinsurance at which BlueAdvantage and the member pays for the services on the PHS (if applicable).
10Out-Of-Pocket MaxThe total out of pocket accumulation during the contractual year. Once the out-of-pocket is met BlueAdvantage will pay 100% of allowed services.
11Payment SummaryA brief summary of the way the claims on the PHS processed.
12Your Health MattersHelpful information to help the member better manage their health.
13ProviderThe healthcare professional or facility that provided services to the patient.
14Claim NumberThe number BlueAdvantage assigned to this claim for tracking purposes.
15Procedure DescriptionA description of the type of service for each claim.
16Service dateThe date the service was performed.
17Claim ReceivedThe date BlueAdvantage received the claim.
18Provider BilledThe amount the provider charged for the service.
19Member DiscountThe difference between the amount the provider billed and the net amount charged.
20Net Amount ChargedThe amount billed after the member discount is deducted.
21HRA PaidThe 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.
22Your Health Plan PaidThe amount BlueAdvantage paid based on the benefit coverage and the contractual agreement with the provider.
23Explanation CodesThis is an explanation of activity that occurred on this claim/service and describes how the claim was processed.
24Other Insurance PaidThe amount paid by the members other primary insurance carrier (if applicable).
25Copay/Excluded ServicesA 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.
26DeductibleThe amount the member pays to providers for services each benefit period before BlueAdvantage starts paying a portion of the coinsurance.
27CoinsuranceThe percentage of allowable charges the member pays to the provider for covered services for which the member is responsible.
28TotalThe amount the member pays to the provider for each line of service. This includes any non-covered services, deductible, & coinsurance.
29TotalsAccumulates the totals for each column.
30Total Charge After DiscountTotal charge after the member discount is applied for all claims on the PHS.
31Your Health Plan(s) PaidTotal BlueAdvantage paid for all claims on the PHS.
32You Owe or May Have PaidTotal the member owes for all claims on the PHS.
33Total member responsibilityThis amount is the same amount from Box #32.