A Simple Guide to Understanding Your Health Insurance Card

There sure is a lot of information on an insurance ID card. Trying to make sense of it may seem pointless at first, but understanding your health insurance card is going to make your trips to the doctor a lot smoother.

Your insurance card is a quick guide to your insurance plan. In addition to identifying you as the insured, it tells you how much you can expect to be charged for a hospital visit and what sort of providers are in-network for you.

Understanding Your Health Insurance Card: Breaking It Down

Every insurance card looks different, but for the most part, they all have the same information. Familiarizing yourself with everything and knowing what each number and acronym means will help you better understand your benefits.

• Enrollee Name: The name of the insured is one of the first things that will appear on the card. If you are not the policyholder, the policyholder’s name will likely appear in addition to yours, typically first.

• Member ID or Policy Number: When you’re on the phone with your insurance and they ask for the policy number or member ID, they mean this.

Typically, each person on a health insurance plan will have a unique ID number. Family members on the same plan often have similar numbers. This ID allows the insurer to easily look up specific information about claims and benefits quickly, and it also allows healthcare providers to verify coverage.

• Group Number: You may not have a group number on your card. Insurance you purchased on your own through the Exchange (that’s Affordable Care Act or Obamacare health insurance) likely will not have a group number. On the other hand, insurance provided through an employer will probably have a group number.This number identifies the benefits associated with your employer’s plan. It is used in conjunction with your policy number to accurately file claims for your care.

• Plan Type or Plan Name: There are many types of health insurance plans, and each one is designed to fulfill certain needs. Your card will likely list your plan type, which is often either a short acronym or (if you are enrolled in Medicare or Medicaid) the plan’s logo. The plan type will also tell you which providers are considered “in-network.”

Let’s briefly go over some of the common insurance plan types:

• Health Maintenance Organization (HMO): HMOs will typically only cover visits to in-network healthcare providers, and may be geographically limited -- that is, you need to live within the HMO’s service area to be eligible for it. Most HMOs will offer some out-of-network coverage in case of emergencies, but the focus is primarily on providing integrated care. That is, every doctor and specialist you see will be working together and to have a clearer view of your health.

• Preferred Provider Organization (PPO): A PPO will cover more if you use in-network healthcare providers, but you may also see providers out of network without a referral.

• Exclusive Provider Organization (EPO): With an EPO, care is covered only with in-network doctors, specialists, and hospitals, except in the case of emergencies.

• High Deductible Health Plan (HDHP): As the name implies, a high deductible health plan has a higher out-of-pocket amount you need to reach before your insurance will begin covering costs. In exchange, the monthly premium for the insurance is usually lower. HDHPs are often used in conjunction with a health savings account (HSA), which allows you to pay for medical expenses with money that is not federally taxed.

• Coverage Amounts or Payment Information: Your card should list the out-of-pocket costs you will be responsible for when you receive healthcare. It will likely list this for common visits such as your family doctor/primary care physician, appointments with specialists, trips to the emergency room, and possibly prescription costs. This section will likely list in one of three ways: fixed-rate, copay/deductible, or a percentage -- what the insurance company will cover vs what you are responsible for.

• Fixed-rate or fixed-indemnity insurance pays a set amount in the event of serious injury or illness.

• A copay is the amount of money you’re responsible for when you visit a healthcare provider, while a deductible is a cost amount that must be reached before the insurance will kick in and start covering care.

• Pharmacy Information: Depending on the type of plan you have, your insurance card may list information regarding prescription benefits. For example, you may see RxBIN and RxPCN numbers.
  • An RxBIN identifies which insurance carrier will be billed for your prescription.
  • An RxPCN is a secondary identifier that insurance carriers use for prescription billing.
  • The Retail RX Copay is a predetermined rate you will pay for retail prescriptions.
  • Contact Information: The back of the card will have a variety of numbers to call if you have any questions about your plan.

  Understanding Your Health Insurance Card: Things To Do

  Now that you’ve got a better understanding of your health insurance card, let’s go over a few things you can do to make sure it works for you.

  • Review your insurance card as soon as you get it. There could be mistakes! Something as simple as a typo in your name could become a pain later when you’re at your doctor’s office. Check that the copay and deductible details are accurate, as well. Making sure your information is correct and up to date will ensure smoother sailing later.
  • Keep that insurance card with you, but make sure it’s in a safe place. Make sure your insurance card is safe and protected in your bag or wallet. Not only will you need the card when you receive healthcare services, but you may also need it when calling your insurance company to follow up on bills and claims.
  • You may have multiple cards. Keep track of all of them! You may have separate cards for prescription services, dental and vision coverage.
  • If you lose your card, call your health insurance company to replace it ASAP! Your card contains personal information. If it is lost or stolen, someone else could use your card or even just the policy number to get prescriptions or medical care. This is fraud.
  • It's not a bad idea to memorize your member ID number or store it on your phone. If you do lose your card or just forget it at home, some providers will still look you up by just the policy number. This isn't a foolproof plan, though. If you don't have your card, some providers will simply require you to pay your bill at the time of service and file for reimbursement through your insurance company later.

  Wrapping Up

  Your insurance card is equal parts ID and reference. Understanding it can make trips to the doctor a whole lot easier. You can have peace of mind knowing which providers are in-network and how much you can expect to pay for a visit. Now that you've familiarized yourself with the details of your card, don't forget to fully review your plan details to get the most out of your plan!