How to Understand a Health Insurance Card

Each element of information on your insurance card is there for a reason.

Each element of information on your insurance card is there for a reason.

Have you ever taken the time to actually read all of the information that’s printed on your health insurance card? At first glance that tiny piece of plastic may seem to contain little to no information. That, however, couldn’t be further from the truth. While small in size, your insurance card is packed full of pertinent information for both yourself and your doctor’s office to ensure your medical services are covered and billed correctly.

Coverage

Your health insurance card lists the type of health insurance plan you are currently covered by and the effective date that your coverage began. The most common types of plans are preferred provider organizations and health maintenance organizations. PPOs offer the flexibility of visiting any physician of your choice, although visiting an in-network provider will result in the best coverage options and less out-of-pocket expenses. HMOs require you to designate a primary care physician from a list of network providers. You must visit that doctor for all general medical needs. This type of plan also requires a referral from your PCP before you can schedule a visit with a specialist, such as a dermatologist or allergist. If you are covered by an HMO you may notice your selected physician’s name printed on your card under the heading “PCP”.

Identification

Your card likely includes several sets of numbers. The “Identification Number” is typically the longest number listed on the card. It consists of a combination or letters and numbers. Many years ago, this number was simply the subscriber’s Social Security number, but in the interest of privacy each plan participant is now assigned a unique identifier that must be supplied to your doctor’s office to verify your insurance coverage and eligibility. You should also notice a “Group Number” which is simply your employer’s insurance policy number, and an “RX Bin Number,” which is used for prescription purchases.

Co-Pays

Your card may also list various types of services such as PCP visits, emergency room, specialist, RX (prescription) and inpatient/outpatient hospital stays along with the corresponding co-pay amounts. This is the total amount that is due out of pocket at the time of service. Co-pays are flat rate fees patients must pay for office visits regardless of the diagnosis or treatment provided. It is important to understand that this is separate from the insurance billing process. This means that even though you have paid your co-pay you may still receive a bill from your insurance company if the services provided are not covered in full by your insurance policy.

Contact Info

Several phone numbers should be printed on the back of your insurance card, showing dedicated lines to assist subscribers and providers or obtain insurance authorizations. Some cards also include contact information for supplemental services offered by your plan, such as 24/7 nurse lines and mail order prescription services. If you or your doctor calls the insurance company, it is helpful to have your insurance card handy in case you are asked to provide your identification or group numbers for verification purposes.

About the Author

Based in Virginia, Amanda Banach has been a writer since 2009. Her professional work experience includes roles in media advertising, financial services and human resources. She holds a Bachelor of Arts in human resources management and is PHR-certified.

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