A Simple Guide to Understanding Your Health Insurance Card – Bennie

There sure is a lot of information on an insurance ID card. Trying to figure it out may seem pointless at first, but understanding your health insurance card will make your trips to the doctor much easier.

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

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Are you still intimidated? don’t worry! Read on to better understand your health insurance card.

Understanding Your Health Insurance Card: Breaking It Down

Each 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 stands for will help you better understand your benefits.

  • member’s name: the member’s name 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, usually first.

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

      Typically, each person in a health insurance plan will have a unique identification number. family members on the same plan often have similar numbers. this ID allows the insurer to quickly look up specific claim and benefit information, and also allows health care providers to verify coverage.

      • Group Number: You may not have a group number on your card. insurance you bought on your own through the exchange (that’s the affordable care act or obamacare health insurance) probably won’t have a group number. on the other hand, insurance provided through an employer will likely have a group number. this number identifies the benefits associated with your employer’s plan. used in conjunction with your policy number to accurately submit claims for your care.

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

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

          • health maintenance organization (hmo): hmos will generally only cover visits to in-network health care providers and may be geographically limited; the hmo’s service area to be eligible. Most HMOS will offer some out-of-network coverage for emergencies, but the focus is primarily on providing integrated care. that is, all the doctors and specialists you consult will be working together and to have a clearer vision of your health.

            • preferred provider organization (ppo): a ppo will cover more if you use in-network health care providers, but you can also see out-of-network providers without a remission.

              • exclusive provider organization (epo): With an epo, care is covered only with in-network doctors, specialists, and hospitals, except in emergencies .

                • high deductible health plan (hdhp): As the name implies, a high deductible health plan has a higher out-of-pocket amount that you must reach before of your insurance. will begin to cover the costs. in return, the monthly insurance premium 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 subject to federal taxes.

                  • Coverage amounts or payment information: Your card should list the out-of-pocket costs you will have to pay when you receive medical care. You’ll likely include this for common visits like your family doctor/primary care doctor, specialist appointments, trips to the emergency room, and possibly prescription drug costs. deductible or a percentage: what the insurance company will cover versus what you are responsible for.

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

                    • A copayment is the amount of money you are responsible for when you visit a health care provider, while a deductible is an out-of-pocket amount that must be achieved before the insurance is activated and begins to cover the care.

                      • pharmacy information – Depending on the type of plan you have, your insurance card may include information about prescription drug benefits. for example, you can see the numbers rxbin and rxpcn.

                        • an rxbin identifies which insurance company your prescription will be billed to.

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                          an rxpcn is a secondary identifier that insurance companies use for prescription billing.

                        • The retail prescription drug copay is a predetermined rate you will pay for retail prescription drugs.

                          • 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 have 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.

                            • Please review your insurance card as soon as you receive 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. verify that the copay and deductible details are correct as well. Making sure your information is correct and up-to-date will ensure smoother browsing later on.

                              • keep that insurance card with you, but make sure it is in a safe place. make sure your insurance card is safe and secure in your purse or wallet. Not only will you need the card when you receive health care services, but you may also need it when you call your insurance company to keep track of bills and claims.

                                • can have multiple cards. keep track of them all! You may have separate cards for prescription drug services, dental coverage, and vision coverage.

                                  • If you lose your card, call your health insurance company to replace it ASAP! your card contains personal information. If it’s 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 in your phone. If you lose your card or just forget it at home, some providers will still look for you by policy number alone. however, this is not a foolproof plan. if you don’t have your card, some providers will simply ask you to pay your bill at the time of service and request reimbursement through your insurance company later.


                                      Your insurance card is equal parts identification and reference. understanding it can make trips to the doctor much easier. You can rest easy knowing which providers are in-network and how much you can expect to pay for a visit. Now that you’re familiar with your card details, don’t forget to fully review your plan details to get the most out of it!

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