the rx bin, rx grp, and rx pcn are three identification numbers you’ll see on almost every insurance card.
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These numbers allow your pharmacy or medical office to process claims through the correct channels. These codes indicate what type of insurance you have, what type of drug coverage you have, and where the claim should be submitted.
Reading: What is a rx bin for insurance
making a mistake can jeopardize your health coverage. for example, you may be forced to pay out of pocket or be denied coverage altogether.
Knowing what they mean will help you maximize your health insurance benefits, advocate for yourself, and understand the medications you’re taking.
We’ll explain what each number means in depth later in the article, but here’s where you can find each number on your insurance card:
click on the image to zoom
let’s get started.
what is rx?
rx is an abbreviation for “prescription”.
Usually forms part of the header (superscription) of a prescription, a written order from a physician to a pharmacist, who then dispenses the medication.
The rx symbol on your insurance card tells you that your health insurance company pays for some or all of your prescription drug costs.
In some cases, insurance cards show the rx symbol along with a dollar amount or percentage to show how much your insurer will pay for your prescription.
what is rx bin?
rx bin stands for “prescription drug bank identification number” (see sample card 1 and 2)
If you have multiple prescription drug plans, such as Medicare Part D and an employer-sponsored plan through work, it’s important to know which prescription container to use when filling prescriptions.
despite the name, the rx tray number on insurance cards has nothing to do with banks. This has understandably caused people to wonder what an rx container is. an rx bin is a six-digit coding system that identifies your insurance providers.
When the pharmacist enters your prescription container number into their database, they will know which insurance company will pay for your prescription.
Also, if you’re wondering if rxbin or bin represent the same thing on insurance cards, they do.
Not all insurance cards contain the container number (see no rx container sample card).
how to find the rx container on the insurance card:
To find out your insurance container number, we recommend that you contact your health insurance provider to confirm your prescription container.
what is grp rx?
the meaning of rx grp is the group number assigned by a health insurance company to identify a member’s group health plan.
tells the pharmacy what type of insurance plan you have so they can look up the list of medications, copays, and deductibles approved for your plan.
Each plan has its own list of prescription drugs that are approved for covered reimbursement. If a drug is not on your plan’s list, it is not covered.
you will need your grp rx number when:
- fill a prescription at the pharmacy
- fill a new drug for you that requires prior authorization
- check drug prices before going to the pharmacy
- using a mail order pharmacy
- file a claim for reimbursement from your insurance company
- schedule certain medical appointments or procedures
- visiting the hospital emergency room
- receive services from an out-of-network provider who needs to file a claim on your behalf
- when you are covered by private insurance instead of your employer
- when you see a doctor outside of your network
- when using a mail order pharmacy
- when transferring prescriptions between pharmacies
- pay for the medication yourself
- ask your doctor to prescribe another medication
- file an appeal with your insurance company for coverage
- Tier 1: Preferred Generic Drugs – These are generally the lowest cost drugs in the plan.
- Tier 2: Generic Drugs: These drugs have the same active ingredients as brand-name drugs but cost less than brand-name drugs.
- Tier 3: Preferred Brand Drugs – These are brand name drugs that generally cost more than generic or preferred generic drugs.
- Tier 4: Non-Preferred Brand Drugs – These are brand name drugs that generally cost more than Preferred Brand Drugs and other lower tier drugs.
- Tier 5: Specialty Prescription Drugs – These are high-cost prescription drugs that typically treat complex or rare conditions.
- hmo: A health maintenance organization that allows you to choose a Primary Care Provider (PCP) who will coordinate your health care. You must get a referral from your PCP if you need to see a specialist.
- pos: Point of Service allows you to choose a Primary Care Provider in your network. You can use an in-network or out-of-network service if you need to see a specialist at the time you need care.
- ppo: The Preferred Provider Organization allows you to see any medical professional without needing a referral from your primary care provider.
If you work for an employer that offers a health plan, you should receive a membership card and additional information about your prescription drug coverage. (see sample card 1 and 2)
if you are not sure what your rx grp is, please contact the customer service phone number on the back of your ID card.
what is pcn on health insurance cards?
its meaning rx pcn is “processor control number“.
Like the rx bin and rx grp code, the pcn is an additional identifier used by insurance companies to determine which processor will handle your claim.
The insurance pcn is also connected to your prescription drug plan. tells the pharmacy if your prescription is covered by your drug plan and, if so, how it would be paid for.
In most cases, you won’t need to provide the pcn on your insurance card when you go to the doctor’s office or pharmacy, as they can automatically retrieve it from your group id.
but there are some situations where a doctor or pharmacist may need to manually enter the pcn:
A doctor’s office may also use this information to verify your eligibility for coverage before providing services.
The PCN insurance number is usually listed on the front of your card along with the group number and member ID. (see sample card 1 and 2)
what is a form?
A formulary is a list of prescription drugs covered by your health insurance. (see sample card 2)
This list shows the brand name and generic versions of each drug, along with copays and requirements to use the drug.
So why is it important to know what’s in your form?
Because your insurance will only pay for drugs on your plan’s formulary.
If your prescription is not on your plan’s drug list, you have the following options:
Pharmacists may also request your formulary when you fill a new prescription or have been prescribed a drug that is not on the list.
In most cases, pharmacists will be happy to help you find cheaper generic versions of your drug based on the formulary.
If you experience side effects with your initial medications, they can also help you find alternatives.
If you have questions about which medications are covered by your health insurance plan, please contact the provider directly or refer to their member materials.
Remember that the form lists are also constantly changing. we recommend searching and bookmarking the formulary section on your insurer’s website to stay up to date on the list.
for example, the cdphp website has a dedicated section for updates to its list of covered drugs. most insurance company websites will have a similar section.
What are the prescription costs or drug tiers?
Formulary listings are also broken down into prescription drug costs, also known as drug tiers:
Some insurance policies do not use a tiered system, but assign each medication a copay amount. in this case, the copay amount should be listed on your card or in your member information packet.
what other information can you find on your insurance card?
Besides the rx bin, rx grp and rx pcn, there are other important details on your insurance card. (see sample card with other information)
plan name refers to the name of the plan or coverage you have from your health insurance provider. cigna, aetna, kaiser, and humano are some of the more common plan names.
The type of health insurance plan you have is also indicated on your health insurance ID. determines which medical provider you can go to and how you can get medical care.
The most common types of plans are:
member name refers to the name of the policy holder. It could be your name or the name of your parents or spouse if you are covered by your health insurance plan.
Each individual who is covered by health insurance has a unique member identification number, which is located on their insurance card. is a set of numbers containing 5 to 12 digits and listed under different headings such as Member ID, ID, or Membership Number.
is the identifier that allows health care providers to verify health insurance coverage and make necessary payment arrangements for health care services provided.
how to use your health insurance ID card?
Make sure all the information on your ID card is correct. if not, have it changed immediately and apply for a new card.
Show your insurance card every time you go for a doctor’s visit or every time you receive health services.
what if you can’t find the rx bin, rx grp or rx pcn on your insurance card?
If you need more information about your insurance or if you can’t find the information you need, you should call your health insurance provider right away.
Are prescription drugs included in the health insurance?
The Affordable Care Act requires all insurance plans offered by insurance companies and small employers to cover prescription drugs. the policyholder, however, usually has to pay a portion of the prescription costs.
Some insurance companies include prescription coverage information on the insurance card. others provide a different card for recipes.
know your insurance card information
Your insurance card can help you save money on visits to your doctor when you receive health care services and every time you go to the pharmacy.
Being familiar with your insurance card information, such as rx bin, rx grp, and rx pcn, gives you a good idea of your prescription drug coverage to ensure the claim is submitted to the appropriate insurance.