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Understanding Your Health Insurance ID Card | The Daily Dose | CDPHP Blog

You may not think about your health insurance ID card very often. after all, it probably spends most of its time in your wallet, until you or your doctor or other medical provider really needs it.

However, let’s take a minute to look at the wealth of important information you can find on your card. after all, it’s your passport to care and coverage, so you need to know what all the information fields really mean.

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The descriptions below apply to most private health insurance ID cards in the United States. If you live outside the U.S. or have government-provided insurance, you may see some different fields on your card. CDPHP® is dedicated to helping you understand your health insurance, but you should always call your own insurer at the customer service number on your card if you have questions about your specific health plan or coverage.

Most health insurance cards contain clearly identifying information about who is covered and what policy you have.

operator and contact information

This is the name of your insurance company and one or more ways to contact them, such as their website and phone numbers for customer service or other specific needs. some of this information may be on the back of the card.

names of people covered

If you are the policyholder, your name will appear on the card. If you have dependents, such as a spouse or children, on your health insurance policy, their names may also appear on your card. if you are not the policyholder, your card may display your name and the policyholder’s name in separate fields.

member ID/policy number

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Each person covered by a health insurance plan has a unique identification number that allows health care providers and their staff to verify coverage and coordinate payment for services. It’s also the number health insurers use to search for specific members and answer questions about claims and benefits. this number is always on the front of the card. if you are the policyholder, the last two digits of your number may be 00, while others on the policy may have numbers ending in 01, 02, etc.

group number

Every employer that buys a health plan for their employees also has a number. This group number identifies the specific benefits associated with your employer’s plan. health care providers use the group number plus your member ID number to submit claims for your care. If you buy insurance through a health care exchange (the marketplaces established by the Affordable Care Act, sometimes called “obamacare”), you may not have a group number.

plan type/plan name

There are many different types of health insurance plans. Insurance companies list the type of plan on your ID card to help health care providers file claims correctly. For some plan types, the plan type will be listed on the ID card (example: HMO), while Medicaid and Child Health Plus cards will have each program’s respective logo. each type of plan has different ways of handling referrals, in-network and out-of-network providers, and out-of-pocket costs. the most common types are:

  • hmo (health maintenance organizations)
  • ppo (preferred provider organizations)
  • epo (exclusive provider organization) insurance plans
  • hdhp (deductible health plan provider organization)
  • essential plan

Some insurance companies give specific names to certain plans, such as those available through health care exchanges, instead of using group numbers (above).

payment information

many health insurance cards show the amount you will pay (your out-of-pocket costs) for common visits to your primary care physician (pcp), specialists, urgent care, and the emergency department. this can be a flat fee (copayment) or a percentage of the cost (coinsurance). If you see two numbers, the first is your cost when you see an in-network provider and the second, usually higher, is your cost when you see an out-of-network (oon) provider. for example, when you are referred to a specific specialist or sent to a specific hospital, they may not be in your insurer’s network.

medical network

Your insurance company may provide out-of-area coverage through a different health care provider network. if so, the name of that network will probably be on your insurance card. this is the network you’ll want to look to if you need access to healthcare while on vacation or out of town on a business trip.

recipe benefits

If your plan includes benefits for prescription drugs, you’ll also find related information on your health insurance ID card.

form

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The formulary is the list of prescription drugs covered by your insurance company. Some insurers have different forms that are covered by different plans, and indicate which form on member ID cards. for example, cdphp members will see form 1, form 2, or the medicaid form on their cards. (if you are a member of cdphp and you don’t have a form on your card, you have form 1).

recipe costs

Most formularies are divided into three tiers that contain different types of drugs. each tier has a different price you’ll pay when you pick up your prescription at a participating pharmacy. Generally, generic drugs make up the majority of tier 1, brand-name drugs cost a little more and make up the majority of tier 2, and specialty drugs (which are the most expensive) make up the majority of tier 3 .

pharmacy network

Different insurance plans sometimes cover different pharmacy networks. if so, it’s probably on your insurance card. for example, cdphp employer plans use a main network; individual cdphp plans (such as those on the health care exchange) use a value network; and cdphp plans for seniors use the medicare network.

rx bin (bank identification number)

Your pharmacist will use this number to process your prescription. indicates which company will reimburse the pharmacy for the cost of the prescription. however, not all insurance identification cards contain this number.

useful resources

Sounds like a lot of information to cram into a little rectangle, and it is! still, you can find additional information on your card, such as:

  • Important phone numbers and addresses that allow your health care providers to call for information (such as coverage verification, claims questions, prior authorizations, etc.)
  • hotlines for help you get specific help quickly (to report fraud, for example)
  • resources to help you find specialty care (chemical dependency services, etc.)

Remember: If you’re a cdphp member, you can view your ID card online through our secure member site or by using the my cdphp mobile app.

You can always call the customer service number on your card with any questions about the details of your plan.

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