Once you enroll in a health insurance plan, you’ll soon receive a member ID card in the mail. This small card is more important than it may look. It’s basically your way of demonstrating to doctors, dentists, eye doctors, and pharmaciststhat you have insurance.
What is a health insurance member ID card?
Your health insurance member ID card tells the provider that you have insurance. More importantly, it details for the provider:
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What type of insurance plan you have
Which benefits you have
Which insurance company your plan is through
Where to submit the claim (the request for payment that the provider sends to the insurance company)
How does such a small card do all that (and more)? It’s all in the codes. Your member ID card will have a variety of codes and acronyms that help the provider find your insurance benefits. In other words, your card may look like it’s full of “mumbo jumbo,” but all those letters and numbers have real meanings.
How do I read and use my insurance identification card?
Member ID cards vary, and different insurance companies have different formats. Some common things you may find on your card include:
1. Your ID number(s)
One thing that all ID cards contain is your member ID number. This number is unique to you, and it’s often at the top and/or in big, bold text. Providers will likely ask you for this number when you see them for the first time. (Aprovider is the person or place that provides a healthcare service — like your doctor, for example.)
The other ID number that you may have on your card is a group ID number. This may be the case if you have your insurance through your employer. In this instance, everyone at your company will have this number.
2. What types of coverage this card can be used for
Remember, there are different types of health insurance: medical, pharmacy, dental, vision, etc. You may have separate cards for each, or they may all be on one card. In other words, if you’re going to a dentist appointment, make sure the card lists "dental."
3. The type of insurance plan you have
You will likely see one of the following acronyms on your card:
HMO (Health Maintenance Organization)
PPO (Preferred Provider Organization)
POS (Point-of Service Plan)
EPO (Exclusive Provider Organization)
These are different structures of plans that may affect which providers you can see and at which rates. It's good to be familiar with your plan and its different rules to help you save money on your health care.
For example, with an HMO plan, you must see an in-network provider. If you see an out-of-network provider, your insurance may not cover the cost, and you may have to pay full price. On the other hand, a PPO plan allows you to see out-of-network providers, but for an extra fee. Plus, HMO, EPO, and POS plans may require you to have a primary care physician. A PPO plan does not.
4. Codes and details for pharmacy needs
Anything with an “Rx” in front of it relates to pharmacies. For example, RxBIN is a code that tells a pharmacist where to submit a claim when you pick up a prescription. You don't need to worry about these codes much: They're mostly to help out the pharmacist when you pick up prescription medicines.
5. A list of phone numbers for getting support
The back of the ID card will often offer ways to call representatives for support. That way, you or the provider can call for help if you ever have questions or issues with your insurance plan and benefits.
6. Your copay information (maybe)
Copays are a set fee that you pay for specific health services. Some ID cards will list the copays you can expect to pay for:
Primary care doctor visits
Visits to specialists
Urgent care visits
Emergency room visits
Prescription medicines
Not all member ID cards share this information. Instead, you may have to check your plan’s brochure or on the insurance company website.
Where can I get help?
You don’t need to know what every number and acronym means on your identification card. Most of these are codes for the doctor or pharmacist, and they’ll know how to use them. As long as you can recognize some of the above items, you’ll likely be just fine.
Have questions about your ID card? Talk to an insurance representative for guidance. Remember, you can find the phone number on the back of your card.
References
U.S. Department of Health and Human Services. (2014). From coverage to care: a roadmap to better care and a healthier you.
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