17. April 2018 17:39
by Nicki
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Understanding Your Health Insurance ID Card

17. April 2018 17:39 by Nicki | 0 Comments



Your health insurance ID card. It’s a tiny piece of plastic that sits in your wallet. It may go largely unnoticed (aside from during doctor appointments and other medical services), but that little card is packed full of some very valuable information about your health insurance plan – information that can help you navigate the world of health care and ensure that when you receive medical care, it’s covered and billed correctly. And that’s a large part of what CDPHP® is about: As part of our Health Care Decoded initiative, it’s our mission to empower you with the tools you need to understand your health insurance.

Let’s start with a closer look at your health insurance ID card and some of the key pieces of information that it contains. Please keep in mind these are general categories of information. Your card might vary, depending on your health insurance company and the type of health plan that you have.

The Basics

First and foremost, your health insurance card contains some straightforward identification information:

  • The name of your health insurance company and possibly contact information (website, phone numbers, etc.)
  • Your name
  • The name of the subscriber or policyholder, if it’s not you. This may appear if you get your health insurance through another family member’s employer (e.g., spouse, parent)
  • The names of other covered family members (e.g., spouse, children) may also appear here

Member ID

Each member of a health plan is assigned a unique ID number, which allows doctors and other health care providers to verify your health insurance coverage and eligibility. If you have a question for your health insurer, this information will allow their customer service department to bring up your account to view your claims and benefits, and to answer any questions you may have.

Group Number

A health insurer also assigns a unique ID number to each employer that purchases one of its plans. This is called the group number, and you’ll see it on your ID card if you receive your health insurance through an employer. It identifies the benefits of your specific plan and your doctor’s office will use it, along with your member ID, to submit claims.

Plan Type

There are many different types of health insurance. The most common plan types you’ll see listed on your ID card are HMO insurance plans (health maintenance organizations), PPO insurance plans (preferred provider organizations), EPO insurance plans (exclusive provider organizations), and HDHPs (high deductible health plans). Each plan type is defined by its specific requirements regarding referrals, in- and out-of-network providers, and how out-of-pocket costs are calculated.

Payment Information

Most health insurance cards will show how much you will be expected to pay (your out-of-pocket costs) for common services like visits with your primary care physician (PCP), specialist visits and urgent care and emergency room visits. This may be listed as a flat rate (a copay) or a percentage of the total cost of the service (coinsurance). If two numbers are listed, the first represents your cost at an in-network provider, and the second is your cost at an out-of-network provider.

Prescription Benefits

Formulary

A formulary is a list of prescription drugs that your insurance company will cover. Some insurers have several formularies. Each CDPHP member will have one of three formularies listed on his or her ID card – Formulary 1, Formulary 2 or the Medicaid Formulary. If your CDPHP member ID card does not have a formulary listed, you have Formulary 1.

Prescription Costs

Formularies are commonly divided into three tiers. Your card may list the price you’ll pay at each tier level when you use a participating pharmacy.

Pharmacy Network

Some insurers have different pharmacy networks for different plans. A CDPHP member has one of three pharmacy networks: Premier (for all CDPHP plans offered through an employer), Value (for CDPHP individual health plans) or Medicare.

Rx BIN (banking identification number)

Your pharmacist will use this number to process your prescription. It indicates which company will reimburse the pharmacy for the cost of the prescription and where to send the claim for reimbursement.

Medical Network

Your insurance company may provide out-of-area coverage through a different health care provider network. If so, this will be listed here.

The Back of the Card

The back of your health insurance ID card is where you’ll be likely to find additional information, like important telephone numbers and addresses for doctors and hospitals so that they can verify eligibility, file claims, get pre-authorizations, etc. It might also provide hotlines and other resources for a variety of specific situations (e.g., chemical dependency services number, fraud hotline).

And there you have it – a breakdown of the most common pieces of information that you’ll find on your health insurance ID card. Now you know why that little piece of plastic is so important. And if you’re a CDPHP member, you can access your ID card online through our secure member site, or have it with you everywhere your smartphone is with the My CDPHP Mobile app!

Does your ID card have something we didn’t explain? Check out more of our Health Care Decodedhealth insurance explanations, or let us know in the comments below! Or, call the customer service number listed on your card for further explanations on the details of your plan.

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