Understanding Your Health Insurance ID Card

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Understanding Your Health Insurance ID Card

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, your doctor, or another medical provider really need it.

Let’s take a minute, though, to look at the many important pieces of information you can find on your card. After all, it’s your passport to care and coverage, so you should know what all of the fields of information really mean.

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.

The Basics

Most health insurance cards contain straightforward identification information about the people covered and the policy you have.

Carrier and Contact Information

This is the name of your insurance company and one or more ways to reach them, like 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 Covered Individuals

If you are the policyholder, your name will be on the card. If you have dependents—like a spouse or children—on your health insurance policy, their names might be listed on your card, too. If you are not the policyholder, then your card may show your name and the policyholder’s name in separate fields.

Member ID/Policy Number

Each person covered by a health insurance plan has a unique ID number that allows healthcare providers and their staff to verify coverage and arrange payment for services. It’s also the number health insurers use to look up specific members and answer questions about claims and benefits. This number is always on the front of the card. If you’re the policyholder, the last two digits in your number might be 00, while others on the policy might have numbers ending in 01, 02, etc.

Group Number

Each employer that purchases a health plan for its employees also has a number. This group number identifies the specific benefits associated you your employer’s plan. Healthcare providers use the group number plus your member ID number to file claims for your care. If you purchase insurance through a healthcare exchange (the marketplaces set up by the Affordable Care Act, sometimes called “Obamacare”), you might not have a group number.

Plan Type/Plan Name

There are many different kinds of health insurance plans. Insurance companies list the type of plan on your ID card to help healthcare providers file claims properly. Each plan type has different ways of handling referrals, in- and out-of-network providers, and out-of-pocket costs. The most common types are:

  • HMO (health maintenance organizations)
  • PPO (preferred provider organizations)
  • EPO insurance plans (exclusive provider organizations)
  • HDHP (high deductible health plans)

Some insurance companies give specific names to certain plans, like those available through the healthcare exchange, 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 may be a flat rate (copay) 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’re 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 likely be on your insurance card. This is the network you’ll want to seek out if you need access to healthcare while you’re away on vacation, or out of town on a business trip.

Prescription Benefits

If your plan includes benefits for prescription drugs, you will also find some information related to them on your health insurance ID card.

Formulary

The formulary is the list of prescription drugs that your insurance company covers. Some insurers have different formularies that are covered under different plans—and they indicate which formulary on members’ ID cards. For example, CDPHP members will see Formulary 1, Formulary 2 or the Medicaid Formulary on their cards. (If you are a CDPHP member with no formulary listed on your card, you have Formulary 1.)

Prescription Costs

Most formularies are divided into three tiers containing different types of drugs. Each tier is set at a different price that you’ll pay when you pick up your prescription at a participating pharmacy. Usually, generic drugs make up most of Tier 1, brand name drugs cost a bit more and make up most of Tier 2, and specialty drugs (which cost the most) make up most of Tier 3.

Pharmacy Network

Different insurance plans sometimes cover different pharmacy networks. If so, this is likely to be on your insurance card. For example, CDPHP employer plans use a Premier network; CDPHP individual plans (like those through the healthcare exchange) use a Value network; and CDPHP plans for seniors use the Medicare network.

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. Not all insurance ID cards contain this number, though.

Helpful Resources

That seems like a lot of information to pack onto a little rectangle—and it is! Still, you may find additional information on your card, such as:

  • Important telephone numbers and addresses that allow your healthcare providers to call for information (such as coverage verification, claims questions, pre-authorizations, etc.)
  • Hotlines to 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 using the My CDPHP Mobile app.

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

33 Responses to “Understanding Your Health Insurance ID Card”

  1. Margaret Ross

    I enjoyed the article explaining what is on my CDPHP card. I would like to offer the following improvement to the card. The most important item, my member number, should appear in much larger type. It would help those of us who are aging and require reading glasses otherwise. Thank you.

    Reply
    • Hello, Margaret. Thank you for your very insightful and useful comment. I will definitely pass that information along to the membership and billing department; it’s always great for us to hear such important feedback from our members!

      Reply
  2. Morgan

    What does “Plan Code” mean on my insurance card? Is it the same as a benefit code?

    Reply
    • Thank you for your comment, Morgan. Because health insurance companies include different information on their ID cards, I suggest that you contact your health insurer’s member services department to find out what a plan code is. Let us know what you learn!

      Reply
    • Thank you for your comment. Because the information on ID cards varies according to which health insurer you have, I suggest that you contact your insurance company. They should be able to help you. Good luck!

      Reply
    • Thank you for your comment. While ID cards vary according to the health plan that designs them, the group number is a vital piece of information that should be included. For example, on CDPHP ID cards, the group number is located on the lower left side of the card and is clearly labeled. I hope this was helpful!

      Reply
  3. Piran Beloa Forcha

    I have heard people say they have multiple family members on one insurance card. Are the other family members indicated the BIN number or person code ?

    Reply
    • Thank you for your comment! While ID cards differ according to the health insurance company that administers them, if a person’s family members, or dependents, are covered under the same plan, each dependent is usually listed on the card under the main policy holder. For example, if John Smith’s wife and two children are covered under his health plan, their names will appear on the ID card as follows:

      John Smith
      Mary Smith
      Sam Smith
      Sally Smith

      The BIN number is used by your pharmacy to process your prescriptions, and I believe the code you’re referring to is the member suffix. Each member of a family account will have the same ID number and a two-digit suffix to differentiate them. The subscriber is always 00 and typically the spouse is 01. The remaining dependents would follow suit.

      I hope this helps!

      Reply
  4. Piran Beloa Forcha

    Thanks so much, you explained everything with clarity.

    Reply
  5. Austin

    All that my card says is Carrier, Policy, ID, and Issue. Is “Carrier”, the so called Group Number?

    Reply
    • Thanks for your comment, Austin. Usually, the “carrier” field includes the name of your health insurance company. If you’re a CDPHP member and have additional questions, please call us at (518) 641-3700. Hope this helps!

      Reply
  6. where can I find who the policy holder is and does it say it on my card?

    Reply
    • Thanks for your comment, Camila. The policyholder is usually the first name listed on your member ID card. On CDPHP ID cards, policyholders are located right below the ID number on the left-hand side and include the “00” suffix. Hope this helps!

      Reply
  7. Leslie Farley

    Hi. Where do I find the group number or plan code number on my Gateway insurance card?

    Reply
    • Thanks for your comment, Leslie. While your best bet is to call the Gateway member services number for the most accurate information, I can tell you that the group number should be clearly identified on your ID card (e.g., Group #: 12345678). On CDPHP ID cards, it’s located in the lower left-hand corner. Hope this helps!

      Reply
  8. great article. after going through, one can get a pretty straightforward idea about the health insurance cards. I think that it is a good idea to maintain an effective health insurance coverage. I think that the cards should also link the patient’s previous medical history.
    thank you.

    Reply
  9. I am looking for Insurance Cards that display Multiple Networks ID’s. For example a Cigna PPO card, with a claim address of Integra Health. This would not be a Cigna PPO plan, but a Commercial Other. How do you explain? Teaching staff how to register patients with Multiple Identification Cards.

    Reply
  10. Hello! I went to the pharmacy today and they told me that I had the wrong card with me for my medication. The card I brought was plastic and much like the one you described. Was it expired or should I bring them the paper copy?

    Reply
    • Hi, Mary! In order to make sure you have the correct ID card, please give our member services team a call at (518) 641-3700 or toll free at 1-800-777-2273.

      Reply
    • Hi Bernard, thank you for taking the time to read our blog and contact us. I believe ‘pref’ is referring to the term ‘preferred’, which would mean an entity CDPHP has a relationship with and in most cases, gives members access to lower-cost or copay-free services.

      Reply
  11. roselyn

    hi,where can i find the Subscriber/policy ID on my insurance card and where can i fine the planID

    Reply
    • Hi Roselyn – thanks for reaching out! Your subscriber ID is the very first item listed on the left-hand side of your card – it says ID#:.

      Your Group # is listed on the bottom left-hand side of the card – it should say Group#:.

      If you have any other questions, try giving member services a call at the number listed on the front of your ID card.

      Reply

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