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.
Most health insurance cards contain straightforward identification information about the people covered and the policy you have.
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.
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.
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.
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.
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. For some plan types, the plan type will be listed on the ID card (example: HMO), while Medicaid and Child Health Plus cards will feature each program’s respective logo. 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:
Some insurance companies give specific names to certain plans, like those available through the healthcare exchange, instead of using group numbers (above).
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.
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.
If your plan includes benefits for prescription drugs, you will also find some information related to them on your health insurance ID card.
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.)
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.
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.
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.
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:
You can always call the customer service number on your card to ask any questions about the details of your plan.
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