How to read and use your health insurance card

Once you understand the numbers and codes, you’ll have access to tons of useful information.

Your health insurance card identifies you as an insured person and provides details about your plan. That’s one reason to always carry your card with you.

“It’s a good idea to keep the actual card in your wallet,” says Tasha Riggs. She’s a licensed insurance agent with HealthMarkets Insurance Agency in Westminster, Colorado. “If you happen to get in an accident or have an emergency medical situation, the ambulance or EMS responders tend to look in your wallet to help identify you and to see if you have health insurance.”

But your insurance card isn’t just for emergencies. Medical providers you visit will likely want to see that card. That’s how they figure out your payment. But what are they looking at, exactly?

Let’s take a closer look at the codes and numbers you’ll find on your insurance card.

Looking for an insurance plan? Call a licensed insurance agent at (800) 827-9990 to discuss what’s available, or browse your options online today.

1. Your member or policy number

This is a number that usually appears below your name on the left side of your card. “Your insurance company uses your policy number to track and process insurance claims and costs,” says Riggs. “These can also be referred to as ‘subscriber’ or ‘member ID’ numbers.”

This number is important, because you may go by more than one name (“Pamela” and “Pam,” for instance). What’s more, your insurer may provide services for more than one person with your name. By giving every customer a unique code, your insurer can avoid accidentally sending you the wrong bill.

2. Group number

For most people, the group your insurance company assigns to you is the company you or your spouse works for, and your “group number” is the code for that business, says Riggs.

This number may not be particularly useful to you, but it’s incredibly useful to your provider.

3. Copay, specialist, urgent care and emergency room costs

Your card may also include a list of prices. This is what you’ll pay at the front desk at your doctor’s office, medical facility or hospital when you use medical services.

For instance, you might see a list like this:

• PCP copay: $10 (“PCP” stands for “primary care provider”)
• Specialist copay: $20
• Urgent care: $25
• Emergency room copay: $100

That means you’ll spend:

• $10 to visit your PCP (i.e., your doctor)
• $20 to visit a specialist (such as a cardiologist, who specializes in treating heart conditions)
• $25 to visit an urgent care clinic
• $100 if you go to the emergency room.

To discuss available plans, call a licensed insurance agent at (800) 827-9990, or browse your options online today.

4. Pharmacy and prescriptions

Many insurance cards have a section for pharmacy and prescription information. If there’s a price listed, that’s what you can expect to pay for certain prescription medications. But some of the numbers you see are actually codes, which your pharmacist will use to process the claim.

The ID and RxGrp numbers in this section are similar to the policy and group numbers listed at the top of your card. They identify who you are and which group of insured people you belong to.

In addition, as Riggs explains it, you may see these numbers:

• RxBIN: Health plans use this number to process electronic pharmacy claims.
• RxPCN (processor control number): This identifies each health plan’s drug benefit processor or pharmacy benefits manager.

5. Plan type

On many cards, you’ll also see the type of plan you’re enrolled in. This provides important information about how your plan operates. Common plan types include:

HMO (Health Maintenance Organization). This type of plan uses a dedicated network of medical providers. In most cases, your appointments and care will only be covered if you stay in that network. If you are not in that network, you will have to cover all of your medical expenses from those providers.

For example:

“If I’m a doctor and I sign a contract with [multiple insurers], then I am considered an in-network provider for those health insurance companies,” says Riggs. “If you have an HMO with one of those companies, you can visit. But if you come to me and you have [a different insurer], then you won’t be covered. You’ll need to find a different provider.”

HMOs may have exceptions that allow you to seek emergency care wherever you can. But in general, if you have this type of plan, you’ll want to double-check to be sure your provider is in your network. Check first with your provider, and then check again with the receptionist when you call to schedule your appointment.

PPO (Preferred Provider Organization). As with HMOs, PPOs come with a network of providers. The difference is that if you seek care outside your network, your still have partial coverage for the costs of covered services.

But it’s worth noting that PPOs vary in how much they pay for out-of-network care. “Many people want a PPO plan, because they assume the copays and cost are the same as the in-network copays — but they are not,” says Riggs. “You may have a whole separate out-of-network deductible and max out-of-pocket expense.”

In other words, if you have a PPO, you’ll still save money by sticking to in-network providers.

EPO (Exclusive Provider Organization). These plans are similar to HMOs in that they only cover in-network doctors, specialists and hospitals. But a key difference is that with HMOs, you often need a referral from a PCP before seeing a specialist. EPOs typically do not have this restriction, says Riggs.

HDHP (High-Deductible Health Plan). If you see “HDHP” on your card, it means your plan comes with a high deductible. For 2024, this amount is defined as not less than $1,600 for an individual or $3,200 for a family. That is the amount you pay out of pocket before your insurance pays the rest for covered services.

HDHP plans typically charge lower monthly bills (premiums), but you’ll pay more for each visit to the doctor. One of the upsides of an HDHP is that your insurer must make you eligible for a Health Savings Account (HSA). This is a regulated investment account that allows you to save pretax dollars, which you can then use to pay for eligible health expenses.

How to find answers about your policy

If you remember only one thing about your insurance card, make it this: The toll-free telephone number on the back will help you find all the answers you need.

It gives you a direct line to your insurance company. That’s where you’ll find answers about copays, in-network providers, whether you need a referral and more.

One thing to note: Some plans may not issue you a physical insurance card. Instead, you’ll likely have access to a digital version on your insurer’s website or in your patient portal. If a provider asks for a hard copy of your card, you’ll likely be able to download a copy to your desktop or smartphone. Then you can simply just print out a copy, the old-fashioned way.

In the market for a new plan? Let us help. You can speak with a licensed insurance agent at (800) 827-9990, or you can browse your options online today.