How to read your insurance card
Your Identifying Information
Your health insurance card usually has your name on it. If you have insurance through someone else, such as a parent, you might see that person’s name on the card instead. The card might also include other information, such as your home address, but this depends on the insurance company.
Insurance cards will have a policy number, usually on the front of the card. Each health insurance policy has an associated policy number. On your card, it is often marked “Policy ID” or “Policy #.” The insurance company uses this number to keep track of your medical bills.
Group Plan Number
If you have health insurance through employer, your insurance card probably has a group plan number. The insurance company uses this number to identify your employer’s health insurance policy. As an employee, you are covered by that policy. Not all insurance cards have a group plan number.
Insurance Company Contact Information
The bottom or back of your health insurance card usually has contact information for the insurance company, such as an address, phone number, and website. This information is important when you need to check your benefits or get other information. For example, you might need to call to check your benefits for a specific treatment, contact your insurance company, or find information on the website.
Coverage Amounts, In and Out of Network, and Co-pays
The “coverage amount” tells you how much of your treatment costs the insurance company will pay. This information might be on the front of your insurance card. It is usually listed by percent, such as 10%, 25%, or 50%. You might see several percent amounts listed together. For example, if you see 4 different percent amounts, they could be for office visits, specialty care, urgent care, and emergency room care.
In-Network and Out-of-Network
You might see another list with 2 different percent amounts. The first percent, which is normally larger, shows how much the insurance company pays doctors and other health care providers who are considered “in-network.” “In-network” means that the insurance company has an agreement with this group of providers. The second percent amount is the amount your insurance company pays doctors and other health care providers who are “out of network.” Your insurance company does not have an agreement with providers who are outside the insurance company’s network. You are allowed to see providers who are “out of network,” but you will have to pay them more than you would to a provider who is “in-network.” When you see any health care provider, you will have to pay the amount that the insurance company does not cover. To find out if a provider is “in-network” contact your insurance company.
Finally, you might see a dollar amount, such as $10 or $25. This is usually the amount of your co-payment, or “co-pay.” A co-pay is a set amount you pay for a certain type of care or medicine. Some health insurance plans do not have co-pays, but many do. If you see several dollar amounts, they might be for different types of care, such as office visits, specialty care, urgent care, and emergency room care. If you see 2 different amounts, you might have different co-pays for doctors in your insurance company’s network and outside the network.
Your health insurance company might pay for some or all the cost of prescription medicines. If so, you might see an Rx symbol on your health insurance card. But not all cards have this symbol, even if your health insurance pays for prescriptions. Look at your own card for an Rx symbol. Sometimes, the Rx symbol has dollar or percent amounts next to it, showing what you or your insurance company will pay for prescriptions. If you are not sure whether your health insurance pays for prescriptions or how much it pays, call the number on your insurance card to find out.