Understanding Your

Insurance Card

The descriptions and samples 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. Emory Healthcare 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.

This is the name of the company that provides your insurance. This is sometimes referred to as the insurer, provider or benefits provider.

There are many 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

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

Some insurance companies give specific names to certain plans, like those available through the healthcare exchange, instead of using group numbers (above).

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 is 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.

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.

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.

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 card may also include prescription benefits.

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 will want to seek out if you need access to healthcare while you’re away on vacation, or out of town on a business trip.

This information is usually on the back of the card. It should include your insurance company name and one or more ways to reach them, like their website and phone numbers for customer service or other specific needs.

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