By Zocdoc | June 12, 2024
If you’ve ever glanced at your insurance card and felt like it was written in a foreign language, you’re not alone. Understanding your insurance card is essential for successfully navigating the healthcare system and avoiding unexpected costs. In this guide, we’ll break down the key components of your insurance card, so you feel empowered to make informed decisions about your healthcare.
1. Find your carrier, member ID, and group number
The first step is to identify the basics: the name of your carrier aka insurance company (e.g. Blue Cross Blue Shield, UnitedHealthcare, Aetna), member name (your name), member number or member ID number (which is unique to you and helps verify your coverage), and group number (which is unique to your company if you receive health insurance through your employer).
2. Identify your plan name
The plan name is usually displayed prominently on the front of your insurance card and helps you find and book with in-network providers. It may be listed under headings such as “Plan Name,” “Coverage Type,” or simply “Name of Plan.”
Example 1: If your carrier or insurance company is Blue Cross Blue Shield, the plan name could be Blue Choice Advantage or HealthyBlue.
Example 2: If your carrier or insurance company is Cigna, the plan name could be Connect Gold or Health Alliance Plan.
3. Identify your plan type
The plan type refers to the category or structure of the insurance plan. Knowing your plan type helps you understand which providers accept your insurance. This information is often included in a section labeled “Plan Type,” “Network,” or “Provider Network.”
Alternatively, you can look for specific identifiers or acronyms associated with different plan types, such as HMO (Health Maintenance Organization), PPO (Preferred Provider Organization), and EPO (Exclusive Provider Organization).
Example: If you see “Cigna Choice Fund PPO” it means that Cigna is the carrier, Choice Fund is the plan name and PPO refers to the plan type.
4. Understand your deductible
Some insurance cards might list your deductible. A deductible is the total amount you must pay out of pocket for covered medical services before your insurance coverage kicks in. Generally, plans with lower monthly premiums have higher deductibles and vice versa.
Many plans cover services such as checkups and disease management programs for chronic conditions regardless of whether deductibles are met. Your deductible for in-network care is typically lower than your deductible for out-of-network care. If your deductible is not listed on your insurance card, you can contact your insurance provider to find out.
Example: Your plan has a $1,000 deductible and your doctor charges you $3,000 for a procedure. You pay $1,000 (plus any copay or coinsurance) and your insurance covers the rest.
5. Locate your copays and/or coinsurance
Your copayments (aka copays) are fixed fees for certain services, helping you anticipate your financial responsibilities for medical services. For instance, you might see the symbols
P or PCP (for primary care), S or SPEC (specialist), CC (convenience care), UC (urgent care), and ER (emergency room) followed by a dollar amount for these types of in-network visits.
Coinsurance is the percentage of the medical bill that you pay once you’ve hit your deductible (the rest is paid by your insurer). Coinsurance is lower for services from an in-network provider than for services from an out-of-network provider.
Example: If your coinsurance for a therapy session is 30 percent and the session normally costs $150, you pay $45 out of pocket (provided you’ve met any deductible).
6. Know your coverage period
Your insurance card often displays coverage period information, indicating the dates during which your policy is active. This could be listed as the start and end date, or simply the start or “effective date.”
7. Find the right contact info
You may need to flip your card over to see important phone numbers. These may include your member service line (for any benefits questions), dental member services, and pharmacy member services.
Understanding your insurance card helps you anticipate costs and make informed decisions about your care, such as choosing an in-network provider to keep costs down. Platforms like Zocdoc allow you to search with your insurance information so you can easily find in-network providers.
If you have any questions or concerns about your insurance coverage, don’t hesitate to reach out to your insurance company or healthcare provider for clarification.
Looking for a doctor? Input your insurance on Zocdoc to find in-network providers today.
