Health insurance is a very common type of insurance and when you buy health insurance the insurance company provides you a health insurance card. Usually, a health insurance card is quite similar to a debit/credit card but the use of a health insurance card is not so frequent as other cards. A health insurance card contains lots of important information therefore it is very important to understand all the information of a health insurance card. Today, we will discuss all the important information about a health insurance card and how you can identify the subscriber for insurance.
In health insurance, a subscriber is a person who subscribes or carries the insurance plan for the patient’s case. The person who pays for health insurance premiums is also the main subscriber for the insurance. If there is only one name available on the ID card then the person named on the card is the subscriber. However, if there is more than one name on the card then the first name on the list is the subscriber for the insurance.
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- 1 Identifying The Subscriber For Insurance
- 2 Understanding The Health Insurance ID Card
- 3 FAQs About How To Identify That Who Is The Subscriber For Insurance
Identifying The Subscriber For Insurance
Basically, the only name or the first name on the insurance ID card is the main subscriber for the insurance. On the other hand, if each person has their own card and the names are in sequential order then the number that comes first or the lowest number is the subscriber. Moreover, if one person is the parent and the other is a child then the parent will be the subscriber. If your health insurance is through an employer, then the employee will be the subscriber of the insurance, and other members of the policy will be the dependents. You can also log into your online insurance account and see if there is any information available about the subscriber. This is also an easy way to identify the subscriber for insurance. Finally, you can call the insurance company and ask about the subscriber of your insurance.
Understanding The Health Insurance ID Card
In the USA, most private health insurance ID cards contain the same information. On the other hand, if you live outside the U.S. or have government-provided insurance then your ID card’s look might be different but they also have the same information with one or two additional information on it. Let’s check out some of the most common information that health insurance ID cards contain.
1. Carrier And Contact Information
Every insurance ID card has carrier information. Carrier is the name of the insurance company and there will be one or two contact information of the company on the card. Usually, the contact information includes phone numbers, customer care numbers, email id, website addresses, etc. Usually, this information is available on the back of the card.
2. Names Of Covered Individuals
In the front of the insurance id card, you will find the name of the policyholder at the top right or left corner. If you are the policyholder then your name will be on the card. If you have dependents like a spouse or children then their name might be listed on the card. If you are not the policyholder then your name and the policy holder’s name will be displayed separately on the card.
3. Member ID/Policy Number
Every health insurance policy has a unique ID number and this number allows the healthcare providers and their staff to verify coverage and arrange payment for services. You can use this number to look up your claims and benefits. You can easily locate the number on your id card. The policy number is always available on the front of the card If you’re the policyholder, then the last two digits of your number would be “00.” If there are other members on the policy then the policy might have numbers ending in 01, 02, etc. For example –
1. XXXXXXX-00 Primary Subscriber
2. XXXXXXX-01 Typically the Spouse or Dependent
3. XXXXXXX-02 Dependent
4. XXXXXXX-03 Dependent
4. Group Number
If an employer purchases a health plan for its employees, then it also has a number and it is known as the group number. This is a unique number and it identifies the specific benefits associated with you and your employer’s plan. The healthcare providers or the staffs use the group number and the member ID number to file claims for your care. However, if you purchase your health insurance policy via a healthcare exchange then your insurance ID card won’t have the group number.
5. Insurance Plan Type And Name
Health insurance id card also contains information about the insurance plan type and insurance name. This information helps the healthcare providers to file the claim properly. Some cards might contain the plan name while other cards might contain each program’s respective logo. Different insurance plan has different ways of handling referrals, in- and out-of-network providers, and out-of-pocket costs. Some common types of insurance plans are –
1. HMO (health maintenance organizations)
2. PPO (preferred provider organizations)
3. EPO insurance plans (exclusive provider organizations)
4. HDHP (high deductible health plans)
5. Essential Plan
6. Payment Information
Nowadays, many insurance id cards contain payment information that includes the payment amount for common visits to doctors, specialists, urgent care, etc. The payment amount might be a flat rate or a percentage of the cost. If there are two numbers then the first number is your cost when you see an in-network provider, and the second number is your cost when you see an out-of-network (OON) provider.
7. Medical Network
If you travel a lot then your health insurance provider might provide you out-of-area coverage through a different health care provider network. If that is the case for you then the name of the medical network will be on the insurance id card. The name of the network is the medical network that you should seek out if you need access to healthcare while you’re away on vacation or you are out of town.
8. Prescription Benefits
If your health insurance plan includes prescription benefits for drugs then there will be some related information on the insurance ID card. The information includes –
Formulary: It is the list of prescription drugs that your insurance company covers under the insurance plan. Different insurance companies have different formularies that are covered under different plans. For example, if your insurance coverage is from CDPHP, then you will see Formulary 1, Formulary 2, or the Medicaid Formulary on their cards.
Prescription Costs: The ID card also contains information about prescription costs. Usually, the formularies are divided into three tiers and each tier contains different types of drugs. Moreover, each tier is set at a different price than you have to pay when you pick up your prescription at a participating pharmacy. The three tiers are –
1. Tier One: Generic drugs
2. Tier Two: Brand name drugs
3. Tier Three: Specialty drugs
Pharmacy Network: Insurance companies cover different pharmacy networks. So, you will also find information about the pharmacy network on the insurance ID card.
Rx BIN: The pharmacist uses this number to process your prescription. This number indicates which insurance company will reimburse the pharmacy for the cost of the prescription.
FAQs About How To Identify That Who Is The Subscriber For Insurance
Is The Policyholder The Same As The Subscriber?
Yes, both the policyholder and subscriber are the same in health insurance. The Policyholder or Subscribe is the person who is the primary insurer in an Individual Insurance Contract.
Is The Subscriber The Patient?
The subscriber can be a patient or not. But the subscriber means a person who is responsible for the insurance plan and pays the insurance premiums.
Am I The Policyholder Of My Insurance Or My Parents?
A policyholder is the owner of the insurance policy. Usually in health insurance, your immediate family who lives in your household are also automatically covered under the same insurance policy. So, if you live with your parents then your parents will be the policyholder of the insurance. On the other hand, if the insurance policy is against you then you will be the policyholder, and your spouse, children will be the member of the insurance.
Where Is The Subscriber Number On An Insurance Card?
Usually, the subscriber number is located on the front of an insurance id card. The subscriber number is usually 8–11 numbers long. If for any reason, you don’t find the subscriber number then contact the insurance company and they will provide the number.
What Is An Insurance Carrier?
An insurance carrier is the insurance provider or an insurance company. So, an insurance carrier is a financial resource that provides coverage. Moreover, the insurance carrier charges the premium and pays for losses and claims under the policy.
Where Can I Find My Member ID Number?
The member ID number is also known as the Subscriber ID number and you will find this number on the front part of your health insurance ID card. Usually, the member ID number consists of 8–11 numbers.
Magalie D. is a Diploma holder in Public Administration & Management from McGill University of Canada. She shares management tips here in MGTBlog when she has nothing to do and gets some free time after working in a multinational company at Toronto.