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Understanding Your Insurance Card

After you enroll in a health plan, you will receive a membership package with your insurance card and a summary of benefits and coverage.

Make sure you understand the information about your coverage. If you need help understanding the information, call your health plan ask them to explain it to you.

Your insurance card is your proof of insurance and might look similar to the example below.

Insurance Company Name

Member Name: Primary Clinic
Clinic Copay: Convenience Clinic
Identification Number: Customer Service Number:
Group Number: Plan Type:
Coverage Year:
Prescription Copay:

Member name: This usually lists who purchased the insurance or the individual covered under the policy.

Member number: This number is used to identify you so your provider knows how to bill your health plan. If your spouse or children are also on your coverage, your numbers may look very similar.

Group number: This number is used to track the specific benefits of your plan. It’s also used to identify you so your provider knows how to bill your insurance.

Plan type: your card might have a label like HMO, PPO, Open, or another word to describe the type of plan you have. These tell you what type of network your plan has and which providers you can see who are “in-network” for you.

Copay: These are the amounts that you will owe when you get health care.

Prescription copayment: These are the amounts that you will owe for each prescription you have filled.

Here are some examples of how your health plan might use the terms discussed in this section to cover your medical care.

Summary of benefits

  • All health plans must provide you with a Summary of Benefits and Coverage, which will have these examples showing how the plan might help pay for services.
  • The actual costs and care will vary by your health care needs and your coverage
Having a Baby (Normal Delivery)
Amount owed to provider $7,450
Plan pays $2,900
Patient pays $4,640
Sample Care Costs
Hospital charges $2,700
Routine obstetric care $2,100
Hospital charge (baby) $900
Anesthesia $900
Laboratory tests $500
Prescriptions $200
Radiology $200
Vaccines (other preventive) $40
Total: $7,450
Patient Pays
Deductibles $4,490
Copays $0
Coinsurance $0
Limits or exclusions $2,050
Total: $4,460
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