How to Read a Patient Health Insurance Card: A Detailed Guide

Reading a health insurance card is crucial for healthcare providers, administrative staff, and patients. Understanding each section ensures accurate billing, seamless claims processing, and proper coordination of benefits, especially when multiple payers are involved. This guide helps healthcare providers how to read a patient’s health insurance card to deal with the patient billing and revenue cycle process efficiently by understanding the insurance types, numbers, IDs, etc. 

Key Elements of a Health Insurance Card

Let’s have a look at the key elements that a patient health card may have: 

1. Member ID (Policy Number)

• Description: A unique identifier assigned to the insured individual.
• Importance: Essential for verifying coverage and processing claims.
• Example: “Member ID: 123456789”

2. Group Number

• Description: Identifies the specific insurance plan offered by an employer or group.
• Importance: Determines the benefits and coverage specific to the group.
• Example: “Group Number: ABC12345”

3. Plan Type

• Description: Indicates the structure of the insurance plan.
• Importance: Affects how and where care is received.
• Examples:
  • HMO (Health Maintenance Organization): Requires care from in-network providers and referrals for specialists.
  • PPO (Preferred Provider Organization): Offers more flexibility with out-of-network providers at a higher cost.

4. Copayments and Coinsurance

• Description: Fixed amounts or percentages the insured pays for services.
• Importance: Determines out-of-pocket costs for the patient.
• Examples:
  • “PCP Visit: $20”
  • “Specialist Visit: $40”
  • “Emergency Room: $100”

5. Payer ID

• Description: A unique identifier for the insurance company used in electronic claims.
• Importance: Facilitates accurate and timely claims processing.
• Example: “Payer ID: 12345”

6. Prescription Information

• Description: Details related to the patient’s prescription drug coverage.
• Importance: Ensures proper billing at pharmacies.
• Examples:
  • RxBIN: Routes the claim to the correct processor.
  • RxPCN: Identifies the specific plan.
  • RxGRP: Groups members under a particular drug plan.

7. Claims Address and Contact Information

• Description: Information on where to send claims and how to contact the insurer.
• Importance: Ensures claims are directed to the correct location and provides support contact details.

Key Information on the Front and Back of a Health Insurance Card

A health insurance card typically contains essential information on both the front and back to help healthcare providers and insured individuals access medical services and file claims correctly. 

So, as a physician, specialty expert, or practice owner, you must check both sides of the patient’s insurance card. 

Let’s see how details are given on the front and back sides of an insurance card: 

Front of a Health Insurance Card

This is the side most often shown at doctor’s offices or pharmacies.

Common details include:

1. Insurance Company Name & Logo – Identifies the provider (e.g., Aetna, Cigna, Blue Cross Blue Shield).
2. Member Name – The name of the insured individual.
3. Member ID Number – A unique identification number assigned to the insured, also known as Subscriber ID.
4. Group Number – Identifies the employer or group plan (if applicable).
5. Plan Type or Coverage Info – May include terms like HMO, PPO, EPO, etc.
6. Effective Date – The date coverage started.
7. Rx BIN, PCN, and Rx Group – Pharmacy-related numbers used for processing prescriptions.
8. Co-pay Information – Sometimes, it lists co-pays for doctor visits, emergency rooms, or specialists.

Back of a Health Insurance Card

This side contains contact and claim-processing information.

Common details include:

1. Customer Service Numbers – Members and providers can call with questions.
2. Mailing Address – For sending paper claims or correspondence.
3. Instructions for Providers – How to verify coverage or submit claims.
4. Authorization Requirements – Some cards list when prior authorization is needed.
5. Disclaimers or Legal Information – Includes notices about privacy or coverage limits.
6. Website or Online Portal Info – Where to manage your account or find more resources.

How to Read Patient Insurance Cards from Major U.S. Health Insurers

Each major insurer in the U.S. has its own card design and information layout. Let’s see how to read insurance cards from major payers like Medicare, Aetna, Cigna, UnitedHealthcare, and more.​

1. Medicare Insurance Card

Medicare is a federal health insurance program primarily for individuals aged 65 and older, though it also covers younger individuals with specific disabilities or chronic conditions.

Medicare was established in 1965 under President Lyndon B. Johnson as part of the Social Security Amendments. Initially designed to provide health coverage for retirees, it now includes Parts A (hospital insurance), B (medical insurance), C (Medicare Advantage), and D (prescription drug coverage). It has since become one of the largest healthcare payors in the U.S.

Medicare provides health insurance for individuals aged 65 and older, specifically younger individuals with disabilities. The Medicare card includes:​

• Medicare Number: A unique identifier for the beneficiary.​ 
• Name: Beneficiary’s full name.​
• Part A and Part B Coverage Dates: Indicates when coverage began for hospital (Part A) and medical (Part B) services.​
• Part C and Part D: If enrolled, the card will indicate participation in Medicare Advantage (Part C) or Prescription Drug Plan (Part D).​

Example:

2. Aetna Insurance Card

Aetna is a health insurance company offering medical, dental, vision, and pharmacy plans to individuals and employers across the U.S.

History: Founded in 1853 in Hartford, Connecticut, Aetna started as a life insurance company. It entered the health insurance market in the 20th century and grew into one of the largest insurers in the country. In 2018, Aetna was acquired by CVS Health, forming a vertically integrated healthcare company.

Aetna offers various health insurance plans, including HMO, PPO, and EPO. Key elements on an Aetna card include​. 

• Member ID: A unique identifier for the member.​
• Group Number: Identifies the employer or organization providing the insurance.​ 
• Plan Type: Indicates the type of plan (e.g., HMO, PPO).​
• Effective Date: The date when coverage begins.​ 
• Copay Information: Details of copayments for various services.​

Example:

3. Cigna Insurance Card

Cigna is a global health services company providing medical, dental, disability, life, and accident insurance to individuals and employers.

Cigna was formed in 1982 from the merger of INA Corporation and Connecticut General Life Insurance Company. Headquartered in Bloomfield, Connecticut, it has grown through acquisitions and now operates globally. In 2021, Cigna launched Evernorth, its health services division.

Cigna provides health insurance plans with various coverage options. Key elements on a Cigna card include​ 

• Member ID: A unique identifier for the member.​ 
• Group Number: Identifies the employer or organization providing the insurance.​
• Plan Type: Indicates the type of plan (e.g., HMO, PPO).​
• Effective Date: The date when coverage begins.​
• Copay Information: Details of copayments for various services.​

Example:

4. UnitedHealthcare Insurance Card

UnitedHealthcare, a division of UnitedHealth Group, offers various health benefit plans, including employer-sponsored Medicare and Medicaid coverage.

UnitedHealthcare was founded in 1977 and is now part of UnitedHealth Group, one of the largest healthcare companies in the world. UHC provides plans to tens of millions of members and is known for its extensive provider network and data-driven approach to care management.

UnitedHealthcare offers a range of health insurance plans. Key elements on a UnitedHealthcare card include:​

• Member ID: A unique identifier for the member.​
• Group Number: Identifies the employer or organization providing the insurance.​
• Plan Type: Indicates the type of plan (e.g., HMO, PPO).​
• Effective Date: The date when coverage begins.​ 
• Copay Information: Details of copayments for various services.​
• Contact Information: Customer service phone numbers.​ 

Example:

5. Blue Cross Blue Shield (BCBS) Insurance Card

BCBS is a federation of 34 independent health insurance organizations that provide coverage in all 50 states and beyond.

Blue Cross was founded in 1929 to provide hospital coverage, and Blue Shield was created in 1939 for physician services. The two merged in 1982 to form the BCBS Association. Each regional plan operates independently, serving over 100 million Americans together.

BCBS provides health insurance plans through various regional companies. Key elements on a BCBS card include:​

• Member ID: A unique identifier for the member.​
• Group Number: Identifies the employer or organization providing the insurance.​
• Plan Type: Indicates the type of plan (e.g., HMO, PPO).​
• Effective Date: The date when coverage begins.​
• Copay Information: Details of copayments for various services.​
• Contact Information: Customer service phone numbers.​

Example:

6. Humana Insurance Card

Humana is a health insurance company known for its Medicare Advantage, Part D prescription drug plans, and employer-based coverage.

Founded in 1961 as a nursing home company, Humana entered the hospital business in the 1970s and then transitioned to health insurance in the 1980s. Headquartered in Louisville, Kentucky, Humana has become one of the top Medicare Advantage providers in the country.

Humana offers a range of health insurance plans, including Medicare Advantage, Medicaid, and commercial plans.​

Key Elements:

• Member ID: A unique identifier for the member.​
• Group Number: Identifies the employer or organization providing the insurance.​
• Plan Type: Indicates the type of plan (e.g., HMO, PPO).​
• Effective Date: The date when coverage begins.​
• Copay Information: Details of copayments for various services.​

Example:

7. Kaiser Permanente Insurance Card

Kaiser Permanente is an integrated managed care consortium providing health insurance and healthcare services through its hospitals and medical groups.

Kaiser Permanente was founded in 1945 by industrialist Henry J. Kaiser and physician Sidney Garfield to provide healthcare to workers on large infrastructure projects. Headquartered in Oakland, California, it is now one of the largest not-for-profit health plans in the U.S., serving over 12 million members.

Kaiser Permanente is a managed care consortium that provides integrated care and coverage.​

Key Elements:

• Member ID: A unique identifier for the member.​
• Group Number: Identifies the employer or organization providing the insurance.​
• Plan Type: Indicates the type of plan (e.g., HMO).​
• Effective Date: The date when coverage begins.​
• Copay Information: Details of copayments for various services.​

Example:

8. Anthem Blue Cross Insurance Card

Anthem is a major health insurer and the largest for-profit licensee of the Blue Cross Blue Shield Association.

Anthem was founded as Blue Cross of Indiana and later became Anthem, Inc. through mergers. In 2004, Anthem merged with WellPoint Health Networks, creating one of the largest health benefits companies in the U.S. It rebranded as Elevance Health in 2022 but continues to offer plans under the Anthem BCBS brand in several states.

Anthem Blue Cross is a health insurance provider offering a variety of plans, including individual, family, and employer-sponsored plans.​

Key Elements:

• Member ID: A unique identifier for the member.​
• Group Number: Identifies the employer or organization providing the insurance.​
• Plan Type: Indicates the type of plan (e.g., PPO, HMO).​
• Effective Date: The date when coverage begins.​
• Copay Information: Details of copayments for various services.​

Example:

9. Molina Healthcare Insurance Card

Molina Healthcare provides healthcare services to low-income individuals through Medicaid and Medicare programs.

Founded in 1980 by Dr. C. David Molina in Long Beach, California, Molina started as a clinic focused on underserved communities. It has grown into a major managed care company, now offering services in over 15 states, serving millions through government-sponsored health plans.

Molina Healthcare provides managed care under Medicaid, Medicare, and Marketplace programs.​

Key Elements:

• Member ID: A unique identifier for the member.​
• Group Number: Identifies the employer or organization providing the insurance.​
• Plan Type: Indicates the type of plan (e.g., Medicaid, Medicare).​
• Effective Date: The date when coverage begins.​
• Copay Information: Details of copayments for various services.​

Example:

10. Centene Insurance Card

Centene is a multinational healthcare enterprise primarily focused on government-sponsored healthcare programs such as Medicaid, Medicare, and the Health Insurance Marketplace.

Centene was founded in 1984 as a nonprofit Medicaid plan in Milwaukee. Now headquartered in St. Louis, Missouri, Centene has grown rapidly through acquisitions (including WellCare in 2020) and is now one of the largest Medicaid-managed care organizations in the U.S.

Centene Corporation provides services to government-sponsored healthcare programs.​

Key Elements:

• Member ID: A unique identifier for the member.​
• Group Number: Identifies the employer or organization providing the insurance.​
• Plan Type: Indicates the type of plan (e.g., Medicaid, Medicare).​
• Effective Date: The date when coverage begins.​
• Copay Information: Details of copayments for various services.​

Example:

Conclusion

Understanding the information on your health insurance card is crucial for accessing healthcare services and ensuring accurate billing. Each insurance provider has its card format and details, but common elements include Member ID, Group Number, Plan Type, Effective Date, and Copay Information. Always keep your card accessible and inform your healthcare providers about any changes to your insurance coverage.​

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