Your Benefits

Understanding Your Health Insurance Card

April 14, 2021 — Tonya Hayes

What is a health insurance card?

Your health insurance ID card is your proof of insurance.

You use it when you visit the doctor, hospital or to get your prescription at a retail pharmacy. It is also a quick reference that tells you how much your copayments are for certain services. Understanding your card can help you plan your healthcare expenses and get the care you need.

Example of Non-Medicare card

Health Insurance

Iron Road, formerly UPREHS, is the health plan for employees of Union Pacific Railroad.

Name of Covered Individual

If you are the policyholder, your name will be on the card.

Member ID/Policy Number

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’s 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.

Group Number

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.

Plan Code

There are many different kinds of health insurance plans. Insurance companies list the Plan Code on your ID card to help healthcare providers file claims properly.

Payment Information

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).

Why does my card have Blue Cross Blue Shield Logo?

To ensure our members have access to healthcare across the U.S., we have contracted with Anthem Blue Cross Blue Shield (BCBS) to make sure you can see a provider, no matter where you live or work.  Most healthcare providers who accept BCBS are in-network.  It’s always a good idea to confirm before your appointment.

What requires prior authorization?

Certain treatments, procedures or medications require prior authorization like Sleep Studies, inpatient hospital, radiology services etc. Prior authorizations are also placed on medications to verify that all the criteria necessary to use the medication has been followed and that the medication is not being used for diseases that have not been approved by the FDA. Prior authorizations are put in place to help assure your safety and that proper procedures are followed. Prior authorizations are completed by OptumRx at 1-800-626-0072.

Prescription Benefits

If your plan includes benefits for prescription drugs, you will also find some information related to them on your health insurance ID card.

Pharmacy Network

Different insurance plans sometimes cover different pharmacy networks. OptumRx is our Pharmacy Benefits Manager, which means they administer your prescription benefits. Iron Road Healthcare members are required to use Depot Drug mail order for maintenance prescriptions like high blood pressure or thyroid medications. However, you can use in-network pharmacies for one-time prescriptions such as pain medication following surgery.

Rx BIN (banking identification number)

Your pharmacist will use this number to process your prescription. It indicates which company will reimburse the pharmacy for the cost of the prescription. Not all insurance ID cards contain this number, though.

Helpful Resources

That seems like a lot of information to pack onto a little rectangle—and it is! Still, 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-certifications, etc.)
  • Resources to help you with Optum Specialty Pharmacy, Complete Sleep for CPAP & BiPap services etc.

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

Topics: Your Benefits

Written by

Tonya Hayes

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