Are you scared by reading unknown terms on your health insurance card? If yes, then do not worry; you came to the right place because, in the article, we will discuss in detail all the terms which may be present in your health in a health insurance card.
So a lot to know, a lot to discuss, and without wasting any time, let us now begin.
Disclaimer: This article is written after 3 days of research. I personally chat with the support of many health insurance companies and watch videos of many health insurance experts and experts on youtube and their respective websites. But still, I personally recommend contacting your health insurance company to get accurate information about your insurance card.
What is BIN in an insurance card?
The B.I.N. number or bank identification number is a six-digit number that helps the doctor identify which insurance provider needs to be claimed for your medical bills.
This number is widely used in the banking sector, where it helps to identify different bank credit cards, whereas, in health insurance, B.I.N. does not involve any banks.
Nowadays B.I.N. number has become an outdated concept and replaced by a magnetic stripe from which the pharmacist can quickly identify the insurance provider. So don’t worry if the B.I.N. number is not present on your insurance card.
You can also contact your health insurance provider if you want to know your B.I.N. number.
What is P.C.N. in an insurance card?
P.C.N. stands for process control number and consists of a combination of alphanumeric or numeric numbers used to find your pharmacy member profile. P.C.N. is generally used to route insurance claimed transactions for people with health insurance.
Nowadays, some companies do not show P.C.N. on their insurance cards. So you can contact your health insurance provider in case you want to know your P.C.N. number.
What is RxGrp/ Group Number?
RxGrp or a group number is a combination of numeric or alphanumeric numbers that help pharmacies figure out the benefits covered under your health insurance plan.
The group number is highly dependent on your insurance plan.
What is a Member ID?
Member ID is a unique alphanumeric or a numeric I.D. given to every person who takes a health insurance plan. It helps the insurance companies to easily find your data in their database.
What is a Member Name?
The member name is simply the name of the covered person under the health insurance scheme. In the case of family health insurance, the name of any significant member of the family can be written, and family I.D. will be separately mentioned on the card.
What are P.C.P. name and mobile number?
P.C.P. means primary care physician. P.C.P is a person who provides basic health facilities like regular health checkups to the patients.
You need to choose your primary care provider from the list of all primary care providers in-network with the insurance company.
What is the Plan type?
There are 3 joint plan types in health insurance which are as under:
HMO means Health maintenance organisation. It is the cheapest health insurance plan type with significantly less premium because it does not cover out of the network doctors, which means you cannot claim insurance if you visit a doctor outside the insurance company’s network for treatment.
In this plan, you need to choose a primary care pharmacist who will coordinate your care and refer you to trusted specialists in their network.
POS refers to the point of service. The P.O.S. plan is the same as the H.M.O. plan. In addition, it also covers out of the network doctors and specialists for treatment.
PPO refers to Preferred provider organisation. In this plan, you do not need to take referrals from Primary care physicians and visit any specialist for treatment.
What is In-network deductible/coinsurance?
In-network simply means all the doctors who have a contract with your health insurance company. So In-network deductible means the minimum amount you need to spend on your health expenses within the network before claiming insurance.
Coinsurance means the percentage of the amount you need to pay after exceeding the in-network deductible limit.
For example: Suppose you made total health expenses of $2,000 by taking services from doctors in-network and In-network deductible/coinsurance is $800/10% (please ignore other limits like E.R., S.P.C. etc. for a time).
So now your net expense will be $800+ 10% of $1200= $800+$120=$920 and the rest $1,080 ($2,000-$920) will be reimbursed by your insurance company.
What is O.O.N.- deductible/Coinsurance?
OON-deductible means out of the network deductible. It comes into action when you visit a doctor for a treatment who does not have any contract with your health insurance company. OON-deductible is not covered under the H.M.O. plan, and generally, its amount and coinsurance are higher than in-network deductible coinsurance.
The meaning of ‘$’ and ‘%’ in OON-deductible and coinsurance is the same as in In-network deductible coinsurance, which I explained earlier.
What is S.P.C. in an insurance card?
S.P.C. means the cost of seeing a specialist. A doctor you visit for a specific problem like a problem related to bones, heart, liver etc., is a specialist.
The S.P.C. will be written in the $ or any other currency in your insurance card, which simply means the minimum amount you need to spend on every visit to a specialist before claiming insurance.
Like, if S.P.C. is $50, it means you need to pay at least $50 on every visit to a specialist, no matter whether you achieved the in-network deductible limit or not. Post that if you already completed the minimum deductible, you just need to contribute in coinsurance ratio; if not, you first need to complete the minimum deductible before claiming insurance.
For example- Suppose you visit a specialist and your total cost is $500, and S.P.C. is $50. Now, if coinsurance is 10% and you have already completed the minimum deductible, then your net expenses will be:
$50+ 10%($500-$450)= $95.
What is P.C.P. in an insurance card?
P.C.P. in insurance cards means the cost of seeing a primary care physician. A doctor to whom you visit for regular health checkups is a Primary care physician.
The P.C.P. will be written in the $ or any other currency in your insurance card, which simply means the minimum amount you need to spend on every visit to a specialist before claiming insurance.
Note: The meaning of ‘$’ in P.C.P. is the same as in S.P.C.
What is E.R. and Urgent in an Insurance card?
In healthcare, an emergency situation means an acute disease or injury that directly risks the patient’s life. In contrast, urgent means a medical condition that is not life-threatening but still requires 24 hours care.
In your insurance card, the Emergency and urgent will be written in the $ or any other currency, which simply means the minimum amount you need to spend on every visit to a specialist before claiming insurance.
Note: The meaning of ‘$’ in Emergency and urgent is the same as in S.P.C.
What are Rx and RxCopay?
Rx means to help pay for prescription drugs and medication-based treatment in health care. Rx is the same as In-network deductible, but it comes into play when you buy any prescription drugs or medicine in simple words.
RxCopay is the percentage of prescription drug cost you need to pay once completing the Rx limit.
What is a formulary?
The formulary is the list of prescription drugs (medicines) covered under your health insurance plan.
Generally, your card mentions Formulary A, Formulary B, Formulary AB, Formulary 1, etc. You can contact your health insurance agency to know the complete list in detail as it is different for different insurance providers.
What are Prescription costs?
Prescription cost may be mentioned in different categories like General, Name brand, etc., with a ‘$’ sign that signifies the minimum amount you need to pay while buying prescription drugs. Above that, you need to pay an amount under coinsurance.
Video to watch
I personally recommend you to watch the below video of Steve Stump a health and life insurance agent.
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Frequently Asked Questions
Are prescription drugs covered under health insurance?
As per the affordable care act, it is compulsory to include prescription costs in health insurance plans but you still need to pay some amount as coinsurance which is generally 10-20%.
What to do in case I don’t find any information on the insurance card?
Contact your health insurance provider, they will definitely provide you with the information.
Which health insurance plan has the least premium?
The health maintenance organisation (HMO) plan has the least premium because it does not cover out of the network doctors.