Your insurance card and your Explanation of Benefits (EOB) contain important information about your coverage.
Each circled number on the examples below correspond to a detailed explanation of each below each image.
INSURANCE CARD
Your card will have your employer’s name at the top, the name of the company who administers your claims, and your name as it appears on your insurance records. This section will also include your member number, usually just after your name.
Each person covered by a health insurance plan has a unique ID number, often followed by a hyphen (dash) and a number for each member of your family. This area of the card also includes the name of the insured person and the relationship of the member to the insured.
The day your insurance company will begin helping to pay for your medical expenses.
Employers that purchase a health plan for their employees have a group number that identifies the specific benefits of the employer’s plan. Healthcare providers use the group number plus your member ID number to file claims for your care.
Your RX, BIN and PCN numbers provide important billing information for your providers. The BIN number is a Bank Identification Number which tells the pharmacy database which benefit manager is to receive the claim for a particular prescription. Banks are not involved in the insurance billing process. Not all providers use the PCN or Processor Control Number.
Your card also gives you and your providers quick reference information on your plan’s copays. How much for primary or specialist primary care visits? How much of a co-payment will you make for urgent care or ER visits? It will list different copays for each tier of coverage: health partners, hp2 and any out-of-network coverage copays.
Your card may also have a logo in addition to the Health Partner’s logo for any out-of-network providers. These services extend your coverage beyond providers participating in your Health Partners coverage.
The address for claims processing is where your provider or you will send claims for payment.
The back of your card will contain important information regarding pre-certification of coverage before you receive services as well as any penalties that will be charged without authorization. It also contains important phone numbers and fax numbers for submitting claims or asking questions.
Other important phone numbers, like the 24-Hour Nurseline and prescription customer service inquiry numbers will also be provided on the back of your card.
The member services phone number gives you access to experts who can help you understand your coverage and benefits.
EXPLANATION OF BENEFITS
Employee’s name and address.
This box provides general information about your coverage (such as your name, group number, patient name, your Group ID, etc.).
Your EOB will also have your name and address. If this needs to be update, be sure to contact your employer/insurance provider.
EOBs generally have a brief paragraph to explain what’s included in the summary. This area also generally has a phone number you can call with any questions.
Dates the services were rendered.
This is a brief description of the services rendered and the procedure code.
This is the total charge(s) billed by the provider of the service.
If a preferred provider is used, this represents the negotiated discount for the service. (Preferred providers must write-off this amount.)
This shows you any amounts that the provider is allowed to charge for this service under your coverage plan.
Any non-covered amounts are shown here. (They are assigned an ineligibility code. The code(s) are explained in detail below. See 16.)
Until you have met your annual deductible, any amounts applied toward your calendar year deductible are shown in this box.
This represents any amounts applied towards your calendar year coinsurance or applicable co-payments. For example, your insurance may cover 80% or 90% of charges for this type of service. The remainder is part of your copayment.
Your co-pay is usually a set amount paid at each visit. You can find this information on your insurance card (see the illustration above.) The co-pay and co-insurance (plus any deductible not met) will make up the portion you are responsible for. That amount will appear on a bill to you from your provider.
This is the amount(s) being paid for by your insurance plan on your behalf.
This area will provide reference numbers about your care and any codes assigned.
Notes about the codes in 15 will appear here.
This section displays any In-Network deductible and lifetime maximums paid and what’s remaining.
This section displays any Out-of-Network deductible and lifetime maximums paid and what’s remaining.
The “CLAIM REMARKS’ section explains any ineligible code displayed in box #10 or on other areas of the explanation of benefits.