*ID cards will vary in the location of this information. This sample ID is only provided to be a guide.
- This is your payor who is responsible to adjudicate(pay) your medical claims as repriced by the network (see B) in accordance with your benefit plan design including: eligibility, deductibles, copays, etc.
- This is the network of hospitals, doctors, and other providers that are considered in-network for your benefit plan. The network will reprice your claims as submitted by your provider to the contracted amount and forward them to your payor (see A) for payment.
- This is your Family ID number under your benefit plan. Often, each member of your family will be assigned a suffix to this ID number to provide a unique ID for each member of your family.
- This is the Group Number to which you are assigned. Your employer may have one or multiple group numbers set up with your Payor.
- Member Name is your name and will often list the other members of your family that participate under your plan.
- Copayment Information is often provided that applies to your benefit plan for common types of visits such as to your Primary Care Physician (PCP) or Specialists.
- This is the Payor's (See A) customer service number that you can call to receive answers to any questions you may have regarding the adjudication (payment) of your claim and what benefit levels apply to the services you may receive.
- If you must obtain precertification for a service before having it completed, you would call this number for the party who is responsible for your medical/utilization management.
- This is the Network's (See B) customer service number wthatyou can call to receive information on a provider's participation in the network and product for which you are a member.
- This is where your provider has been directed to submit your claims for processing (including network discount processing and claim adjudication by your payor).
- If your provider submits claims electronically, this is the appropriate party's electronic ID.
- This is where additional information can be found for which network of providers should be used for certain service areas if you are traveling outside of your county, state, etc. You may need to contact the network listed here depending upon the location of the provider you desire to see.