Families often question why the policyholder is the only one listed on a health insurance identification card. Parents, to avoid delays in receiving medical services question whether they should request individual identification cards in the name of each child. Health insurance carriers typically issue either one or two identification cards to the adult members of a family. The policyholder is listed on the card because that individual authorized the health insurance application and has agreed to the financial responsibility in order to maintain the coverage. Health insurance policies will always designate one primary individual as the policyholder as compared to joint ownership that may be found with other insurance products such as automobile or homeowner’s coverage.
Although the option is available to have separate identification cards issued for each family member, Stateside advises clients not to request separate cards for children. Multiple identification cards require the parents to keep up with more than one identification card and to locate the specific card each time it is needed. The hassle factor of keeping up with multiple cards is not justified because policy information is contained on the card’s magnetic strip or is referenced by the single identification number assigned to the policy.
When services are received from health care providers, the identification card is used to identify the carrier providing health insurance, the policyholder, and the benefit structure of the policy. Basic policy information will include deductible, whether an office visit co-pay benefit is applicable and the plan’s prescription benefit. Health insurance carriers use the identification number to verify that the person receiving services is assigned as a covered individual under the policy and the benefits associated with the coverage.
The services received by and information pertaining to the health care provider are summarized on a document titled Explanation of Benefits (EOB). The EOB is not a bill but a billing summary that should be used to reconcile with the invoice or statement from the health care provider. The EOB will indicate the amount billed for each service provided, the amount that qualified for the carrier’s negotiated rate, the amount for which the insured member will be responsible and typically the document will show how much of the individual deductible has been satisfied. Since each service provided is subject to the negotiated rate, the net amount owed by the insured member can vary significantly.
The entire financial transaction between the three parties involved – the insured member, the healthcare provider, and the health insurance carrier – begins with the identification card. The information contained on the identification card and the ability to transmit this information electronically is an important component in making sure health insurance carriers comply with Texas legislation titled the “Clean Claims Act” (SB 418), which requires health insurance claims to be processed and the health care provider paid within 45 days. The single identification card provides comprehensive information on all individuals covered under the policy and ensures the timely processing of claims.
STATESIDE CAN HELP!
Stateside Insurance Services, since 2003, has focused on providing comprehensive health insurance information, responsive customer service and expert industry knowledge for Texas consumers. Stateside has annually been recognized by health insurance carriers and the Health Insurance Marketplace as a Top Producer in Texas.
Whether the health insurance policy is for an individual, family, small business or supplemental Medicare coverage, Stateside dedicates the time, and our deep industry expertise, to ensure our clients have identified the best health insurance plan for their specific needs.
Stateside is available to answer any general questions regarding your coverage options, can provide a subsidy determination, and even assist in creating and submitting online applications for ACA compliant plans during an Open Enrollment or throughout Special Enrollment periods.
By using the Telephone Appointment System, clients can take advantage of scheduling a health insurance discussion when convenient for their schedule. During Open Enrollment phone appointment availability is expanded to include extended hours and weekends.