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What to Ask When You Receive Your Health Insurance Card

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Insurance Company

Plan type: Titanium PPO Plan
Effective Date: 01/01/2020

Prescription Group # XXXX

Prescription Co-Pay

$15.00 Generic
$20.00 Name Brand
Member Name: John Doe
Member Number: XXX-XX-XXX
Group Number: XXXXX-XX
PCP: Robin Jones, MD
PCP Co-Pay: $15.00
Specialist Co-Pay: $25.00
Emergency Room Co-Pay: $75.00
Member Services: 800-XXX-XXX

Member Services: 800-XXX-XXX
Nurse Advice Line 24/7: 866-XXX-XXXX
Telehealth Services: 888-XXX-XXXX

Send claims to:

My Plan, INC
City, State XXXXX