What is RXGRP, RX, BIN and PCN on an insurance card and where to find it

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Health insurance covers your medical expenses. During your doctor’s visit, your health care provider will ask for your insurance information. You can prove that you’re covered by presenting your insurance card.

If you take a look at your insurance card, you’ll find information that your doctor or medical facility will need to get your insurer to pay for your medical expenses. 

It also contains details that let your medical providers know how to submit your claims. If your health insurance plan includes coverage for prescription drugs, you’ll also find related information on your insurance card.

What Is BIN?

The bank identification number (BIN) or bank code is a six-digit number on your health insurance card. It tells which insurance provider will get the claim for your prescription once it’s used at the pharmacy’s computer database. 

The acronym was commonly used in the banking industry to identify which financial institution issued the card. In the medical field, the BIN, despite its name, doesn’t involve banks. 

When you go to a pharmacy to fill your prescription, the pharmacist will ask for your insurance card and check the BIN. The latter identifies which insurer will reimburse the pharmacy for the cost of your medications. 

However, not all insurance cards contain this identifier. Contact your health insurance provider if you need to know your BIN.

What is Rx?

The Rx symbol on your insurance card tells you that your health insurance company pays for some or all of the prescription costs. 

In some cases, insurance cards show the Rx symbol along with a dollar or percent amount to show how much your insurer will pay for your prescription.

What is RxGrp?

RxGrp or prescription group is a set of alphanumeric or numeric numbers that pharmacies use to process your prescription benefits. 

For example, some insurers group the benefits based on physical benefits or pharmacy benefits, depending on your health care plan.

Not all insurance cards have this identifier. You may call your insurance provider if you need this information. Otherwise, you can leave this blank.

What is PCN?

A processor control number (PCN) is a group of alphanumeric or numeric numbers that is used to locate your pharmacy member profile under the pharmacy benefits manager, which is a company that administers your drug benefits. 

Your PCN is an identifier that’s used to route pharmacy reimbursement transactions for health insurers.

What is a Formulary?

Some insurance cards have a formulary, which represents a list of prescription drugs covered by the insurer. 

Some providers have different formularies (formulary 1, formulary 2, etc.) covered under different health insurance plans.

What are Prescription Costs?

Prescription costs may also be shown on your insurance card. It is divided into three categories, each containing different sets of drugs.

  • Tier 1 – generic drugs
  • Tier 2 – brand-name drugs
  • Tier 3 – specialty drugs

Each tier has a different price, which you need to pay when you pick up your prescription at the pharmacy.

What Other Information Can You Find on Your Insurance Card?

Aside from the BIN, RX, RXGRP, and PCN, there are other important information on your insurance card.

Plan Name

The plan name refers to the name of the plan or coverage you have from your health insurance provider. Cigna, Aetna, Kaiser, and Humana are some of the most common plan names.

Plan Type

The type of health insurance plan you have is also indicated on your health insurance ID. It determines what medical provider you can go to and how you can get medical care.

The most common plan types are:

  • HMO – Health Maintenance Organization lets you choose the primary care provider (PCP) that will coordinate your medical care. You need to get a referral from your PCP if you need to see a specialist.
  • POS – Point of Service lets you choose a primary care provider in your network. You can use an in-network or out-of-network if you need to see a specialist at the time you need care.
  • PPO – Preferred Provider Organization lets you visit any medical professional without the need for a referral from your primary care provider.

Member Name

The member name refers to the name of the policyholder. It could be your name or the name of your parents or spouse if you’re covered by their health insurance plan.

Member ID

Every individual who is covered by health insurance has a unique member ID number, which is found in your insurance card. It’s a set of numbers that contains 5 to 12 digits and is listed under different headers such as member ID, ID, or membership #. 

It’s the identifier that lets healthcare providers verify the health insurance coverage and make the needed payment arrangements for the health care services provided.

How to Use your Health Insurance ID Card?

Make sure that all the information on your ID card is correct. If not, have it changed immediately and request a new card. 

Show your insurance card every time you go on a doctor’s visit or whenever you receive health services.

What If You Can’t Find the BIN, Rx, RxGrp, or PCN on Your Insurance Card?

If you need more information about your insurance or if you can’t find the information you need, you should call your health insurance provider right away.

Are Prescriptions Included in Health Care Insurance?

The Affordable Care Act requires all insurance plans offered by insurance companies and small employers to cover prescription medications. The policyholder, however, usually has to pay a part of the prescription costs. 

Some insurance companies include information about the prescription coverage on the insurance card. Others provide a different card for prescriptions.

Get to Know the Info on Your Insurance Card

Your insurance card can help you save money during your doctor’s visits when you receive healthcare services and every time you go to the pharmacy. 

Familiarizing yourself with the information on your insurance card, such as the BIN, Rx, RxGrp, and PCN, gives you a good idea of your prescription coverage to make sure that a claim is submitted to the right insurance.

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