What is rxpcn on insurance card

There are different types of insurance cards that are used in different circumstances, and this article will help you find the insurance information you need. The types of insurance cards we’ll discuss are medical insurance cards, pharmacy benefit insurance cards, and Medicaid insurance cards. 

What’s the difference between a medical insurance card and a pharmacy benefits insurance card?

Some people may have one insurance card that covers them for medical expenses (like the doctor or hospital) and also includes pharmacy benefits (to cover medications), but often times these are two separate cards with different identification numbers. 

Medical card example:

Pharmacy card examples:

Pharmacies typically need a pharmacy benefits card to process a prescription for medication, which contains an RxGroup, RxPCN, and RxBIN number in addition to the Member ID number. “Rx” is another way to refer to a prescription. Medical cards usually only have a Member ID number. If your insurance only sent you a medical insurance card in the mail, you can typically find your pharmacy benefits information online or by calling your insurance (look for the phone number for Member Services on the back of your card). 

What do RxBIN and RxPCN stand for and what do they do?

RxBIN stands for Bank Identification Number, which helps the pharmacy figure out which insurance company’s prescription plan to process. RxPCN stands for Processor Control Number and is another unique identifier to help the pharmacy identify you. It’s important for the pharmacy to have this information to find your coverage and get coverage for your prescriptions. 

Do Medicaid insurance cards look different from other insurance cards?

Medicaid provides free or low-cost health coverage to millions of Americans, including people with low income, families and children, pregnant people, and people with disabilities.

Medicaid cards look different for each state and will not contain an RxGroup, RxPCN, and RxBIN number, only a Member ID number. If you have a Medicaid managed care plan, then you should still be able to access pharmacy benefits information. For people with Medicaid coverage, many states will require you to switch to a managed care plan after 30 days. Below is an example of a Florida Medicaid card and a FL Medicaid managed care card. Note that the gold Medicaid card only has a Member ID, whereas the managed care plan lists the Member ID, RxBIN, RxPCN, and RxGroup numbers. 

What if I can’t find the RxBIN, RxPCN, or RxGroup number on the card?

The first tip is to check the back of your card, it’s not always on the front! Most pharmacy cards will have all four pieces of information (Member ID, RxGroup, RxPCN, and RxBIN numbers), but there are a few exceptions of plans that do not have all four numbers and can still be accepted. 

The two most important pieces of information to provide are your Member ID and RxBIN in order for the pharmacy to find your health insurance coverage. Providing the RxGroup and RxPCN numbers can help the pharmacy find your health insurance info even faster and more accurately. 

For example, Aetna cards sometimes only have a Member ID number and a RxBIN number. 

If you only have a medical insurance card and need to find your pharmacy benefits information, you can contact your insurance for this information. For tips on how to call your insurance company, check out our article here.  

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Need additional help? If you have an account with Twentyeight Health you can reach out to contact@twentyeight health or text us at (929) 352-0060 and our customer service team will support you. You can also reach out to Member Services of your insurance company (their phone number is typically on the back of your insurance card). 

The Rx BIN, Rx Grp, and Rx PCN are three identification numbers you will see on almost every insurance card. 

These numbers allow your pharmacy or doctor’s office to process claims through the right channels. These codes indicate what type of insurance you have, what type of drug coverage you’re under, and where the claim needs to be submitted.

Getting them wrong can jeopardize your medical coverage. For instance, you may be forced to pay out-of-pocket or get denied coverage altogether.

Knowing what they mean will help you maximize your health insurance benefits, advocate for yourself, and understand the medications you’re taking.

We'll explain what each number means in depth later in the article, but here's where you might find each number on your insurance card:

click the image to zoom

Let’s get started.

What is Rx?

Rx is an abbreviation for “medical prescription.”

It’s usually part of the heading (superscription) of a prescription, a written order from a physician to a pharmacist, who then dispenses the medication.  

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 Rx BIN?

Rx BIN stands for “prescription bank identification number.”  (SEE SAMPLE CARD 1 & 2)

If you have multiple prescription drug plans, such as Medicare Part D and an employer-sponsored plan through work, it’s important to know which Rx BIN to use when filling prescriptions.

Despite the name, the Rx BIN number on insurance cards have nothing to do with banks. This has understandably caused people to wonder what is an Rx BIN. An Rx Bin is a six-digit coding system that identifies your insurance providers.

When the pharmacist types your Rx BIN number into their database, they’ll know which insurance company will pay for your prescription.

Also, if you're wondering whether the RxBIN or BIN stands for the same thing on insurance cards, they do.

Note:

Not all insurance cards contain the BIN number (SEE NO Rx BIN SAMPLE CARD).

How to find Rx bIN on insurance card:

To find out your bin number insurance, we recommend contacting your health insurance provider to confirm your Rx BIN.

What is Rx Grp?

The meaning of Rx Grp is the group number assigned by a health insurance company to identify a member's group health plan.

It tells the pharmacy what type of insurance plan you have so they can look up the list of approved drugs, copays, and deductibles for your plan.

Each plan has its own list of prescription medications that are approved for reimbursement with coverage. If a medication isn't on the list under your plan, it’s not covered.

You’ll need your Rx Grp number when:

• Filling a prescription at the pharmacy
• Filling a new-to-you medication that requires prior authorization
• Checking medicine prices before going to the pharmacy
• Using a mail-order pharmacy
• Submitting a reimbursement claim from your insurance company
• Scheduling certain medical appointments or procedures
• Visiting the hospital emergency room
• Receiving services from an out-of-network provider who needs to file a claim on your behalf

Note:

If you work for an employer that offers a health plan, you should be given a membership card and additional information about your prescription drug coverage. (SEE SAMPLE CARD 1 & 2)

If you're not sure what your Rx Grp is, contact the customer service phone number listed on the back of your ID card.

What is PCN on Health Insurance Cards?

Your Rx PCN meaning is “processor control number.”

Like the Rx BIN and Rx Grp code, the PCN is an additional identifier used by insurance companies to determine which processor will handle your claim.

The insurance PCN is also connected to your prescription drug plan. It tells the pharmacy whether your prescription is covered under your drug plan and if it is, how it would be paid.

In most cases, you won't need to provide the PCN on your insurance card when you go to the doctor's office or pharmacy, because they will be able to get it automatically from your group ID.

But there are some situations where a doctor or pharmacist may need to manually enter the PCN:

• When you're covered through private insurance instead of your employer
• When you're seeing a doctor who is outside your network
• When using a mail-order pharmacy
• When transferring prescriptions between pharmacies

A doctor's office could also use this information to verify your eligibility for coverage before providing services.

The PCN insurance number is usually listed on the front of your card along with the group number and member ID. (SEE SAMPLE CARD 1 & 2)

What is a Formulary?

A formulary is a list of prescription medications covered by your health insurance.  (SEE SAMPLE CARD 2)

This list shows the brand name and generic versions of each drug, along with co-payments and requirements for using the drug.

So why is it important to know what is in your formulary?

Because your insurance will only pay for drugs included in your plan’s formulary. 

If your prescription medication is not included in your plan’s drug list, you have the following options:

• Pay out-of-pocket for the medication yourself
• Ask your doctor to prescribe another medication
• File an appeal with your insurance company to get coverage for it

Pharmacists may also ask for your formulary when you get a new prescription or you were prescribed a drug that's not on the list.

In most cases, pharmacists would be happy to help you find cheaper, generic versions for your medication based on the formulary.

If you experience side effects on the initial drugs, they can also help you find alternatives.

Note:

If you have questions about which drugs are covered under your health insurance plan, contact the provider directly or consult its member materials.

Remember that formulary lists constantly change as well. We recommend finding and bookmarking the formulary section on your insurer’s website to stay updated on the list.

For instance, the CDPHP website has a section exclusively for updates to their covered drug list. Most insurance company websites will have a similar section.

What are Prescription Costs or Drug Tiers?

Formulary lists are also divided into prescription costs, aka drug tiers:

• Tier 1: Preferred generic drugs: These are usually the lowest-cost drugs in the plan.
• Tier 2: Generic drugs: These drugs have the same active ingredients as brand-name drugs but cost less than brand-name drugs.
• Tier 3: Preferred brand-name drugs: These are brand-name medications that generally cost more than generic or preferred generic medications.
• Tier 4: Nonpreferred brand-name drugs: These are brand-name medications that generally cost more than preferred brand-name medications and other lower-tier medications.
• Tier 5: Specialty prescription drugs: These are high-cost prescription drugs that usually treat complex or rare conditions.

Note:

Some insurance policies do not use a tiered system, but instead, assign each drug a copayment amount. In this case, the copayment amount should be listed on your card or your member information packet.

Aside from the Rx BIN, Rx Grp, and Rx PCN, there are other important details on your insurance card. (SEE SAMPLE CARD WITH OTHER INFORMATION)

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 on 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 Rx BIN, Rx Grp, or Rx 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.

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 Rx BIN, Rx Grp, and Rx PCN, gives you a good idea of your prescription coverage to make sure that a claim is submitted to the right insurance.

Aidan has been writing about personal finance for over 6 years. Prior to this, he worked as a Corporate Finance Analyst where he specialized in Due Diligence, Company Valuations and more. He is a CFA charterholder.