Member ID card summary for
ACA-compliant health plans
The following summary shares information about member ID cards for Blue Cross and Blue
Shield of Georgia, Inc. and Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. (collectively
“BCBSGa”) ACA-compliant health plans (often referred to as plans purchased on or off the Health
Insurance Marketplace, or exchange). While these member ID cards have a similar format to
other BCBSGa ID cards, some information on the card may look slightly different.
Understanding the member ID card is important, as this information provides details about
member benefits and the provider network supporting the member’s health plan. Some ACAcompliant health plans have limited or no out-of-area and/or out-of network benefits. Please read
this information carefully and share with your office staff as appropriate. At the end of the
summary, we’ve included sample copies of the member ID cards for your reference.
Note that BCBSGa may issue a combined ID card for members who have medical, dental, and/or
vision plans. Combined ID cards are only issued when the medical, dental, and/or vision plans all
share the same renewal date and/or effective date.
Card Detail
Benefit
Information
Description
Important Information
Member ID cards include benefit
information such as the health plan
deductible, coinsurance, or out-of-pocket
details.
Providers should continue to verify
eligibility and benefit information for
all members via Availity or by
contacting Provider Service using
the phone number indicated on the
member ID card.
If a member or dependent has
pediatric dental benefits, this is noted
on the front, lower left of the ID card.
If a member or dependent has
pediatric vision benefits, this is noted
on the front, lower left of the ID card.
Claim and
Contact
Information
Drug List
Formulary
The backs of ID cards include the claim
submission address and important
contact information, such as phone
numbers for Provider Service and
preauthorization requests.
The phone number for pediatric
dental benefits is indicated on the
back of the member ID card.
ID cards indicate that the Select Drug
List formulary is utilized by BCBSGa.
Many plans use the Select Drug List,
which covers a select number of
medications in all therapeutic
categories and classes. Providers
may receive questions from
members about their current
prescriptions as they make decisions
about their health care coverage.
Our new searchable formulary tool
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helps providers search for drug
information within our drug lists.
Group
Number
The presence of a group number on the
ACA-compliant member ID card
indicates that the plan is a small group
policy.
If the member ID card does not have
a group number, this indicates that
the plan is an individual health plan.
Limited
Benefit
Disclaimer
PPO health plans with limited out-of-area
benefits include a disclaimer on the back
of the member ID card.
This disclaimer advises providers
when PPO plan benefits may be
limited to Urgent or Emergency care
outside of the member’s Home Plan
service area.
Network
Name
Prefixes
IMPORTANT – This field reflects the
name of the provider network that
supports the member’s medical health
plan. The Network Name field is located
on the bottom front of the ID card.
Member ID cards include prefixes as part
of the member identification number.
Prefixes are specific to medical ACAcompliant plans sold on and off the
Health Insurance Marketplace, or
exchange.
• JRA, JRC, XKY and XKZ are
supported by the Pathway
network
• XKW is supported by the HMO
Gatekeeper network
• XKU, and JRE is supported by
the Open Access POS network
• XKX is supported by the PPO
network
The medical product name is indicated
on the top right side of the member ID
card.
Product
Name
Suitcase
Logo
If a member has a stand-alone dental
plan, the dental plan name is indicated
below the medical plan name on a
combined card.
Member ID cards for
PPO health plans
purchased on the
exchange may include
a PPO suitcase logo
followed by the letter
“B”.
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Some plans include little or no outof-network benefits. Services
rendered by non-contracted
providers will be processed as outof-network. Providers should
always review the network name
indicated on the member ID card
and confirm that the provider
participates in the network that
supports the member’s health
plan.
Prefixes can help providers identify
members with medical ACAcompliant health plans.
Product names for plans purchased
on or off the Health Insurance
Marketplace, or exchange include
the reference to a metal level
(bronze, silver, gold, or platinum).
Some new plan names will also
include the name of the supporting
provider network.
The presence of the PPOB suitcase
logo on a Blue Plan member ID card
indicates the member has access to
the National BlueCard® PPO Basic
Network (the national exchange
network) for covered services
received out-of-area.
If you are participating in BCBSGa’s
Pathway X Enhanced network in
Georgia, and an exchange member
from another state is seeking care,
then you are participating in the
National BlueCard PPO Basic
Network (PPOB). More information
about BlueCard for exchanges is
provided below.
PPO health plans with limited out-ofarea benefits include a disclaimer on
the back of the member ID card
which indicated that benefits may be
limited to Urgent or Emergency care
outside of the member’s Home Plan
service area.
Member ID cards for
PPO health plans
purchased off the
exchange include the
PPO suitcase logo.
Some on exchange
health plans may also
include the PPO
suitcase logo.
ID cards for members
with HMO, POS, or
Traditional health
plans include the
blank suitcase logo.
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Providers should continue to verify
eligibility and benefits for all
members.
The presence of the PPO suitcase
logo (without the letter B) indicates a
member has access to the BlueCard
PPO Network for covered services
received out-of-area. If you are
participating in BCBSGa’s Pathway
X Enhanced network in Georgia, and
a member from another state is
seeking care, then you are
participating in the BlueCard PPO
Network (PPO).
PPO health plans with limited out-ofarea benefits include a disclaimer on
the back of the member ID card
which indicates that benefits may be
limited to Urgent or Emergency care
outside of the member’s Home Plan
service area.
Providers should continue to verify
eligibility and benefits for all
members.
The presence of the blank suitcase
logo indicates a member has access
to the BlueCard Traditional Network
for services received out-of-area that
are Urgent or Emergency care only.
Providers should continue to verify
eligibility and benefits for all
members.
Member ID card sample
Please note that this is a sample copy of a member ID card. The policy and benefit information
indicated on this sample does not necessarily represent actual information for any member health
plan. Policy and benefit information on actual member ID cards will vary by plan and final
copies of member ID cards may vary slightly from this sample.
BlueCard for exchanges and Multi-State Plan products
Under the Affordable Care Act (ACA), the Office of Personnel Management (OPM) is required to
offer OPM sponsored products on the exchange and implement a Multi-State Plan (MSP)
product. For coverage beginning January 1, 2015, Blue Cross and Blue Shield health plans will
offer 254 Multi-State products in 32 states and in the District of Columbia.
BlueCard is an existing national program that enables members of one Blue Plan to obtain
healthcare service benefits while traveling or living in another Blue Plan’s service area. Because
of the possibility that variations may exist on how exchange plans operate from state to state, the
Blue Cross and Blue Shield Association, along with Blue Plans, has developed a Blue System
Multi-State Plan Program that operates within the BlueCard program. This enhanced BlueCard
program is supported by the national exchange network called the National BlueCard PPO Basic
Network. BCBSGa’s PPO health plans utilizing this national exchange network for out-of-area
covered services will carry the new suitcase logo “PPOB” on the member ID card.
Please note, other Blue Plans acting as the Home Plan make their own decisions regarding which
networks their PPO exchange members will have access to when traveling out-of-area. Providers
should continue to verify eligibility and benefits for all out-of-state members.
Additional considerations for customization:
• If your state has a tiered network, you may wish to mention this in the section for
“Network Name” or include a detail about what this means to the provider when using the
member ID card (if anything).
• If there are details indicated on the member ID card that can assist providers in
delineating between contracts, reimbursement rates, or other unique factors related to
contracting, consider including verbiage as appropriate (local contracting will have to
advise). (For example, “Please note, the Network Name on the member ID card can
help providers verify the contractual rate that applies for services rendered to members
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with an on or off exchange health plan. Providers should consider this information when
determining how to best configure software systems that assist with accounts receivable,
auto-reconciliation, or auto-posting functions.”)
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