Haris Ashley
Knowing what type of insurance plan you have is essential for understanding your rights and coverage. The first step is to identify who regulates your plan, as this determines the laws and appeal processes that apply. You can then review your plan's details, either by contacting your insurance provider's Member Services team or by checking your enrollment information. Creating an online account with your insurance provider can also help you access specific plan benefits and coverage options. Understanding your insurance plan's formulary (drug list) is crucial, especially if you require prescription drug coverage. Additionally, if you have health insurance through your employer, your human resources department can provide valuable insights into your policy.
| Characteristics | Values |
|---|---|
| Determining the regulator of your plan | Contact your insurance company |
| Finding out what your plan covers | Contact your insurance company's Member Services team |
| Knowing your health plan's website | Check the back of your insurance ID card |
| Knowing your health plan's website | Contact your human resources team |
| Knowing your health plan's website | Check your enrollment information |
| Knowing your health plan's website | Check your insurance card |
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What You'll Learn
Contact your insurance company
If you are unsure about what kind of insurance you have, the best course of action is to contact your insurance company directly. They will be able to answer any questions you have about your insurance plan and its coverage.
You can usually find the phone number for your insurance company's Member Services team on the back of your insurance ID card. If you get your insurance through work, you can also contact your human resources team or check your enrollment information. Alternatively, you can check your state's insurance department website to confirm that the company or HMO is licensed and obtain information on other licensed companies in your state.
The Member Services team is there to answer any questions you may have about your plan's coverage. They can tell you whether a specific doctor, prescription, or service is covered, and how much your insurance will pay. They can also provide you with a copy of your plan's Summary of Benefits and Coverage (SBC). This document outlines the benefits and coverage provided by your plan, including any specific details relevant to your situation.
If your insurance plan includes prescription drug coverage, you can also request a copy of the plan's formulary or drug list. This will allow you to review and confirm whether the prescriptions you need are included and if they require any special approvals or pre-authorizations. Some plans also offer a calculator tool to help you find the lowest prices on prescriptions from specific pharmacies or in different quantities.
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Check your insurance card
If you have a physical insurance card, you can check it to find out what type of insurance you have. Insurance cards contain important information and provide proof of insurance. They also help your providers keep your insurance information up to date.
Insurance cards may contain different information based on the insurance company and type of plan you choose. However, most cards include your name and policy number. If you are covered under your spouse's or parent's plan, your card may include their name, too. The policy number on your insurance card is a unique code associated with your insurance plan.
The coverage amount refers to how much of your healthcare costs your insurance company will pay. You can usually find this information on the front of your insurance card. Coverage amounts may be listed as fixed dollar amounts or percentages, such as 25%, 50%, or 75%. Often, several amounts are listed together and may correspond to different types of treatments or office visits. You may also see additional information regarding copays and in-network or out-of-network care.
Your insurance card may list two coverage percentages for in-network or out-of-network providers. In-network providers are those who have a contractual agreement with your insurance company to provide lower-cost services and treatments. Visiting an in-network provider will usually result in lower expenses compared to visiting an out-of-network provider. For most plans, you can still see an out-of-network provider if you choose to do so. However, you’ll likely pay more for out-of-network care.
You can find your insurance provider’s contact information on the back or bottom of your card. This information is useful in case you need to ask questions about your insurance coverage.
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Ask your doctor's office
If you are unsure about what type of insurance you have, it is a good idea to ask your doctor's office. They may be able to tell you if they take your insurance plan by looking at your health insurance card. However, it is always best to confirm with your insurance company as well.
Your doctor's office may use a third-party eligibility platform to check your insurance details. These platforms can sometimes be outdated, so it is a good idea to also check with your insurance company. You can usually find their phone number on your health insurance member ID card.
If you are a HealthPartners member, you can also sign in to your online account or mobile app to find an in-network provider. You can also call your insurance company and ask for a list of in-network doctors in your area. They may be able to email or mail you a list, or give you the information over the phone.
It is important to know what type of insurance plan you have, as different plans cover different doctors, specialists, and clinics. For example, a Preferred Provider Organization (PPO) plan offers coverage through a specific network of doctors, clinicians, and specialists. Most PPO plans allow you to see providers both in and out of the network, but you pay less out of pocket when going to in-network doctors. On the other hand, a Health Maintenance Organization (HMO) plan limits coverage to healthcare services provided by doctors who are in your network. These plans typically don't cover out-of-network services outside of emergencies.
You can also ask your doctor's office about your insurance coverage for specific treatments or services. If a service is covered, it means your health plan will pay for some or all of the cost. Covered services typically include regular office visits, tests, urgent and emergency care, hospital stays, prescription drugs, and medical equipment. However, it's important to note that the amount your health plan pays depends on the type of care you use and where you receive it.
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Consult your human resources team
If you have job-based insurance, your human resources team can help you understand your insurance plan. HR can provide education on important health insurance plan features, deadlines, benefits, etc. Your HR representative may have an initial sit-down with you during the employee onboarding process to talk about health insurance plans, or they may offer an annual lunch for all employees to learn about their coverage options.
HR can help you decide on the best health insurance plan for you that is offered by your employer. Your HR rep can help break down everything (deductibles, co-pays, etc.) so you can feel confident in your selected plan. Consulting HR can also help you determine how different plans might affect your health and financial planning. For example, if one plan has higher co-pays on office visits than another, HR can help you pick out a plan that’s affordable for you.
If you have issues getting your supplies, services and/or medications covered, HR should be there to assist you with submitting the necessary paperwork or finding resources to get you the supplies and services you need. In addition to working with HR, employee assistance programs (EAPs) can help you with other personal or work-related concerns. Ask your HR team if there is an EAP available to you.
If you have job-based insurance now or get an offer for job-based insurance, you won’t qualify for savings on a Marketplace plan if the job-based plan is considered "affordable". In 2025, a job-based health plan is considered "affordable" if your share of the monthly premium in the lowest-cost plan offered by the employer is less than 9.02% of your household income.
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Review your insurance's website
Review your insurances
Knowing what type of insurance coverage you have is important to understand your rights and the laws that govern your plan's appeal process. This can be especially important in the case of health insurance, where you need to know what doctors, clinics, and prescriptions are covered by your plan.
Contact your insurance provider
The first step to understanding your insurance coverage is to contact your insurance provider. You can do this by calling the phone number on the back of your insurance ID card. If you receive your insurance through work, you can also contact your human resources team or check your enrollment information.
Review your plan's details
Once you have contacted your insurance provider, ask about the specific details of your plan. This includes understanding:
- The type of insurance plan you have (e.g., HDHP, PPO, HMO)
- The network of doctors, clinics, and hospitals that are covered by your plan
- What prescriptions are covered and if any special approvals are needed
- Your plan's formulary (drug list)
- Your copay and/or coinsurance amounts
- Any additional benefits or coverage, such as mental health, chiropractic, or breastfeeding support
Utilize online resources
In addition to contacting your insurance provider directly, you can also utilize online resources to review your insurance coverage. This includes creating an online account with your insurance company, visiting official government websites (such as HealthCare.gov in the US), or using online tools provided by your insurance company, such as a calculator to find the lowest prices on prescriptions.
Stay informed
It is important to stay informed about any changes to your insurance coverage. Review any updates to your plan's benefits, coverage, or network of providers. Understanding your insurance coverage can help you make informed decisions about your healthcare and ensure you are getting the most out of your plan.
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Frequently asked questions
You can find out what type of insurance plan you have by contacting your insurance provider's Member Services team. The phone number is usually on the back of your insurance ID card. If you receive your insurance through work, you can also contact your human resources team or check your enrollment information.
If you don't know who your insurance provider is, you can try calling your doctor's office and asking, or creating an account on your insurance provider's website to find out more information.
If you have Medicare, visit the Medicare website or call the Medicare Help Line at 1-800-MEDICARE (1-800-633-4227). If you have Medicaid, the type of services covered will depend on the state you live in.
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