Front of Card
Back of Card
Highmark Blue Cross Blue Shield, Highmark Senior Health Company, and Highmark Choice Company are independent licensees of the Blue Cross and Blue Shield Association.
SAMPLE OF A MEMBER ID CARD
1. Licensed Product Name
2. Member Identification Information
3. Dependent and PCP Information, if applicable
4. Medical and Rx Claims Processing Information
5. Member Cost Sharing
*Pharmacy copayments are not displayed
*Deductibles and coinsurance may not be displayed
6. Additional Coverage Information, if applicable
7. Suitcase Logo – Indicates BlueCard® Program
8. Rx Logo for Pharmacy Benefits, if applicable
9. Additional Plan Information
10. Plan Website
11. Plan Contact Information
12. Claim Submission Information and Independent
Licensee Disclosure
13. Pharmacy Benefits Administrator, if applicable
NOTE: Please confirm eligibility and benefits via Availity®
or an electronic HIPAA 270 transaction; contact Provider
Services with any questions.
Medicare Advantage Freedom Blue PPO and Community Blue Medicare PPO
are administered by Highmark Senior Health Company. Medicare Advantage
HMO products (Security Blue HMO and Community Blue Medicare HMO),
Commercial HMO products, and the Children’s Health Insurance Program
(CHIP) are administered by Highmark Choice Company.
