Code identifying eligibility or benefit information
Type
ID
Length
Max 2 / Min 1
Codes
<> 1
Active Coverage
<> 2
Active - Full Risk Capitation
<> 3
Active - Services Capitated
<> 4
Active - Services Capitated to Primary Care Physician
<> 5
Active - Pending Investigation
<> 6
Inactive
<> 7
Inactive - Pending Eligibility Update
<> 8
Inactive - Pending Investigation
<> A
Co-Insurance
<> AA
Patient Reimbursement
<> AB
Co-payment Maximum
<> AC
Co-insurance Maximum
<> B
Co-Payment
<> C
Deductible
<> CB
Coverage Basis
<> D
Benefit Description
<> E
Exclusions
<> F
Limitations
<> G
Out of Pocket (Stop Loss)
<> H
Unlimited
<> I
Non-Covered
<> J
Cost Containment
<> K
Reserve
<> L
Primary Care Provider
<> M
Pre-existing Condition
<> MC
Managed Care Coordinator
<> N
Services Restricted to Following Provider
<> O
Not Deemed a Medical Necessity
<> P
Benefit Disclaimer
<> Q
Second Surgical Opinion Required
<> R
Other or Additional Payor
<> S
Prior Year(s) History
<> SB
Shared Benefit Limitation
<> SD
Shared Benefit Deductible
<> T
Card(s) Reported Lost/Stolen
<> U
Contact Following Entity for Eligibility or Benefit Information
<> V
Cannot Process
<> W
Other Source of Data
<> WV
Waiver
<> X
Health Care Facility
<> Y
Spend Down
