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 |
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 |