Active - Services Capitated to Primary Care Physician
5
Active - Pending Investigation
6
Inactive
7
Inactive - Pending Eligibility Update
8
Inactive - Pending Investigation
9
Coverage Never Activated
10
Inactive - Premium Payment Not Received
Indicates that the payer has deemed the member inactive, based on the inquiry date submitted on the request, the eligibility status is returned as inactive because the date is either (1) after the due date of the initial premium payment or (2) after end of the 3 month grace period and the member is not eligible for benefits but whose membership may be effectuated.
11
Active - Pending Receipt of Premium Payment
Indicates that the payer has deemed the member active, but, based on the inquiry date submitted on the request, the eligibility status is returned as Active because the date is either (1) prior to the due date of the initial premium payment or (2) within the 3 month grace period and the member is in the first month of the grace period, and any delinquent payment has not yet been received.
12
Inactive - Pending Receipt of Premium Payment
Indicates that the payer has deemed the member inactive, based on the inquiry date submitted on the request, the eligibility status is returned as inactive because the date is either (1) after the due date of the initial premium payment or (2) the member is in the 2nd or 3rd month of the grace period and any delinquent payment has not yet been received by the payer.
A
Co-Insurance
AA
Patient Reimbursement
AB
Co-payment Maximum
AC
Co-insurance Maximum
B
Co-Payment
C
Deductible
CB
Coverage Basis
CF
Combination Forward Rolling Limitation (CFRL)
D
Benefit Description
E
Exclusions
F
Limitations
FC
First Dollar Coverage, Applies to the Entire Plan
FD
First Dollar Coverage
FG
First Dollar Coverage, Group of Services
FS
First Dollar Coverage, Single Service
G
Out of Pocket (Stop Loss)
H
Unlimited
HR
Health Reimbursement Account
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
SF
Simple Forward Rolling Limitation (SFRL)
T
Card(s) Reported Lost/Stolen
TB
Tiered Benefit
U
Contact Following Entity for Eligibility or Benefit Information