SBI Specific Benefit Information

To specify specifc benefit scenarios

Position: SBI-01 · Element: 1390 · Name: Eligibility or Benefit Information Code · Type: Identifier (ID) · Requirement: Mandatory · Min: 1 · Max: 2 · Repeat: 1

Code identifying eligibility or benefit information

Position: SBI-02 · Element: 615 · Name: Time Period Qualifier · Type: Identifier (ID) · Requirement: Conditional · Min: 1 · Max: 2 · Repeat: 1

Code specifying periods

Position: SBI-03 · Element: 616 · Name: Number of Periods · Type: Numeric (N0) · Requirement: Optional · Min: 1 · Max: 3 · Repeat: 1

Total number of periods

C0302: If SBI-03 is present, then SBI-02 is required

Position: SBI-04 · Element: 954 · Name: Percentage as Decimal · Type: Decimal number (R) · Requirement: Optional · Min: 1 · Max: 10 · Repeat: 1

Percentage expressed as a decimal (e.g., 0.0 through 1.0 represents 0% through 100%)

Position: SBI-05 · Element: 782 · Name: Monetary Amount · Type: Decimal number (R) · Requirement: Optional · Min: 1 · Max: 18 · Repeat: 1

Monetary amount

SBI05 represents a single benefit amount or minimum benefit amount dependent upon the code sent in SBI01.

Position: SBI-06 · Element: 782 · Name: Monetary Amount · Type: Decimal number (R) · Requirement: Optional · Min: 1 · Max: 18 · Repeat: 1

Monetary amount

SBI06 represents a remaining benefit amount or maximum benefit amount dependent upon the code sent in SBI01.

Position: SBI-07 · Element: 1790 · Name: Tier identifier · Type: Numeric (N0) · Requirement: Optional · Min: 1 · Max: 2 · Repeat: 1

Number identifying the level to which the benefits are assigned or limited

Position: SBI-08 · Element: 1204 · Name: Plan Coverage Description · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 50 · Repeat: 1

A description or number that identifies the plan or coverage

Position: SBI-09 · Element: 1073 · Name: Yes/No Condition or Response Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 1 · Repeat: 1

Code indicating a Yes or No condition or response

SBI09 is the triggering event indicator. A "Y" indicates that a triggering event has occurred, an "N" indicates no triggering event has occurred, a "U" indicates it cannot be determined if a triggering event occurred.

Position: SBI-10 · Element: 1073 · Name: Yes/No Condition or Response Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 1 · Repeat: 1

Code indicating a Yes or No condition or response

SBI10 is the single use benefit indicator. A "Y" indicates that the benefit is a single use per period (one time use), an "N" indicates an exhaustive benefit (used until benefit or benefit amount is '0') a "U" indicates it's unknown if the benefit is of single use or exhaustive type.

Position: SBI-11 · Element: 782 · Name: Monetary Amount · Type: Decimal number (R) · Requirement: Optional · Min: 1 · Max: 18 · Repeat: 1

Monetary amount

SBI11 amount represents the tiered benefit dollar amount.