| ADALLO |
873 |
874 |
ALC/DRUG INPAT DETOX ALL LIMIT:ALL |
| ADCOIN |
914 |
915 |
ALC/DRUG INPAT DETOX TYPE COINS |
| ADCOINI |
885 |
886 |
ALC/DRUG INPAT DETOX INTRN LIMIT:COINS |
| ADCOINO |
877 |
878 |
ALC/DRG INPAT DETOX ALL LIMT:COINS/COPAY |
| ADCOINP |
916 |
918 |
ALC/DRUG INPAT DETOX % COINS |
| ADCOVI |
541 |
542 |
BNFT CVRG FOR ALC/DRUG INPAT DETOX-IN |
| ADCOVO |
563 |
564 |
BNFT CVRG FOR ALC/DRUG INPAT DETOX-OUT |
| ADDECYD |
905 |
908 |
A/D INP DETOX TYP DED:AMNT DED/CONFIN/YR |
| ADDEDCY |
895 |
896 |
ALC/DRUG INPAT DETOX TYPE DED:/CONFIN/YR |
| ADDEDDF |
897 |
898 |
ALC/DRUG INPAT DETOX TYPE DED:/DAY FIX |
| ADDEDDV |
899 |
900 |
ALC/DRUG INPAT DETOX TYPE DED:/DAY VARY |
| ADDEDDY |
901 |
902 |
A/DRG INP DETOX TYP DED:# DAYS/CONFIN/YR |
| ADDEDFD |
909 |
911 |
A/D INP DETOX DED:AMT DED/DAY FIX|VARY |
| ADDEDI |
883 |
884 |
ALC/DRUG INPAT DETOX INTRN LIMIT:DEDUCT |
| ADDEDNS |
903 |
904 |
ALC/DRUG INATP DETOX TYP DED:NOT SPECFD |
| ADDEDO |
875 |
876 |
ALC/DRUG INPAT DETOX ALL LIMIT:DEDUCT |
| ADDEDYN |
912 |
913 |
A/D INP DETOX TYP DED:# DAYS/CONFIN/YR |
| ADMAXCYN |
923 |
925 |
A/D INP DETOX DAY MAX:MAX #DYS/CONFIN/YR |
| ADMAXDI |
891 |
892 |
ALC/DRUG INPAT DETOX INTRN LIMIT:$ MAX |
| ADMAXNI |
889 |
890 |
ALC/DRUG INPAT DETOX INTRN LIMIT:DAY MAX |
| ADMAXO |
881 |
882 |
ALC/DRUG INPAT DETOX ALL LIMIT:PLAN MAX |
| ADMDMX |
571 |
572 |
$ LIFE MAX FOR MNTL HLTH,ALCOHOL/DRUGS |
| ADMDMXAD |
585 |
586 |
ALC/DRUG INPAT DETOX APPLIES $ LIFE MAX |
| ADMDMXAL |
579 |
580 |
ALL MH,ALCOHOL/DRUGS APPLY 2 $ LIFE MAX |
| ADMDMXAO |
589 |
590 |
ALC/DRUG OUTP REHAB APPLIES $ LIFE MAX |
| ADMDMXAR |
587 |
588 |
ALC/DRUG INPAT REHAB APPLIES $ LIFE MAX |
| ADMDMXD |
573 |
578 |
AMNT $ LIFE MAX-MNTL HLTH,ALCOHOL/DRUGS |
| ADMDMXMI |
581 |
582 |
MNTL HLTH INPAT APPLIES $ LIFE MAX |
| ADMDMXMO |
583 |
584 |
MNTL HLTH OUTPAT APPLIES $ LIFE MAX |
| ADMVMX |
591 |
592 |
DAY/VISIT LIFE MAXS 4 MH,ALCOHOL/DRUGS |
| ADMVMXAD |
599 |
600 |
ALC/DRUG INPAT DETOX-DAY/VISIT LIFE MAX |
| ADMVMXAL |
593 |
594 |
ALL MH,ALCOHOL,DRUG-DAY/VST LIFE MAX |
| ADMVMXAO |
603 |
604 |
ALC/DRUG OUTPAT REHAB-DAY/VISIT LIFE MAX |
| ADMVMXAR |
601 |
602 |
ALC/DRUG INPAT REHAB-DAY/VISIT LIFE MAX |
| ADMVMXMI |
595 |
596 |
MH INPAT APPLIES 2 DAY/VISIT LIFE MAX |
| ADMVMXMO |
597 |
598 |
MH OUTPAT APPLIES 2 DAY/VST LIFE MAX |
| ADMXCY |
926 |
927 |
ALC/DRUG INPAT DETOX TYP $ MAX:/CONFN/YR |
| ADMXCYD |
932 |
937 |
A/D INPAT DETOX $ MAX:AMT $MAX/CONFIN/YR |
| ADMXDY |
928 |
929 |
ALC/DRUG INPAT DETOX TYPE $ MAX: /DAY |
| ADMXDYD |
938 |
940 |
A/D INPAT DETOX TYPE $ MAX:AMT $ MAX/DAY |
| ADMXNS |
930 |
931 |
ALC/DRUG INPAT DETOX TYPE $ MAX:NOT SPEC |
| ADOOPD |
919 |
922 |
ALC/DRUG INPAT DETOX AMNT OOP LIMIT |
| ADOOPI |
887 |
888 |
ALC/DRUG INPAT DETOX INTRN LIMT:OOP LIMT |
| ADOOPO |
879 |
880 |
ALC/DRUG INPAT DETOX ALL LIMIT:OOP LIMIT |
| ADOTHI |
893 |
894 |
ALC/DRUG INPAT DETOX INTRN LIMIT:OTHR |
| ADSAME |
569 |
570 |
ALC/DRUG BNFTS SAME AS EACH OTHR |
| AGE1X |
52 |
52 |
AGE-RD1 (EDITED / IMPUTED) |
| AOALLO |
1440 |
1441 |
ALC/DRUG OUTP REHAB ALL LIMT:ALL |
| AOCOIFI |
1452 |
1453 |
ALC/DRUG OUTP REHAB INTRN LIMT:COINS FIX |
| AOCOINO |
1444 |
1445 |
ALC/DRUG OUTP REHAB ALL LIMT:COINS/COPAY |
| AOCOINP |
1471 |
1473 |
ALC/DRUG OUTP REHAB:% COINS FIX|VARY |
| AOCOIVI |
1454 |
1455 |
ALC/DRUG OUTP REHAB INTRN LMT:COINS VARY |
| AOCOPD |
1474 |
1476 |
A/D OUTP REHAB:AMT COPAY/VST FIX|VARY |
| AOCOPFI |
1456 |
1457 |
A/D OUTP REHAB INTRN LMT:COPAY/VST FIX |
| AOCOPVI |
1458 |
1459 |
A/D OUTP REHAB INTRN LMT:COPAY/VST VARY |
| AOCOVI |
545 |
546 |
BNFT CVRG FOR ALC/DRUG OUTPAT REHAB-IN |
| AOCOVO |
567 |
568 |
BNFT CVRG FOR ALC/DRUG OUTPAT REHAB-OUT |
| AODEDD |
1468 |
1470 |
ALC/DRUG OUTP REHAB:AMNT DEDUCT/YR |
| AODEDI |
1450 |
1451 |
ALC/DRUG OUTP REHAB INTRN LIMT:DEDUCT/YR |
| AODEDO |
1442 |
1443 |
ALC/DRUG OUTP REHAB ALL LIMT:DEDUCT |
| AOMAXO |
1448 |
1449 |
ALC/DRUG OUTP REHAB ALL LIMIT:PLAN MAX |
| AOMXDVD |
1480 |
1482 |
ALC/DRUG OUTP REHAB:$ AMNT $ MAX /VST |
| AOMXDVI |
1462 |
1463 |
ALC/DRUG OUTP REHAB INTRN LMT:$ MAX/VST |
| AOMXNVI |
1460 |
1461 |
ALC/DRUG OUTP REHAB INTRN LMT:MAX #VISTS |
| AOMXNVN |
1477 |
1479 |
ALC/DRUG OUTP REHAB:# MAX # VISITS |
| AOMXYRD |
1483 |
1487 |
ALC/DRUG OUTP REHAB:$ AMNT $ MAX/YR |
| AOMXYRI |
1464 |
1465 |
A/DRUG OUTP REHAB INTRN LIMT:$ MAX/YR |
| AOOOPO |
1446 |
1447 |
ALC/DRUG OUTP REHAB ALL LIMT:OOP LIMIT |
| AOOTHI |
1466 |
1467 |
ALC/DRUG OUTP REHAB INTRN LIMT:OTHR |
| APEXPED |
347 |
348 |
EXPEDITED PROCESS AVAILABLE-APPEAL |
| APINFO |
343 |
344 |
INFO PROVIDED-WHERE TO SEND APPEAL |
| APPEAL |
339 |
340 |
APPEAL PROCESS PROVIDED FOR 1ST LVL |
| APPEAL2L |
341 |
342 |
2ND+ LEVEL(S) OF APPEAL PROVIDED IF |
| APTIME |
345 |
346 |
TIME LIMITS SPECIFIED FOR THE APPEAL |
| ARALLO |
941 |
942 |
ALC/DRUG INPAT REHAB ALL LIMIT:ALL |
| ARCOIN |
982 |
983 |
ALC/DRUG INPAT REHAB TYPE COINS |
| ARCOINI |
953 |
954 |
ALC/DRUG INPAT REHAB INTRN LIMIT:COINS |
| ARCOINO |
945 |
946 |
ALC/DRUG INPAT REHB ALL LIMT:COINS/COPAY |
| ARCOINP |
984 |
986 |
ALC/DRUG INPAT REHAB % COINS |
| ARCOVI |
543 |
544 |
BNFT CVRG FOR ALC/DRUG INPAT REHAB-IN |
| ARCOVO |
565 |
566 |
BNFT CVRG FOR ALC/DRUG INPAT REHAB-OUT |
| ARDECYD |
973 |
976 |
A/D INPAT REHAB DED:AMT DED/CONFIN/YR |
| ARDEDCY |
963 |
964 |
ALC/DRUG INPAT REHAB TYPE DED:/CONFIN/YR |
| ARDEDDF |
965 |
966 |
ALC/DRUG INPAT REHAB TYPE DED:/DAY FIX |
| ARDEDDV |
967 |
968 |
ALC/DRUG INPAT REHAB TYPE DED:/DAY VARY |
| ARDEDDY |
969 |
970 |
A/D INPAT REHAB TYPE DED:#DAYS/CONFIN/YR |
| ARDEDFD |
977 |
979 |
A/D INP REHAB DED:AMNT DED/DAY FIX|VARY |
| ARDEDI |
951 |
952 |
ALC/DRUG INPAT REHAB INTRN LIMIT:DEDUCT |
| ARDEDNS |
971 |
972 |
ALC/DRUG INPAT REHAB TYPE DED:NOT SPEC |
| ARDEDO |
943 |
944 |
ALC/DRUG INPAT REHAB ALL LIMIT:DEDUCT |
| ARDEDYN |
980 |
981 |
A/D INPAT REHAB TYPE DED:#DAYS/CONFIN/YR |
| ARMAXCYN |
991 |
993 |
A/D INP REHB DAY MAX:MAX # DYS/CONFIN/YR |
| ARMAXDI |
959 |
960 |
ALC/DRUG INPAT REHAB INTRN LIMIT:$ MAX |
| ARMAXNI |
957 |
958 |
ALC/DRUG INPAT REHAB INTRN LIMIT:DAY MAX |
| ARMAXO |
949 |
950 |
ALC/DRUG INPAT REHAB ALL LIMIT:PLAN MAX |
| ARMXCY |
994 |
995 |
A/D INPAT REHAB TYPE $ MAX:/CONFIN/YR |
| ARMXCYD |
1000 |
1005 |
A/D INPT REHAB $ MAX:AMNT $MAX/CONFIN/YR |
| ARMXDY |
996 |
997 |
ALC/DRUG INPAT REHAB TYPE $ MAX:/DAY |
| ARMXDYD |
1006 |
1008 |
A/D INPAT REHAB TYPE $ MAX:AMNT $MAX/DAY |
| ARMXNS |
998 |
999 |
ALC/DRUG INPAT REHAB TYPE $ MAX:NOT SPEC |
| AROOPD |
987 |
990 |
ALC/DRUG INPAT REHAB AMNT OOP LIMIT: |
| AROOPI |
955 |
956 |
ALC/DRUG INPAT REHAB INTRN LIMT:OOP LIMT |
| AROOPO |
947 |
948 |
ALC/DRUG INPAT REHAB ALL LIMIT:OOP LIMIT |
| AROTHI |
961 |
962 |
ALC/DRUG INPAT REHAB INTRN LIMIT:OTHR |
| CCAUDIT |
301 |
302 |
COST CONTAIN:PENLTY 4 ER OUT OF NET |
| CCNONE |
291 |
292 |
COST CONTAIN: NONE |
| CCOTH |
307 |
308 |
COST CONTAIN: OTHR |
| CCOUTSUR |
305 |
306 |
COST CONTAIN: OUTPAT SURGRY INCENTV |
| CCPC |
293 |
294 |
COST CONTAIN: PREADM CERTIFICATION |
| CCPCCOIN |
315 |
316 |
PREADM CERT: COINS REDUCED |
| CCPCCOP |
317 |
318 |
PREADM CERT: COPAY INCREASED |
| CCPCDED |
313 |
314 |
PREADM CERT:DEDUCT IMPOSE/INCREASE |
| CCPCNOCV |
311 |
312 |
PREADM CERT: NO CVRG PROVIDED |
| CCPCNOPN |
309 |
310 |
PREADM CERT: NO PENALTY |
| CCPCNS |
321 |
322 |
PREADM CERT: NOT SPECIFIED |
| CCPCOTH |
319 |
320 |
PREADM CERT: OTHR |
| CCPRETST |
295 |
296 |
COST CONTAIN: PREADMISSION TESTING |
| CCSS |
303 |
304 |
COST CONTAIN: 2ND SURGICAL OPINION |
| CCSSCOIN |
329 |
330 |
PNLTY NO 2ND SURG OPIN: COINS REDUCED |
| CCSSCOP |
331 |
332 |
PNLTY NO 2ND SURG OPIN: COPAY INCREASED |
| CCSSDED |
327 |
328 |
PNLTY NO 2ND SURG OPIN: DEDUCT |
| CCSSLOW |
333 |
334 |
PNLTY NO 2ND SRG OPIN:LOWER SCHD PAYMNT |
| CCSSNOCV |
325 |
326 |
PNLTY NO 2ND SURG OPIN:NO CVRG PROVD |
| CCSSNOPN |
323 |
324 |
PNLTY NO 2ND SURG OPIN: NO PENALTY |
| CCSSNS |
337 |
338 |
PNLTY NO 2ND SURG OPIN: NOT SPECFD |
| CCSSOTH |
335 |
336 |
PNLTY NO 2ND SURG OPIN: OTHR |
| CCUTIL |
297 |
298 |
COST CONTAIN: UTILIZATION|CONCUR REVU |
| CCWKEND |
299 |
300 |
COST CONTAIN:NON-EMRG WEEKEND ADM |
| COICOPDI |
397 |
398 |
AMT COPAY 4 COINS/COPAY:COPA FIX|VARY-IN |
| COICOPDO |
404 |
405 |
AMT COPA 4 COINS/COPAY:COPA FIX|VARY-OUT |
| COICOPI |
392 |
393 |
TYPE COINS/COPAY-IN |
| COICOPO |
399 |
400 |
TYPE COINS/COPAY-OUT |
| COICOPPI |
394 |
396 |
% COINS 4 COINS/COPAY:COINS FIX|VARY-IN |
| COICOPPO |
401 |
403 |
% COINS 4 COINS/COPAY:COINS FIX|VARY-OUT |
| COVCOUNT |
217 |
217 |
NUMBER OF POLICIES COVERING PERSON |
| DEDFDI |
359 |
363 |
FAM DEDUCT:/YR|$ AMNT VARY BY ERNGS-IN |
| DEDFDO |
379 |
383 |
FAMILY DEDUCT:/YR|$ AMT VARY-ERNGS-OUT |
| DEDFPCTI |
368 |
369 |
FAM DEDUCT:PERCENT OF EARNINGS-IN |
| DEDFPCTO |
388 |
389 |
FAMILY DEDUCT:PERCENT OF EARNINGS-OUT |
| DEDI |
353 |
354 |
TYPE DEDUCT-IN |
| DEDIDI |
355 |
358 |
INDIV DEDUCT:/YR|$ AMNT VARY BY ERNGS-IN |
| DEDIDO |
374 |
378 |
INDIV DEDUCT:/YR|$ AMT VARY BY ERNGS-OUT |
| DEDINUMO |
390 |
391 |
# INDIV FOR DEDUCT:% OF EARNINGS-OUT |
| DEDIPCTI |
366 |
367 |
INDIV DEDUCT: PERCENT OF EARNINGS-IN |
| DEDIPCTO |
386 |
387 |
INDIV DEDUCT:PERCENT OF EARNINGS-OUT |
| DEDNUMDI |
364 |
365 |
# INDV 4 DEDUC:/YR|$ AMT VARY-ERNGS-IN |
| DEDNUMDO |
384 |
385 |
# INDV 4 DEDUCT:/YR|$ AMT VARY-ERNGS-OUT |
| DEDNUMPI |
370 |
371 |
# INDIV FOR DEDUCT:% OF EARNINGS-IN |
| DEDO |
372 |
373 |
TYPE DEDUCT-OUT |
| DENTAL |
265 |
266 |
DENTAL CVRG PROVIDED |
| DEPNDNT |
51 |
51 |
DEPENDENT OF POLICYHOLDER |
| DNCR1CIP |
1769 |
1771 |
CRWN/PROS:% COINS (PROV 1) |
| DNCR1CPD |
1772 |
1774 |
CRWN/PROS:AMNT COPAY /PROC|/VST (P 1) |
| DNCR1CV |
1767 |
1768 |
BNFT CVRG FOR CRWN/PROS (PROV 1) |
| DNCR1DSD |
1778 |
1779 |
CRWN/PROS:AMNT NEGOTIATED DISCNT (P 1) |
| DNCR1FED |
1775 |
1777 |
CRWN/PROS:AMNT FEE SCHD SPEC PROC (P 1) |
| DNCR2CIP |
1782 |
1783 |
CRWN/PROS:% COINS (PROV 2) |
| DNCR2CPD |
1784 |
1785 |
CRWN/PROS:AMNT COPAY /PROC|/VST (P 2) |
| DNCR2CV |
1780 |
1781 |
BNFT CVRG FOR CRWN/PROS (PROV 2) |
| DNCR2DSD |
1789 |
1790 |
CRWN/PROS:AMNT NEGOTIATED DISCNT (P 2) |
| DNCR2FED |
1786 |
1788 |
CRWN/PROS:AMNT FEE SCHD SPEC PROC (P 2) |
| DNDED |
1619 |
1620 |
DENTAL DEDUCT |
| DNDEDALL |
1630 |
1631 |
DNTL SRVCS SUBJ 2 DEDUCT:ALL COVRD SRVCS |
| DNDEDCR |
1642 |
1643 |
DENTL SRVCS SUBJ 2 DEDUCT:CRWN/PROS |
| DNDEDEN |
1640 |
1641 |
DENTL SRVCS SUBJ 2 DEDUCT:ENDO |
| DNDEDEX |
1632 |
1633 |
DENTL SRVCS SUBJ 2 DEDUCT:EXAM,XRAY |
| DNDEDFD |
1624 |
1627 |
AMNT FAMILY DEDUCT |
| DNDEDFL |
1636 |
1637 |
DENTL SRVCS SUBJ 2 DEDUCT:FILLINGS |
| DNDEDID |
1621 |
1623 |
AMNT INDIV DEDUCT |
| DNDEDN |
1628 |
1629 |
# INDIV FOR DENTAL DEDUCT |
| DNDEDOR |
1644 |
1645 |
DENTL SRVCS SUBJ 2 DEDUCT:ORTHODONTIA |
| DNDEDPR |
1638 |
1639 |
DENTL SRVCS SUBJ 2 DEDUCT:PERIO |
| DNDEDSR |
1634 |
1635 |
DENTL SRVCS SUBJ 2 DEDUCT:SURGERY |
| DNDETAIL |
1617 |
1618 |
DETAILS PROVIDED FOR DENTAL CVRG |
| DNEN1CIP |
1745 |
1747 |
ENDO:% COINS (PROV 1) |
| DNEN1CPD |
1748 |
1750 |
ENDO:AMNT COPAY /PROC OR /VST (P 1) |
| DNEN1CV |
1743 |
1744 |
BNFT CVRG FOR ENDO (PROV 1) |
| DNEN1DSD |
1754 |
1755 |
ENDO:AMNT NEGOTIATED DISCNT (PROV 1) |
| DNEN1FED |
1751 |
1753 |
ENDO:AMNT FEE SCHD SPEC PROC (P 1) |
| DNEN2CIP |
1758 |
1759 |
ENDO:% COINS (PROV 2) |
| DNEN2CPD |
1760 |
1761 |
ENDO:AMNT COPAY /PROC OR /VST (PRV 2) |
| DNEN2CV |
1756 |
1757 |
BNFT CVRG FOR ENDO (PROV 2) |
| DNEN2DSD |
1765 |
1766 |
ENDO:AMNT NEGOTIATED DISCNT (PROV 2) |
| DNEN2FED |
1762 |
1764 |
ENDO:AMNT FEE SCHD SPEC PROC (PRV 2) |
| DNEX1CIP |
1654 |
1656 |
EXAM,XRAY,CLEAN:% COINS (PROV 1) |
| DNEX1CPD |
1657 |
1658 |
EXAM,XRAY:AMNT COPAY /PROC|/VST (P 1) |
| DNEX1CV |
1652 |
1653 |
BNFT CVRG FOR EXAM,XRAY,CLEAN (P 1) |
| DNEX1DSD |
1661 |
1662 |
EXAM,XRAY:AMNT NEGOTIATED DISCNT (P 1) |
| DNEX1FED |
1659 |
1660 |
EXAM,XRAY:AMNT FEE SCHD SPEC PROC (P 1) |
| DNEX2CIP |
1665 |
1667 |
EXAM,XRAY,CLEAN:% COINS (PROV 2) |
| DNEX2CPD |
1668 |
1669 |
EXAM,XRAY:AMNT COPAY /PROC|/VST (P 2) |
| DNEX2CV |
1663 |
1664 |
BNFT CVRG FOR EXAM,XRAY,CLEAN (PROV 2) |
| DNEX2DSD |
1672 |
1673 |
EXAM,XRAY:AMNT NEGOTIATED DISCNT (P 2) |
| DNEX2FED |
1670 |
1671 |
EXAM,XRAY:AMNT FEE SCHD SPEC PROC (P 2) |
| DNFL1CIP |
1699 |
1701 |
FILLINGS:% COINS (PROV 1) |
| DNFL1CPD |
1702 |
1703 |
FILLINGS:AMNT COPAY /PROC|/VST (P 1) |
| DNFL1CV |
1697 |
1698 |
BNFT CVRG FOR FILLINGS (PROV 1) |
| DNFL1DSD |
1707 |
1708 |
FILLINGS:AMNT NEGOTIATED DISCNT (P 1) |
| DNFL1FED |
1704 |
1706 |
FILLINGS:AMNT FEE SCHD SPEC PROC (P 1) |
| DNFL2CIP |
1711 |
1713 |
FILLINGS:% COINS (PROV 2) |
| DNFL2CPD |
1714 |
1715 |
FILLINGS:AMNT COPAY /PROC|/VST (P 2) |
| DNFL2CV |
1709 |
1710 |
BNFT CVRG FOR FILLINGS (PROV 2) |
| DNFL2DSD |
1718 |
1719 |
FILLINGS:AMNT NEGOTIATED DISCNT (P 2) |
| DNFL2FED |
1716 |
1717 |
FILLINGS:AMNT FEE SCHD SPEC PROC (P 2) |
| DNMAX |
1646 |
1647 |
YEARLY DENTAL MAX |
| DNMAXD |
1648 |
1651 |
AMNT YEARLY DENTAL MAX |
| DNORTH |
1615 |
1616 |
ORTHODONTIA CVRG |
| DNPR1CIP |
1722 |
1724 |
PERIO:% COINS (PROV 1) |
| DNPR1CPD |
1725 |
1727 |
PERIO:AMNT COPAY /PROC OR /VST (P 1) |
| DNPR1CV |
1720 |
1721 |
BNFT CVRG FOR PERIO (PROV 1) |
| DNPR1DSD |
1731 |
1732 |
PERIO:AMNT NEGOTIATED DISCNT (PROV 1) |
| DNPR1FED |
1728 |
1730 |
PERIO:AMNT FEE SCHD SPEC PROC (P 1) |
| DNPR2CIP |
1735 |
1736 |
PERIO:% COINS (PROV 2) |
| DNPR2CPD |
1737 |
1738 |
PERIO:AMNT COPAY /PROC OR /VST (P 2) |
| DNPR2CV |
1733 |
1734 |
BNFT CVRG FOR PERIO (PROV 2) |
| DNPR2DSD |
1741 |
1742 |
PERIO:AMNT NEGOTIATED DISCNT (PROV 2) |
| DNPR2FED |
1739 |
1740 |
PERIO:AMNT FEE SCHD SPEC PROC (P 2) |
| DNPREV |
1613 |
1614 |
PREVENTIVE DENTAL CARE CVRG |
| DNPROV |
1611 |
1612 |
TYPE DENTAL PROVIDER |
| DNSR1CIP |
1676 |
1678 |
SURGERY:% COINS (PROV 1) |
| DNSR1CPD |
1679 |
1680 |
SURGERY:AMNT COPAY /PROC|/VST (P 1) |
| DNSR1CV |
1674 |
1675 |
BNFT CVRG FOR SURGERY (PROV 1) |
| DNSR1DSD |
1684 |
1685 |
SURGERY:AMNT NEGOTIATED DISCNT (P 1) |
| DNSR1FED |
1681 |
1683 |
SURGERY:AMNT FEE SCHD SPEC PROC (P 1) |
| DNSR2CIP |
1688 |
1690 |
SURGERY:% COINS (PROV 2) |
| DNSR2CPD |
1691 |
1692 |
SURGERY:AMNT COPAY /PROC|/VST (P 2) |
| DNSR2CV |
1686 |
1687 |
BNFT CVRG FOR SURGERY (PROV 2) |
| DNSR2DSD |
1695 |
1696 |
SURGERY:AMNT NEGOTIATED DISCNT (P 2) |
| DNSR2FED |
1693 |
1694 |
SURGERY:AMNT FEE SCHD SPEC PROC (P 2) |
| DRALLOB |
1534 |
1535 |
OUTPAT PMEDS ALL LIMIT:ALL (BRAND) |
| DRALLOG |
1573 |
1574 |
OUTP PMEDS ALL LIMIT:ALL (GEN) |
| DRCOINIB |
1546 |
1547 |
OUTP PMEDS INTRN LIMIT:COINS (BRAND) |
| DRCOINIG |
1585 |
1586 |
OUTP PMEDS INTRN LIMT:COINS (GEN) |
| DRCOINOB |
1538 |
1539 |
OUTPAT PMEDS ALL LIMIT:COINS (BRAND) |
| DRCOINOG |
1577 |
1578 |
OUTP PMEDS ALL LIMIT:COINS (GEN) |
| DRCOINPB |
1563 |
1565 |
% COINS (BRAND) |
| DRCOINPG |
1601 |
1603 |
% COINS (GENERIC) |
| DRCOPDB |
1566 |
1567 |
AMNT COPAY PER PRESCRIPTION (BRAND) |
| DRCOPDG |
1604 |
1605 |
AMNT COPAY PER PRESCRIPTION (GEN) |
| DRCOPIB |
1548 |
1549 |
OUTP PMEDS INTRN LMT:COPAY/SCRIPT(BRAND) |
| DRCOPIG |
1587 |
1588 |
OUTP PMEDS INTRN LMT:COPAY/SCRIPT(GEN) |
| DRDEDFDB |
1558 |
1560 |
AMNT FAMILY DEDUCT/YR (BRAND) |
| DRDEDFDG |
1596 |
1598 |
AMNT FAMILY DEDUCT/YR (GENERIC) |
| DRDEDIB |
1544 |
1545 |
OUTP PMEDS INTRN LIMIT:DEDUCT/YR (BRAND) |
| DRDEDIDB |
1554 |
1557 |
AMNT INDIV DEDUCT/YR (BRAND) |
| DRDEDIDG |
1593 |
1595 |
AMNT INDIV DEDUCT/YR (GENERIC) |
| DRDEDIG |
1583 |
1584 |
OUTP PMEDS INTRN LIMT:DEDUCT/YR (GEN) |
| DRDEDNB |
1561 |
1562 |
# INDIV FOR DEDUCT/YR (BRAND) |
| DRDEDNG |
1599 |
1600 |
# INDIV FOR DEDUCT/YR (GENERIC) |
| DRDEDOB |
1536 |
1537 |
OUTPAT PMEDS ALL LIMIT:DEDUCT (BRAND) |
| DRDEDOG |
1575 |
1576 |
OUTP PMEDS ALL LIMIT:DEDUCT (GEN) |
| DRFORMUL |
1532 |
1533 |
FORMULARY DRUGS |
| DRGCOV |
185 |
186 |
DRUG COVERAGE INDICATOR |
| DRGDEDI |
187 |
190 |
DRUG INDIVIDUAL DEDUCTIBLE |
| DRGINOOP |
215 |
216 |
FLAG: DRUGS INCLUDED IN OOP LIMIT? |
| DRGMAXIL |
207 |
214 |
DRUG LIFETIME MAXIMUM |
| DRGMAXIY |
198 |
204 |
DRUG ANNUAL MAXIMUM |
| DRGPAYT |
196 |
197 |
DRUG PAYMENT TYPE |
| DRGRATE |
193 |
195 |
DRUG COINSURANCE RATE |
| DRMAIL |
1528 |
1529 |
MAIL ORDER DRUGS |
| DRMAXDB |
1568 |
1572 |
AMNT $ LIMIT/YR (BRAND) |
| DRMAXDG |
1606 |
1610 |
AMNT $ LIMIT/YR. (GENERIC) |
| DRMAXIB |
1550 |
1551 |
OUTP PMEDS INTRN LIMIT:$ MAX/YR (BRAND) |
| DRMAXIG |
1589 |
1590 |
OUTP PMEDS INTRN LIMT:$ MAX/YR (GEN) |
| DRMAXOB |
1542 |
1543 |
OUTP PMEDS ALL LIMIT:PLAN MAX (BRAND) |
| DRMAXOG |
1581 |
1582 |
OUTP PMEDS ALL LIMT:PLAN MAX (GEN) |
| DROOPOB |
1540 |
1541 |
OUTP PMEDS ALL LIMIT:OOP LIMIT (BRAND) |
| DROOPOG |
1579 |
1580 |
OUTP PMEDS ALL LIMT:OOP LIMT (GEN) |
| DROTHIB |
1552 |
1553 |
OUTP PMEDS INTRN LIMIT:OTHR (BRAND) |
| DROTHIG |
1591 |
1592 |
OUTP PMEDS INTRN LIMIT:OTHR (GEN) |
| DRPP |
1530 |
1531 |
PARTICIPATING PHARMACIES |
| DRUGCOVB |
1524 |
1525 |
BNFT CVRG FOR OUTPAT PMEDS (BRAND) |
| DRUGCOVG |
1526 |
1527 |
BNFT CVRG FOR OUTPAT PMEDS (GEN) |
| DRUGS |
263 |
264 |
PRESCRIPTION DRUG CVRG PROVIDED |
| DRVCOV |
148 |
149 |
PHYSICIAN OFF. VIS. COVERAGE INDICATOR |
| DRVDEDI |
150 |
153 |
PHYSICIAN OFF. VIS. IND. DEDUCTIBLE |
| DRVMAXIL |
170 |
177 |
PHYSICIAN OFF. VIS. LIFETIME MAXIMUM |
| DRVMAXIY |
161 |
167 |
PHYSICIAN OFF. VIS. ANNUAL MAXIMUM |
| DRVMAXVS |
178 |
184 |
PHYSICIAN OFF. VIS. MAX VISITS / YEAR |
| DRVPAYT |
159 |
160 |
PHYSICIAN OFF. VIS. PAYMENT TYPE |
| DRVRATE |
156 |
158 |
PHYSICIAN OFF. VIS. COINSURANCE RATE |
| DUID |
1 |
5 |
DWELLING UNIT ID |
| DUPERSID |
9 |
16 |
PERSON ID (DUID+PID) |
| EPRSIDX |
28 |
49 |
ESTABLISHMENT ID + POLICYHOLDER ID |
| ESTBIDX |
17 |
27 |
ESTABLISHMENT ID |
| FDEDIO_D |
191 |
192 |
FLAG: DRUG. DED. INTERNAL / OVERALL |
| FDEDIO_H |
111 |
112 |
FLAG: HOSP. DED. INTERNAL / OVERALL |
| FDEDIO_P |
154 |
155 |
FLAG: PHYS. DED. INTERNAL / OVERALL |
| FMAXIO_D |
205 |
206 |
FLAG: DRUG. ANN. MAX INTERNAL / OVERALL |
| FMAXIO_H |
125 |
126 |
FLAG: HOSP. ANN. MAX INTERNAL / OVERALL |
| FMAXIO_P |
168 |
169 |
FLAG: PHYS. ANN. MAX INTERNAL / OVERALL |
| FOOP_H |
139 |
140 |
FLAG: HOSP OOP INTERNAL / OVERALL |
| GAPA |
1490 |
1491 |
PART A BNFT |
| GAPA1COP |
1492 |
1493 |
PART A BNFT:HOSP COPAY - DAYS 61-90 |
| GAPA2COP |
1494 |
1495 |
PART A BNFT:HOSP COPAY - DAYS 91-150 |
| GAPA3COP |
1496 |
1497 |
PART A BNFT:HOSP COPAY GT 150 DAYS |
| GAPADED |
1500 |
1501 |
PART A BNFT:DEDUCT |
| GAPASNF |
1498 |
1499 |
PART A BNFT:SNF COPAY - DAYS 21-100 |
| GAPB |
1502 |
1503 |
PART B BNFT |
| GAPB1COI |
1508 |
1509 |
PART B BNFT:COINS, W/OUT ADDTL DEDUCT |
| GAPB2COI |
1510 |
1511 |
PART B BNFT:COINS, W/ ADDTL DEDUCT |
| GAPB3COI |
1512 |
1513 |
PART B BNFT:COINS-OUTPAT MNTL HLTH |
| GAPBDED |
1506 |
1507 |
PART B BNFT:DEDUCT |
| GAPBEXC |
1504 |
1505 |
PART B BNFT:EXCESS CHARGE |
| GAPOTH |
1514 |
1515 |
OTHR BNFT |
| GAPOTHBL |
1516 |
1517 |
OTHR BNFT:BLOOD DEDUCT |
| GAPOTHHM |
1520 |
1521 |
OTHR BNFT:AT-HOME RECOVERY |
| GAPOTHPR |
1522 |
1523 |
OTHR BNFT:PREVENTIVE MEDICAL CARE |
| GAPOTHTR |
1518 |
1519 |
OTHR BNFT:FOREIGN TRAVL BNFT-MED EMRG |
| GAPTYPE |
1488 |
1489 |
TYPE MEDIGAP PLAN |
| GATEKEEP |
275 |
276 |
REQUIRE PRIM-CARE DR-REFER SPECIALIST |
| GATELEV |
277 |
278 |
LEVEL(S):REQ PRIM-CARE DR-REFER SPCLST |
| HHALLO |
1344 |
1345 |
HOME HEALTH CARE ALL LIMIT:ALL |
| HHCOIFI |
1356 |
1357 |
HOME HEALTH CARE INTRN LIMIT:COINS FIX |
| HHCOINO |
1348 |
1349 |
HOME HEALTH CARE ALL LIMIT:COINS/COPAY |
| HHCOINP |
1375 |
1377 |
HOME HEALTH CARE:% COINS FIX|VARY |
| HHCOIVI |
1358 |
1359 |
HOME HEALTH CARE INTRN LIMIT:COINS VARY |
| HHCOPD |
1378 |
1379 |
HOME HEALTH CARE:AMNT COPAY/VST FIX|VARY |
| HHCOPFI |
1360 |
1361 |
HOME HLTH CARE INTRN LMT:COPAY/VST FIX |
| HHCOPVI |
1362 |
1363 |
HOME HLTH CARE INTRN LMT:COPAY/VST VARY |
| HHCOVI |
535 |
536 |
BNFT CVRG FOR HOME HEALTH CARE-IN |
| HHCOVO |
557 |
558 |
BNFT CVRG FOR HOME HEALTH CARE-OUT |
| HHDEDD |
1372 |
1374 |
HOME HEALTH CARE:AMNT DEDUCT/YR |
| HHDEDI |
1354 |
1355 |
HOME HEALTH CARE INTRN LIMIT:DEDUCT/YR |
| HHDEDO |
1346 |
1347 |
HOME HEALTH CARE ALL LIMIT:DEDUCT |
| HHMAXO |
1352 |
1353 |
HOME HEALTH CARE ALL LIMIT:PLAN MAX |
| HHMXDVD |
1384 |
1386 |
HOME HEALTH CARE:$ AMNT $ MAX /VST |
| HHMXDVI |
1366 |
1367 |
HOME HEALTH CARE INTRN LIMIT:$ MAX /VST |
| HHMXNVI |
1364 |
1365 |
HOME HEALTH CARE INTRN LIMIT:MAX #VISTS |
| HHMXNVN |
1380 |
1383 |
HOME HEALTH CARE:# MAX # VISITS |
| HHMXYRD |
1387 |
1391 |
HOME HEALTH CARE:$ AMNT $ MAX/YR |
| HHMXYRI |
1368 |
1369 |
HOME HEALTH CARE INTRN LIMIT:$ MAX/YR |
| HHOOPO |
1350 |
1351 |
HOME HEALTH CARE ALL LIMIT:OOP LIMIT |
| HHOTHI |
1370 |
1371 |
HOME HEALTH CARE INTRN LIMIT:OTHR |
| HMOFEDQ |
283 |
284 |
HMO FEDERALLY QUALIFIED |
| HMOMODEL |
281 |
282 |
HMO MODEL TYPE |
| HOSPCOV |
104 |
105 |
HOSPITAL R / B COVERAGE INDICATOR |
| HOSPDEDI |
106 |
110 |
HOSPITAL R / B INDIVIDUAL DEDUCTIBLE |
| HOSPMAXL |
127 |
134 |
HOSPITAL R / B LIFETIME MAXIMUM |
| HOSPMAXY |
118 |
124 |
HOSPITAL R / B ANNUAL MAXIMUM |
| HOSPMOOP |
135 |
138 |
HOSPITAL R / B INTERNAL OOP MAXIMUM |
| HOSPPAYT |
116 |
117 |
HOSPITAL R / B PAYMENT TYPE |
| HOSPRATE |
113 |
115 |
HOSPITAL R / B COINSURANCE RATE |
| HSALLOI |
669 |
670 |
HOSP R/B ALL LIMIT:ALL-IN |
| HSALLOO |
736 |
737 |
HOSP R/B ALL LIMIT:ALL-OUT |
| HSCOINI |
709 |
710 |
HOSP R/B TYPE COINS-IN |
| HSCOINII |
681 |
682 |
HOSP R/B INTRN LIMIT:COINS-IN |
| HSCOINIO |
748 |
749 |
HOSP R/B INTRN LIMIT:COINS-OUT |
| HSCOINO |
777 |
778 |
HOSP R/B TYPE COINS-OUT |
| HSCOINOI |
673 |
674 |
HOSP R/B ALL LIMIT:COINS/COPAY-IN |
| HSCOINOO |
740 |
741 |
HOSP R/B ALL LIMIT:COINS/COPAY-OUT |
| HSCOINPI |
711 |
713 |
HOSP R/B % COINS-IN |
| HSCOINPO |
779 |
781 |
HOSP R/B % COINS-OUT |
| HSCOVI |
525 |
526 |
BNFT CVRG FOR HOSP R/B-IN |
| HSCOVO |
547 |
548 |
BNFT CVRG FOR HOSP R/B-OUT |
| HSDECYDI |
701 |
703 |
HSP R/B TYP DEDUC:AMT DEDUC/CONFIN/YR-IN |
| HSDECYDO |
768 |
771 |
HSP RB TYP DED:AMNT DEDUC/CONFIN/YR-OUT |
| HSDEDCYI |
691 |
692 |
HOSP R/B TYPE DEDUCT:/CONFIN/YEAR-IN |
| HSDEDCYO |
758 |
759 |
HOSP R/B TYPE DEDUCT:/CONFIN/YEAR-OUT |
| HSDEDDFI |
693 |
694 |
HOSP R/B TYPE DEDUCT:/DAY FIX-IN |
| HSDEDDFO |
760 |
761 |
HOSP R/B TYPE DEDUCT:/DAY FIX-OUT |
| HSDEDDVI |
695 |
696 |
HOSP R/B TYPE DEDUCT:/DAY VARY-IN |
| HSDEDDVO |
762 |
763 |
HOSP R/B TYPE DEDUCT:/DAY VARY-OUT |
| HSDEDDYI |
697 |
698 |
HOSP R/B TYPE DEDUCT:# DAYS/CONFIN/YR-IN |
| HSDEDDYO |
764 |
765 |
HSP R/B TYPE DEDUCT:# DAYS/CONFIN/YR-OUT |
| HSDEDFDI |
704 |
706 |
HSP RB TYP DEDUC:AMT DED/DAY FIX|VARY-IN |
| HSDEDFDO |
772 |
774 |
HSP RB TYP DED:AMT DED/DAY FIX|VARY-OUT |
| HSDEDII |
679 |
680 |
HOSP R/B INTRN LIMIT:DEDUCT-IN |
| HSDEDIO |
746 |
747 |
HOSP R/B INTRN LIMIT:DEDUCT-OUT |
| HSDEDNSI |
699 |
700 |
HOSP R/B TYPE DEDUCT:NOT SPECIFIED-IN |
| HSDEDNSO |
766 |
767 |
HOSP R/B TYPE DEDUCT:NOT SPECIFIED-OUT |
| HSDEDOI |
671 |
672 |
HOSP R/B ALL LIMIT:DEDUCT-IN |
| HSDEDOO |
738 |
739 |
HOSP R/B ALL LIMIT:DEDUCT-OUT |
| HSDEDYNI |
707 |
708 |
HOSP R/B TYPE DEDUCT:# DAYS/CONFIN/YR-IN |
| HSDEDYNO |
775 |
776 |
HSP R/B TYPE DEDUCT:# DAYS/CONFIN/YR-OUT |
| HSMAXDII |
687 |
688 |
HOSP R/B INTRN LIMIT:$ MAX-IN |
| HSMAXDIO |
754 |
755 |
HOSP R/B INTRN LIMIT:$ MAX-OUT |
| HSMAXNII |
685 |
686 |
HOSP R/B INTRN LIMIT:DAY MAX-IN |
| HSMAXNIO |
752 |
753 |
HOSP R/B INTRN LIMIT:DAY MAX-OUT |
| HSMAXOI |
677 |
678 |
HOSP R/B ALL LIMIT:PLAN MAX-IN |
| HSMAXOO |
744 |
745 |
HOSP R/B ALL LIMIT:PLAN MAX-OUT |
| HSMXCYDI |
727 |
732 |
HSP R/B TYP $ MAX:AMT $ MAX/CONFIN/YR-IN |
| HSMXCYDO |
795 |
800 |
HSP RB TYP $MAX:AMNT $MAX/CONFIN/YR-OUT |
| HSMXCYI |
721 |
722 |
HOSP R/B TYPE $ MAX:/CONFIN/YEAR-IN |
| HSMXCYNI |
718 |
720 |
HOSP R/B DAY MAX:MAX # DAYS/CONFIN/YR-IN |
| HSMXCYNO |
786 |
788 |
HSP RB DAY MAX:MAX # DAYS/CONFIN/YR-OUT |
| HSMXCYO |
789 |
790 |
HOSP R/B TYPE $ MAX:/CONFIN/YEAR-OUT |
| HSMXDYDI |
733 |
735 |
HOSP R/B TYPE $ MAX:AMT $ MAX/DAY-IN |
| HSMXDYDO |
801 |
804 |
HSP RB TYPE $ MAX: AMNT $ MAX /DAY-OUT |
| HSMXDYI |
723 |
724 |
HOSP R/B TYPE $ MAX:/DAY-IN |
| HSMXDYO |
791 |
792 |
HOSP R/B TYPE $ MAX:/DAY-OUT |
| HSMXNSI |
725 |
726 |
HOSP R/B TYPE $ MAX:NOT SPECIFIED-IN |
| HSMXNSO |
793 |
794 |
HOSP R/B TYPE $ MAX:NOT SPECIFIED-OUT |
| HSOOPDI |
714 |
717 |
HOSP R/B AMNT OOP LIMIT-IN |
| HSOOPDO |
782 |
785 |
HOSP R/B AMNT OOP LIMIT-OUT |
| HSOOPII |
683 |
684 |
HOSP R/B INTRN LIMIT:OOP LIMIT-IN |
| HSOOPIO |
750 |
751 |
HOSP R/B INTRN LIMIT:OOP LIMIT-OUT |
| HSOOPOI |
675 |
676 |
HOSP R/B ALL LIMIT:OOP LIMIT-IN |
| HSOOPOO |
742 |
743 |
HOSP R/B ALL LIMIT:OOP LIMIT-OUT |
| HSOTHII |
689 |
690 |
HOSP R/B INTRN LIMIT:OTHR-IN |
| HSOTHIO |
756 |
757 |
HOSP R/B INTRN LIMIT:OTHR-OUT |
| HSPMAXNT |
141 |
147 |
HOSPITAL R / B MAX NIGHTS / YEAR |
| ICIMP |
258 |
258 |
FLAG: RECORD IMPUTED USING IC DATA |
| IDRGDEDI |
252 |
253 |
IMPUTATION FLAG FOR DRGDEDI |
| IDRGMAXL |
256 |
257 |
IMPUTATION FLAG FOR DRGMAXIL |
| IDRGMAXY |
254 |
255 |
IMPUTATION FLAG FOR DRGMAXIY |
| IDRGRATE |
250 |
251 |
IMPUTATION FLAG FOR DRGRATE |
| IDRVDEDI |
242 |
243 |
IMPUTATION FLAG FOR DRVDEDI |
| IDRVMAXL |
248 |
249 |
IMPUTATION FLAG FOR DRVMAXIL |
| IDRVMAXY |
246 |
247 |
IMPUTATION FLAG FOR DRVMAXIY |
| IDRVRATE |
244 |
245 |
IMPUTATION FLAG FOR DRVRATE |
| IHSPDEDI |
234 |
235 |
IMPUTATION FLAG FOR HOSPDEDI |
| IHSPMAXL |
240 |
241 |
IMPUTATION FLAG FOR HOSPMAXY |
| IHSPMAXY |
238 |
239 |
IMPUTATION FLAG FOR HOSPMAXL |
| IHSPMOOP |
236 |
237 |
IMPUTATION FLAG FOR HOSPMOOP |
| IHSPRATE |
232 |
233 |
IMPUTATION FLAG FOR HOSPRATE |
| IOVDEDF |
220 |
221 |
IMPUTATION FLAG FOR OVDEDF |
| IOVDEDI |
218 |
219 |
IMPUTATION FLAG FOR ODEDDI |
| IOVMAXIL |
226 |
227 |
IMPUTATION FLAG FOR OVMAXIL |
| IOVMAXIY |
224 |
225 |
IMPUTATION FLAG FOR OVMAXIY |
| IOVMOOPF |
230 |
231 |
IMPUTATION FLAG FOR OVMOOPF |
| IOVMOOPI |
228 |
229 |
IMPUTATION FLAG FOR OVMOOPI |
| IOVRATE |
222 |
223 |
IMPUTATION FLAG FOR OVRATE |
| ISALLOI |
1009 |
1010 |
INPAT SURGERY ALL LIMIT:ALL-IN |
| ISALLOO |
1062 |
1063 |
INPAT SURGERY ALL LIMIT:ALL-OUT |
| ISCOINII |
1021 |
1022 |
INPAT SURGERY INTRN LIMIT:COINS-IN |
| ISCOINIO |
1074 |
1075 |
INPAT SURGERY INTRN LIMIT:COINS-OUT |
| ISCOINOI |
1013 |
1014 |
INPAT SURGERY ALL LIMIT:COINS/COPAY-IN |
| ISCOINOO |
1066 |
1067 |
INPAT SURGERY ALL LIMIT:COINS/COPAY-OUT |
| ISCOINPI |
1032 |
1034 |
INPAT SURGERY:% COINS-IN |
| ISCOINPO |
1085 |
1087 |
INPAT SURGERY:% COINS-OUT |
| ISCOPDI |
1035 |
1037 |
INPAT SURGERY:AMNT COPAY-IN |
| ISCOPDO |
1088 |
1090 |
INPAT SURGERY:AMNT COPAY-OUT |
| ISCOPII |
1023 |
1024 |
INPAT SURGERY INTRN LIMIT:COPAY-IN |
| ISCOPIO |
1076 |
1077 |
INPAT SURGERY INTRN LIMIT:COPAY-OUT |
| ISCOVI |
527 |
528 |
BNFT CVRG FOR INPAT SURGERY-IN |
| ISCOVO |
549 |
550 |
BNFT CVRG FOR INPAT SURGERY-OUT |
| ISDEDDI |
1029 |
1031 |
INPAT SURGERY:AMNT DEDUCT-IN |
| ISDEDII |
1019 |
1020 |
INPAT SURGERY INTRN LIMIT:DEDUCT-IN |
| ISDEDIO |
1072 |
1073 |
INPAT SURGERY INTRN LIMIT:DEDUCT-OUT |
| ISDEDNO |
1082 |
1084 |
INPAT SURGERY:AMNT DEDUCT-OUT |
| ISDEDOI |
1011 |
1012 |
INPAT SURGERY ALL LIMIT:DEDUCT-IN |
| ISDEDOO |
1064 |
1065 |
INPAT SURGERY ALL LIMIT:DEDUCT-OUT |
| ISMAXII |
1025 |
1026 |
INPAT SURGERY INTRN LIMIT:$ MAX-IN |
| ISMAXIO |
1078 |
1079 |
INPAT SURGERY INTRN LIMIT:$ MAX-OUT |
| ISMAXOI |
1017 |
1018 |
INPAT SURGERY ALL LIMIT:PLAN MAX-IN |
| ISMAXOO |
1070 |
1071 |
INPAT SURGERY ALL LIMIT:PLAN MAX-OUT |
| ISMXCYDI |
1046 |
1050 |
INPAT SRGRY $ MAX:AMT $MAX/CONFIN/YR-IN |
| ISMXCYDO |
1099 |
1103 |
INPAT SRGY $ MAX:AMT $MAX/CONFIN/YR-OUT |
| ISMXCYI |
1038 |
1039 |
INPAT SURGERY TYPE $ MAX:/CONFIN/YEAR-IN |
| ISMXCYO |
1091 |
1092 |
INPAT SURGERY TYPE $ MAX:/CONFIN/YR-OUT |
| ISMXFE1I |
1056 |
1058 |
INPAT SRGRY TYPE $MAX:AMT $MAX:APPEND-IN |
| ISMXFE1O |
1106 |
1107 |
INPAT SRGY TYP $ MAX:AMT $MAX:APPEND-OUT |
| ISMXFE2I |
1059 |
1061 |
INPAT SRGY $ MAX:AMT $MAX:ING HERNIA-IN |
| ISMXFE2O |
1108 |
1109 |
INPAT SRGY $ MAX:AMT $MAX:ING HERNIA-OUT |
| ISMXFEI |
1042 |
1043 |
INPAT SURGERY TYPE $ MAX:FEE SCHD-IN |
| ISMXFEO |
1095 |
1096 |
INPAT SURGERY TYPE $ MAX:FEE SCHD-OUT |
| ISMXNSI |
1044 |
1045 |
INPAT SURGERY TYPE $ MAX:NOT SPECFD-IN |
| ISMXNSO |
1097 |
1098 |
INPAT SURGERY TYPE $ MAX:NOT SPECFD-OUT |
| ISMXSRDI |
1051 |
1055 |
INPAT SRGRY TYPE $ MAX:AMT $MAX/SURG-IN |
| ISMXSRDO |
1104 |
1105 |
INPAT SRGY TYPE $ MAX:AMT $MAX:SRGY-OUT |
| ISMXSRI |
1040 |
1041 |
INPAT SURGERY TYPE $ MAX:PER SURGERY-IN |
| ISMXSRO |
1093 |
1094 |
INPAT SURGERY TYPE $ MAX:PER SRGERY-OUT |
| ISOOPOI |
1015 |
1016 |
INPAT SURGERY ALL LIMIT:OOP LIMIT-IN |
| ISOOPOO |
1068 |
1069 |
INPAT SURGERY ALL LIMIT:OOP LIMIT-OUT |
| ISOTHII |
1027 |
1028 |
INPAT SURGERY INTRN LIMIT:OTHR-IN |
| ISOTHIO |
1080 |
1081 |
INPAT SURGERY INTRN LIMIT:OTHR-OUT |
| LEVELS |
273 |
274 |
LEVELS OF BNFTS FOR PLAN |
| MAXCYDI |
493 |
499 |
AMNT /CONFIN/YEAR MAX-IN |
| MAXCYDO |
518 |
524 |
AMNT /CONFIN/YEAR MAX-OUT |
| MAXCYI |
479 |
480 |
CONFIN/YEAR MAX-IN |
| MAXCYO |
504 |
505 |
/CONFIN/YEAR MAX-OUT |
| MAXLIFDI |
485 |
492 |
AMNT LIFETIME MAX-IN |
| MAXLIFDO |
510 |
517 |
AMNT LIFETIME MAX-OUT |
| MAXLIFI |
477 |
478 |
LIFETIME MAX-IN |
| MAXLIFO |
502 |
503 |
LIFETIME MAX-OUT |
| MAXNONEI |
475 |
476 |
NO PLAN MAX-IN |
| MAXNONEO |
500 |
501 |
NO PLAN MAX-OUT |
| MAXNSI |
483 |
484 |
PLAN MAX NOT SPECIFIED-IN |
| MAXNSO |
508 |
509 |
PLAN MAX NOT SPECIFIED-OUT |
| MAXOTHI |
481 |
482 |
OTHR PLAN MAX-IN |
| MAXOTHO |
506 |
507 |
OTHR PLAN MAX-OUT |
| MEDCOORD |
287 |
288 |
COORDINATION OF PLAN BNFTS W/MEDICARE |
| MEDICAL |
259 |
260 |
MEDICAL CVRG PROVIDED |
| MEDIGAP |
261 |
262 |
MEDIGAP CVRG PROVIDED |
| MIALLO |
805 |
806 |
MNTL HLTH INPAT ALL LIMIT:ALL |
| MICOIN |
845 |
846 |
MNTL HLTH INPAT TYPE COINS |
| MICOINI |
817 |
818 |
MNTL HLTH INPAT INTRN LIMIT:COINS |
| MICOINO |
809 |
810 |
MNTL HLTH INPAT ALL LIMIT:COINS/COPAY |
| MICOINP |
847 |
849 |
MNTL HLTH INPAT % COINS |
| MICOVI |
537 |
538 |
BNFT CVRG FOR MNTL HLTH INPAT-IN |
| MICOVO |
559 |
560 |
BNFT CVRG FOR MNTL HLTH INPAT-OUT |
| MIDECYD |
837 |
839 |
MH INPAT TYPE DED:AMNT DEDUCT/CONFIN/YR |
| MIDEDCY |
827 |
828 |
MNTL HLTH INPAT TYPE DEDUCT:/CONFIN/YR |
| MIDEDDF |
829 |
830 |
MNTL HLTH INPAT TYPE DEDUCT:/DAY FIX |
| MIDEDDV |
831 |
832 |
MNTL HLTH INPAT TYPE DEDUCT:/DAY VARY |
| MIDEDDY |
833 |
834 |
MH INPAT TYPE DEDUCT:# DAYS/CONFIN/YR |
| MIDEDFD |
840 |
842 |
MH INPAT TYPE DED:AMNT DED/DAY FIX|VARY |
| MIDEDI |
815 |
816 |
MNTL HLTH INPAT INTRN LIMIT:DEDUCT |
| MIDEDNS |
835 |
836 |
MNTL HLTH INPAT TYPE DEDUCT:NOT SPECIFD |
| MIDEDO |
807 |
808 |
MNTL HLTH INPAT ALL LIMIT:DEDUCT |
| MIDEDYN |
843 |
844 |
MH INPAT TYPE DEDUCT:# DAYS /CONFIN/YR |
| MIMAXCYN |
854 |
856 |
MH INPAT DAY MAX:MAX # DAYS /CONFIN/YR |
| MIMAXDI |
823 |
824 |
MNTL HLTH INPAT INTRN LIMIT:$ MAX |
| MIMAXNI |
821 |
822 |
MNTL HLTH INPAT INTRN LIMIT:DAY MAX |
| MIMAXO |
813 |
814 |
MNTL HLTH INPAT ALL LIMIT:PLAN MAX |
| MIMXCY |
857 |
858 |
MNTL HLTH INPAT TYPE $ MAX:/CONFIN/YR |
| MIMXCYD |
863 |
868 |
MH INPAT TYPE $ MAX:AMNT $ MAX/CONFIN/YR |
| MIMXDY |
859 |
860 |
MNTL HLTH INPAT TYPE $ MAX:/DAY |
| MIMXDYD |
869 |
872 |
MH INPAT TYPE $ MAX: AMNT $ MAX /DAY |
| MIMXNS |
861 |
862 |
MNTL HLTH INPAT TYPE $ MAX:NOT SPECIFID |
| MIOOPD |
850 |
853 |
MNTL HLTH INPAT AMNT OOP LIMIT |
| MIOOPI |
819 |
820 |
MNTL HLTH INPAT INTRN LIMIT:OOP LIMIT |
| MIOOPO |
811 |
812 |
MNTL HLTH INPAT ALL LIMIT:OOP LIMIT |
| MIOTHI |
825 |
826 |
MNTL HLTH INPAT INTRN LIMIT:OTHR |
| MMBASIC |
285 |
286 |
BASIC W/SUPPLEMENTARY MAJ MED PLAN |
| MOALLO |
1392 |
1393 |
MNTL HLTH OUTPAT ALL LIMIT:ALL |
| MOCOIFI |
1404 |
1405 |
MNTL HLTH OUTPAT INTRN LIMIT:COINS FIX |
| MOCOINO |
1396 |
1397 |
MNTL HLTH OUTPAT ALL LIMIT:COINS/COPAY |
| MOCOINP |
1423 |
1425 |
MNTL HLTH OUTPAT:% COINS FIX|VARY |
| MOCOIVI |
1406 |
1407 |
MNTL HLTH OUTPAT INTRN LIMIT:COINS VARY |
| MOCOPD |
1426 |
1428 |
MNTL HLTH OUTPT:AMT COPAY/VST FIX|VARY |
| MOCOPFI |
1408 |
1409 |
MNTL HLTH OUTPAT INTRN LMT:COPAY/VST FIX |
| MOCOPVI |
1410 |
1411 |
MNTL HLTH OUTPT INTRN LMT:COPAY/VST VARY |
| MOCOVI |
539 |
540 |
BNFT CVRG FOR MNTL HLTH OUTPAT-IN |
| MOCOVO |
561 |
562 |
BNFT CVRG FOR MNTL HLTH OUTPAT-OUT |
| MODEDD |
1420 |
1422 |
MNTL HLTH OUTPAT:AMNT DEDUCT/YR |
| MODEDI |
1402 |
1403 |
MNTL HLTH OUTPAT INTRN LIMIT:DEDUCT/YR |
| MODEDO |
1394 |
1395 |
MNTL HLTH OUTPAT ALL LIMIT:DEDUCT |
| MOMAXO |
1400 |
1401 |
MNTL HLTH OUTPAT ALL LIMIT:PLAN MAX |
| MOMXDVD |
1432 |
1434 |
MNTL HLTH OUTPAT:$ AMNT $ MAX /VST |
| MOMXDVI |
1414 |
1415 |
MNTL HLTH OUTPAT INTRN LIMIT:$ MAX/VIST |
| MOMXNVI |
1412 |
1413 |
MNTL HLTH OUTPT INTRN LIMIT:MAX # VISITS |
| MOMXNVN |
1429 |
1431 |
MNTL HLTH OUTPAT:# MAX # VISITS |
| MOMXYRD |
1435 |
1439 |
MNTL HLTH OUTPAT:$ AMNT $ MAX/YR |
| MOMXYRI |
1416 |
1417 |
MNTL HLTH OUTPAT INTRN LIMIT:$ MAX/YR |
| MOOOPO |
1398 |
1399 |
MNTL HLTH OUTPAT ALL LIMIT:OOP LIMIT |
| MOOTHI |
1418 |
1419 |
MNTL HLTH OUTPAT INTRN LIMIT:OTHR |
| OFALLOI |
1164 |
1165 |
DR OFC VSTS ALL LIMIT:ALL-IN |
| OFALLOO |
1213 |
1214 |
DR OFC VSTS ALL LIMIT:ALL-OUT |
| OFCOIFII |
1176 |
1177 |
DR OFC VSTS INTRN LIMIT:COINS FIX-IN |
| OFCOIFIO |
1225 |
1226 |
DR OFC VSTS INTRN LIMIT:COINS FIX-OUT |
| OFCOINOI |
1168 |
1169 |
DR OFC VSTS ALL LIMIT:COINS/COPAY-IN |
| OFCOINOO |
1217 |
1218 |
DR OFC VSTS ALL LIMIT:COINS/COPAY-OUT |
| OFCOINPI |
1197 |
1199 |
DR OFC VSTS:% COINS FIX|VARY-IN |
| OFCOINPO |
1246 |
1248 |
DR OFC VSTS:% COINS FIX|VARY-OUT |
| OFCOIVII |
1178 |
1179 |
DR OFC VSTS INTRN LIMIT:COINS VARY-IN |
| OFCOIVIO |
1227 |
1228 |
DR OFC VSTS INTRN LIMIT:COINS VARY-OUT |
| OFCOPDI |
1200 |
1201 |
DR OFC VSTS:AMNT COPAY /VST FIX|VARY-IN |
| OFCOPDO |
1249 |
1250 |
DR OFC VSTS:AMNT COPAY /VST FIX|VARY-OUT |
| OFCOPFII |
1180 |
1181 |
DR OFC VSTS INTRN LIMIT:COPAY/VST FIX-IN |
| OFCOPFIO |
1229 |
1230 |
DR OFC VSTS INTRN LIMT:COPAY/VST FIX-OUT |
| OFCOPVII |
1182 |
1183 |
DR OFC VSTS INTRN LIMT:COPAY/VST VARY-IN |
| OFCOPVIO |
1231 |
1232 |
DR OFC VSTS INTRN LMT:COPAY/VST VARY-OUT |
| OFCOVI |
531 |
532 |
BNFT CVRG FOR DR OFC VSTS-IN |
| OFCOVO |
553 |
554 |
BNFT CVRG FOR DR OFC VSTS-OUT |
| OFDEDDI |
1194 |
1196 |
DR OFC VSTS:AMNT DEDUCT/YR-IN |
| OFDEDDO |
1243 |
1245 |
DR OFC VSTS:AMNT DEDUCT/YR-OUT |
| OFDEDII |
1174 |
1175 |
DR OFC VSTS INTRN LIMIT:DEDUCT/YR-IN |
| OFDEDIO |
1223 |
1224 |
DR OFC VSTS INTRN LIMIT:DEDUCT/YR-OUT |
| OFDEDOI |
1166 |
1167 |
DR OFC VSTS ALL LIMIT:DEDUCT-IN |
| OFDEDOO |
1215 |
1216 |
DR OFC VSTS ALL LIMIT:DEDUCT-OUT |
| OFDIFFII |
1184 |
1185 |
DR OF INTRN LMT:COINS/PAY DIF:SPCLST-IN |
| OFDIFFIO |
1233 |
1234 |
DR OF INTRN LMT:COINS/PAY DIF:SPCLST-OUT |
| OFMAXOI |
1172 |
1173 |
DR OFC VSTS ALL LIMIT:PLAN MAX-IN |
| OFMAXOO |
1221 |
1222 |
DR OFC VSTS ALL LIMIT:PLAN MAX-OUT |
| OFMXDVDI |
1205 |
1207 |
DR OFC VSTS:$ AMNT $ MAX /VST-IN |
| OFMXDVDO |
1253 |
1254 |
DR OFC VSTS:$ AMNT $ MAX /VST-OUT |
| OFMXDVII |
1188 |
1189 |
DR OFC VSTS INTRN LIMIT:$ MAX /VST-IN |
| OFMXDVIO |
1237 |
1238 |
DR OFC VSTS INTRN LIMIT:$ MAX /VST-OUT |
| OFMXNVII |
1186 |
1187 |
DR OFC VSTS INTRN LIMIT:MAX # VISITS-IN |
| OFMXNVIO |
1235 |
1236 |
DR OFC VSTS INTRN LIMIT:MAX # VISITS-OUT |
| OFMXNVNI |
1202 |
1204 |
DR OFC VSTS:# MAX # VISITS-IN |
| OFMXNVNO |
1251 |
1252 |
DR OFC VSTS:# MAX # VISITS-OUT |
| OFMXYRDI |
1208 |
1212 |
DR OFC VSTS:$ AMNT $ MAX/YR-IN |
| OFMXYRDO |
1255 |
1257 |
DR OFC VSTS:$ AMNT $ MAX/YR-OUT |
| OFMXYRII |
1190 |
1191 |
DR OFC VSTS INTRN LIMIT:$ MAX/YR-IN |
| OFMXYRIO |
1239 |
1240 |
DR OFC VSTS INTRN LIMIT:$ MAX/YR-OUT |
| OFOOPOI |
1170 |
1171 |
DR OFC VSTS ALL LIMIT:OOP LIMIT-IN |
| OFOOPOO |
1219 |
1220 |
DR OFC VSTS ALL LIMIT:OOP LIMIT-OUT |
| OFOTHII |
1192 |
1193 |
DR OFC VSTS INTRN LIMIT:OTHR-IN |
| OFOTHIO |
1241 |
1242 |
DR OFC VSTS INTRN LIMIT:OTHR-OUT |
| OISMAXI |
1126 |
1127 |
OUTPAT SURGERY INTRN LIMIT:$ MAX |
| OOPADI |
430 |
431 |
ALC/DRUGS DOES NOT APPLY OOP LIMIT-IN |
| OOPADO |
465 |
466 |
ALC/DRUGS DOES NOT APPLY OOP LIMIT-OUT |
| OOPAPPI |
426 |
427 |
ALL BNFTS APPLY TO THE OOP LIMIT-IN |
| OOPAPPO |
461 |
462 |
ALL BNFTS APPLY TO THE OOP LIMIT-OUT |
| OOPDEDFL |
102 |
103 |
FLAG: DEDUCTIBLE INCLUDED IN OOP LIMIT? |
| OOPDEDI |
424 |
425 |
DEDUCT INCLUDED IN THE OOP LIMIT-IN |
| OOPDEDO |
459 |
460 |
DEDUCT INCLUDED IN THE OOP LIMIT-OUT |
| OOPDENTI |
434 |
435 |
DENTAL DOES NOT APPLY OOP LIMIT-IN |
| OOPDENTO |
469 |
470 |
DENTAL DOES NOT APPLY OOP LIMIT-OUT |
| OOPDRUGI |
432 |
433 |
DRUGS DOES NOT APPLY OOP LIMIT-IN |
| OOPDRUGO |
467 |
468 |
DRUGS DOES NOT APPLY OOP LIMIT-OUT |
| OOPEARNI |
408 |
409 |
OOP LIMIT BASED ON EARNINGS-IN |
| OOPEARNO |
442 |
443 |
OOP LIMIT BASED ON EARNINGS-OUT |
| OOPFDI |
419 |
423 |
AMNT FAMILY OOP LIMIT-IN |
| OOPFDO |
453 |
458 |
AMNT FAMILY OOP LIMIT-OUT |
| OOPFI |
417 |
418 |
TYPE FAMILY OOP LIMIT-IN |
| OOPFO |
451 |
452 |
TYPE FAMILY OOP LIMIT-OUT |
| OOPI |
406 |
407 |
OOP LIMIT-IN |
| OOPIDI |
412 |
416 |
AMNT INDIV OOP LIMIT-IN |
| OOPIDO |
446 |
450 |
AMNT INDIV OOP LIMIT-OUT |
| OOPII |
410 |
411 |
TYPE INDIV OOP LIMIT-IN |
| OOPIO |
444 |
445 |
TYPE INDIV OOP LIMIT-OUT |
| OOPMHI |
428 |
429 |
MNTL HLTH DOES NOT APPLY OOP LIMIT-IN |
| OOPMHO |
463 |
464 |
MNTL HLTH DOES NOT APPLY OOP LIMIT-OUT |
| OOPO |
440 |
441 |
OOP LIMIT-OUT |
| OOPOTHI |
438 |
439 |
OTHR BNFTS DO NOT APPLY TO OOP LIMIT-IN |
| OOPOTHO |
473 |
474 |
OTHR BNFTS DO NOT APPLY OOP LIMIT-OUT |
| OOPVISI |
436 |
437 |
VISION DOES NOT APPLY OOP LIMIT-IN |
| OOPVISO |
471 |
472 |
VISION DOES NOT APPLY OOP LIMIT-OUT |
| OSALLO |
1110 |
1111 |
OUTPAT SURGERY ALL LIMIT:ALL |
| OSCOINI |
1122 |
1123 |
OUTPAT SURGERY INTRN LIMIT:COINSURANCE |
| OSCOINO |
1114 |
1115 |
OUTPAT SURGERY ALL LIMIT:COINS/COPAY |
| OSCOINP |
1134 |
1136 |
OUTPAT SURGERY:% COINS |
| OSCOPD |
1137 |
1139 |
OUTPAT SURGERY:AMNT COPAY |
| OSCOPI |
1124 |
1125 |
OUTPAT SURGERY INTRN LIMIT:COPAY |
| OSCOVI |
529 |
530 |
BNFT CVRG FOR OUTPAT SURGERY-IN |
| OSCOVO |
551 |
552 |
BNFT CVRG FOR OUTPAT SURGERY-OUT |
| OSDEDD |
1130 |
1133 |
OUTPAT SURGERY:AMNT DEDUCT |
| OSDEDI |
1120 |
1121 |
OUTPAT SURGERY INTRN LIMIT:DEDUCT |
| OSDEDO |
1112 |
1113 |
OUTPAT SURGERY ALL LIMIT:DEDUCT |
| OSMAXO |
1118 |
1119 |
OUTPAT SURGERY ALL LIMIT:PLAN MAX |
| OSMX1FE |
1158 |
1160 |
OUTPAT SRGY $ MAX:AMT $MAX:TONSIL/ADENOI |
| OSMX2FE |
1161 |
1163 |
OUTP SRG TYP $ MAX:AMT $MAX:DIAG D AND C |
| OSMXCY |
1140 |
1141 |
OUTPAT SURGERY TYPE $ MAX:/CONFIN/YEAR |
| OSMXCYD |
1148 |
1152 |
OUTPAT SRGY $ MAX:AMT $MAX/CONFIN/YR |
| OSMXFE |
1144 |
1145 |
OUTPAT SURGERY TYPE $ MAX:FEE SCHD |
| OSMXNS |
1146 |
1147 |
OUTPAT SURGERY TYPE $ MAX:NOT SPECIFIED |
| OSMXSR |
1142 |
1143 |
OUTPAT SURGERY TYPE $ MAX:PER SURGERY |
| OSMXSRD |
1153 |
1157 |
OUTPAT SRGY TYPE $ MAX:AMT $MAX/SURGERY |
| OSOOPO |
1116 |
1117 |
OUTPAT SURGERY ALL LIMIT:OOP LIMIT |
| OSOTHI |
1128 |
1129 |
OUTPAT SURGERY INTRN LIMIT:OTHR |
| OTHAIMI |
621 |
622 |
ADULT IMMUNIZATIONS-IN |
| OTHAIMO |
653 |
654 |
ADULT IMMUNIZATIONS-OUT |
| OTHCHIRI |
627 |
628 |
CHIROPRACTIC CARE-IN |
| OTHCHIRO |
659 |
660 |
CHIROPRACTIC CARE-OUT |
| OTHCIMI |
623 |
624 |
CHILD IMMUNIZATIONS-IN |
| OTHCIMO |
655 |
656 |
CHILD IMMUNIZATIONS-OUT |
| OTHCONVI |
631 |
632 |
REHABILITATION FACILITY-IN |
| OTHCONVO |
663 |
664 |
CONVALESCENT-OUT |
| OTHHOSPI |
635 |
636 |
HOSPICE CARE-IN |
| OTHHOSPO |
667 |
668 |
HOSPICE CARE-OUT |
| OTHIPCVI |
609 |
610 |
INPAT DR'S CHARGES CVRG-IN |
| OTHIPCVO |
641 |
642 |
INPAT DR'S CHARGES CVRG-OUT |
| OTHIPI |
607 |
608 |
INPAT DR-IN |
| OTHIPO |
639 |
640 |
INPAT DR-OUT |
| OTHMAMI |
613 |
614 |
ROUTINE MAMMOGRAMS-IN |
| OTHMAMO |
645 |
646 |
ROUTINE MAMMOGRAMS-OUT |
| OTHNONEI |
605 |
606 |
NO OTHR BNFT INCLUDED IN PLAN DESC-IN |
| OTHNONEO |
637 |
638 |
NO OTHR BNFT INCLUDED IN PLAN DESC-OUT |
| OTHNONPI |
629 |
630 |
OTHR NON-DR PROVIDERS-IN |
| OTHNONPO |
661 |
662 |
OTHR NON-DR PROVIDERS-OUT |
| OTHPAPI |
617 |
618 |
ROUTINE PAP SMEARS-IN |
| OTHPAPO |
649 |
650 |
ROUTINE PAP SMEARS-OUT |
| OTHPEI |
615 |
616 |
ADULT ROUTINE PHYSICAL EXAMS-IN |
| OTHPEO |
647 |
648 |
ADULT ROUTINE PHYSICAL EXAMS-OUT |
| OTHPRENI |
619 |
620 |
OFC VSTS FOR PRENATAL CARE-IN |
| OTHPRENO |
651 |
652 |
OFC VSTS FOR PRENATAL CARE-OUT |
| OTHSNFI |
633 |
634 |
EXTENDED CARE/SNF-IN |
| OTHSNFO |
665 |
666 |
EXTENDED CARE/SNF-OUT |
| OTHWCCI |
625 |
626 |
WELL-CHILD CARE, 2-4 YEARS-IN |
| OTHWCCO |
657 |
658 |
WELL-CHILD CARE, 2-4 YEARS-OUT |
| OTHXRAYI |
611 |
612 |
DIAGNOSTIC X-RAYS AND LAB-IN |
| OTHXRAYO |
643 |
644 |
DIAGNOSTIC X-RAYS AND LAB-OUT |
| OVDEDF |
63 |
67 |
OVERALL FAMILY DEDUCTIBLE |
| OVDEDI |
59 |
62 |
OVERALL INDIVIDUAL DEDUCTIBLE |
| OVERLIMI |
349 |
350 |
OVERALL LIMIT-IN |
| OVERLIMO |
351 |
352 |
OVERALL LIMIT-OUT |
| OVLIMIT |
57 |
58 |
OVERALL LIMIT INDICATOR |
| OVMAXIL |
80 |
87 |
OVERALL LIFETIME MAXIMUM |
| OVMAXIY |
73 |
79 |
OVERALL ANNUAL MAXIMUM |
| OVMOOPF |
95 |
101 |
OVERALL FAMILY OOP MAXIMUM |
| OVMOOPI |
88 |
94 |
OVERALL INDIVIDUAL OOP MAXIMUM |
| OVPAYT |
71 |
72 |
OVERALL PAYMENT TYPE |
| OVRATE |
68 |
70 |
OVERALL COINSURANCE RATE |
| PHOLDER |
50 |
50 |
POLICYHOLDER |
| PID |
6 |
8 |
PERSON ID |
| PLANTYPE |
269 |
270 |
TYPE PLAN FROM BKLT |
| PROVTYPE |
271 |
272 |
TYPE PLAN AS DETERMINED BY PLAN CHAR |
| RACETHNX |
55 |
55 |
RACE/ETHNICITY (EDITED / IMPUTED) |
| RACEX |
53 |
54 |
RACE (EDITED / IMPUTED) |
| REFOBGYN |
279 |
280 |
REQUIRE PRIM-CARE DR-REFER OB-GYN |
| RESTRICT |
289 |
290 |
RESTRICT CVRG OF PRE-EXISTING COND |
| SEX |
56 |
56 |
SEX |
| VISION |
267 |
268 |
VISION CVRG PROVIDED |
| VSCOV |
1793 |
1794 |
VISION BNFT APPLIED |
| VSDED |
1797 |
1798 |
VISION DEDUCT |
| VSDEDD |
1799 |
1801 |
AMNT VISION DEDUCT |
| VSDETAIL |
1795 |
1796 |
DETAILS PROVIDED FOR VISION CVRG |
| VSEX1CIP |
1810 |
1812 |
EYE EXAMS:% COINS (PROV 1) |
| VSEX1CPD |
1813 |
1814 |
EYE EXAMS:AMNT COPAY (PROV 1) |
| VSEX1CV |
1808 |
1809 |
BNFT CVRG FOR EYE EXAMS (PROV 1) |
| VSEX1MXD |
1815 |
1817 |
EYE EXAMS:AMNT $ MAX (PROV 1) |
| VSEX2CIP |
1820 |
1822 |
EYE EXAMS:% COINS (PROV 2) |
| VSEX2CPD |
1823 |
1824 |
EYE EXAMS:AMNT COPAY (PROV 2) |
| VSEX2CV |
1818 |
1819 |
BNFT CVRG FOR EYE EXAMS (PROV 2) |
| VSEX2MXD |
1825 |
1826 |
EYE EXAMS:AMNT $ MAX (PROV 2) |
| VSEX3CIP |
1829 |
1830 |
EYE EXAMS:% COINS (PROV 3) |
| VSEX3CPD |
1831 |
1832 |
EYE EXAMS:AMNT COPAY (PROV 3) |
| VSEX3CV |
1827 |
1828 |
BNFT CVRG FOR EYE EXAMS (PROV 3) |
| VSEX3MXD |
1833 |
1834 |
EYE EXAMS:AMNT $ MAX (PROV 3) |
| VSGL1CIP |
1837 |
1839 |
EYE GLASSES:% COINS (PROV 1) |
| VSGL1CPD |
1840 |
1842 |
EYE GLASSES:AMNT COPAY (PROV 1) |
| VSGL1CV |
1835 |
1836 |
BNFT CVRG FOR EYE GLASSES (PROV 1) |
| VSGL1MXD |
1843 |
1845 |
EYE GLASSES:AMNT $ MAX (PROV 1) |
| VSGL2CIP |
1848 |
1849 |
EYE GLASSES:% COINS (PROV 2) |
| VSGL2CPD |
1850 |
1851 |
EYE GLASSES:AMNT COPAY (PROV 2) |
| VSGL2CV |
1846 |
1847 |
BNFT CVRG FOR EYE GLASSES (PROV 2) |
| VSGL2MXD |
1852 |
1854 |
EYE GLASSES:AMNT $ MAX (PROV 2) |
| VSGL3CIP |
1857 |
1858 |
EYE GLASSES:% COINS (PROV 3) |
| VSGL3CPD |
1859 |
1860 |
EYE GLASSES:AMNT COPAY (PROV 3) |
| VSGL3CV |
1855 |
1856 |
BNFT CVRG FOR EYE GLASSES PROV 3) |
| VSGL3MXD |
1861 |
1862 |
EYE GLASSES:AMNT $ MAX (PROV 3) |
| VSMAX |
1802 |
1803 |
VISION MAX |
| VSMAXD |
1804 |
1807 |
AMNT VISION MAX |
| VSPROV |
1791 |
1792 |
TYPE VISION PROVIDER |
| WBALLOI |
1258 |
1259 |
WELL BABY ALL LIMIT:ALL-IN |
| WBALLOO |
1301 |
1302 |
WELL BABY ALL LIMIT:ALL-OUT |
| WBCOIFII |
1270 |
1271 |
WELL BABY INTRN LIMIT:COINS FIX-IN |
| WBCOIFIO |
1313 |
1314 |
WELL BABY INTRN LIMIT:COINS FIX-OUT |
| WBCOINOI |
1262 |
1263 |
WELL BABY ALL LIMIT:COINS/COPAY-IN |
| WBCOINOO |
1305 |
1306 |
WELL BABY ALL LIMIT:COINS/COPAY-OUT |
| WBCOINPI |
1288 |
1290 |
WELL BABY:% COINS FIX|VARY-IN |
| WBCOINPO |
1332 |
1334 |
WELL BABY:% COINS FIX|VARY-OUT |
| WBCOIVII |
1272 |
1273 |
WELL BABY INTRN LIMIT:COINS VARY-IN |
| WBCOIVIO |
1315 |
1316 |
WELL BABY INTRN LIMIT:COINS VARY-OUT |
| WBCOPDI |
1291 |
1292 |
WELL BABY:AMNT COPAY /VST FIX|VARY-IN |
| WBCOPDO |
1335 |
1336 |
WELL BABY:AMNT COPAY /VST FIX|VARY-OUT |
| WBCOPFII |
1274 |
1275 |
WELL BABY INTRN LIMIT:COPAY /VST FIX-IN |
| WBCOPFIO |
1317 |
1318 |
WELL BABY INTRN LIMIT:COPAY /VST FIX-OUT |
| WBCOPVII |
1276 |
1277 |
WELL BABY INTRN LIMIT:COPAY /VST VARY-IN |
| WBCOPVIO |
1319 |
1320 |
WELL BABY INTRN LIMIT:COPAY/VST VARY-OUT |
| WBCOVI |
533 |
534 |
BNFT CVRG FOR WELL BABY-IN |
| WBCOVO |
555 |
556 |
BNFT CVRG FOR WELL BABY-OUT |
| WBDEDDI |
1286 |
1287 |
WELL BABY:AMNT DEDUCT/YR-IN |
| WBDEDDO |
1329 |
1331 |
WELL BABY:AMNT DEDUCT/YR-OUT |
| WBDEDII |
1268 |
1269 |
WELL BABY INTRN LIMIT:DEDUCT/YR-IN |
| WBDEDIO |
1311 |
1312 |
WELL BABY INTRN LIMIT:DEDUCT/YR-OUT |
| WBDEDOI |
1260 |
1261 |
WELL BABY ALL LIMIT:DEDUCT-IN |
| WBDEDOO |
1303 |
1304 |
WELL BABY ALL LIMIT:DEDUCT-OUT |
| WBMAXOI |
1266 |
1267 |
WELL BABY ALL LIMIT:PLAN MAXIM UM-IN |
| WBMAXOO |
1309 |
1310 |
WELL BABY ALL LIMIT:PLAN MAX-OUT |
| WBMXDVDI |
1295 |
1297 |
WELL BABY:$ AMNT $ MAX /VST-IN |
| WBMXDVDO |
1339 |
1340 |
WELL BABY:$ AMNT $ MAX /VST-OUT |
| WBMXDVII |
1280 |
1281 |
WELL BABY INTRN LIMIT:$ MAX /VST-IN |
| WBMXDVIO |
1323 |
1324 |
WELL BABY INTRN LIMIT:$ MAX /VST-OUT |
| WBMXNVII |
1278 |
1279 |
WELL BABY INTRN LIMIT:MAX # VISITS-IN |
| WBMXNVIO |
1321 |
1322 |
WELL BABY INTRN LIMIT:MAX # VISITS-OUT |
| WBMXNVNI |
1293 |
1294 |
WELL BABY:# MAX # VISITS-IN |
| WBMXNVNO |
1337 |
1338 |
WELL BABY:# MAX # VISITS-OUT |
| WBMXYRDI |
1298 |
1300 |
WELL BABY:$ AMNT $ MAX/YR-IN |
| WBMXYRDO |
1341 |
1343 |
WELL BABY:$ AMNT $ MAX/YR-OUT |
| WBMXYRII |
1282 |
1283 |
WELL BABY INTRN LIMIT:$ MAX/YR-IN |
| WBMXYRIO |
1325 |
1326 |
WELL BABY INTRN LIMIT:$ MAX/YR-OUT |
| WBOOPOI |
1264 |
1265 |
WELL BABY ALL LIMIT:OOP LIMIT-IN |
| WBOOPOO |
1307 |
1308 |
WELL BABY ALL LIMIT:OOP LIMIT-OUT |
| WBOTHII |
1284 |
1285 |
WELL BABY INTRN LIMIT:OTHR-IN |
| WBOTHIO |
1327 |
1328 |
WELL BABY INTRN LIMIT:OTHR-OUT |
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