SBI Specific Benefit Information

To specify specifc benefit scenarios

Position
Element
Name
Type
Requirement
Min
Max
Repeat
SBI-01
Eligibility or Benefit Information Code
Identifier (ID)
Mandatory
1
2
1
Code identifying eligibility or benefit information
SBI-02
Time Period Qualifier
Identifier (ID)
Conditional
1
2
1
Code specifying periods
SBI-03
Number of Periods
Numeric (N0)
Optional
1
3
1
Total number of periods
C0302: If SBI-03 is present, then SBI-02 is required
SBI-04
Percentage as Decimal
Decimal number (R)
Optional
1
10
1
Percentage expressed as a decimal (e.g., 0.0 through 1.0 represents 0% through 100%)
SBI-05
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
SBI05 represents a single benefit amount or minimum benefit amount dependent upon the code sent in SBI01.
SBI-06
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
SBI06 represents a remaining benefit amount or maximum benefit amount dependent upon the code sent in SBI01.
SBI-07
Tier identifier
Numeric (N0)
Optional
1
2
1
Number identifying the level to which the benefits are assigned or limited
SBI-08
Plan Coverage Description
String (AN)
Optional
1
50
1
A description or number that identifies the plan or coverage
SBI-09
Yes/No Condition or Response Code
Identifier (ID)
Optional
1
1
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.
SBI-10
Yes/No Condition or Response Code
Identifier (ID)
Optional
1
1
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.
SBI-11
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
SBI11 amount represents the tiered benefit dollar amount.

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