FSA Tax Advantage Account

To report Health Insurance Tax Advantage Account information

Position: FSA-01 · Element: 875 · Name: Maintenance Type Code · Type: Identifier (ID) · Requirement: Mandatory · Min: 3 · Max: 3 · Repeat: 1

Code identifying the specific type of item maintenance

Position: FSA-02 · Element: 1202 · Name: Flexible Spending Account Selection Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 1 · Repeat: 1

Code indicating selection of a type of Flexible Spending Account

Position: FSA-03 · Element: 1203 · Name: Maintenance Reason Code · Type: Identifier (ID) · Requirement: Optional · Min: 2 · Max: 3 · Repeat: 1

Code identifying the reason for the maintenance change

FSA-04 C062 Tax Advantage Account Information Composite (composite) Optional 1

Position: 01 · Element: 1636 · Name: Account Relationship Code · Type: Identifier (ID) · Requirement: Mandatory · Min: 1 · Max: 2 · Repeat: -

Code indicating relationship or type of account an entity maintains with a vendor or financial institution

Position: 02 · Element: 508 · Name: Account Number · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 35 · Repeat: -

Account number assigned

Position: FSA-05 · Element: 594 · Name: Frequency Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 1 · Repeat: 1

Code indicating frequency or type of activities or actions being reported

FSA05 specifies the frequency of contribution.

Position: FSA-06 · 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: FSA-07 · Element: 1161 · Name: Product Option Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 2 · Repeat: 1

Code indicating an option chosen for the product

Position: FSA-08 · Element: 1161 · Name: Product Option Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 2 · Repeat: 1

Code indicating an option chosen for the product

Position: FSA-09 · Element: 1161 · Name: Product Option Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 2 · Repeat: 1

Code indicating an option chosen for the product