HD Health Coverage

To provide information on health coverage

Sequence

Element

Name

Type

Requirement

Min

Max

Repeat

01

875

Maintenance Type Code

Identifier (ID)

Mandatory

3

3

1

Code identifying the specific type of item maintenance

Codes (128)

02

1203

Maintenance Reason Code

Identifier (ID)

Optional

2

3

1

Code identifying the reason for the maintenance change

Codes (118)

03

1205

Insurance Line Code

Identifier (ID)

Optional

2

3

1

Code identifying a group of insurance products

Codes (58)

04

1204

Plan Coverage Description

String (AN)

Optional

1

50

1

A description or number that identifies the plan or coverage

05

1207

Coverage Level Code

Identifier (ID)

Optional

3

3

1

Code indicating the level of coverage being provided for this insured

Codes (25)

06

609

Count

Numeric (N0)

Optional

1

9

1

Occurrence counter

HD06 is the number of collateral dependents for the primary insured. A collateral dependent is a relative related by blood or marriage who resides in the home and is dependent on the employee for support.

07

609

Count

Numeric (N0)

Optional

1

9

1

Occurrence counter

HD07 is the number of sponsored dependents for the primary insured. A sponsored dependent is a dependent between the ages of 19 and 25 who is not in school.

08

1209

Underwriting Decision Code

Identifier (ID)

Optional

1

1

1

Code indicating the decision made by the underwriter

Codes (7)

09

1073

Yes/No Condition or Response Code

Identifier (ID)

Optional

1

1

1

Code indicating a Yes or No condition or response

HD09 is a late enrollee indicator. A "Y" value indicates the insured is a late enrollee, which can result in a reduction of benefits; an "N" value indicates the insured is a regular enrollee.

Codes (9)

10

1211

Drug House Code

Identifier (ID)

Optional

2

3

1

Code indicating a drug house with which the insurance plan is affiliated

Codes (8)

11

1073

Yes/No Condition or Response Code

Identifier (ID)

Optional

1

1

1

Code indicating a Yes or No condition or response

HD11 is a prescription drug service coverage indicator. A "Y" value indicates that prescription drug service coverage applies; an "N" value indicates that prescription drug service coverage does not apply.

Codes (9)