Eligibility Benefit Info Codes

CodeDescription
1Active Coverage
2Active – Full Risk Capitation
3Active – Services Capitated
4Active – Services Capitated to Primary Care Physician
5Active – Pending Investigation
6Inactive
7Inactive – Pending Eligibility Update
8Inactive – Pending Investigation
ACo-Insurance
BCo-Payment
CDeductible
CBCoverage Basis
DBenefit Description
EExclusions
FLimitations
GOut of Pocket (Stop Loss)
HUnlimited
INon-Covered
JCost Containment
KReserve
LPrimary Care Provider
MPre-Existing Condition
MCManaged Care Coordinator
NServices Restricted to Following Provider
ONot Deemed a Medical Necessity
PBenefit Disclaimer
QSecond Surgical Opinion Required
ROther or Additional Payer
SPrior Year(s) History
TCard(s) Reported Lost/Stolen
UContact Following Entity for Eligibility or Benefit Information
VCannot Process
WOther Source of Data
XHealth Care Facility
YSpend Down

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