AMT

Member Policy Amounts

Pos: 120	Max: 4
Detail - Optional
Loop: 2100A	Elements: 2

Ref

Id

Element Name

Req

Type

Min/Max

Usage

AMT01

522

Amount Qualifier Code
Description: Code to qualify amount

M

ID

1/3

Required

Code

Name

B9

Co-insurance - Actual

This will contain any co-insurance selection amount. The option of adjusting this amount to produce the actual co-insurance can be defined in the insurance contract.

C1

Co-Payment Amount

D2

Deductible Amount

P3

Premium Amount

AMT02

782

Monetary Amount
Description: Monetary amount
Industry: Contract Amount

M

R

1/18

Required

Notes:

1. This data should only be transmitted when such transmission is required under the insurance contract between the sponsor and payer.

Example:

AMT*D2*100~