	Ref	Id	Element Name	Req	Type	Min/Max	Usage
	HD01	875	Maintenance Type Code Description: Code identifying the specific type of item maintenance	M	ID	3/3	Required

Code

Name

001

Change

002

Delete

Use this code for deleting an incorrect coverage record.

021

Addition

024

Cancellation or Termination

Use this code for cancelling/terminating a coverage.

025

Reinstatement

026

Correction

This code is used to correct an incorrect record.

030

Audit or Compare

032

Employee Information Not Applicable

Certain situations, such as military duty and CHAMPUS, classify the subscriber as ineligible for coverage or benefits. However, dependents of the
subscribers are still eligible for coverage or benefits under the subscriber. Subscriber identifying
elements are needed to accurately identify dependents.

Code

Name

Preventative Care/Wellness

24 Hour Care

Medicare Risk

Mental Health

Hearing

Major Medical

Utilization Review

DCP

Dental Capitation

This identifies a dental managed care organization (DMO).

DEN

Dental

EPO

Exclusive Provider Organization

FAC

Facility

HLT

Health

Includes both hospital and professional coverage.

HMO

Health Maintenance Organization

LTC

Long-Term Care

LTD

Long-Term Disability

MOD

Mail Order Drug

PDG

Prescription Drug

POS

Point of Service

PPO

Preferred Provider Organization

PRA

Practitioners

STD

Short-Term Disability

VIS

Vision

	HD04	1204	Plan Coverage Description Description: A description or number that identifies the plan or coverage Use this element when additional information is needed by the insurer to describe the exact type of coverage being provided. If required by an insurer, this information must be included. The insurer establishes the content of this element in the contract.	O	AN	1/50	Situational
	HD05	1207	Coverage Level Code Description: Code indicating the level of coverage being provided for this insured This data should only be transmitted when such transmission is required under the insurance contract between the sponsor and payer and allowed by federal and state regulations. This element is NOT USED when the member identified in the related INS segment is not the subscriber. See section 2.7, �Coverage Levels and Dependents�, for additional information.	O	ID	3/3	Situational

Code

Name

CHD

Children Only

DEP

Dependents Only

E1D

Employee and One Dependent

For this code, the dependent is a non-spouse dependent. This code is not used for identification of Employee and Spouse. See code ESP.

E2D

Employee and Two Dependents

E3D

Employee and Three Dependents

E5D

Employee and One or More Dependents

E6D

Employee and Two or More Dependents

E7D

Employee and Three or More Dependents

E8D

Employee and Four or More Dependents

E9D

Employee and Five or More Dependents

ECH

Employee and Children

EMP

Employee Only

ESP

Employee and Spouse

FAM

Family

IND

Individual

SPC

Spouse and Children

SPO

Spouse Only

TWO

Two Party

1.	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.
2.	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.
3.	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.
4.	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.