PPS EDB Data Element Definition

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System Number: EDB0293

User Access Name: 0293-2

Programming Name: HLTH_COVERCODE IN PPPBEN

Revision Date: 11/08/02

Comments

Location(s):   BRT 3300  - Health Plan Coverage Code
               HBN 4529  - Medical Plan Coverage Code-HBN in HDB
               APS 0272  - Primary Health Plan Coverage Code-PPS
               BCS 0272  - Primary Health Plan Coverage Code-PPS
               CPS 0272  - Primary Health Plan Coverage Code-PPS
               IPS 0272  - Primary Health Plan Coverage Code-PPS
               OPP 0272  - Primary Health Plan Coverage Code-PPS
               BCS 2565  - BRT Health Plan Coverage Code
               APS 2757  - Primary Health Plan Coverage Code-CPS (coding is different)
               CPS 2757  - Primary Health Plan Coverage Code-CPS (coding is different)
               IPS 2757  - Primary Health Plan Coverage Code-CPS (coding is different)
               OPP 2757  - Primary Health Plan Coverage Code-CPS (coding is different)


Name: MEDICAL PLAN COVERAGE CODE-EDB

Type: ALPHANUMERIC

Length: 3

Format

A three character code consisting of "U", "C", "A", "M", and blanks. The first character represents the employee. The second character represents adult or child(ren) when no adult. The third character represents child(ren) when there is an adult.

A "U", "A" or "C" indicates uninsured by Medicare; an "M" indicates insured by Medicare; and, a blank indicates no coverage.

Valid values are: U, UA, UC, UAC, M, MM, MMM, MA, MC, MAC, MMC.

General Description

Code indicating self, self and adult, self and children, and self and family plan coverage and indicating the number of insured covered by Medicare.

Code Interpretation

U	Self only
UA	Self and Adult
UC	Self and Children
UAC	Self and Family
M	Self only - Medicare
MM	Self and Adult - Medicare
MA	Self and Adult - One in Medicare
MC	Self and Children - One in Medicare
MAC	Self and Family - One in Medicare
MMC	Self and Family - Two in Medicare
MMM	Self and Family	- Three or more in Medicare 


NOTE - Previous code values

Code values prior to 01/01/03

Values are: U, M, UU, UM, MU, MM, UUU, UUM, UMU, UMM, MUU, MUM, MMU, MMM