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Segment
in
X12 Release 005040

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 (124)
02
Maintenance Reason Code
Identifier (ID)
Optional
2
3
1
Code identifying the reason for the maintenance change
Codes (118)
03
Insurance Line Code
Identifier (ID)
Optional
2
3
1
Code identifying a group of insurance products
Codes (55)
04
Plan Coverage Description
String (AN)
Optional
1
50
1
A description or number that identifies the plan or coverage
05
Coverage Level Code
Identifier (ID)
Optional
3
3
1
Code indicating the level of coverage being provided for this insured
Codes (25)
06
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
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
Underwriting Decision Code
Identifier (ID)
Optional
1
1
1
Code indicating the decision made by the underwriter
Codes (7)
09
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 (4)
10
Drug House Code
Identifier (ID)
Optional
2
3
1
Code indicating a drug house with which the insurance plan is affiliated
Codes (8)
11
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 (4)
Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference and Mapping Guides are provided for marketing purposes and are free of charge. All names, logos, and brands of third parties listed on our site are trademarks of their respective owners (including “X12”, which is a trademark of X12 Incorporated). Stedi, Inc. and its products and services are not endorsed by, sponsored by, or affiliated with these third parties. Our use of these names, logos, and brands is for identification purposes only, and does not imply any such endorsement, sponsorship, or affiliation.
Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference and Mapping Guides are provided for marketing purposes and are free of charge. All names, logos, and brands of third parties listed on our site are trademarks of their respective owners (including “X12”, which is a trademark of X12 Incorporated). Stedi, Inc. and its products and services are not endorsed by, sponsored by, or affiliated with these third parties. Our use of these names, logos, and brands is for identification purposes only, and does not imply any such endorsement, sponsorship, or affiliation.