Report the maximum amount of member / subscriber's annual deductible across all benefit types (Medical, RX, vision, behavioral health, etc.) before Annual certain services are covered. Report maximum out only In-Network Deductibles here if plan of pocket Member has an In and Out-of-Network ME 49 12/1/10 Integer Currency varchar[10] Member All 90% A2 Deductible Deductible. Report 0 when there is no Deductible deductible applied to all benefits for this across all eligibility. Do not code decimal or round benefit types up / down to whole dollars, code zero cents (00) when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070 Report the amount to-date the member / subscriber has incurred towards maximum deductible. Report 0 if no Member Member deductible has been incurred. Do not Required deductible ME 50 Deductible 11/8/12 Integer Currency varchar[10] code decimal or round up / down to when ME049 100% A2 amount Used whole dollars, code zero cents (00) > 0 incurred when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070 Behavioral Report the value that defines the Lookup Indicator - Health element. EXAMPLE: 1 = Yes, ME 51 11/8/12 Table - int[1] Behavioral All 100% A2 Benefit Behavioral/Mental Health is a covered Integer Health Option Flag benefit. Value Description 1 Yes 2 No 3 Unknown 4 5 Not Applicable Laboratory Lookup Indicator - Report the value that defines the ME 52 Benefit 11/8/12 Table - int[1] Laboratory element. EXAMPLE: 1 = Yes, Lab is All 100% A2 Flag Integer Option covered benefit. Value Description 1 Yes 2 No
ME 49 Member Deductible 12/1/10 Integer Currency varchar[10] Annual maximum out of pocket Member Deductible across all benefit types Report the maximum amount of member / subscriber's annual deductible across all benefit types (Medical, RX, vision, behavioral health, etc.) before certain services are covered. Report only In-Network Deductibles here if plan has an In and Out-of-Network Deductible. Report 0 when there is no deductible applied to all benefits for this eligibility. Do not code decimal or round up / down to whole dollars, code zero cents (00) when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070 All 90% A2 ME 50 Member Deductible Used 11/8/12 Integer Currency varchar[10] Member deductible amount incurred Report the amount to-date the member / subscriber has incurred towards maximum deductible. Report 0 if no deductible has been incurred. Do not code decimal or round up / down to whole dollars, code zero cents (00) when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070 Required when ME049 > 0 100% A2 ME 51 Behavioral Health Benefit Flag 11/8/12 Lookup Table - Integer int[1] Indicator - Behavioral Health Option Report the value that defines the element. EXAMPLE: 1 = Yes, Behavioral/Mental Health is a covered benefit. All 100% A2 Value Description 1 Yes 2 No 3 Unknown 4 5 Not Applicable ME 52 Laboratory Benefit Flag 11/8/12 Lookup Table - Integer int[1] Indicator - Laboratory Option Report the value that defines the element. EXAMPLE: 1 = Yes, Lab is covered benefit. All 100% A2 Value Description 1 Yes 2 No