Full Century Year Member's Required Date of Report the date of the subscriber's ME 65 11/8/12 Date - Month Day - int[8] date of when ME060 98% B Retirement retirement in CCYYMMDD Format. Integer CCYYMMDD Retirement = R Lookup COBRA Report the value that defines the COBRA ME 66 11/8/12 Table - int[1] usage element. EXAMPLE: 1 = Yes, Member All 98% A2 Status Integer indicator is covered using COBRA benefit. Code Description 1 Yes 2 No 3 Unknown 4 5 Not Applicable Carrier Carrier Report the code that defines the plan Required Spouse Defined Table Spouse Plan type of the spouse of the employee when ME062 ME 67 11/8/12 char[2] 1% C Plan Type - GIC Plan Type Code when Medicare coverage is selected = M and Table - Type and separate from GIC. ME134 = 3 Text Carrier Report the code that defines the plan Required Carrier Spouse Plan Spouse type of the spouse of the employee when ME062 ME 68 11/8/12 Defined Table char[2] Medicare 1% C Plan when Medicare coverage is selected = M and Table - - GIC Plan Code and separate from GIC. ME134 = 3 Text Carrier Spouse Report the code that defines the Required Spouse Carrier Medical medical coverage of the spouse of the when = ME 69 Medical 11/8/12 Defined Table char[2] Medicare 1% C employee when Medicare coverage is M and ME134 Coverage Table - - GIC Medical Coverage selected and separate from GIC. = 3 Text Code Carrier Carrier Spouse Report the code that defines the Required Spouse Defined Table Medicare Medicare Type of the spouse of the when ME062 ME 70 Medicare 11/8/12 char[2] 1% C - GIC Selected employee when Medicare coverage is = M and Indicator Table - Medicare Code selected and separate from GIC. ME134 = 3 Text Report the value that defines one of the two GIC Risk Pools in which this Lookup member is enrolled. This element is Required Pool Pool Indicator ME 71 11/8/12 - int[1] required for GIC carriers only. Non GIC when ME134 98% B Indicator Code Integer carriers should not report any value = 3 here. EXAMPLE: 1 = Regular State Employee and Retirees Value Description
ME 65 Date of Retirement 11/8/12 Full Date - Integer Century Year Month Day - CCYYMMDD int[8] Member's date of Retirement Report the date of the subscriber's retirement in CCYYMMDD Format. Required when ME060 = R 98% B ME 66 COBRA Status 11/8/12 Lookup Table - Integer int[1] COBRA usage indicator Report the value that defines the element. EXAMPLE: 1 = Yes, Member is covered using COBRA benefit. All 98% A2 Code Description 1 Yes 2 No 3 Unknown 4 5 Not Applicable ME 67 Spouse Plan Type 11/8/12 Carrier Table - Text Carrier Defined Table - GIC Plan Type char[2] Spouse Plan Type Code Report the code that defines the plan type of the spouse of the employee when Medicare coverage is selected and separate from GIC. Required when ME062 = M and ME134 = 3 1% C ME 68 Spouse Plan 11/8/12 Carrier Table - Text Carrier Defined Table - GIC Plan char[2] Spouse Plan Medicare Code Report the code that defines the plan type of the spouse of the employee when Medicare coverage is selected and separate from GIC. Required when ME062 = M and ME134 = 3 1% C ME 69 Spouse Medical Coverage 11/8/12 Carrier Table - Text Carrier Defined Table - GIC Medical char[2] Spouse Medical Medicare Coverage Code Report the code that defines the medical coverage of the spouse of the employee when Medicare coverage is selected and separate from GIC. Required when = M and ME134 = 3 1% C ME 70 Spouse Medicare Indicator 11/8/12 Carrier Table - Text Carrier Defined Table - GIC Medicare char[2] Spouse Medicare Selected Code Report the code that defines the Medicare Type of the spouse of the employee when Medicare coverage is selected and separate from GIC. Required when ME062 = M and ME134 = 3 1% C ME 71 Pool Indicator 11/8/12 Lookup - Integer int[1] Pool Indicator Code Report the value that defines one of the two GIC Risk Pools in which this member is enrolled. This element is required for GIC carriers only. Non GIC carriers should not report any value here. EXAMPLE: 1 = Regular State Employee and Retirees Required when ME134 = 3 98% B Value Description
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