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 - Text Medicare Code selected and separate from GIC. ME134 = 3 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 Table - int[1] required for GIC carriers only. Non GIC when = 98% B Indicator Code Integer carriers should not report any value 3 here. EXAMPLE: 1 = Regular State Employee and Retirees Value Description Regular State Employees and Retirees, 1 plus local authorities Elderly Governmental Retirees (EGR) 2 and Retired Municipal Teachers (RMTs) Report the number of individuals covered under the policy/contract Family Size (ME009) of the subscriber. This is ME 72 Family Size 11/8/12 Integer Counter varchar[2] All 100% A2 Contracted required for Risk Assessment and Division of Insurance reporting. No alpha or special characters Lookup Report the value that defines the Fully Insured ME 73 Insured 11/8/12 Table - int[1] element. EXAMPLE: 1 = Yes, Member All 100% A0 identifier member Integer is fully insured. Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable Lookup Indicator - Report the value that defines the ME 74 Interpreter 11/8/12 - int[1] Interpreter element. EXAMPLE: 1 = Yes, Member All 100% A2 Integer Need requires an interpreter. Value Description 1 Yes 2 No 3 Unknown
ME 70 Spouse Medicare Indicator 11/8/12 Carrier - 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 Table - 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 = 3 98% B Value Description 1 Regular State Employees and Retirees, plus local authorities 2 Elderly Governmental Retirees (EGR) and Retired Municipal Teachers (RMTs) ME 72 Family Size 11/8/12 Integer Counter varchar[2] Family Size Contracted Report the number of individuals covered under the policy/contract (ME009) of the subscriber. This is required for Risk Assessment and Division of Insurance reporting. No alpha or special characters All 100% A2 ME 73 Insured member 11/8/12 Lookup Table - Integer int[1] Fully Insured identifier Report the value that defines the element. EXAMPLE: 1 = Yes, Member is fully insured. All 100% A0 Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable ME 74 Interpreter 11/8/12 Lookup - Integer int[1] Indicator - Interpreter Need Report the value that defines the element. EXAMPLE: 1 = Yes, Member requires an interpreter. All 100% A2 Value Description 1 Yes 2 No 3 Unknown
v6-apcd-member-eligibility-file-submission-guide-FINAL.docx