5 Not Applicable Report the code that defines the type of Lookup Type of Coverage insurance policy by the enrollee is ME 29 11/8/12 Table - char[3] Coverage All 98% A0 Type covered. EXAMPLE: UND = Plan Text Code underwritten by the insurer Code Description Self-funded plans that are administered by a third-party administrator, where the ASW employer has purchased stop-loss, or group excess, insurance coverage Self-funded plans that are administered by a third-party administrator, where the ASO employer has not purchased stop-loss, or group excess, insurance coverage non-renewable health STN insurance UND underwritten by the insurer Any other plan. Insurers using this code OTH shall obtain prior approval. Market Lookup Market Report the code that defines the market, ME 30 Category 11/8/12 Table - varchar[4] Category by size and or association, to which the All 99% A0 Code Text Code policy is directly sold and issued Code Description IND Individuals (non-group) ISCO Individuals as a Senior Care Option FCH Individuals on a franchise basis GCV Individuals as group conversion Policies GS1 Employers having exactly 1 employee GS2 Employers having 2 thru 9 employees GS3 Employers having 10 thru 25 employees GS4 Employers having 26 thru 50 employees Employers having 51 thru 100 GLG1 employees Employers having 101 thru 250 GLG2 employees Employers having 251 thru 500 GLG3 employees
5 Not Applicable ME 29 Coverage Type 11/8/12 Lookup Table - Text char[3] Type of Coverage Code Report the code that defines the type of insurance policy by the enrollee is covered. EXAMPLE: UND = Plan underwritten by the insurer All 98% A0 Code Description ASW Self-funded plans that are administered by a third-party administrator, where the employer has purchased stop-loss, or group excess, insurance coverage ASO Self-funded plans that are administered by a third-party administrator, where the employer has not purchased stop-loss, or group excess, insurance coverage STN non-renewable health insurance UND underwritten by the insurer OTH Any other plan. Insurers using this code shall obtain prior approval. ME 30 Market Category Code 11/8/12 Lookup Table - Text varchar[4] Market Category Code Report the code that defines the market, by size and or association, to which the policy is directly sold and issued All 99% A0 Code Description IND Individuals (non-group) ISCO Individuals as a Senior Care Option FCH Individuals on a franchise basis GCV Individuals as group conversion Policies GS1 Employers having exactly 1 employee GS2 Employers having 2 thru 9 employees GS3 Employers having 10 thru 25 employees GS4 Employers having 26 thru 50 employees GLG1 Employers having 51 thru 100 employees GLG2 Employers having 101 thru 250 employees GLG3 Employers having 251 thru 500 employees
v6-apcd-member-eligibility-file-submission-guide-FINAL.docx