EDI X12 00303 HD Segment Schema | 知行 EDI 规范查询平台

Elements

HD01 875 Maintenance Type Code
ID
M必须(Mandatory)
Code identifying the specific type of item maintenance.
Codes (16)
- 001Change
- 002Delete
- 003Add Full Item Detail
- 004Withdraw Item (Temporary)
- 005Restore Item
- 021Addition
- 022Change in Status
- 023Change in Rate Factors
- 024Cancellation or Termination
- 025Reinstatement
- 026Correction
- 028Policy Adjustment
- 029Inquiry
- 030Audit or Compare
- 032Employee Information Not Applicable
- ZZZMutually Defined
HD02 1203 Maintenance Reason Code
ID
O可选(Optional)
Code identifying the reason for the maintenance change.
Codes (42)
- 10Consolidation Omnibus Budget Reconciliation Act (COBRA) Premium Paid
- 11Surviving Spouse
- 12Lay Off
- 13Leave of Absence
- 14Voluntary Withdrawal
- 15Primary Care Provider (PCP) Change
- 16Quit
- 17Fired
- 18Suspended
- 19Sabbatical
- 20Active
- 21Disability
- 22Plan Change
- 23Furloughed
- 24Resigned
- 25Change in Identifying Data Elements
- 26Declined Coverage
- 27Pre-Enrollment
- 28Initial Enrollment
- 29Benefit Selection
- 30Discrimination Test
- 31Legal Separation
- 32Marriage
- 33Personnel Data
- 34Investment Elections and Contribution Rates
- 35Loan Repayment
- 36Contribution or Plan Allocation
- 37Leave of Absence with Benefits
- 38Leave of Absence without Benefits
- 39Lay Off with Benefits
- 40Lay Off without Benefits
- 41Re-enrollment
- 01Divorce
- 02Birth
- 03Death
- 04Retirement
- 05Adoption
- 06Strike
- 07Termination of Benefits
- 08Termination of Employment
- 09Consolidation Omnibus Budget Reconciliation Act (COBRA)
- ZZMutually Defined
HD03 1205 Insurance Line Code
ID
O可选(Optional)
Code identifying a group of insurance products.
Codes (37)
- 401
- 403403(B) Tax Sheltered Annuity
- 457
- ACBasic Life
- AFSupplemental Life
- APPaid Up Life
- ARDependent Life
- BCDeath and Dismemberment
- BESupplemental Death and Dismemberment
- BHWeekly Indemnity
- BKWeekly Indemnity - New York Employees
- CVEmployee Comprehensive
- LLLifestyle Life (Individualized Basic Life)
- NQNon-Qualified
- ULUniversal Life
- URUtilization Review
- ADDAccidental Death or Dismemberment
- CLFContributory Life
- DENDental
- FSAFlexible Spending
- GDC457(B) Government Deferred Compensation
- HLTHealth
- HMOHealth Maintenance Organization
- IRAGroup Individual Retirement Account
- IRC408(B) Individual Retirement Account (IRA) Annuity Contract
- LTCLong-Term Care
- LTDLong-Term Disability
- MODMail Order Drug
- NGD457(F) Non-Government Deferred Compensation
- PDGPrescription Drug
- PSPProfit-Sharing Plan
- QDA401(K) Qualified Cash or Deferred Arrangement
- QDC401(A) Qualified Defined Contribution
- STDShort-Term Disability
- TSA
- VISVision
- ZZZMutually Defined
HD04 1204 Plan Coverage Description
AN
O可选(Optional)
Min 1 / Max 50
A description or number that identifies the plan or coverage.
HD05 1207 Coverage Level Code
ID
O可选(Optional)
Code indicating the level of coverage being provided for this insured
Codes (18)
- CHDChildren Only
- DEPDependents Only
- E1DEmployee and One Dependent
- E2DEmployee and Two Dependents
- E3DEmployee and Three Dependents
- E5DEmployee and One or More Dependents
- E6DEmployee and Two or More Dependents
- E7DEmployee and Three or More Dependents
- E8DEmployee and Four or More Dependents
- E9DEmployee and Five or More Dependents
- ECHEmployee and Children
- EMPEmployee Only
- ESPEmployee and Spouse
- FAMFamily
- INDIndividual
- SPCSpouse and Children
- SPOSpouse Only
- TWOTwo Party
HD06 609 Count
N
O可选(Optional)
Min 1 / Max 6
Occurence counter
HD07 609 Count
N
O可选(Optional)
Min 1 / Max 6
Occurence counter
HD08 1209 Underwriting Decision Code
ID
O可选(Optional)
Code indicating the decision made by the underwriter
Codes (5)
- AApproved
- CConditioned
- DDeclined
- ICertified
- NNot Medically Underwritten
HD09 1073 Yes/No Condition or Response Code
ID
O可选(Optional)
Code indicating a Yes or No condition or response.
Codes (3)
- NNo
- UUnknown
- YYes
HD10 1211 Drug House Code
ID
O可选(Optional)
Code indicating a drug house that the insurance plan is affiliated with.
Codes (8)
- AMAmericas
- NPNational Pharmacy
- ZZMutually Defined
- BAXBaxter-Travenol
- FLRFlex Rx
- HCSHealth Case Services
- PCSPharmaceutical Card System (PCS)
- THRThrift
HD11 1073 Yes/No Condition or Response Code
ID
O可选(Optional)
Code indicating a Yes or No condition or response.
Codes (3)
- NNo
- UUnknown
- YYes