GLOBAL MAP DATA DICTIONARY #355.4 -- ANNUAL BENEFITS FILE 6/27/25 PAGE 1
STORED IN ^IBA(355.4, *** NO DATA STORED YET *** SITE: WWW.BMIRWIN.COM UCI: VISTA,VISTA (VERSION 2.0)
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This file contains the fields to maintain the annual benefits by year for an insurance policy.
Per VHA Directive 10-93-142, this file definition should not be modified.
CROSS
REFERENCED BY: HEALTH INSURANCE POLICY(APY), BENEFIT YEAR BEGINNING ON(APY1), BENEFIT YEAR BEGINNING ON(B),
HEALTH INSURANCE POLICY(C)
^IBA(355.4,D0,0)= (#.01) BENEFIT YEAR BEGINNING ON [1D] ^ (#.02) HEALTH INSURANCE POLICY [2P:355.3] ^ ^ ^ (#.05) MAX. OUT OF
==>POCKET [5N] ^ (#.06) AMBULANCE COVERAGE (%) [6N] ^
^IBA(355.4,D0,1)= (#1.01) DATE ENTERED [1D] ^ (#1.02) ENTERED BY [2P:200] ^ (#1.03) DATE LAST VERIFIED [3D] ^ (#1.04) VERIFIED BY
==>[4P:200] ^ (#1.05) DATE LAST EDITED [5D] ^ (#1.06) LAST EDIT BY [6P:200] ^ (#1.07) PERSON CONTACTED [7F] ^
==>(#1.08) COMMENTS [8F] ^ (#1.09) CONTACT'S PHONE NUMBER [9F] ^
^IBA(355.4,D0,2)= (#2.01) ANNUAL DEDUCTIBLE (OPT) [1N] ^ (#2.02) PER VISIT DEDUCTIBLE [2N] ^ (#2.03) OUTPATIENT LIFETIME MAXIMUM
==>[3N] ^ (#2.04) OUTPATIENT ANNUAL MAXIMUM [4N] ^ (#2.05) MH LIFETIME OUTPATIENT MAX. [5N] ^ (#2.06) MH ANNUAL
==>OUTPATIENT MAX. [6N] ^ (#2.07) DENTAL COVERAGE TYPE [7S] ^ (#2.08) DENTAL COVERAGE $ OR % [8N] ^ (#2.09)
==>OUTPATIENT VISIT (%) [9N] ^ (#2.1) EMERGENCY OUTPATIENT (%) [10N] ^ (#2.11) MENTAL HEALTH OUTPATIENT (%) [11N]
==>^ (#2.12) PRESCRIPTION (%) [12N] ^ (#2.13) OUTPATIENT SURGERY (%) [13N] ^ (#2.14) MH OPT. MAX DAYS PER YEAR
==>[14N] ^ (#2.15) OUTPATIENT VISITS PER YEAR [15N] ^ ^ (#2.17) ADULT DAY HEALTH CARE [17S] ^
^IBA(355.4,D0,3)= (#3.01) HOME HEALTH CARE LEVEL [1S] ^ (#3.02) HOME HEALTH VISITS PER YEAR [2N] ^ (#3.03) HOME HEALTH MAX DAYS
==>PER YEAR [3N] ^ (#3.04) HOME HEALTH MED. EQUIPMENT (%) [4N] ^ (#3.05) HOME HEALTH VISIT DEFINITION [5F] ^
==>(#3.06) OCCUPATIONAL THERAPY # VISITS [6N] ^ (#3.07) PHYSICAL THERAPY # VISITS [7N] ^ (#3.08) SPEECH THERAPY #
==>VISITS [8N] ^ (#3.09) MEDICATION COUNSELING # VISITS [9N] ^
^IBA(355.4,D0,4)= (#4.01) HOSPICE ANNUAL DEDUCTIBLE [1N] ^ (#4.02) HOSPICE INPATIENT ANNUAL MAX [2N] ^ (#4.03) HOSPICE INPT.
==>LIFETIME MAX [3N] ^ (#4.04) ROOM AND BOARD (%) [4N] ^ (#4.05) OTHER INPATIENT CHARGES (%) [5N] ^ (#4.06) IV
==>INFUSION OPT. [6S] ^ (#4.07) IV INFUSION INPT. [7S] ^ (#4.08) IV ANTIBIOTICS OPT. [8S] ^ (#4.09) IV ANTIBIOTICS
==>INPT. [9S] ^
^IBA(355.4,D0,5)= (#5.01) ANNUAL DEDUCTIBLE (INPATIENT) [1N] ^ (#5.02) PER ADMISSION DEDUCTIBLE [2N] ^ (#5.03) INPATIENT LIFETIME
==>MAXIMUM [3N] ^ (#5.04) INPATIENT ANNUAL MAXIMUM [4N] ^ (#5.05) MH LIFETIME INPATIENT MAXIMUM [5N] ^ (#5.06) MH
==>ANNUAL INPATIENT MAXIMUM [6N] ^ (#5.07) DRUG & ALCOHOL LIFETIME MAX [7N] ^ (#5.08) DRUG & ALCOHOL ANNUAL MAX
==>[8N] ^ (#5.09) ROOM AND BOARD (%) [9N] ^ (#5.1) NURSING HOME (%) [10N] ^ (#5.11) MENTAL HEALTH INPATIENT (%)
==>[11N] ^ (#5.12) OTHER INPATIENT CHARGES (%) [12N] ^ ^ (#5.14) MH INPT. MAX DAYS PER YEAR [14N] ^
INPUT TEMPLATE(S):
^DIE(1775)= IBCN AB ACCEPT
^DIE(565)= IBCN AB ADD COM
^DIE(566)= IBCN AB EDIT ALL
^DIE(563)= IBCN AB HOME HEA
^DIE(564)= IBCN AB HOSPC
^DIE(562)= IBCN AB INPT
^DIE(573)= IBCN AB IV MGMT
^DIE(559)= IBCN AB MEN H
^DIE(561)= IBCN AB OPT
^DIE(560)= IBCN AB POL INF
^DIE(572)= IBCN AB REHAB
PRINT TEMPLATE(S):
SORT TEMPLATE(S):
FORM(S)/BLOCK(S):