STANDARD 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)
DATA NAME GLOBAL DATA
ELEMENT TITLE LOCATION TYPE
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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.
DD ACCESS: @
WR ACCESS: @
DEL ACCESS: @
LAYGO ACCESS: @
AUDIT ACCESS: @
IDENTIFIED BY: HEALTH INSURANCE POLICY (#.02)
CROSS
REFERENCED BY: HEALTH INSURANCE POLICY(APY), BENEFIT YEAR BEGINNING ON(APY1), BENEFIT YEAR BEGINNING ON(B),
HEALTH INSURANCE POLICY(C)
LAST MODIFIED: OCT 22,2023@22:53:55
355.4,.01 BENEFIT YEAR BEGINNING ON 0;1 DATE (Required)
INPUT TRANSFORM: S %DT="EX" D:$D(X) ^%DT S X=Y K:Y<1 X D DATECHK^IBCNSA2
LAST EDITED: JUN 10, 2004
HELP-PROMPT: Partial benefit years not allowed.
DESCRIPTION:
This is the year to which the health insurance policy's benefits apply.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: 355.4^B
1)= S ^IBA(355.4,"B",$E(X,1,30),DA)=""
2)= K ^IBA(355.4,"B",$E(X,1,30),DA)
CROSS-REFERENCE: 355.4^APY1^MUMPS
1)= S:$P(^IBA(355.4,DA,0),U,2) ^IBA(355.4,"APY",$P(^(0),U,2),-X,DA)=""
2)= K ^IBA(355.4,"APY",+$P(^IBA(355.4,DA,0),U,2),-X,DA)
3)= DO NOT DELETE
Cross-reference of all policies by calendar year.
CROSS-REFERENCE: ^^TRIGGER^355.4^1.01
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(355.4,D0,1)):^(1),1:"") S X=$P(Y(1),U,1),X=X S
DIU=X K Y S X=DIV S X=DT S DIH=$G(^IBA(355.4,DIV(0),1)),DIV=X S $P(^(1),U,1)=DIV,DIH=355.4,DIG=1.01
D ^DICR
2)= Q
CREATE VALUE)= S X=DT
DELETE VALUE)= NO EFFECT
FIELD)= #1.01
CROSS-REFERENCE: ^^TRIGGER^355.4^1.02
1)= X ^DD(355.4,.01,1,4,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.4,D0,1)):^(1),1:"") S X=$P(Y(1),U,2)
,X=X S DIU=X K Y S X=DIV S X=DUZ S DIH=$G(^IBA(355.4,DIV(0),1)),DIV=X S $P(^(1),U,2)=DIV,DIH=355.4,
DIG=1.02 D ^DICR
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^IBA(355.4,D0,1)):^(1),1:"") S X=$P($G(^V
A(200,+$P(Y(1),U,2),0)),U)=""
2)= Q
CREATE CONDITION)= #1.02=""
CREATE VALUE)= S X=DUZ
DELETE VALUE)= NO EFFECT
FIELD)= #1.02
355.4,.02 HEALTH INSURANCE POLICY 0;2 POINTER TO GROUP INSURANCE PLAN FILE (#355.3)
LAST EDITED: AUG 31, 1993
DESCRIPTION: This is the particular health insurance policy that provides some subset of all of the possible
benefits for the year selected. Enter the name of the health insurance policy.
CROSS-REFERENCE: 355.4^C
1)= S ^IBA(355.4,"C",$E(X,1,30),DA)=""
2)= K ^IBA(355.4,"C",$E(X,1,30),DA)
CROSS-REFERENCE: 355.4^APY^MUMPS
1)= S:+^IBA(355.4,DA,0) ^IBA(355.4,"APY",X,-^(0),DA)=""
2)= K ^IBA(355.4,"APY",X,-^IBA(355.4,DA,0),DA)
3)= DO NOT DELETE
Cross-reference of all policies by calendar year.
355.4,.05 MAX. OUT OF POCKET 0;5 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<0) X
LAST EDITED: AUG 25, 1993
HELP-PROMPT: Type a Dollar Amount between 0 and 999999, 2 Decimal Digits
DESCRIPTION: This is the dollar amount that this policy does not cover in claims. This information will be used
in calculating whether reimbursement for claims against this policy are appropriate.
355.4,.06 AMBULANCE COVERAGE (%) 0;6 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>100)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: MAY 13, 1993
HELP-PROMPT: Type a Number between 0 and 100, 0 Decimal Digits
DESCRIPTION:
If this policy provides an ambulance coverage benefit, then this is the amount of that benefit.
355.4,1.01 DATE ENTERED 1;1 DATE
INPUT TRANSFORM: S %DT="ESTX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: FEB 28, 1994
DESCRIPTION: This is the date that the information was first entered. It is necessary to supply a time as well
as date, for example "12/12/93@1300".
WRITE AUTHORITY: ^
NOTES: TRIGGERED by the BENEFIT YEAR BEGINNING ON field of the ANNUAL BENEFITS File
355.4,1.02 ENTERED BY 1;2 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: MAY 20, 1993
DESCRIPTION:
This is the name of the person who entered the information.
WRITE AUTHORITY: ^
NOTES: TRIGGERED by the BENEFIT YEAR BEGINNING ON field of the ANNUAL BENEFITS File
355.4,1.03 DATE LAST VERIFIED 1;3 DATE
INPUT TRANSFORM: S %DT="ETXR" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JUL 07, 1993
DESCRIPTION: This is the date that the information was last verified. It is necessary to supply a time as well
as date, for example "12/12/93@1300".
355.4,1.04 VERIFIED BY 1;4 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: MAY 20, 1993
DESCRIPTION:
This is the name of the person who verified the information on "DATE LAST VERIFIED".
355.4,1.05 DATE LAST EDITED 1;5 DATE
INPUT TRANSFORM: S %DT="ETXR" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JUL 07, 1993
DESCRIPTION: This is the date that the information was last edited. The time must be included, for example
12/12/93@1300.
WRITE AUTHORITY: ^
355.4,1.06 LAST EDIT BY 1;6 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: MAY 20, 1993
DESCRIPTION:
This is the name of the person who last edited the information.
WRITE AUTHORITY: ^
355.4,1.07 PERSON CONTACTED 1;7 FREE TEXT
WHO DID YOU TALK TO AT THE INSURANCE COMPANY
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: JUL 01, 1993
HELP-PROMPT: Answer must be 3-30 characters in length.
DESCRIPTION:
This is the name of the person who was contacted for verification purposes.
355.4,1.08 COMMENTS 1;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>80!($L(X)<3) X
LAST EDITED: MAY 20, 1993
HELP-PROMPT: Answer must be 3-80 characters in length.
DESCRIPTION:
Enter any additional information here.
355.4,1.09 CONTACT'S PHONE NUMBER 1;9 FREE TEXT
WHAT WAS THEIR PHONE NUMBER
INPUT TRANSFORM: K:$L(X)>20!($L(X)<7) X
LAST EDITED: SEP 07, 1993
HELP-PROMPT: Answer must be 7-20 characters in length.
DESCRIPTION:
Enter the telephone number of the person who was contacted for verification purposes.
355.4,2.01 ANNUAL DEDUCTIBLE (OPT) 2;1 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<0) X
LAST EDITED: JUN 04, 1993
HELP-PROMPT: Type a Dollar Amount between 0 and 999999, 2 Decimal Digits
DESCRIPTION: This is the amount that this policy does not cover in claims. This information will be used in
calculating whether reimbursement for claims against this policy are appropriate.
355.4,2.02 PER VISIT DEDUCTIBLE 2;2 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99999)!(X<0) X
LAST EDITED: MAY 13, 1993
HELP-PROMPT: Type a Dollar Amount between 0 and 99999, 2 Decimal Digits
DESCRIPTION:
This is the deductible that the patient must pay for each outpatient visit.
355.4,2.03 OUTPATIENT LIFETIME MAXIMUM 2;3 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999)!(X<0) X
LAST EDITED: OCT 28, 1993
HELP-PROMPT: Type a Dollar Amount between 0 and 9999999, 2 Decimal Digits
DESCRIPTION: If this policy has a lifetime maximum benefit for outpatient services, then this is the amount of
that benefit.
355.4,2.04 OUTPATIENT ANNUAL MAXIMUM 2;4 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99999)!(X<0) X
LAST EDITED: MAY 13, 1993
HELP-PROMPT: Type a Dollar Amount between 0 and 99999, 2 Decimal Digits
DESCRIPTION: If this policy has a benefit for outpatient services, then this amount is the maxiumum of that
benefit for one year.
355.4,2.05 MH LIFETIME OUTPATIENT MAX. 2;5 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9999999)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: OCT 28, 1993
HELP-PROMPT: Type a Number between 0 and 9999999, 0 Decimal Digits
DESCRIPTION: If this policy has a lifetime maximum benefit for mental health services, then this is the amount
of that benefit.
355.4,2.06 MH ANNUAL OUTPATIENT MAX. 2;6 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<0) X
LAST EDITED: MAY 13, 1993
HELP-PROMPT: Type a Dollar Amount between 0 and 999999, 2 Decimal Digits
DESCRIPTION: If this policy has a benefit for mental health services, then this amount is the maximum of that
benefit for one year.
355.4,2.07 DENTAL COVERAGE TYPE 2;7 SET
'0' FOR NONE;
'1' FOR PER VISIT AMOUNT;
'2' FOR PERCENTAGE AMOUNT;
LAST EDITED: JAN 07, 1994
DESCRIPTION:
This indicates whether there is a dental benefit, and if so, the per visit or percentage amount.
CROSS-REFERENCE: ^^TRIGGER^355.4^2.08
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(355.4,D0,2)):^(2),1:"") S X=$P(Y(1),U,8),X=X S
DIU=X K Y S X="" X ^DD(355.4,2.07,1,1,1.4)
1.4)= S DIH=$S($D(^IBA(355.4,DIV(0),2)):^(2),1:""),DIV=X S $P(^(2),U,8)=DIV,DIH=355.4,DIG=2.08 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(355.4,D0,2)):^(2),1:"") S X=$P(Y(1),U,8),X=X S
DIU=X K Y S X="" X ^DD(355.4,2.07,1,1,2.4)
2.4)= S DIH=$S($D(^IBA(355.4,DIV(0),2)):^(2),1:""),DIV=X S $P(^(2),U,8)=DIV,DIH=355.4,DIG=2.08 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
CREATE VALUE)= @
DELETE VALUE)= @
FIELD)= #2.08
When changing or deleting DENTAL COVERAGE TYPE delete DENTAL COVERAGE $ OR %.
355.4,2.08 DENTAL COVERAGE $ OR % 2;8 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>99999)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: MAY 13, 1993
HELP-PROMPT: Type a Number between 0 and 99999, 0 Decimal Digits if coverage is a $ amount, or between 0 and 100
if %.
DESCRIPTION: If there is a dental benefit, this number indicates the dollar or percentage amount of that
benefit.
NOTES: TRIGGERED by the DENTAL COVERAGE TYPE field of the ANNUAL BENEFITS File
355.4,2.09 OUTPATIENT VISIT (%) 2;9 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>100)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: JUN 03, 1993
HELP-PROMPT: Type a Number between 0 and 100, 0 Decimal Digits
DESCRIPTION:
If this policy has an outpatient benefit, this is the percentage coverage per outpatient visit.
355.4,2.1 EMERGENCY OUTPATIENT (%) 2;10 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>100)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: MAR 06, 2023
HELP-PROMPT: Type a Whole Number between 0 and 100.
DESCRIPTION: If this policy has a benefit for emergency outpatient services, this is the percentage covered by
that benefit.
355.4,2.11 MENTAL HEALTH OUTPATIENT (%) 2;11 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>100)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: JUN 03, 1993
HELP-PROMPT: Type a Number between 0 and 100, 0 Decimal Digits
DESCRIPTION: If this policy has a benefit for mental health outpatient services, this is the percentage covered
by that benefit.
355.4,2.12 PRESCRIPTION (%) 2;12 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>100)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: MAR 06, 2023
HELP-PROMPT: Type a Whole Number between 0 and 100.
DESCRIPTION: If this policy has a benefit for prescription services, this is the percentage covered by that
benefit.
355.4,2.13 OUTPATIENT SURGERY (%) 2;13 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>100)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: MAR 06, 2023
HELP-PROMPT: Type a Whole Number between 0 and 100.
DESCRIPTION: If this policy has a benefit for outpatient surgery services, this is the percentage covered by
that benefit.
355.4,2.14 MH OPT. MAX DAYS PER YEAR 2;14 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>365)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: JUL 08, 1993
HELP-PROMPT: Type a Number between 0 and 365, 0 Decimal Digits
DESCRIPTION: If this policy provides a benefit for mental health outpatient services, this is the maximum number
of days per year of this benefit.
355.4,2.15 OUTPATIENT VISITS PER YEAR 2;15 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>365)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: AUG 25, 1993
HELP-PROMPT: Type a Number between 0 and 365, 0 Decimal Digits
DESCRIPTION:
If this policy provides outpatient benefits, this is the maximum number of visits per year.
355.4,2.17 ADULT DAY HEALTH CARE 2;17 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: AUG 27, 1993
DESCRIPTION:
This indicates whether the policy has a benefit for Adult Day Health Care services.
355.4,3.01 HOME HEALTH CARE LEVEL 3;1 SET
'0' FOR NONE;
'1' FOR NURSES AIDE;
'2' FOR LPN;
'3' FOR RN;
'4' FOR THERAPIST/OTHER;
LAST EDITED: SEP 24, 1993
DESCRIPTION: If this policy provides home health care, this is the highest level of nursing care that it will
cover.
355.4,3.02 HOME HEALTH VISITS PER YEAR 3;2 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>365)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: MAY 13, 1993
HELP-PROMPT: Type a Number between 0 and 365, 0 Decimal Digits
DESCRIPTION:
If this policy provides home health care, this is the maximum number of visits per year.
355.4,3.03 HOME HEALTH MAX DAYS PER YEAR 3;3 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>365)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: MAY 13, 1993
HELP-PROMPT: Type a Number between 0 and 365, 0 Decimal Digits
DESCRIPTION: If this policy provides home health care, this is the maximum number of days per year of home
health care services.
355.4,3.04 HOME HEALTH MED. EQUIPMENT (%) 3;4 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>100)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: MAY 13, 1993
HELP-PROMPT: Type a Number between 0 and 100, 0 Decimal Digits
DESCRIPTION: If this policy provides a benefit for medical equipment used in home health care services, this is
the percentage of that benefit.
355.4,3.05 HOME HEALTH VISIT DEFINITION 3;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: MAY 13, 1993
HELP-PROMPT: Answer must be 3-30 characters in length.
DESCRIPTION:
If this policy provides for home health visits, this defines the nature of the visits.
355.4,3.06 OCCUPATIONAL THERAPY # VISITS 3;6 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>365)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: AUG 26, 1993
HELP-PROMPT: Type a Number between 0 and 365, 0 Decimal Digits
DESCRIPTION: If this policy has a benefit for occupational therapy, then this is the maximum number of OT visits
that the policy allows in one year.
355.4,3.07 PHYSICAL THERAPY # VISITS 3;7 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>365)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: AUG 26, 1993
HELP-PROMPT: Type a Number between 0 and 365, 0 Decimal Digits
DESCRIPTION: If this policy has a benefit for physical therapy, then this is the maximum number of PT visits
that the policy allows in one year.
355.4,3.08 SPEECH THERAPY # VISITS 3;8 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>365)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: AUG 26, 1993
HELP-PROMPT: Type a Number between 0 and 365, 0 Decimal Digits
DESCRIPTION: If this policy has a benefit for speech therapy, then this is the maximum number of ST visits that
the policy allows in one year.
355.4,3.09 MEDICATION COUNSELING # VISITS 3;9 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>365)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: AUG 26, 1993
HELP-PROMPT: Type a Number between 0 and 365, 0 Decimal Digits
DESCRIPTION: If this policy has a benefit for medication counseling, then this is the maximum number of MC
visits that the policy allows in one year.
355.4,4.01 HOSPICE ANNUAL DEDUCTIBLE 4;1 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<0) X
LAST EDITED: MAY 13, 1993
HELP-PROMPT: Type a Dollar Amount between 0 and 999999, 2 Decimal Digits
DESCRIPTION: If this policy provides hospice services, this is the amount that the policy does not cover in
claims. This information will be used in calculating whether reimbursement for claims against this
policy are appropriate.
355.4,4.02 HOSPICE INPATIENT ANNUAL MAX 4;2 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<0) X
LAST EDITED: MAY 13, 1993
HELP-PROMPT: Type a Dollar Amount between 0 and 999999, 2 Decimal Digits
DESCRIPTION: If this policy provides hospice inpatient services, this is the maximum amount of coverage for one
year.
355.4,4.03 HOSPICE INPT. LIFETIME MAX 4;3 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999)!(X<0) X
LAST EDITED: OCT 28, 1993
HELP-PROMPT: Type a Dollar Amount between 0 and 9999999, 2 Decimal Digits
DESCRIPTION: If this policy provides hospice inpatient services, this is the maximum amount over the life of the
policy for this benefit.
355.4,4.04 ROOM AND BOARD (%) 4;4 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>100)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: MAY 13, 1993
HELP-PROMPT: Type a Number between 0 and 100, 0 Decimal Digits
DESCRIPTION: If this policy provides a room and board benefit, this is the percentage of the charges that the
policy will cover.
355.4,4.05 OTHER INPATIENT CHARGES (%) 4;5 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>100)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: MAY 13, 1993
HELP-PROMPT: Type a Number between 0 and 100, 0 Decimal Digits
DESCRIPTION: If this policy provides a benefit for other inpatient charges, this is the percentage covered by
that benefit.
355.4,4.06 IV INFUSION OPT. 4;6 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: AUG 26, 1993
DESCRIPTION:
This indicates whether the policy has a benefit for outpatient IV Infusion services.
355.4,4.07 IV INFUSION INPT. 4;7 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: AUG 26, 1993
DESCRIPTION:
This indicates whether the policy has a benefit for inpatient IV Infusion services.
355.4,4.08 IV ANTIBIOTICS OPT. 4;8 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: AUG 26, 1993
DESCRIPTION:
This indicates whether the policy has a benefit for outpatient IV Antibiotics services.
355.4,4.09 IV ANTIBIOTICS INPT. 4;9 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: SEP 07, 1993
DESCRIPTION:
This indicates whether the policy has a benefit for inpatient IV Antibiotics.
355.4,5.01 ANNUAL DEDUCTIBLE (INPATIENT) 5;1 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<0) X
LAST EDITED: JUN 04, 1993
HELP-PROMPT: Type a Dollar Amount between 0 and 999999, 2 Decimal Digits
DESCRIPTION: If this policy provides for inpatient services, this is the amount that the policy does not cover
in claims. This information will be used in calculating whether reimburseent for claims against
this policy are appropriate.
355.4,5.02 PER ADMISSION DEDUCTIBLE 5;2 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<0) X
LAST EDITED: MAY 20, 1993
HELP-PROMPT: Type a Dollar Amount between 0 and 999999, 2 Decimal Digits
DESCRIPTION:
This is the dollar amount that this policy does not cover in claims for each admission.
355.4,5.03 INPATIENT LIFETIME MAXIMUM 5;3 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999)!(X<0) X
LAST EDITED: OCT 28, 1993
HELP-PROMPT: Type a Dollar Amount between 0 and 9999999, 2 Decimal Digits
DESCRIPTION: If this policy provides inpatient services, this is the maximum amount over the life of this policy
for this benefit.
355.4,5.04 INPATIENT ANNUAL MAXIMUM 5;4 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<0) X
LAST EDITED: MAY 20, 1993
HELP-PROMPT: Type a Dollar Amount between 0 and 999999, 2 Decimal Digits
DESCRIPTION:
If this policy provides inpatient services, this is the maximum annual amount of this benefit.
355.4,5.05 MH LIFETIME INPATIENT MAXIMUM 5;5 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999)!(X<0) X
LAST EDITED: OCT 28, 1993
HELP-PROMPT: Type a Dollar Amount between 0 and 9999999, 2 Decimal Digits
DESCRIPTION: If this policy provides a benefit for mental health inpatient services, this is the maximum amount
over the life of the policy for this benefit.
355.4,5.06 MH ANNUAL INPATIENT MAXIMUM 5;6 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<0) X
LAST EDITED: MAY 20, 1993
HELP-PROMPT: Type a Dollar Amount between 0 and 999999, 2 Decimal Digits
DESCRIPTION: If this policy provides a benefit for mental health inpatient services, this is the maximum amount
that this policy will pay toward these services in one year.
355.4,5.07 DRUG & ALCOHOL LIFETIME MAX 5;7 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999)!(X<0) X
LAST EDITED: OCT 28, 1993
HELP-PROMPT: Type a Dollar Amount between 0 and 9999999, 2 Decimal Digits
DESCRIPTION: If this policy provides a benefit for drug and alcohol services, this is the maximum amount over
the life of the policy for this benefit.
355.4,5.08 DRUG & ALCOHOL ANNUAL MAX 5;8 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<0) X
LAST EDITED: MAY 20, 1993
HELP-PROMPT: Type a Dollar Amount between 0 and 999999, 2 Decimal Digits
DESCRIPTION: If this policy provides a benefit for drug and alcohol services, this is the maximum amount that
this policy will pay toward these services in one year.
355.4,5.09 ROOM AND BOARD (%) 5;9 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>100)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: MAY 20, 1993
HELP-PROMPT: Type a Number between 0 and 100, 0 Decimal Digits
DESCRIPTION: If this policy provides a room and board benefit, this is the percentage of room and board charges
that the policy will cover.
355.4,5.1 NURSING HOME (%) 5;10 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>100)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: MAY 20, 1993
HELP-PROMPT: Type a Number between 0 and 100, 0 Decimal Digits
DESCRIPTION: If this policy provides a benefit for nursing home services, this is the percentage of nursing home
charges that the policy will cover.
355.4,5.11 MENTAL HEALTH INPATIENT (%) 5;11 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>100)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: MAY 20, 1993
HELP-PROMPT: Type a Number between 0 and 100, 0 Decimal Digits
DESCRIPTION: If this policy provides a benefit for mental health inpatient services, this is the percentage of
the charges that the policy will cover.
355.4,5.12 OTHER INPATIENT CHARGES (%) 5;12 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>100)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: MAY 20, 1993
HELP-PROMPT: Type a Number between 0 and 100, 0 Decimal Digits
DESCRIPTION: If this policy provides a benefit for other inpatient charges, this is the percentage of those
charges that the policy will cover.
355.4,5.14 MH INPT. MAX DAYS PER YEAR 5;14 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>365)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: JUL 08, 1993
HELP-PROMPT: Type a Number between 0 and 365, 0 Decimal Digits
DESCRIPTION: If this policy provides a benefit for mental health inpatient services, this is the maximum number
of days per year of this benefit.
FILES POINTED TO FIELDS
GROUP INSURANCE PLAN (#355.3) HEALTH INSURANCE POLICY (#.02)
NEW PERSON (#200) ENTERED BY (#1.02)
VERIFIED BY (#1.04)
LAST EDIT BY (#1.06)
INPUT TEMPLATE(S):
IBCN AB ACCEPT JAN 08, 2016@10:16 USER #0
New Input Template used to format the Annual Benefits screen for user
editing. Called from routine IBCNB*. This is for the MCCF HAPE
Eligibility Benefits and Claims project.
IBCN AB ADD COM JUN 11, 1993@11:42 USER #11985
IBCN AB EDIT ALL JAN 06, 1994@11:08 USER #12540
IBCN AB HOME HEA JUN 11, 1993@11:21 USER #11985
IBCN AB HOSPC JUN 11, 1993@11:29 USER #11985
IBCN AB INPT JUN 11, 1993@11:20 USER #11985
IBCN AB IV MGMT AUG 27, 1993@11:46 USER #0
IBCN AB MEN H JAN 06, 1994@13:08 USER #12540
IBCN AB OPT JAN 06, 1994@13:01 USER #12540
IBCN AB POL INF JUL 08, 1993@12:22 USER #11985
IBCN AB REHAB AUG 27, 1993@11:46 USER #0
PRINT TEMPLATE(S):
SORT TEMPLATE(S):
FORM(S)/BLOCK(S):