Class: Healthcare_benefit_coverage

Description of: Healthcare_benefit_coverage

Class steward is Patient Administration
A defined level of healthcare insurance coverage.

Rationale: Consistency with other Healthcare_benefit classes.

Attribute definitions for: Healthcare_benefit_coverage

agreement_type_cd

A code serving as an additional refinement of an insurance plan. (e.g., standard, unified, maternity, . . .).

Rationale: This attribute is more appropriately related to a healthcare coverage benefit.

|IN1^31^00456^Type of Agreement Code|

annual_limit_amt

The annual limit amount for the Healthcare coverage benefit.

baby_coverage_ind

An indication of the existence of baby coverage under the insurance plan.

Rationale: This attribute is more appropriately related to a healthcare coverage benefit.

|IN2^19^00490^Baby Coverage|

benefit_desc

A textual description of the benefit.

benefit_product_nm

The name of the benefit product.

blood_deductible_amt

The deductible amount for blood.

Rationale: This attribute is more approprriately related to a healthcare coverage benefit.

|IN2^21^00492^Blood Deductible|

copay_limit_ind

An indication as to whether the patient has reached the copay limit.

Rationale: This attribute is more appropriately related to a healthcare coverage benefit.

|IN2^67^00807^Copay Limit Flag|

daily_deductible_amt

The amount of the daily deductible for this insurance plan.

Rationale: This attribute is more appropriately related to a healthcare coverage benefit.

|IN2^30^00501^Daily Deductible|

dependent_coverage_ind

An indication as to whether the benefit includes dependent coverage.

dependent_coverage_limit_amt

The limit on the dependent coverage amount.

effective_dttm

The date and time the benefit becomes effective.

lifetime_limit_amt

The lifetime limit amount for the Healthcare coverage benefit.

non_covered_insurance_cd

A code depicting the reason why a service is not covered.

Rationale: This attribute is more appropriately related to a healthcare coverage benefit.

|IN2^24^00495^Non-Covered Insurance Code|

policy_amount_class_cd

The code classifying the amount (e.g. AT-Amount, PC-Percentage, LM-Limit)

Rationale: IN2-29. This attribute is more appropriately related to a healthcare coverage benefit.

OpenIssue:

|IN2^29^00500^Policy Type/Amount|

policy_amt

The benefit limit amount or percentage.

Rationale: IN2-29. This attribute is more appropriately related to a healthcare coverage benefit.

OpenIssue:

|IN2^29^00500^Policy Type/Amount|

policy_category_cd

The policy category code (e.g., ANC-ancillary, MMD-major medical)

Rationale: IN2-29. This attribute is more appropriately related to a healthcare coverage benefit.

OpenIssue:

|IN2^29^00500^Policy Type/Amount|

policy_deductible_amt

The deductible amount specified by the insurance plan.

Rationale: This attribute is more appropriately related to a healthcare coverage benefit.

|IN1^37^00462^Policy Deductible|

policy_limit_day_qty

The maximum number of days that the insurance policy will cover.

Rationale: This attribute is more appropriately related to a healthcare coverage benefit.

|IN1^39^00464^Policy Limit - Days|

policy_scope_cd

A code depicting the extent of the coverage for a participating member (e.g., single, family, . . .).

Rationale: This attribute is more appropriately related to a healthcare coverage benefit.

|IN2^59^00799^Policy Scope |

room_coverage_type_amount_cd

A rate for a given room type.

Rationale: This attribute is more appropriately related to a healthcare coverage benefit.

|IN2^28^00499^Room Coverage Type/Amount|

termination_dttm

The date the benefit is no longer in effect.

Whole-part definitions for: Healthcare_benefit_coverage

has_parts (0,n) :: Healthcare_benefit_service :: is_part_of (1,1)

is_part_of (1,1) :: Healthcare_benefit_product :: has_parts (0,n)