Search Member
Member Information
Plan Information - Coverage and Deductible
IN | OUT | ||||||
Procedure Category | Procedure Category Description | Coverage | Deductible Applies | Waiting Period Met Date | Coverage | Deductible Applies | Waiting Period Met Date |
---|
Plan Information - Deductible
IN | OUT | |||
Description | Member Amount | Family Amount | Member Amount | Family Amount |
---|
Plan Information - Limit
IN | OUT | |||
Description | Member Limit Amount | Family Limit Amount | Member Limit Amount | Family Limit Amount |
---|
Amount of Limit Met
IN | OUT | |||
Limit Description | Member Limit Amount | Family Limit Amount | Member Limit Amount | Family Limit Amount |
---|
Rollover Benefit
Benefit Year Maximum:
Benefit Year Award Received:
Benefit Year Bonus Received:
Benefit Year Maximum Paid Toward Award:
Benefit Year Award Used:
Benefit Year Bonus Used:
Benefit Year Award Balance:
Benefit Year Bonus Balance:
Utilization
ADA Code | ADA Description | Procedure Category | Service Dates | Service Date Procedure Code Frequency* (i-ii-iii) | Age Limit | Alternate Benefit | Related Codes | |||
---|---|---|---|---|---|---|---|---|---|---|
* Frequency Definition: i = Number of Procedure (999 = unlimited); ii = ProcedureFrequency Type (C=Calendar Year, F=Floating, P=Plan Year); iii = Period and Timeframe(D=Day, M=Month, Y=Year) Example: 1 F 36M read as 1 Procedure per 36 Floating Months |
Claims Address
Payor Id:
521337971