Files > TYPE OF PLAN

name
TYPE OF PLAN
number
355.1
location
^IBE(355.1,
description
This file contains the standard types of plans that an insurance company may provide. The type of plan may be dependent on the type of coverage provided by the insurance company and may affect the type of benefits that are available for the plan. Per VHA Directive 10-93-142, this file definition should not be modified.
Fields
#NameLocationTypeDetailsIndexDescription
.01name(+)0;1FREE TEXTThere are a number of different types of policies, some have very specific types of coverage while others cover a much broader range of care. This is the name of the type of policy. Select the name that best describes the type of policy. This is a list of standard types of policies. The type of policy may be dependent on the type of coverage provided by the insurance company and may affect the type of benefits that are available for the policy. This will be used in determining if the reimbursement from the insurance company is appropriate for this policy.
.02abbreviation0;2FREE TEXTDEnter the standard abbreviation for this type of policy. The abbreviation will be used on standard displays of policy information where space is limited.
.03major category0;3SET OF CODES1:MAJOR MEDICAL
2:DENTAL
3:HMO
4:PPO
5:MEDICARE
6:MEDICAIDE
7:CHAMPUS
8:WORKMANS COMP
9:INDEMNITY
10:PRESCRIPTION
11:MEDICARE SUPPLEMENTAL
12:ALL OTHER
CEach type of policy must be identified with a major category. It is the major category field that will be used to determine the type of policy internally by the computer.
.04inactive0;4BOOLEAN1:YES
An Inactive Type of Plan should no longer be used to define Plans.
10description10;0WORD-PROCESSINGEnter a one or two sentence description of the type of policy.
14effective date14;0MULTIPLE355.14The effective date multiple contains the date(s) on which the coverage amounts paid by a supplemental Type of Plan go into effect or change. The percentages paid are stored within this Effective Date multiple by Group Code and Reason Code. When these percentages change, a new effective date should be entered along with each Group and Reason Code for which this plan pays. If there is no effective date entry or the effective date is AFTER the claim service From date, the secondary balance due will be calculated as 100% of Patient Responsibility as indicated on the Medicare-equivalent Remittance Advice (MRA).

Referenced by 2 types

  1. GROUP INSURANCE PLAN (355.3) -- type of plan
  2. INSURANCE VERIFICATION PROCESSOR (355.33) -- type of plan