AuditClaimHistoryModel

Amount applied to periodic deductible for member

Amount applied to periodic deductible for family

Dollar amount of claims during the specified interval and for a benefit code (if supplied) that count toward a person deductible

Dollar amount of claims during the specified interval and for a benefit code (if supplied) that count toward a family deductible

Dollar amount of claims during the specified interval and for a benefit code (if supplied) that count toward a person max out of pocket limit

Dollar amount of claims during the specified interval and for a benefit code (if supplied) that count toward a family max out of pocket limit

Dollar amount of claims during the specified interval and for a benefit code (if supplied) that the plan has paid for a member

Dollar amount of claims during the specified interval and for a benefit code (if supplied) that the plan has paid for a member's family

Dollar amount of claims during the specified interval and for a benefit code (if supplied) that apply toward a plan incentive for a member

Start date of the period for which the claim dollar amounts apply

End date of the period for which the claim dollar amounts apply

Interval for which the claim dollar amounts apply (M=Month, P=Period, L=Lifetime)

If a benefit code description is present here, the amounts for MOOP, deductible and plan incentive only apply to this benefit code

Rx dollar amount of claims during the specified interval and for a benefit code (if supplied) that count toward a person deductible

Rx dollar amount of claims during the specified interval and for a benefit code (if supplied) that count toward a family deductible

Amount applied to periodic deductible for member for Rx claims only

Amount applied to periodic deductible for member for Rx claims only

Rx dollar amount of claims during the specified interval and for a benefit code (if supplied) that count toward a person max out of pocket limit

Rx dollar amount of claims during the specified interval and for a benefit code (if supplied) that count toward a family max out of pocket limit

Rx dollar amount of claims during the specified interval and for a benefit code (if supplied) that the plan has paid for a member

Rx dollar amount of claims during the specified interval and for a benefit code (if supplied) that the plan has paid for a member's family

Accumulator dollar amount of claims during the specified interval and for a benefit code (if supplied) that count toward a person deductible

Accumulator dollar amount of claims during the specified interval and for a benefit code (if supplied) that count toward a family deductible

Amount applied to periodic deductible for member for medical accumulator only

Amount applied to periodic deductible for member for medical accumulator only

Accumulator dollar amount of claims during the specified interval and for a benefit code (if supplied) that count toward a person max out of pocket limit

Accumulator dollar amount of claims during the specified interval and for a benefit code (if supplied) that count toward a family max out of pocket limit

Accumulator dollar amount of claims during the specified interval and for a benefit code (if supplied) that the plan has paid for a member

Accumulator dollar amount of claims during the specified interval and for a benefit code (if supplied) that the plan has paid for a member's family

Other claim dollar amount of claims during the specified interval and for a benefit code (if supplied) that count toward a person deductible

Other claim dollar amount of claims during the specified interval and for a benefit code (if supplied) that count toward a family deductible

Amount applied to periodic deductible for member for other claims only

Amount applied to periodic deductible for member for other claims only

Other claim dollar amount of claims during the specified interval and for a benefit code (if supplied) that count toward a person max out of pocket limit

Other claim dollar amount of claims during the specified interval and for a benefit code (if supplied) that count toward a family max out of pocket limit

Other claim dollar amount of claims during the specified interval and for a benefit code (if supplied) that the plan has paid for a member

Other claim dollar amount of claims during the specified interval and for a benefit code (if supplied) that the plan has paid for a member's family

Claim adjustment dollar amount of claims during the specified interval and for a benefit code (if supplied) that count toward a person deductible

Claim adjustment dollar amount of claims during the specified interval and for a benefit code (if supplied) that count toward a family deductible

Amount applied to periodic deductible for member for claim adjustments only

Amount applied to periodic deductible for member for claim adjustments only

Claim adjustment dollar amount of claims during the specified interval and for a benefit code (if supplied) that count toward a person max out of pocket limit

Claim adjustment dollar amount of claims during the specified interval and for a benefit code (if supplied) that count toward a family max out of pocket limit

Claim adjustment dollar amount of claims during the specified interval and for a benefit code (if supplied) that the plan has paid for a member

Claim adjustment dollar amount of claims during the specified interval and for a benefit code (if supplied) that the plan has paid for a member's family