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Back  RFI # 1898: 271 EB02 Requirement

Formal vs. Informal Help Informal Formal


Deb McCachern


A health plan has told us that they have individual plan coverage levels only (no family levels, etc.) They are returning a 2110C/D EB02 of IND for certain benefits, such as their remaining deductible and Out-of-Pocket Stop Loss. The situational rule for EB02 states "If not required by this rule, do not send." Considering the plan does not need to distinguish IND benefits versus other coverage levels, is it compliant for them to be returning IND in EB02?

Submitter Assigned Keywords

Coverage Level EB02 271


The situational rule for the 2110 EB02 element reads "Required when needed to identify the types of individuals associated with the eligibility or benefits being identified in the 2110C loop. If not required by this implementation guide, do not send."

Since not all receivers may know that all of the coverage through this health plan is individual only, the Information Source is within the rule to determine that they need to send this information.
Submission 2/24/2014
Status Date 5/16/2014
Status F - Final
Primary References
Document 005010X279A1
Set ID271
Segment IDEB
Component Position04
Industry NameCoverage Level