| Parent File | Name | Number | Package | 
|---|---|---|---|
| COVERAGE TYPE(#9999999.65) | CO-PAY/DED RATES | 9999999.6519 | Utility Tables | 
| Field # | Name | Loc | Type | Details | 
|---|---|---|---|---|
| .01 | START DATE | 0;1 | DATE | ************************REQUIRED FIELD************************ 
 | 
| .02 | OP CO-PAY | 0;2 | NUMBER | 
 | 
| .03 | OP CO-INSURANCE | 0;3 | NUMBER | 
 | 
| .04 | ER CO-PAY | 0;4 | NUMBER | 
 | 
| .05 | DAY SURGERY CO-PAY | 0;5 | NUMBER | 
 | 
| .06 | DAY SURGERY CO-INSURANCE | 0;6 | NUMBER | 
 | 
| .07 | IP CO-PAY | 0;7 | NUMBER | 
 | 
| .08 | IP CO-INSURANCE | 0;8 | NUMBER | 
 | 
| .09 | DENTAL CO-INSURANCE | 0;9 | NUMBER | 
 | 
| .11 | MENTAL HEALTH DEDUCTIBLE | 0;10 | NUMBER | 
 | 
| .12 | DEDUCTIBLE/FAMILY | 0;11 | NUMBER | 
 | 
| .13 | DEDUCTIBLE/INDIVIDUAL | 0;12 | NUMBER | 
 | 
| .14 | DEDUCTIBLE/OUT-OF-POCKET | 0;13 | NUMBER | 
 | 
| .15 | MCR PART A IP DED | 0;14 | NUMBER | 
 | 
| .16 | MCR PART A CO-INS(61-90) | 0;15 | NUMBER | 
 | 
| .17 | MCR PART A LIFETIME RES | 0;16 | NUMBER | 
 | 
| .18 | MCR PART A SNF CO-INS | 0;17 | NUMBER | 
 | 
| .19 | MCR PART A MEDICARE DAYS | 0;18 | NUMBER | 
 | 
| .21 | MCR PART B DED | 0;19 | NUMBER | 
 | 
| .22 | MCR PART B CO-INS | 0;20 | NUMBER | 
 |