CARVE-OUT (62)    TYPE OF PLAN (355.1)

Name Value
NAME CARVE-OUT
ABBREVIATION COUT
MAJOR CATEGORY MAJOR MEDICAL
DESCRIPTION
Employer provided benefits that deduct the amount that any other
insurance pays for a service from the plan's allowed charge for the same
service and pays the difference after the patient pays the annual
deductible.
EFFECTIVE DATE
  • GROUP CODE:
    • Patient Responsibility
      REASON CODE:
      • 1
        PART A PERCENTAGE:   100
        PART B PERCENTAGE:   100
      • 2
        PART A PERCENTAGE:   100
        PART B PERCENTAGE:   100
      • 3
        PART A PERCENTAGE:   100
        PART B PERCENTAGE:   100
    • Contractual Obligations
      REASON CODE:
      • 45
        PART A PERCENTAGE:   0
        PART B PERCENTAGE:   100