Medicare Advantage and Prescription Drug Plans December 28 ...

Plan Communications User Guide Appendices, Version 6.3
F.19.2 Detail Record (Transaction)
Item Field Size Position Position Description
1 Record Type 1 1 CHAR ‘D’ = Detail Record
2
MCO Contract
Number
5 2-6 CHAR
Contract ID: 9xxxx, Exxxx, Fxxxx, Hxxxx, Rxxxx, or
Sxxxx, where “xxxx” is the contract’s numeric
designation.
3 PBP Number 3 7-9 CHAR
PBP Number, blank when Beneficiary premium
profile is unavailable.
4 HIC Number 12 10-21 CHAR Beneficiary’s HIC #
5 Surname 12 22-33 CHAR Beneficiary’s Surname
6 First Name 7 34-40 CHAR Beneficiary’s First Initial
7 Middle Initial 1 41 CHAR Beneficiary’s Middle Initial
8 Sex 1 42 CHAR M = Male, F = Female
9 Date of Birth 8 43-50 CHAR Date of Birth YYYYMMDD – Format
10
11
Low Income
Period Start
Date
Low Income
Period End Date
8 51-58 CHAR
8 59-66 CHAR
12 LIPS Percentage 3 67-69 CHAR
13
Premium LIS
Amount
8 70-77 CHAR
Start date for beneficiary’s Low Income Period
Amount:
YYYYMMDD – Format
End date for beneficiary’s Low Income Period
Amount:
YYYYMMDD – Format
Beneficiary’s LIPS Percentage
‘100’ = 100% Premium subsidy
‘075’ = 75% Premium subsidy
‘050’ = 50% Premium subsidy
‘025’ = 25% Premium subsidy
The portion of the Part D basic premium paid by the
Government on behalf of a low-income individual. A
zero dollar amount here represents several
possibilities:
1. There is no Plan premium and therefore no
premium subsidy.
2. Although the Beneficiary is enrolled and LIS
eligible, a system error occurred making premium data
unavailable.
Premium LIS Amount is entered in spaces when data
is unavailable.
99999.99 – Format
14
Low Income
Co-pay Level
ID
1 78 CHAR
Co-Payment Category Definitions:
‘1’ = High
‘2’ = Low
‘3’ = $0
‘4’ = 15%
Co-pay level IDs 1 and 2 change each year.
In 2007, 1 = $2.15/$5.35 and 2 = $1/$3.10.
In 2006 1 = $2/$5 and 2 = $1/$3.
December 28, 2012 F-99 LIS History Data File (LISHIST)