Benefit Sample

SAMPLE BENEFIT PLAN AND BRULES FOR MONTGOMERY COUNTY UNDER HIPAA
BENEFIT PLAN	BRULES ATTACHED
57B00001 STANDARD TX 30 BRULES	ADMCDDAYS ADMCDOUTP1 ADMCDOUTP2 OHINVALID MHPARHOSPA MHPARHOSPC 5700000005 60 STD NONMCD EXCLUS-1 5700000007 60 STD NONMCD EXCLUS-3 5700000008 60 STD NONMCD EXCLUS-4 ALL SUBSIDY RULES (21)
57B00002 OUT OF COUNTY PLAN 31 BRULES	ADMCDDAYS ADMCDOUTP1 ADMCDOUTP2 OHINVALID MHPARHOSPA MHPARHOSPC 5700000005 60 STD NONMCD EXCLUS-1 5700000007 60 STD NONMCD EXCLUS-3 5700000008 60 STD NONMCD EXCLUS-4 5700000013 50 OOC HOLDS #1 ALL SUBSIDY RULES (21)
57B00003 PREVENTION AND ADJ. SRVS PLAN 7 BRULES	ADMCDDAYS ADMCDOUTP1 ADMCDOUTP2 OHINVALID MHPARHOSPA MHPARHOSPC 5700000012 60 PREV/ADJUNC ONLY
57B00004 MH ONLY 33 BRULES	ADMCDDAYS ADMCDOUTP1 ADMCDOUTP2 OHINVALID MHPARHOSPA MHPARHOSPC 5700000001 60 MH ONLY PLAN 5700000005 60 STD NONMCD EXCLUS-1 5700000007 60 STD NONMCD EXCLUS-3 5700000008 60 STD NONMCD EXCLUS-4 57FY200106 50 STD NONMCD EXCLUS-2 57B2002 60 NEW MEDEF EXCLUSION ALL SUBSIDY RULES(21)