Section 1.4.7.1, #2 indicates for each plan which the individual has active or inactive coverage, a 2110C/D loop is required with the status and Service Type Code = 30 (Health Plan Coverage) and Plan Name. We would like to verify if the following is a correct response to a Service Type Code “30” when the health plan includes only a dental plan and no medical plans:
Dependent Eligibility or Benefit Information (2110D)
EB*1**30*PR*XXX STANDARD PLAN P0010~
LS*2120~
Dependent Benefit Related Entity Name (2120D)
NM1*PR*2*XXX SPECIALTY BENEFITS DENTAL*****PI*412014834~
N3*P.O. BOX 5464~
N4*SALT LAKE CITY*UT*84130~
PER*IC**UR*WWW.XXXDENTAL.COM~
LE*2120~
Dependent Eligibility or Benefit Information (2110D)
EB*C*FAM*30***22*150*****W~
EB*C*IND*30***22*50*****W~
EB*G*FAM*30*PR**22*0*****W~
EB*G*IND*30*PR**22*0*****W~
EB*1**35*********W~
The example response appears to be compliant with the requirements of 005010X279A1 Section 1.4.7.1 271 item 2. The example reflects Dental benefits only and that coverage has been carved out to the entity identified in the 2120 loop.