| EligibilityBenifitInfoCode | AN | 1 | 2 | |
| EligibilityBenifitInfoDescription | AN | 1 | 50 | |
| CoverageLevelCode | AN | 3 | 3 | |
| CoverageLevelDescription | AN | 1 | 50 | |
| ServiceTypeCode | AN | 1 | 2 | |
| ServiceTypeDescription | AN | 1 | 50 | |
| InsuranceTypeCode | AN | 1 | 3 | |
| InsuranceTypeDescription | AN | 1 | 50 | |
| PlanCoverageDescription | AN | 1 | 50 | |
| TimePeriodQualifierCode | AN | 1 | 2 | |
| MonetaryAmount | Numeric | 1 | 18 | |
| Percent | Numeric | 1 | 10 | |
| QuantityQualifierCode | AN | 2 | 2 | |
| QuantityQualifierDescription | AN | 1 | 50 | |
| Quantity | Numeric | 1 | 15 | |
| AuthorizationOrCertificationIndicatorCode | AN | 1 | 1 | |
| AuthorizationOrCertificationIndicatorDescription | AN | 1 | 50 | |
| InPlanNetworkIndicatorCode | AN | 1 | 1 | |
| InPlanNetworkIndicatorDescription | AN | 1 | 50 | |
| Procedure | AN | 1 | 48 | |
