| FSA-01 |
875 |
Maintenance Type Code |
Identifier (ID) |
Mandatory |
3 |
3 |
| Code identifying the specific type of item maintenance |
Codes (123) |
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| FSA-02 |
1202 |
Flexible Spending Account Selection Code |
Identifier (ID) |
Optional |
1 |
1 |
| Code indicating selection of a type of Flexible Spending Account |
Codes (5) |
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| FSA-03 |
1203 |
Maintenance Reason Code |
Identifier (ID) |
Optional |
2 |
3 |
| Code identifying the reason for the maintenance change |
Codes (118) |
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| FSA-04 |
508 |
Account Number |
String (AN) |
Optional |
1 |
35 |
| Account number assigned |
FSA04 is the flexible spending account (FSA) policy number. |
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| FSA-05 |
594 |
Frequency Code |
Identifier (ID) |
Optional |
1 |
1 |
| Code indicating frequency or type of activities or actions being reported |
FSA05 specifies the frequency of contribution. |
Codes (23) |
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| FSA-06 |
1204 |
Plan Coverage Description |
String (AN) |
Optional |
1 |
50 |
| A description or number that identifies the plan or coverage |
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| FSA-07 |
1161 |
Product Option Code |
Identifier (ID) |
Optional |
1 |
2 |
| Code indicating an option chosen for the product |
Codes (30) |
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| FSA-08 |
1161 |
Product Option Code |
Identifier (ID) |
Optional |
1 |
2 |
| Code indicating an option chosen for the product |
Codes (30) |
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| FSA-09 |
1161 |
Product Option Code |
Identifier (ID) |
Optional |
1 |
2 |
| Code indicating an option chosen for the product |
Codes (30) |
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