| Code | Display | Definition |
| benefit | Benefit | Maximum benefit allowable. |
| deductable | Deductable | Cost to be incurred before benefits are applied |
| visit | Visit | Service visit |
| room | Room | Type of room |
| copay | Copayment per service | Copayment per service |
| copay-percent | Copayment Percent per service | Copayment percentage per service |
| copay-maximum | Copayment maximum per service | Copayment maximum per service |
| vision-exam | Vision Exam | Vision Exam |
| vision-glasses | Vision Glasses | Frames and lenses |
| vision-contacts | Vision Contacts Coverage | Contact Lenses |
| medical-primarycare | Medical Primary Health Coverage | Medical Primary Health Coverage |
| pharmacy-dispense | Pharmacy Dispense Coverage | Pharmacy Dispense Coverage |