Medigap No

Medigap number assigned by Medicare to this plan/carrier

Box 9a

Indicates if Box 9a should be blank on Medigap Claims for this plan.

Box 9b

Indicates if Box 9b should be blank on Medigap Claims for this plan.

Box 9c

Indicates if Box 9c should be blank on Medigap Claims for this plan.

Box 9d

Indicates if Box 9d should be blank on Medigap Claims for this plan.

Box 10d

Indicates if Box 10d should be blank on Medigap Claims for this plan.

Box 11

Indicates if Box 11 should be blank on Medigap Claims for this plan.

Box 11a

Indicates if Box 11a should be blank on Medigap Claims for this plan.

Box 11b

Indicates if Box 11b should be blank on Medigap Claims for this plan.

Box 11c

Indicates if Box 11c should be blank on Medigap Claims for this plan.

Box 11d

Indicates if Box 11d should be blank on Medigap Claims for this plan.

Prefix

Literal prefix to print in first Medigap field.  This may be anything defined by the carrier, but is frequently "MG" or "MEDIGAP".

Option

First Optional part of the first Medigap field.  Allowable values are:

Option

Second Optional part of the first Medigap field.  Allowable values are:

Suffix

Literal suffix to print in first Medigap field.  This may be anything defined by the carrier.

Show Message 1 In

Indicates where Medigap Message 1 should print on the HCFA-1500 form.  Allowable values are:

Prefix

Literal prefix to print in second Medigap field.  This may be anything defined by the carrier, but is frequently "MG" or "MEDIGAP".

Option

First Optional part of the second Medigap field.  Allowable values are:

Option

Second Optional part of the second Medigap field.  Allowable values are:

Suffix

Literal suffix to print in second Medigap field.  This may be anything defined by the carrier.

Show Message 2 In

Indicates where Medigap Message 2 should print on the HCFA-1500 form.  Allowable values are: