Back to search

member cost sharing

mbr_cst_shr
member·Updated Jun 23, 2026

Definition

ISO-11179 Definition

The total out-of-pocket cost obligation a health plan member is responsible for paying for covered healthcare services, encompassing all forms of cost sharing including deductibles, copayments, and coinsurance. Member cost sharing is a core benefit design element that affects healthcare utilization patterns, member financial burden, and plan actuarial value calculations under ACA metal tier requirements. CMS sets maximum out-of-pocket limits for Medicare Advantage plans annually.

Healthcare data teams build cost sharing accumulator pipelines that track deductible, copay, and coinsurance payments chronologically throughout the plan year to determine member liability at each point of service and identify when members reach their out-of-pocket maximum.

Standard Abbreviation

mbr_cst_shr

Category

member

Production DDL — DIM_MEMBER

DIM_MEMBER.sql
CREATE OR REPLACE TABLE DIM_MEMBER (
    mbr_key           INTEGER        NOT NULL  -- surrogate key,
    mbr_id            VARCHAR(50)    NOT NULL  -- member identifier,
    mbr_first_nm      VARCHAR(100)             -- first name,
    mbr_last_nm       VARCHAR(100)             -- last name,
    mbr_birth_dt      DATE                     -- date of birth,
    mbr_gndr_cd       CHAR(1)                  -- gender code M/F/U,
    mbr_age           SMALLINT                 -- age in years,
    mbr_state_cd      CHAR(2)                  -- state code,
    mbr_zip_cd        VARCHAR(10)              -- zip code,
    mbr_elig_ind      BOOLEAN                  -- eligibility indicator,
    mbr_enrl_dt       DATE                     -- enrollment date,
    mbr_term_dt       DATE                     -- termination date,
    mbr_plan_cd       VARCHAR(20)              -- plan code,
    mbr_dual_elig_cd  VARCHAR(10)              -- dual eligibility code,
    load_dt           TIMESTAMP_NTZ  NOT NULL  -- load timestamp
);

Standard Snowflake DDL for the canonical member table. Convert to BigQuery or Databricks →

Why This Term Matters

Member and enrollment data governs who receives care and who pays for it — making it foundational to every downstream healthcare analytics workflow. Data engineers who understand member terminology build eligibility pipelines that prevent coverage gaps, correctly identify dual-eligible members, and support accurate risk adjustment submissions to CMS. Enrollment errors directly affect capitation payments and can trigger CMS corrective action plans.

Related Content

Looking for more healthcare terms?

Browse our complete library of 100,000+ standardized healthcare data terms

Browse All Terms