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member deductible accumulator

mbr_ded_accum
member·Updated Jun 12, 2026

Definition

ISO-11179 Definition

The running year-to-date total of payments a health plan member has applied toward their annual deductible within a plan year. Once the deductible accumulator reaches the deductible threshold, the insurance plan begins paying its share of covered costs for deductible-subject services. Family plans maintain both individual and family aggregate deductible accumulators.

Deductible accumulators reset to zero at the start of each new plan year. Healthcare data teams build deductible tracking pipelines that process medical and pharmacy claims chronologically, apply deductible rules by service category and benefit tier, and expose current deductible accumulator balances through real-time eligibility API responses for provider point-of-service cost estimation.

Standard Abbreviation

mbr_ded_accum

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.

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