member plan code
mbr_pln_cdDefinition
ISO-11179 Definition
A coded identifier for the specific health insurance plan product in which a member is enrolled, used to reference the associated benefit design, formulary, network, and cost-sharing structure. Plan codes are assigned by the health plan or CMS and link member enrollment records to plan benefit tables in claims adjudication systems. In Medicare Advantage, CMS assigns plan benefit package identifiers that define the specific benefit package approved in the annual bid submission.
Healthcare data teams use mbr_pln_cd as a foreign key joining member enrollment tables to plan benefit design reference tables, enabling claims adjudication systems to apply correct copay amounts, prior authorization rules, formulary tiers, and network restrictions based on the member enrolled plan.
Standard Abbreviation
mbr_pln_cd
Category
Production DDL — DIM_MEMBER
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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