member plan year
mbr_pln_yrDefinition
ISO-11179 Definition
The twelve-month period during which a health plan member benefits, deductibles, and out-of-pocket maximums are measured and reset. Most commercial plan years run January through December though employer-sponsored plans may follow fiscal year cycles. Medicare Advantage plan years run calendar year.
Plan year boundaries are critical for claims adjudication, HEDIS measure year assignment, deductible accumulation tracking, and annual enrollment reconciliation. Healthcare data teams use mbr_pln_yr as a partitioning key in member cost-sharing tables and HEDIS measure calculation pipelines to correctly assign claims and clinical events to the appropriate measurement year and avoid cross-year accumulation errors.
Standard Abbreviation
mbr_pln_yr
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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