HCFA-1500 Box 11d - Is There Another Health Plan

On the HCFA-1500 form, Box 11d is used to indicate whether the patient has another health benefit plan in addition to the primary insurance reported in Box 11. This checkbox is critical for determining whether coordination of benefits is required.

Tip: If Box 11d is marked YES, the provider must also complete Boxes 9, 9a, and 9d to supply information about the other insured and their policy details.

In our example below, we marked Box 11d as 'NO', indicating that there is no other health benefit plan.

So far, we've discussed how Box 11d is used to indicate additional insurance coverage on the HCFA-1500 form. Now let’s look at how this selection affects reporting in the X12 837 electronic format.

In the X12 837 transaction, the presence of another health plan (i.e., when Box 11d is marked YES) typically results in the inclusion of the 2320 Other Subscriber Information Loop and the corresponding 2330A Other Subscriber Name Loop. These loops provide the necessary details for the other insurance, mirroring the information reported in Boxes 9, 9a, and 9d.

When Box 11d is marked YES:
  • Loop 2320 is used to report the coordination of benefits.
  • Loop 2330A provides the other insured’s name.
  • Required HCFA-1500 Boxes: 9, 9a, and 9d

When Box 11d is marked NO:
  • Loops 2320 and 2330A are omitted from the 837.
  • Boxes 9, 9a, and 9d should be left blank.

Sample 837P (5010/4010) - Subscriber Coordination of Benefits

Note: Box 11d determines whether a secondary insurance is reported. If marked YES, it triggers the inclusion of Loops 2320 and 2330A in the 837. If marked NO, these loops are not included.

For additional information on the X12 837 standard, please refer to the official implementation guides published by X12.

HCFA-1500 Form Box Locations

• HCFA-1500 Box 0 - Carrier Block
• HCFA-1500 Box 1 - Insurance Type
• HCFA-1500 Box 1a - Insured's ID Number
• HCFA-1500 Box 2 - Patient's Name
• HCFA-1500 Box 3 - Patient's Birth Date and Sex
• HCFA-1500 Box 4 - Insured's Name
• HCFA-1500 Box 5 - Patient's Address
• HCFA-1500 Box 6 - Patient Relationship to Insured
• HCFA-1500 Box 7 - Insured's Address
• HCFA-1500 Box 8 - Reserved For NUCC Use
• HCFA-1500 Box 9 - Other Insured's Name
• HCFA-1500 Box 9a - Other Insured's Policy or Group Number
• HCFA-1500 Box 9b - Reserved For NUCC Use
• HCFA-1500 Box 9c - Reserved For NUCC Use
• HCFA-1500 Box 9d - Insurance Plan Name or Program Name
• HCFA-1500 Box 10 - Is Patient's Condition Related To
• HCFA-1500 Box 10d - Claim Codes
• HCFA-1500 Box 11 - Insured's Policy Group or FECA Number
• HCFA-1500 Box 11a - Insured's Date of Birth and Sex
• HCFA-1500 Box 11b - Other Claim ID
• HCFA-1500 Box 11c - Insurance Plan Name or Program Name
• HCFA-1500 Box 11d - Is There Another Health Plan [You are Here]
• HCFA-1500 Box 12 - Patient's or Authorized Person's Signature
• HCFA-1500 Box 13 - Insured's or Authorized Person's Signature
• HCFA-1500 Box 14 - Date of Current Illness, Injury, Pregnancy (LMP)
• HCFA-1500 Box 15 - Other Date
• HCFA-1500 Box 16 - Dates Patient Unable to Work in Current Occupation
• HCFA-1500 Box 17 - Name of Referring Provider or Other Source
• HCFA-1500 Box 17a - Other ID
• HCFA-1500 Box 17b - NPI
• HCFA-1500 Box 18 - Hospitalization Dates Related to Current Services
• HCFA-1500 Box 19 - Additional Claim Information
• HCFA-1500 Box 20 - Outside Lab Charges

Grab a sample of the HCFA-1500 claim form here - HCFA 02/12 Claim Form