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MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL M1 Uninsured beneficiary (qualified for automatic HIB but requests only SMIB) O Combined A and B beneficiary in the same payment T *Fully insured beneficiaries who have elected entitlement only to HIB (usually but not always along with SMIB) *Uninsured beneficiary or renal disease beneficiary only *Deemed insured (hospital insurance only) TA Medicare Qualified Government Employment (MQGE) primary beneficiary TB MQGE aged spouse (1st claimant) TC MQGE childhood disability benefits (CDB) (1st claimant) TD MQGE aged widow(er) (1st claimant) TE MQGE young widow(er) (1st claimant) TF MQGE parent (male) TG MQGE aged spouse (2nd claimant) TH MQGE aged spouse (3rd claimant) TJ MQGE aged spouse (4th claimant) TK MQGE aged spouse (5th claimant) TL MQGE aged widow(er) (2nd claimant) TM MQGE aged widow(er) (3rd claimant) TN MQGE aged widow(er) (4th claimant) TP MQGE aged widow(er) (5th claimant) TQ MQGE parent (female) TR MQGE young widow(er) (2nd claimant) TS MQGE young widow(er) (3rd claimant) TT MQGE young widow(er) (4th claimant) TU MQGE young widow(er) (5th claimant) TV MQGE disabled widow(er) (1st claimant) TW MQGE disabled widow(er) (1st claimant) TX MQGE disabled widow(er) (2nd claimant) TY MQGE disabled widow(er) (3rd claimant) TZ MQGE disabled widow(er) (4th claimant) T2 MQGE (CDB) (2nd claimant) T3 MQGE (CDB) (3rd claimant) T4 MQGE (CDB) (4th claimant) T5 MQGE (CDB) (5th claimant) T6 MQGE (CDB) (6th claimant) T7 MQGE (CDB) (7th claimant) T8 MQGE (CDB) (8th claimant) T9 MQGE (CDB) (9th claimant) W Disabled widow, age 50 or over (1st claimant) W1 Disabled widower, age 50 or over (1st claimant) W2 Disabled widow (2nd claimant)

APPENDIX E Division of Welfare and Supportive Services MEDICAL ASSISTANCE PROGRAM MANUAL Medical Assistance Manual BIC CODE VALUES MTL 02/13 01 Nov 13