Benefit Type Rule Code ^*

Benefit Type Rule Description

Expiration Reason

Effective Date ^*

Expiration Date

Notes

Authorization Required

Allowable Units with no Auth.

Number of Days to Expire Auth.

Service Item	Min. Auth. Units	Max. Auth. Units	Co-Pay Amount	Co-Pay percent	Notes	Effective Date	Expiration Date	Expiration Reason
Initial Assessment	2	2	200	2	Test	22/12/2016	22/12/2016	04/30/2017
Individual Counselling	2	2	200	2	Test	22/12/2016	22/12/2016	04/30/2017

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