---
kind: "section"
citation: "45 C.F.R. § 162.1201"
title: "45"
number: "162.1201"
heading: "Eligibility for a health plan transaction."
url: "https://uscodex.org/cfr/45/162.1201"
---

# §162.1201. Eligibility for a health plan transaction.


The eligibility for a health plan transaction is the transmission of either of the following:

- (a) An inquiry from a health care provider to a health plan, or from one health plan to another health plan, to obtain any of the following information about a benefit plan for an enrollee:
  - (1) **Eligibility to receive health care under the health plan.**
  - (2) **Coverage of health care under the health plan.**
  - (3) **Benefits associated with the benefit plan.**
- (b) A response from a health plan to a health care provider's (or another health plan's) inquiry described in [paragraph (a)](#a) of this section.

## Notes

### Authority

Authority: 42 U.S.C. 1320d—1320d-9 and secs. 1104 and 10109 of Pub. L. 111-148, 124 Stat. 146-154 and 915-917.

### Source

Source: 65 FR 50367, Aug. 17, 2000, unless otherwise noted.