INS Insured Benefit

To provide benefit information on insured entities

Position: INS-01 · Element: 1073 · Name: Yes/No Condition or Response Code · Type: Identifier (ID) · Requirement: Mandatory · Min: 1 · Max: 1 · Repeat: -

Code indicating a Yes or No condition or response.

INS01 is insured indicator. A ``Y'' value indicates the insured is a subscriber. An ``N'' value indicates the insured is a dependent.

Position: INS-02 · Element: 1069 · Name: Individual Relationship Code · Type: Identifier (ID) · Requirement: Mandatory · Min: 2 · Max: 2 · Repeat: -

Code indicating the relationship between two individuals or entities.

Position: INS-03 · Element: 875 · Name: Maintenance Type Code · Type: Identifier (ID) · Requirement: Optional · Min: 3 · Max: 3 · Repeat: -

Code identifying the specific type of item maintenance.

Position: INS-04 · Element: 1203 · Name: Maintenance Reason Code · Type: Identifier (ID) · Requirement: Optional · Min: 2 · Max: 3 · Repeat: -

Code identifying the reason for the maintenance change.

Position: INS-05 · Element: 1216 · Name: Benefit Status Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 1 · Repeat: -

The type of coverage under which benefits are paid.

Position: INS-06 · Element: 1218 · Name: Medicare Plan Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 1 · Repeat: -

Code identifying the Medicare Plan.

Position: INS-07 · Element: 1219 · Name: Consolidated Omnibus Budget Reconciliation Act (COBRA) Qualifying Event Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 2 · Repeat: -

A Qualifying Event is any of the following which results in loss of coverage for a Qualified Beneficiary.

Position: INS-08 · Element: 584 · Name: Employment Status Code · Type: Identifier (ID) · Requirement: Optional · Min: 2 · Max: 2 · Repeat: -

Code showing the general employment status of an employee/claimant.

Position: INS-09 · Element: 1220 · Name: Student Status Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 1 · Repeat: -

Code indicating the student status of the patient if 19 years of age or older, not handicapped and not the insured

Position: INS-10 · Element: 1073 · Name: Yes/No Condition or Response Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 1 · Repeat: -

Code indicating a Yes or No condition or response.

INS10 is handicapped status indicator. A ``Y'' value indicates an individual is handicapped. An ``N'' value indicates an individual is not handicapped.

Position: INS-11 · Element: 1250 · Name: Date Time Period Format Qualifier · Type: Identifier (ID) · Requirement: Conditional · Min: 2 · Max: 3 · Repeat: -

Code indicating the date format, time format, or date and time format.

P1112: If either INS-11 or INS-12 is present, then the other is required

Position: INS-12 · Element: 1251 · Name: Date Time Period · Type: String (AN) · Requirement: Conditional · Min: 1 · Max: 35 · Repeat: -

Expression of a date, a time, or range of dates, times or dates and times.

INS12 is Date of Death.

Position: INS-13 · Element: 1165 · Name: Confidentiality Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 1 · Repeat: -

Code indicating the access to insured information.

Position: INS-14 · Element: 19 · Name: City Name · Type: String (AN) · Requirement: Optional · Min: 2 · Max: 30 · Repeat: -

Free-form text for city name.

INS14, INS15, and INS16 is where the employee works.

Position: INS-15 · Element: 156 · Name: State or Province Code · Type: Identifier (ID) · Requirement: Optional · Min: 2 · Max: 2 · Repeat: -

Code (Standard State/Province) as defined by appropriate government agency.

Position: INS-16 · Element: 26 · Name: Country Code · Type: Identifier (ID) · Requirement: Optional · Min: 2 · Max: 3 · Repeat: -

Code identifying the country.