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_Ref_ |
Id |
_________Element Name__________ |
Req |
Type |
Min/Max |
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|
| |
INS01 |
1073 |
Yes/No Condition or Response Code |
M |
ID |
1/1 |
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|
| |
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Description: Code indicating a Yes or No condition or response |
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Code |
Name_______________________________ |
| |
|
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N |
No |
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INS02 |
1069 |
Individual Relationship Code |
M |
ID |
2/2 |
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| |
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Description: Code indicating the relationship between two individuals or entities |
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|
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|
Code |
Name_______________________________ |
| |
|
|
|
01 |
Spouse |
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19 |
Child |
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Description: Dependent between the ages of 0 and 19; age qualifications may vary depending on policy |
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21 |
Unknown |
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34 |
Other Adult |
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INS03 |
875 |
Maintenance Type Code |
O |
ID |
3/3 |
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| |
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Description: Code identifying the specific type of item maintenance |
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|
Code |
Name_______________________________ |
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001 |
Change |
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INS04 |
1203 |
Maintenance Reason Code |
O |
ID |
2/3 |
|
|
| |
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Description: Code identifying the reason for the maintenance change |
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Code |
Name_______________________________ |
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25 |
Change in Identifying Data Elements |
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Description: A change has been made to the primary elements that identify a specific employee. Such elements are first name, last name, social security number, date of birth, and employee identification number |
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INS09 |
1220 |
Student Status Code |
O |
ID |
1/1 |
|
|
| |
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Description: Code indicating the student status of the patient if 19 years of age or older, not handicapped and not the insured |
| |
|
|
|
Code |
Name_______________________________ |
| |
|
|
|
F |
Full-time |
| |
|
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N |
Not a Student |
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P |
Part-time |
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INS10 |
1073 |
Yes/No Condition or Response Code |
O |
ID |
1/1 |
|
|
| |
|
|
Description: Code indicating a Yes or No condition or response |
| |
|
|
|
Code |
Name_______________________________ |
| |
|
|
|
N |
No |
| |
|
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Y |
Yes |
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INS17 |
1470 |
Number |
O |
N0 |
1/9 |
|
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Description: A generic number |
