Benefit Enrollment and Maintenance

Transfer Due to Interest and Servicing Sold

Termination of Additional Insured Interest

Addition of Additional Insured Endorsement

Abbreviated First Report on an Acquired Claim

Occupational Safety and Health Administration Injury and Illness Log (OSHA-300)

Office of Workers Compensation Program Injury Claim Report (OWCP CA-1)

Office of Workers Compensation Program Illness Claim Report (OWCP CA-2)

Occupational Safety and Health Administration Injury and Illness Record 
(OSHA-301)

Suspended Pending Appeal or Judicial Review

To place in force again, without the usual probationary or service period, a 
group contract or an individual's group insurance that for some reason has 
terminated

Certain situations such as military duty and CHAMPUS classify the subscriber 
ineligible for coverage or benefits. However, dependents of the subscriber are 
still eligible for coverage or benefits under the subscriber. Subscriber 
identifying elements are needed to accurately identify dependents

Suspension Medically Determined or Qualified to Return to Work

Non-compliance of Administrative Requirements

Consolidation Omnibus Budget Reconciliation Act (COBRA) Premium Paid

A physical or mental condition that makes an insured incapable of performing 
one or more duties of his or her own occupation

A change has been made to the primary elements that identify a specific person 
or relationship; such elements can include but are not limited to first name, 
last name, social security number, date of birth, and identification number.

A deferral-percentage test, defined by the Internal Revenue Code, to ensure a 
defined contribution retirement plan complies with limitations on contributions 
made by highly compensated employees as compared to all other employees covered 
by the plan

General information about the participant

Investment Elections and Contribution Rates

Percentage of contributions to be invested in specified funds and percentage of 
salary which the participant has elected to contribute to specified sources (or 
categories)

Financial information for repayment of the participant's loan

Financial information for contributions made to the plan

Current Customer Information File in Error

Revocation of Voluntary Market Acceptance

Primary Business Management includes corporate officer, partner or sole 
proprietor

Change Insured Federal Employer Identification Number (FEIN)

Change Employer Federal Employer Identification Number (FEIN)

Change Employer Unemployment Insurance (UI) Code

Modification without a Specific Operating Unit Location in Jurisdiction

Change Insurer Federal Employer Identification Number (FEIN)

Duplicate Entry on Customer Identification File

Removal of the Customer Identification File Merge ID

Removal of the Customer Identification File Buyout ID

Removal of the Customer Identification File in Error ID

Re-activation of an Out-of-Business Customer

Consolidation Omnibus Budget Reconciliation Act (COBRA)

A federal act that enables an insured, spouse, or dependent to continue 
benefits after a qualifying event which would otherwise cause them to lose 
their benefits

Borrowing Account with Established Credit Line

Negotiable Order on Withdrawal (NOW) Account

FSA04 is the Tax Advantage Account Information.

FSA05 specifies the frequency of contribution.

The money applied to benefits before federal taxes have been incurred

The money applied to benefits after federal taxes have been incurred

Registered under the Income Tax Act of Canada

Non-Registered under the Income Tax Act of Canada

Registered under the Income Tax Act of Canada with contributions made by the 
owner's spouse

An amendment which modifies the terms of the life contract or certificate of 
insurance as they pertain to a dependent child. It may increase or decrease 
benefits, waive a condition or coverage, or in any other way amend the original 
contract

The individual employee has chosen to discontinue one-bill submission

Health benefits that continue to be paid after termination or death

The individual employee will submit only one bill

Salary that continues to be paid after a disability

The individual employee has chosen not to participate in one-bill submission

FSA Tax Advantage Account

To report Health Insurance Tax Advantage Account information