INS Insured Benefit

To provide benefit, characteristics, and identification information on insured entities.

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

Code indicating a Yes or No condition or response

INS01 indicates status of the insured. 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: 1

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: 1

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: 1

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: 1

Code identifying the type of coverage under which benefits are paid

INS-06 C052 Medicare Status Code Composite (composite) Optional 1

Position: 01 · Element: 1218 · Name: Medicare Plan Code · Type: Identifier (ID) · Requirement: Mandatory · Min: 1 · Max: 1 · Repeat: -

Code identifying the Medicare Plan

Position: 02 · Element: 1701 · Name: Eligibility Reason Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 1 · Repeat: -

Code specifying reason for eligibility

Position: 03 · Element: 1701 · Name: Eligibility Reason Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 1 · Repeat: -

Code specifying reason for eligibility

Position: 04 · Element: 1701 · Name: Eligibility Reason Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 1 · Repeat: -

Code specifying reason for eligibility

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: 1

Code identifying a qualifying event 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: 1

Code indicating 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: 1

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: 1

Code indicating a Yes or No condition or response

INS10 is the 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: 1

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: 1

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

INS12 is the date of death.

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

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: 1

Free-form text for city name

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

Position: INS-15 · Element: 156 · Name: State or Province Code · Type: Identifier (ID) · Requirement: Optional · Min: 2 · Max: 2 · Repeat: 1

Code specifying the 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: 1

Code identifying the country

Position: INS-17 · Element: 1470 · Name: Number · Type: Numeric (N0) · Requirement: Optional · Min: 1 · Max: 9 · Repeat: 1

A generic number

INS17 is the number assigned to each family member born with the same birth date. This number identifies birth sequence for multiple births allowing proper tracking and response of benefits for each dependent (i.e., twins, triplets, etc.).

Position: INS-18 · Element: 1792 · Name: Changed Identifying Information Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 2 · Repeat: 20

Code specifying the identification information that changed from a request to a response.

Position: INS-19 · Element: 1793 · Name: Provider Network Status Information Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 2 · Repeat: 1

Code specifying that the Provider Network Information changed from a request to a response.