INS Insured Benefit
To provide benefit, characteristics, and identification information on insured entities.
Sequence
Element
Name
Type
Requirement
Min
Max
Repeat
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.
Codes (9)
Code indicating the relationship between two individuals or entities
Codes (155)
Code identifying the specific type of item maintenance
Codes (128)
Code identifying the reason for the maintenance change
Codes (118)
Code identifying the type of coverage under which benefits are paid
Codes (7)
Code identifying the Medicare Plan
Codes (9)
Code specifying reason for eligibility
Codes (3)
Code specifying reason for eligibility
Codes (3)
Code specifying reason for eligibility
Codes (3)
07
Consolidated Omnibus Budget Reconciliation Act (COBRA) Qualifying Event Code
Identifier (ID)
Optional
1
2
1
Code identifying a qualifying event which results in loss of coverage for a
Qualified Beneficiary
Codes (11)
Code indicating the general employment status of an employee/claimant
Codes (91)
Code indicating the student status of the patient if 19 years of age or older,
not handicapped and not the insured
Codes (3)
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.
Codes (9)
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
Codes (42)
Expression of a date, a time, or range of dates, times or dates and times
INS12 is the date of death.
Code indicating the access to insured information
Codes (3)
Free-form text for city name
INS14, INS15, and INS16 identify where the employee works.
Code specifying the Standard State/Province as defined by appropriate
government agency
Code identifying the country
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.).
Code specifying the identification information that changed from a request to a
response.
Codes (19)
Code specifying that the Provider Network Information changed from a request to
a response.
Codes (4)