INS Insured Benefit

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

Sequence

Element

Name

Type

Requirement

Min

Max

Repeat

01

1073

Yes/No Condition or Response Code

Identifier (ID)

Mandatory

1

1

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.

Codes (9)

02

1069

Individual Relationship Code

Identifier (ID)

Mandatory

2

2

1

Code indicating the relationship between two individuals or entities

Codes (155)

03

875

Maintenance Type Code

Identifier (ID)

Optional

3

3

1

Code identifying the specific type of item maintenance

Codes (128)

04

1203

Maintenance Reason Code

Identifier (ID)

Optional

2

3

1

Code identifying the reason for the maintenance change

Codes (118)

05

1216

Benefit Status Code

Identifier (ID)

Optional

1

1

1

Code identifying the type of coverage under which benefits are paid

Codes (7)

06

C052

Medicare Status Code

Composite (composite)

Optional

1

01

1218

Medicare Plan Code

Identifier (ID)

Mandatory

1

1

-

Code identifying the Medicare Plan

Codes (9)

02

1701

Eligibility Reason Code

Identifier (ID)

Optional

1

1

-

Code specifying reason for eligibility

Codes (3)

03

1701

Eligibility Reason Code

Identifier (ID)

Optional

1

1

-

Code specifying reason for eligibility

Codes (3)

04

1701

Eligibility Reason Code

Identifier (ID)

Optional

1

1

-

Code specifying reason for eligibility

Codes (3)

07

1219

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)

08

584

Employment Status Code

Identifier (ID)

Optional

2

2

1

Code indicating the general employment status of an employee/claimant

Codes (91)

09

1220

Student Status Code

Identifier (ID)

Optional

1

1

1

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

Codes (3)

10

1073

Yes/No Condition or Response Code

Identifier (ID)

Optional

1

1

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.

Codes (9)

11

1250

Date Time Period Format Qualifier

Identifier (ID)

Conditional

2

3

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

Codes (42)

12

1251

Date Time Period

String (AN)

Conditional

1

35

1

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

INS12 is the date of death.

13

1165

Confidentiality Code

Identifier (ID)

Optional

1

1

1

Code indicating the access to insured information

Codes (3)

14

19

City Name

String (AN)

Optional

2

30

1

Free-form text for city name

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

15

156

State or Province Code

Identifier (ID)

Optional

2

2

1

Code specifying the Standard State/Province as defined by appropriate government agency

16

26

Country Code

Identifier (ID)

Optional

2

3

1

Code identifying the country

17

1470

Number

Numeric (N0)

Optional

1

9

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.).

18

1792

Changed Identifying Information Code

Identifier (ID)

Optional

1

2

20

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

Codes (19)

19

1793

Provider Network Status Information Code

Identifier (ID)

Optional

1

2

1

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

Codes (4)