INS Insured Benefit

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

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Position

Element

Name

Type

Requirement

Min

Max

Repeat

INS01

1073

Yes/No Condition or Response Code

Identifier (ID)

Mandatory

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.

INS02

1069

Individual Relationship Code

Identifier (ID)

Mandatory

Code indicating the relationship between two individuals or entities

INS03

875

Maintenance Type Code

Identifier (ID)

Optional

Code identifying the specific type of item maintenance

INS04

1203

Maintenance Reason Code

Identifier (ID)

Optional

Code identifying the reason for the maintenance change

INS05

1216

Benefit Status Code

Identifier (ID)

Optional

Code identifying the type of coverage under which benefits are paid

INS06

C052

Medicare Status Code

Composite (composite)

Optional

1218

Medicare Plan Code

Identifier (ID)

Mandatory

Code identifying the Medicare Plan

1701

Eligibility Reason Code

Identifier (ID)

Optional

Code specifying reason for eligibility

1701

Eligibility Reason Code

Identifier (ID)

Optional

Code specifying reason for eligibility

1701

Eligibility Reason Code

Identifier (ID)

Optional

Code specifying reason for eligibility

INS07

1219

Consolidated Omnibus Budget Reconciliation Act (COBRA) Qualifying Event Code

Identifier (ID)

Optional

Code identifying a qualifying event which results in loss of coverage for a Qualified Beneficiary

INS08

584

Employment Status Code

Identifier (ID)

Optional

Code indicating the general employment status of an employee/claimant

INS09

1220

Student Status Code

Identifier (ID)

Optional

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

INS10

1073

Yes/No Condition or Response Code

Identifier (ID)

Optional

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.

INS11

1250

Date Time Period Format Qualifier

Identifier (ID)

Conditional

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

INS12

1251

Date Time Period

String (AN)

Conditional

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

INS12 is the date of death.

INS13

1165

Confidentiality Code

Identifier (ID)

Optional

Code indicating the access to insured information

INS14

City Name

String (AN)

Optional

Free-form text for city name

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

INS15

156

State or Province Code

Identifier (ID)

Optional

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

INS16

Country Code

Identifier (ID)

Optional

Code identifying the country

INS17

1470

Number

Numeric (N0)

Optional

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.).

INS18

1792

Changed Identifying Information Code

Identifier (ID)

Optional

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

INS19

1793

Provider Network Status Information Code

Identifier (ID)

Optional

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