Sequence
Element
Name
Type
Requirement
Min
Max
Repeat
01
Maintenance Type Code
Identifier (ID)
Mandatory
3
3
1
Code identifying the specific type of item maintenance
02
Maintenance Reason Code
Identifier (ID)
Optional
2
3
1
Code identifying the reason for the maintenance change
03
Insurance Line Code
Identifier (ID)
Optional
2
3
1
Code identifying a group of insurance products
04
Plan Coverage Description
String (AN)
Optional
1
50
1
A description or number that identifies the plan or coverage
05
Quantity
Decimal number (R)
Optional
1
15
1
Numeric value of quantity
LC05 is the salary multiplier.
06
Product Option Code
Identifier (ID)
Optional
1
2
1
Code indicating an option chosen for the product
07
Yes/No Condition or Response Code
Identifier (ID)
Optional
1
1
1
Code indicating a Yes or No condition or response
LC07 is the employee signature on file indicator. A "Y" value indicates the
employee signature has been obtained and is on file; an "N" value indicates the
employee signature has not been obtained.
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