28 400 400 New card Flag 1 A/N Y Not used M = Married Member/dependents 29 401 402 Martial Status 2 A/N Y N = Single marital status. U = Undefined If not supplied: Null Member/dependents alternate (work) phone. 30 403 412 Alt Phone 10 A/N N If not supplied: Null or ‘0000000000’ 31 413 420 Hire Date 8 N N Not Used YYYYMMDD For member record leave blank, For dependent record put dependents 32 421 429 Dependent Social 9 A/N Y SSN. If dependent SSN is not available leave blank. DO NOT PUT MEMBER SSN If dependent is handicapped, just a Y or N 33 430 430 ID Handicap Code 1 A/N N or blank, Only applies to dependents. (Incapacitated Child) 34 431 431 Student Code 1 A/N N Not Used Coverage level such as – 35 432 441 Tier code 10 A/N Y Member, member and spouse etc 36 442 451 Division 10 A/N Y Division Number 37 452 459 Alt Ins From Date 8 N N Not used 38 460 467 Alt Ins Thru Date 8 N N Not used 39 468 468 Pen Claim 1 A/N N Y or N Not used 40 469 469 Pre Ex 1 A/N N Y or N Not used HCIN Number, SSN+ 1 or 2 special code to ID 41 470 480 HICN 11 A/N N Medicare person. Member Custom Disenrollment Disenrollment Code This is 42 481 490 10 A/N N Code for MAPD/PDP plans Signature Date on 43 491 500 Signature Date 10 A/N N MAPD/PDP enrollment MMDDYYYY form From Member 44 501 509 9 A/N N Old Member SSN SSN From Person_ 45 510 511 2 A/N N Old Person Code Code 46 512 519 Original Eff Date 8 N N Not used YYYYMMDD 47 520 527 Dental Penalty 8 N N Not used YYYYMMDD Life Insurance 48 528 535 8 N N 999999.99 Not used Amt
28 400 400 New card Flag 1 A/N Y Not used 29 401 402 Martial Status 2 A/N Y M = Married N = Single U = Undefined Member/dependents marital status. If not supplied: Null 30 403 412 Alt Phone 10 A/N N Member/dependents alternate (work) phone. If not supplied: Null or ‘0000000000’ 31 413 420 Hire Date 8 N N YYYYMMDD Not Used 32 421 429 Dependent Social 9 A/N Y For member record leave blank, For dependent record put dependents SSN. If dependent SSN is not available leave blank. DO NOT PUT MEMBER SSN 33 430 430 ID Handicap Code 1 A/N N If dependent is handicapped, just a Y or N or blank, Only applies to dependents. (Incapacitated Child) 34 431 431 Student Code 1 A/N N Not Used 35 432 441 Tier code 10 A/N Y Coverage level – such as Member, member and spouse etc 36 442 451 Division 10 A/N Y Division Number 37 452 459 Alt Ins From Date 8 N N Not used 38 460 467 Alt Ins Thru Date 8 N N Not used 39 468 468 Pen Claim 1 A/N N Y or N Not used 40 469 469 Pre Ex 1 A/N N Y or N Not used 41 470 480 HICN 11 A/N N HCIN Number, SSN+ 1 or 2 special code to ID Medicare person. Member Custom 42 481 490 Disenrollment Code 10 A/N N Disenrollment Code This is for MAPD/PDP plans 43 491 500 Signature Date 10 A/N N MMDDYYYY Signature Date on MAPD/PDP enrollment form 44 501 509 From Member SSN 9 A/N N Old Member SSN 45 510 511 From Person_ Code 2 A/N N Old Person Code 46 512 519 Original Eff Date 8 N N YYYYMMDD Not used 47 520 527 Dental Penalty 8 N N YYYYMMDD Not used 48 528 535 Life Insurance Amt 8 N N 999999.99 Not used