The first name of this person 94 143 First Name Y record. Middle The middle initial of this 144 144 Y Initial person record. 145 145 Sex Y The sex of this person record. Date of The birth date of this person 146 153 Y Birth record. Effective The effective date for this 154 161 Y Date person's coverage Termination No term on a Full File – not 162 169 8 N N Date used 170 229 Address1 Y Member Address_Line1. 230 259 Address2 Y Member Address_Line2. 260 309 City Y Member City 310 311 State Y Member State 312 321 Zip Y Member Zip Primary 322 331 Y Member Primary Phone Phone Alt Ins From Member Info Tab Not – 332 332 1 A/N N Indicator used From Member Info Tab – Not 333 342 Alt Ins Code 10 A/N N used From Member Info Tab Not – 343 360 Alt Ins ID 18 A/N N used Alt physician 361 369 N Provider ID- Not used Id Always = A Member Status defaulted to – 370 379 Status Y (Active) A Always = 380 389 Plan Code Y Defaulted to 22 22(Disability)
94 143 First Name Y The first name of this person record. 144 144 Middle Initial Y The middle initial of this person record. 145 145 Sex Y The sex of this person record. 146 153 Date of Birth Y The birth date of this person record. 154 161 Effective Date Y The effective date for this person's coverage 162 169 Termination Date 8 N N No term on a Full File – not used 170 229 Address1 Y Member Address_Line1. 230 259 Address2 Y Member Address_Line2. 260 309 City Y Member City 310 311 State Y Member State 312 321 Zip Y Member Zip 322 331 Primary Phone Y Member Primary Phone 332 332 Alt Ins Indicator 1 A/N N From Member Info Tab – Not used 333 342 Alt Ins Code 10 A/N N From Member Info Tab – Not used 343 360 Alt Ins ID 18 A/N N From Member Info Tab – Not used 361 369 Alt physician Id N Provider ID- Not used 370 379 Status Y Always = A (Active) Member Status – defaulted to A 380 389 Plan Code Y Always = 22(Disability) Defaulted to 22
Solicitation0900000297ExhibitH.docx