From Member Info Tab – Not 390 397 Plan Eff Date 8 N N used New card From Member Info Tab – Not 398 398 1 A/N N Flag used Martial 399 400 Y The marital status of member Status The Alt phone of member if 401 410 Alt Phone N not populated, should be = 0000000000 411 418 Hire Date 8 N N Not used Dependent 419 427 9 A/N N Not used Social ID Handicap 428 428 1 A/N N Not used Code 429 429 Student Code 1 A/N N Not used Default = M Code indicating who is 430 439 Tier code Y (member only) enrolled in reported benefit Member's employer-division 440 449 Division Y code Alt Ins From 450 457 8 N N Member Info Tab Not used – Date Alt Ins Thru 458 465 8 N N Member Info Tab Not used. – Date 466 466 Pen Claim 1 A/N N Y or N Member Info Tab – Not used 467 467 Pre Ex 1 A/N N Y or N Member Info Tab – Not used 468 478 HCIN 11 A/N N Member Info Tab – Not used 479 488 From Group 10 A/N N Member Info Tab – Not used 489 498 From Account 10 A/N N Member Info Tab Not used –
390 397 Plan Eff Date 8 N N From Member Info Tab – Not used 398 398 New card Flag 1 A/N N From Member Info Tab – Not used 399 400 Martial Status Y The marital status of member 401 410 Alt Phone N The Alt phone of member if not populated, should be = 0000000000 411 418 Hire Date 8 N N Not used 419 427 Dependent Social 9 A/N N Not used 428 428 ID Handicap Code 1 A/N N Not used 429 429 Student Code 1 A/N N Not used 430 439 Tier code Y Default = M (member only) Code indicating who is enrolled in reported benefit 440 449 Division Y Member's employer-division code 450 457 Alt Ins From Date 8 N N Member Info Tab – Not used 458 465 Alt Ins Thru Date 8 N N Member Info Tab – Not used. 466 466 Pen Claim 1 A/N N Y or N Member Info Tab – Not used 467 467 Pre Ex 1 A/N N Y or N Member Info Tab – Not used 468 478 HCIN 11 A/N N Member Info Tab – Not used 479 488 From Group 10 A/N N Member Info Tab – Not used 489 498 From Account 10 A/N N Member Info Tab – Not used
Solicitation0900000297ExhibitH.docx