Page # Id Reference Name Codes Length Notes/Comments 52 2000 INS07 COBRA Qualifying Event 1 Termination 1/2 Required if member is enrolled in COBRA – Code 2 Reduction of work hours – 3 Medicare – 4 Death – 5 Divorce – 6 Separation – 7 Ineligible Child – 8 Bankruptcy of Retired – Employee’s former employer 9 Layoff – 10 Leave of Absence – 52 2000 INS08 Employment Status Code AO Active Military Overseas 2/2 Required for subscriber – – AU Active Military – – FT Full-time active employee – L1 Leave of Absence – PT Part-time Active Employee – RT Retired – TE Terminated – 53 2000 INS09 Student Status Code The preferred values for this are: 1/1 F Full-time – N Not a Student – P Part-time will be treated as – a “Not Student” 53 2000 INS10 Yes/No Condition or N No individual is not 1/1 – Response Handicap handicapped – Indicator Y Yes individual is – handicapped 54 2000 INS12 Date Time Period 1/35 Date of death of the subscriber/dependent 55 2000 REF01 Reference Identification 0F Subscriber Number 2/3 Required field for all members. – Qualifier 55 2000 REF02 Reference Identification 1/50 The Social Security number of the subscriber or the Employee ID number supplied by the employer. If both are required, use NM109 for the SSN. If SSN is required but EIN is optional, use REF01 = DX for the EIN. Numeric values only.
Page # Id Reference Name Codes Length Notes/Comments 52 2000 INS07 COBRA Qualifying Event Code 1 – Termination 2 – Reduction of work hours 3 – Medicare 4 – Death 5 – Divorce 6 – Separation 7 – Ineligible Child 8 – Bankruptcy of Retired Employee’s former employer 9 – Layoff 10 – Leave of Absence 1/2 Required if member is enrolled in COBRA 52 2000 INS08 Employment Status Code AO – Active Military – Overseas AU – Active Military – FT – Full-time active employee L1 – Leave of Absence PT – Part-time Active Employee RT – Retired TE – Terminated 2/2 Required for subscriber 53 2000 INS09 Student Status Code The preferred values for this are: F – Full-time N – Not a Student P – Part-time will be treated as “Not a Student” 1/1 53 2000 INS10 Yes/No Condition or Response – Handicap Indicator N – No individual is not handicapped Y – Yes individual is handicapped 1/1 54 2000 INS12 Date Time Period 1/35 Date of death of the subscriber/dependent 55 2000 REF01 Reference Identification Qualifier 0F – Subscriber Number 2/3 Required field for all members. 55 2000 REF02 Reference Identification 1/50 The Social Security number of the subscriber or the Employee ID number supplied by the employer. If both are required, use NM109 for the SSN. If SSN is required but EIN is optional, use REF01 = DX for the EIN. Numeric values only.
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