Example: INS*Y*18*021**A~ INS*N*19*001*AI*A****F~ INS*N*19*001*AI*A*****Y~ Min/Max Segment Usage Name Values Description Length INS01 M Yes/No Condition Subscriber 1/1 “Y” Dependent “N” INS02 M Individual Relationship Code Spouse 2/2 “01” Adopted Child “09” Self “18” Child “19” Ex-Spouse “25” Life Partner “53” INS03 M Maintenance Type Code Change 3/3 “001” Addition “021” Termination “024” Audit/No Change “030” INS04 O Maintenance Reason Code Death 2/2 “03” “04” Retirement Surviving Spouse “11” No Reason Given “AI” INS05 M Benefit Status Code Active 1/1 “A” COBRA “C” Surviving Spouse “S” INS06 O Medicare Plan Code Medicare Part A 1/1 “A” Medicare Part B “B” Medicare Part A and B “C” Medicare “D” No Medicare “E” INS07 NOT USED INS08 O Employment Status Code Retired 2/2 “RT” INS09 O Student Status Code Full-time 1/1 “F” Not a Student “N” Part-time “P” INS10 O Handicap Status Yes, handicapped 1/1 Indicator “Y” No, not handicapped “N” INS11 NOT USED INS12 NOT USED INS13 NOT USED INS14 NOT USED INS15 NOT USED INS16 NOT USED INS17 NOT USED
Example: INS*Y*18*021**A~ INS*N*19*001*AI*A****F~ INS*N*19*001*AI*A*****Y~ Min/Max Segment Usage Name Values Description Length INS01 M Yes/No Condition “Y” Subscriber 1/1 “N” Dependent INS02 M Individual Relationship Code “01” Spouse 2/2 “09” Adopted Child “18” Self “19” Child “25” Ex-Spouse “53” Life Partner INS03 M Maintenance Type Code “001” Change 3/3 “021” Addition “024” Termination “030” Audit/No Change INS04 O Maintenance Reason Code “03” Death 2/2 “04” Retirement “11” Surviving Spouse “AI” No Reason Given INS05 M Benefit Status Code “A” Active 1/1 “C” COBRA “S” Surviving Spouse INS06 O Medicare Plan Code “A” Medicare Part A 1/1 “B” Medicare Part B “C” Medicare Part A and B “D” Medicare “E” No Medicare INS07 NOT USED INS08 O Employment Status Code “RT” Retired 2/2 INS09 O Student Status Code “F” Full-time 1/1 “N” Not a Student “P” Part-time INS10 O Handicap Status Indicator “Y” Yes, handicapped 1/1 “N” No, not handicapped INS11 NOT USED INS12 NOT USED INS13 NOT USED INS14 NOT USED INS15 NOT USED INS16 NOT USED INS17 NOT USED
834_05010_MAPPING_SPECIFICATIONS_1_.docx