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Segment
in
X12 Release 008010

INS Insured Benefit

To provide benefit, characteristics, and identification information on insured entities.
Sequence
Element
Name
Type
Requirement
Min
Max
Repeat
01
1073
Yes/No Condition or Response Code
Identifier (ID)
Mandatory
1
1
1
Code indicating a Yes or No condition or response
INS01 indicates status of the insured. A "Y" value indicates the insured is a subscriber: an "N" value indicates the insured is a dependent.
Codes (9)
02
Individual Relationship Code
Identifier (ID)
Mandatory
2
2
1
Code indicating the relationship between two individuals or entities
Codes (155)
03
Maintenance Type Code
Identifier (ID)
Optional
3
3
1
Code identifying the specific type of item maintenance
Codes (128)
04
Maintenance Reason Code
Identifier (ID)
Optional
2
3
1
Code identifying the reason for the maintenance change
Codes (118)
05
Benefit Status Code
Identifier (ID)
Optional
1
1
1
Code identifying the type of coverage under which benefits are paid
Codes (7)
06
Medicare Status Code
Composite (composite)
Optional
1
01
Medicare Plan Code
Identifier (ID)
Mandatory
1
1
-
Code identifying the Medicare Plan
Codes (9)
02
Eligibility Reason Code
Identifier (ID)
Optional
1
1
-
Code specifying reason for eligibility
Codes (3)
03
Eligibility Reason Code
Identifier (ID)
Optional
1
1
-
Code specifying reason for eligibility
Codes (3)
04
Eligibility Reason Code
Identifier (ID)
Optional
1
1
-
Code specifying reason for eligibility
Codes (3)
07
Consolidated Omnibus Budget Reconciliation Act (COBRA) Qualifying Event Code
Identifier (ID)
Optional
1
2
1
Code identifying a qualifying event which results in loss of coverage for a Qualified Beneficiary
Codes (11)
08
Employment Status Code
Identifier (ID)
Optional
2
2
1
Code indicating the general employment status of an employee/claimant
Codes (91)
09
Student Status Code
Identifier (ID)
Optional
1
1
1
Code indicating the student status of the patient if 19 years of age or older, not handicapped and not the insured
Codes (3)
10
Yes/No Condition or Response Code
Identifier (ID)
Optional
1
1
1
Code indicating a Yes or No condition or response
INS10 is the handicapped status indicator. A "Y" value indicates an individual is handicapped; an "N" value indicates an individual is not handicapped.
Codes (9)
11
Date Time Period Format Qualifier
Identifier (ID)
Conditional
2
3
1
Code indicating the date format, time format, or date and time format
P1112
Codes (42)
12
Date Time Period
String (AN)
Conditional
1
35
1
Expression of a date, a time, or range of dates, times or dates and times
INS12 is the date of death.
13
Confidentiality Code
Identifier (ID)
Optional
1
1
1
Code indicating the access to insured information
Codes (3)
14
City Name
String (AN)
Optional
2
30
1
Free-form text for city name
INS14, INS15, and INS16 identify where the employee works.
15
State or Province Code
Identifier (ID)
Optional
2
2
1
Code specifying the Standard State/Province as defined by appropriate government agency
16
Country Code
Identifier (ID)
Optional
2
3
1
Code identifying the country
17
Number
Numeric (N0)
Optional
1
9
1
A generic number
INS17 is the number assigned to each family member born with the same birth date. This number identifies birth sequence for multiple births allowing proper tracking and response of benefits for each dependent (i.e., twins, triplets, etc.).
18
Changed Identifying Information Code
Identifier (ID)
Optional
1
2
20
Code specifying the identification information that changed from a request to a response.
Codes (19)
19
Provider Network Status Information Code
Identifier (ID)
Optional
1
2
1
Code specifying that the Provider Network Information changed from a request to a response.
Codes (4)
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Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference and Mapping Guides are provided for marketing purposes and are free of charge. All names, logos, and brands of third parties listed on our site are trademarks of their respective owners (including “X12”, which is a trademark of X12 Incorporated). Stedi, Inc. and its products and services are not endorsed by, sponsored by, or affiliated with these third parties. Our use of these names, logos, and brands is for identification purposes only, and does not imply any such endorsement, sponsorship, or affiliation.