INS

Dependent Relationship

Pos: 110	Max: 1
Detail - Optional
Loop: 2100D	Elements: 3

Ref

Id

Element Name

Req

Type

Min/Max

Usage

INS01

1073

Yes/No Condition or Response Code
Description: Code indicating a Yes or No condition or response
Industry: Insured Indicator

M

ID

1/1

Required

Code

Name

N

No

INS02

1069

Individual Relationship Code
Description: Code indicating the relationship between two individuals or entities

M

ID

2/2

Required

Code

Name

01

Spouse

19

Child

34

Other Adult

INS17

1470

Number
Description: A generic number
Industry: Birth Sequence Number
Use to indicate the birth order in the event of multiple birth’s in association with the birth date supplied in DMG02.

O

N0

1/9

Situational

1.

P1112 - If either INS11,INS12 is present, then all are required

1.

INS01 indicates status of the insured. A "Y" value indicates the insured is a subscriber: an "N" value indicates the insured is a dependent.

2.

INS10 is the handicapped status indicator. A "Y" value indicates an individual is handicapped; an "N" value indicates an individual is not handicapped.

3.

INS12 is the date of death.

4.

INS14, INS15, and INS16 identify where the employee works.

5.

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.).

Notes:

1. Use this segment only in the absence of all of the data for the mandated search option identified in Section 1.3.8. Use only if it is necessary to identify the dependent’s relationship to the subscriber identified in loop 2100C or the dependent’s birth sequence in the case of multiple births with the same birth date.
2. Different types of health plans identify patients in different manners depending upon how their eligibility is structured. However, two approaches predominate.
The first approach is to assign each member of the family (and plan) a unique ID number. This number can be used to identify and access that individual’s information independent of whether he or she is a child, spouse, or the actual subscriber to the plan. The relationship of this individual to the actual subscriber or contract holder would be one of spouse, child, self, etc.
The second approach is to assign the actual subscriber or contract holder a unique ID number that is entered into the eligibility system. Any related spouse, children, or dependents are identified through he subscriber’s ID and have no unique identification number of their own. In this approach, the subscriber would be identified at the Loop 2100C subscriber or insured level and the actual patient (spouse, child, etc.) would be identified at the Loop 2100D dependent level under the subscriber.

Example:

INS*N*01~