INS

Dependent Relationship

Pos: 260

Max: 1

Detail - Optional

Loop: 2010DA

Elements: 3

User Option (Usage): Situational

To provide benefit information on insured entities

Element Summary:

	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
Alias: Relationship to Insured Code

2/2

Required

	Code	Name
	01	Spouse
	04	Grandfather or Grandmother
	05	Grandson or Granddaughter
	07	Nephew or Niece
	09	Adopted Child
	10	Foster Child
	15	Ward
	17	Stepson or Stepdaughter
	19	Child
	20	Employee
	21	Unknown
	22	Handicapped Dependent
	23	Sponsored Dependent
	24	Dependent of a Minor Dependent
	29	Significant Other
	32	Mother
	33	Father
	34	Other Adult
	36	Emancipated Minor
	39	Organ Donor
	40	Cadaver Donor
	41	Injured Plaintiff
	43	Child Where Insured Has No Financial Responsibility
	53	Life Partner
	G8	Other Relationship

INS17

1470

Number
Description: A generic number
Industry: Birth Sequence Number
This data element is not used unless the dependent is a child from a multiple birth.

1/9

Situational

Syntax:

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

Semantics:

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 to convey information on the relationship of the dependent to the insured.
2. Required when necessary to further identify the patient. Examples include identifying a patient in a multiple birth or differentiating dependents with the same name.

Example:

INS*N*19~

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