Financial instrument which may be used to pay for or reimburse health care products and services.

Health care programs and insurers are significant payors of health service costs.

The program or plan underwriter or payor.

Need to identify the issuer to target for processing and for coordination of benefit processing.

Business Identification Number (BIN number) used to identify the routing of eClaims.

Time period during which the coverage is in force. A missing start date indicates the start date isn't known, a missing end date means the coverage is continuing to be in force.

The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health.

The order of application of coverages is dependent on the types of coverage.

The party who 'owns' the insurance contractual relationship to the policy or to whom the benefit of the policy is due.

The party who benefits from the insurance coverage.

The relationship of the patient to the planholdersubscriber).

To determine relationship between the patient and the subscriber.

The main (and possibly only) identifier for the coverage - often referred to as a Member Id, Subscriber Id, Certificate number or Personal Health Number or Case ID.

This value may uniquely identify the coverage or it may be used in conjunction with the additional identifiers below.

Identifies a style or collective of coverage issues by the underwriter, for example may be used to identify a class of coverage or employer group. May also be referred to as a Policy or Group ID.

Identifies a style or collective of coverage issues by the underwriter, for example may be used to identify a class of coverage or employer group. May also be referred to as a Policy or Group ID.

Identifies a sub-style or sub-collective of coverage issues by the underwriter, for example may be used to identify a specific employer group within a class of employers. May be referred to as a Section or Division ID.

A unique identifier for a dependent under the coverage.

For some coverage a single identifier is issued to the PolicyHolder and a dependent number issued to each beneficiary.

An optional counter for a particular instance of the identified coverage which increments upon each renewal.

Some coverage, for example social plans, may be offered in short time increments, for example for a week or a month at a time, so while the rest of the plan details and identifiers may remain constant over time, the instance is incremented with each renewal and provided to the covered party on their 'card'.

Factors which may influence the applicability of coverage.

To determine extenuating circumstances for coverage.

Name of school for over-aged dependants.

Often required for over-age dependents.

The identifier for a community of providers.

The policy(s) which constitute this insurance coverage.