Health Care Surveys Reporting
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Health Care Surveys Reporting - Downloaded Version 2.0.0-ballot See the Directory of published versions

Example Coverage: Coverage Example 1

Page standards status: Informative

identifier: An identifier for the insured of an insurance policy (this insured always has a subscriber), usually assigned by the insurance carrier./88800933501

status: Active

policyHolder: Dominique369 Ledner144 Female, DoB: 1965-06-22 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

subscriber: Dominique369 Ledner144 Female, DoB: 1965-06-22 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

subscriberId: 888009335

beneficiary: Dominique369 Ledner144 Female, DoB: 1965-06-22 ( MRN: Alaska Driver's License#abc123 (use: usual, ))

dependent: 01

relationship: Self

period: 2020-01-01 --> (ongoing)

payor: UPMC Health Plan

class

type: An employee group

value: MCHMO1

name: MEDICARE HMO PLAN

class

type: A specific suite of benefits.

value: GR5

name: GR5-HMO DEDUCTIBLE

network: GR5-HMO DEDUCTIBLE