Downloaded 10/4/99 ***May not match data file, use layout provided with file*** 1 GROUP HEALTH PLAN (GHP) MASTER RECORD POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ **** GROUP HEALTH PLAN (GHP) REC 330 1 330 SYSTEM ALIAS: GHPMSTR MASTER RECORD 1. GHP MASTER RECORD CHAR 1 1 1 CODES: IDENTIFICATION CODE A = GHP MASTER RECORD (CONSTANT) 2. GHP MASTER RECORD LENGTH PACK 3 2 4 4 DIGITS SIGNED CODES: 205 = MINIMUM 330 = MAXIMUM 280 = AVERAGE **** GHP CLAIM NUMBER GROUP 13 5 17 THE NUMBER UNDER WHICH THE RECORD IS CURRENTLY HOUSED IN THE GHP MASTER FILE. 3. BENEFICIARY CLAIM ACCOUNT CHAR 9 5 13 THE NUMBER IDENTIFYING THE PRIMARY BENEFICIARY NUMBER UNDER THE SSA OR RRB PROGRAMS. STANDARD ALIAS: BENE_CLM_ACNT_NUM COMMON ALIAS: CAN SAS ALIAS: CAN SOURCE: SSA,RRB LIMITATIONS: RRB-ISSUED NUMBERS CONTAIN AN OVERPUNCH IN THE FIRST POSITION THAT MAY APPEAR AS A PLUS ZERO OR A-G. RRB-FORMATTED NUMBERS MAY CAUSE MATCHING PROBLEMS ON NON-IBM MACHINES. 4. BENEFICIARY IDENTIFICATION CHAR 2 14 15 THE CODE IDENTIFYING THE TYPE OF RELATIONSHIP CODE BETWEEN AN INDIVIDUAL AND A PRIMARY SOCIAL SECURITY ADMINISTRATION (SSA) BENEFICIARY OR A PRIMARY RAILROAD BOARD (RRB) BENEFICIARY. STANDARD ALIAS: BENE_IDENT_CD COMMON ALIAS: BIC SAS ALIAS: BIC EDIT-RULES: REQUIRED FIELD CODES: SOCIAL SECURITY ADMINISTRATION: A = PRIMARY CLAIMANT B = AGED WIFE, AGE 62 OR OVER (1ST CLAIMANT) B1 = AGED HUSBAND, AGE 62 OR OVER (1ST CLAIMANT) B2 = YOUNG WIFE, WITH A CHILD IN HER CARE 1 GROUP HEALTH PLAN (GHP) MASTER RECORD POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ (1ST CLAIMANT) B3 = AGED WIFE (2ND CLAIMANT) B4 = AGED HUSBAND (2ND CLAIMANT) B5 = YOUNG WIFE (2ND CLAIMANT) B6 = DIVORCED WIFE, AGE 62 OR OVER (1ST CLAIMANT) B7 = YOUNG WIFE (3RD CLAIMANT) B8 = AGED WIFE (3RD CLAIMANT) B9 = DIVORCED WIFE (2ND CLAIMANT) BA = AGED WIFE (4TH CLAIMANT) BD = AGED WIFE (5TH CLAIMANT) BG = AGED HUSBAND (3RD CLAIMANT) BH = AGED HUSBAND (4TH CLAIMANT) BJ = AGED HUSBAND (5TH CLAIMANT) BK = YOUNG WIFE (4TH CLAIMANT) BL = YOUNG WIFE (5TH CLAIMANT) BN = DIVORCED WIFE (3RD CLAIMANT) BP = DIVORCED WIFE (4TH CLAIMANT) BQ = DIVORCED WIFE (5TH CLAIMANT) BR = DIVORCED HUSBAND (1ST CLAIMANT) BT = DIVORCED HUSBAND (2ND CLAIMANT) BW = YOUNG HUSBAND (2ND CLAIMANT) BY = YOUNG HUSBAND (1ST CLAIMANT) C1-C9,CA-CK = CHILD (INCLUDES MINOR, STUDENT OR DISABLED CHILD) D = AGED WIDOW, 60 OR OVER (1ST CLAIMANT) D1 = AGED WIDOWER, AGE 60 OR OVER (1ST CLAIMANT) D2 = AGED WIDOW (2ND CLAIMANT) D3 = AGED WIDOWER (2ND CLAIMANT) D4 = WIDOW (REMARRIED AFTER ATTAINMENT OF AGE 60) (1ST CLAIMANT) D5 = WIDOWER (REMARRIED AFTER ATTAINMENT OF AGE 60) (1ST CLAIMANT) D6 = SURVIVING DIVORCED WIFE, AGE 60 OR OVER (1ST CLAIMANT) D7 = SURVIVING DIVORCED WIFE (2ND CLAIMANT) D8 = AGED WIDOW (3RD CLAIMANT) D9 = REMARRIED WIDOW (2ND CLAIMANT) DA = REMARRIED WIDOW (3RD CLAIMANT) DD = AGED WIDOW (4TH CLAIMANT) DG = AGED WIDOW (5TH CLAIMANT) DH = AGED WIDOWER (3RD CLAIMANT) DJ = AGED WIDOWER (4TH CLAIMANT) DK = AGED WIDOWER (5TH CLAIMANT) DL = REMARRIED WIDOW (4TH CLAIMANT) DM = SURVIVING DIVORCED HUSBAND (2ND CLAIMANT) DN = REMARRIED WIDOW (5TH CLAIMANT) DP = REMARRIED WIDOWER (2ND CLAIMANT) DQ = REMARRIED WIDOWER (3RD CLAIMANT) DR = REMARRIED WIDOWER (4TH CLAIMANT) DS = SURVIVING DIVORCED HUSBAND (3RD CLAIMANT) 1 GROUP HEALTH PLAN (GHP) MASTER RECORD POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ DT = REMARRIED WIDOWER (5TH CLAIMANT) DV = SURVIVING DIVORCED WIFE (3RD CLAIMANT) DW = SURVIVING DIVORCED WIFE (4TH CLAIMANT) DX = SURVIVING DIVORCED HUSBAND (4TH CLAIMANT) DY = SURVIVING DIVORCED WIFE (5TH CLAIMANT) DZ = SURVIVING DIVORCED HUSBAND (5TH CLAIMANT) E = MOTHER (WIDOW) (1ST CLAIMANT) E1 = SURVIVING DIVORCED MOTHER (1ST CLAIMANT) E2 = MOTHER (WIDOW) (2ND CLAIMANT) E3 = SURVIVING DIVORCED MOTHER (2ND CLAIMANT) E4 = FATHER (WIDOWER) (1ST CLAIMANT) E5 = SURVIVING DIVORCED FATHER (WIDOWER) (1ST CLAIMANT) E6 = FATHER (WIDOWER) (2ND CLAIMANT) E7 = MOTHER (WIDOW) (3RD CLAIMANT) E8 = MOTHER (WIDOW) (4TH CLAIMANT) E9 = SURVIVING DIVORCED FATHER (WIDOWER) (2ND CLAIMANT) EA = MOTHER (WIDOW) (5TH CLAIMANT) EB = SURVIVING DIVORCED MOTHER (3RD CLAIMANT) EC = SURVIVING DIVORCED MOTHER (4TH CLAIMANT) ED = SURVIVING DIVORCED MOTHER (5TH CLAIMANT EF = FATHER (WIDOWER) (3RD CLAIMANT) EG = FATHER (WIDOWER) (4TH CLAIMANT) EH = FATHER (WIDOWER) (5TH CLAIMANT) EJ = SURVIVING DIVORCED FATHER (3RD CLAIMANT) EK = SURVIVING DIVORCED FATHER (4TH CLAIMANT) EM = SURVIVING DIVORCED FATHER (5TH CLAIMANT) F1 = FATHER F2 = MOTHER F3 = STEPFATHER F4 = STEPMOTHER F5 = ADOPTING FATHER F6 = ADOPTING MOTHER F7 = SECOND ALLEGED FATHER F8 = SECOND ALLEGED MOTHER J1 = PRIMARY PROUTY ENTITLED TO HIB (LESS THAN 3 Q.C.) (GENERAL FUND) J2 = PRIMARY PROUTY ENTITLED TO HIB (OVER 2 Q.C.) (RSI TRUST FUND) J3 = PRIMARY PROUTY NOT ENTITLED TO HIB (LESS THAN 3 Q.C.) (GENERAL FUND) J4 = PRIMARY PROUTY NOT ENTITLED TO HIB (OVER 2 Q.C.) (RSI TRUST FUND) 1 GROUP HEALTH PLAN (GHP) MASTER RECORD POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ K1 = PROUTY WIFE ENTITLED TO HIB (LESS THAN 3 Q.C.) (GENERAL FUND) (1ST CLAIMANT) K2 = PROUTY WIFE ENTITLED TO HIB (OVER 2 Q.C.) (RSI TRUST FUND) (1ST CLAIMANT) K3 = PROUTY WIFE NOT ENTITLED TO HIB (LESS THAN 3 Q.C.) (GENERAL FUND) (1ST CLAIMANT) K4 = PROUTY WIFE NOT ENTITLED TO HIB (OVER 2 Q.C.) (RSI TRUST FUND) (1ST CLAIMANT) K5 = PROUTY WIFE ENTITLED TO HIB (LESS THAN 3 Q.C.) (GENERAL FUND) (2ND CLAIMANT) K6 = PROUTY WIFE ENTITLED TO HIB (OVER 2 Q.C.) (RSI TRUST FUND) (2ND CLAIMANT) K7 = PROUTY WIFE NOT ENTITLED TO HIB (LESS THAN 3 Q.C.) (GENERAL FUND) (2ND CLAIMANT) K8 = PROUTY WIFE NOT ENTITLED TO HIB (OVER 2 Q.C.) (RSI TRUST FUND) (2ND CLAIMANT) K9 = PROUTY WIFE ENTITLED TO HIB (LESS THAN 3 Q.C.) (GENERAL FUND) (3RD CLAIMANT) KA = PROUTY WIFE ENTITLED TO HIB (OVER 2 Q.C.) (RSI TRUST FUND) (3RD CLAIMANT) KB = PROUTY WIFE NOT ENTITLED TO HIB (LESS THAN 3 Q.C.) (GENERAL FUND) (3RD CLAIMANT) KC = PROUTY WIFE NOT ENTITLED TO HIB (OVER 2 Q.C.) (RSI TRUST FUND) (3RD CLAIMANT) KD = PROUTY WIFE ENTITLED TO HIB (LESS THAN 3 Q.C.) (GENERAL FUND) (4TH CLAIMANT) KE = PROUTY WIFE ENTITLED TO HIB (OVER 2 Q.C (4TH CLAIMANT) KF = PROUTY WIFE NOT ENTITLED TO HIB (LESS THAN 3 Q.C.)(4TH CLAIMANT) KG = PROUTY WIFE NOT ENTITLED TO HIB (OVER 2 Q.C.)(4TH CLAIMANT) KH = PROUTY WIFE ENTITLED TO HIB (LESS THAN 3 Q.C.)(5TH CLAIMANT) KJ = PROUTY WIFE ENTITLED TO HIB (OVER 2 Q.C.) (5TH CLAIMANT) KL = PROUTY WIFE NOT ENTITLED TO HIB (LESS THAN 3 Q.C.)(5TH CLAIMANT) KM = PROUTY WIFE NOT ENTITLED TO HIB (OVER 2 Q.C.) (5TH CLAIMANT) M = UNINSURED-NOT QUALIFIED FOR DEEMED HIB M1 = UNINSURED-QUALIFIED BUT REFUSED HIB T = UNINSURED-ENTITLED TO HIB UNDER DEEMED OR RENAL PROVISIONS TA = MQGE (PRIMARY CLAIMANT) TB = MQGE AGED SPOUSE (FIRST CLAIMANT) TC = MQGE DISABLED ADULT CHILD (FIRST CLAIMANT) TD = MQGE AGED WIDOW(ER) (FIRST CLAIMANT) 1 GROUP HEALTH PLAN (GHP) MASTER RECORD POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ TE = MQGE YOUNG WIDOW(ER) (FIRST CLAIMANT) TF = MQGE PARENT (MALE) TG = MQGE AGED SPOUSE (SECOND CLAIMANT) TH = MQGE AGED SPOUSE (THIRD CLAIMANT) TJ = MQGE AGED SPOUSE (FOURTH CLAIMANT) TK = MQGE AGED SPOUSE (FIFTH CLAIMANT) TL = MQGE AGED WIDOW(ER) (SECOND CLAIMANT) TM = MQGE AGED WIDOW(ER) (THIRD CLAIMANT) TN = MQGE AGED WIDOW(ER) (FOURTH CLAIMANT) TP = MQGE AGED WIDOW(ER) (FIFTH CLAIMANT) TQ = MQGE PARENT (FEMALE) TR = MQGE YOUNG WIDOW(ER) (SECOND CLAIMANT) TS = MQGE YOUNG WIDOW(ER) (THIRD CLAIMANT) TT = MQGE YOUNG WIDOW(ER) (FOURTH CLAIMANT) TU = MQGE YOUNG WIDOW(ER) (FIFTH CLAIMANT) TV = MQGE DISABLED WIDOW(ER) FIFTH CLAIMANT TW = MQGE DISABLED WIDOW(ER) FIRST CLAIMANT TX = MQGE DISABLED WIDOW(ER) SECOND CLAIMANT TY = MQGE DISABLED WIDOW(ER) THIRD CLAIMANT TZ = MQGE DISABLED WIDOW(ER) FOURTH CLAIMANT T2-T9 = DISABLED CHILD (SECOND TO NINTH CLAIMANT) W = DISABLED WIDOW, AGE 50 OR OVER (1ST CLAIMANT) W1 = DISABLED WIDOWER, AGE 50 OR OVER (1ST CLAIMANT) W2 = DISABLED WIDOW (2ND CLAIMANT) W3 = DISABLED WIDOWER (2ND CLAIMANT) W4 = DISABLED WIDOW (3RD CLAIMANT) W5 = DISABLED WIDOWER (3RD CLAIMANT) W6 = DISABLED SURVIVING DIVORCED WIFE (1ST CLAIMANT) W7 = DISABLED SURVIVING DIVORCED WIFE (2ND CLAIMANT) W8 = DISABLED SURVIVING DIVORCED WIFE (3RD CLAIMANT) W9 = DISABLED WIDOW (4TH CLAIMANT) WB = DISABLED WIDOWER (4TH CLAIMANT) WC = DISABLED SURVIVING DIVORCED WIFE (4TH CLAIMANT) WF = DISABLED WIDOW (5TH CLAIMANT) WG = DISABLED WIDOWER (5TH CLAIMANT) WJ = DISABLED SURVIVING DIVORCED WIFE (5TH CLAIMANT) WR = DISABLED SURVIVING DIVORCED HUSBAND (1ST CLAIMANT) WT = DISABLED SURVIVING DIVORCED HUSBAND (2ND CLAIMANT) RAILROAD RETIREMENT BOARD: NOTE: EMPLOYEE: A MEDICARE BENEFICIARY WHO IS STILL WORKING OR A WORKER WHO 1 GROUP HEALTH PLAN (GHP) MASTER RECORD POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ DIED BEFORE RETIREMENT ANNUITANT: A PERSON WHO RETIRED UNDER THE RAILROAD RETIREMENT ACT AFTER 03/01/37 PENSIONER: A PERSON WHO RETIRED PRIOR TO 03/01/37 AND WAS INCLUDED IN THE RAILROAD RETIREMENT ACT 10 = RETIREMENT - EMPLOYEE OR ANNUITANT 80 = RR PENSIONER (AGE OR DISABILITY) 14 = SPOUSE OF RR EMPLOYEE OR ANNUITANT (HUSBAND OR WIFE) 84 = SPOUSE OF RR PENSIONER 43 = CHILD OF RR EMPLOYEE 13 = CHILD OF RR ANNUITANT 17 = DISABLED ADULT CHILD OF RR ANNUITANT 46 = WIDOW/WIDOWER OF RR EMPLOYEE 16 = WIDOW/WIDOWER OF RR ANNUITANT 86 = WIDOW/WIDOWER OF RR PENSIONER 43 = WIDOW OF EMPLOYEE WITH A CHILD IN HER CARE 13 = WIDOW OF ANNUITANT WITH A CHILD IN HER CARE 83 = WIDOW OF PENSIONER WITH A CHILD IN HER CARE 45 = PARENT OF EMPLOYEE 15 = PARENT OF ANNUITANT 85 = PARENT OF PENSIONER 11 = SURVIVOR JOINT ANNUITANT (REDUCED BENEFITS TAKEN TO INSURE BENEFITS FOR SURVIVING SPOUSE) SOURCE: SSA/RRB 5. PREVIOUS BIC CHAR 2 16 17 PRIOR BENEFICIARY IDENTIFICATION CODE ASSOCIATED WITH THE CURRENT BENEFICIARY CLAIM ACCOUNT NUMBER. CODES: SOCIAL SECURITY ADMINISTRATION: A = PRIMARY CLAIMANT B = AGED WIFE, AGE 62 OR OVER (1ST CLAIMANT) B1 = AGED HUSBAND, AGE 62 OR OVER (1ST CLAIMANT) B2 = YOUNG WIFE, WITH A CHILD IN HER CARE (1ST CLAIMANT) B3 = AGED WIFE (2ND CLAIMANT) B4 = AGED HUSBAND (2ND CLAIMANT) B5 = YOUNG WIFE (2ND CLAIMANT) B6 = DIVORCED WIFE, AGE 62 OR OVER (1ST CLAIMANT) B7 = YOUNG WIFE (3RD CLAIMANT) B8 = AGED WIFE (3RD CLAIMANT) B9 = DIVORCED WIFE (2ND CLAIMANT) BA = AGED WIFE (4TH CLAIMANT) 1 GROUP HEALTH PLAN (GHP) MASTER RECORD POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ BD = AGED WIFE (5TH CLAIMANT) BG = AGED HUSBAND (3RD CLAIMANT) BH = AGED HUSBAND (4TH CLAIMANT) BJ = AGED HUSBAND (5TH CLAIMANT) BK = YOUNG WIFE (4TH CLAIMANT) BL = YOUNG WIFE (5TH CLAIMANT) BN = DIVORCED WIFE (3RD CLAIMANT) BP = DIVORCED WIFE (4TH CLAIMANT) BQ = DIVORCED WIFE (5TH CLAIMANT) BR = DIVORCED HUSBAND (1ST CLAIMANT) BT = DIVORCED HUSBAND (2ND CLAIMANT) BW = YOUNG HUSBAND (2ND CLAIMANT) BY = YOUNG HUSBAND (1ST CLAIMANT) C1-C9,CA-CK = CHILD (INCLUDES MINOR, STUDENT OR DISABLED CHILD) D = AGED WIDOW, 60 OR OVER (1ST CLAIMANT) D1 = AGED WIDOWER, AGE 60 OR OVER (1ST CLAIMANT) D2 = AGED WIDOW (2ND CLAIMANT) D3 = AGED WIDOWER (2ND CLAIMANT) D4 = WIDOW (REMARRIED AFTER ATTAINMENT OF AGE 60) (1ST CLAIMANT) D5 = WIDOWER (REMARRIED AFTER ATTAINMENT OF AGE 60) (1ST CLAIMANT) D6 = SURVIVING DIVORCED WIFE, AGE 60 OR OVER (1ST CLAIMANT) D7 = SURVIVING DIVORCED WIFE (2ND CLAIMANT) D8 = AGED WIDOW (3RD CLAIMANT) D9 = REMARRIED WIDOW (2ND CLAIMANT) DA = REMARRIED WIDOW (3RD CLAIMANT) DD = AGED WIDOW (4TH CLAIMANT) DG = AGED WIDOW (5TH CLAIMANT) DH = AGED WIDOWER (3RD CLAIMANT) DJ = AGED WIDOWER (4TH CLAIMANT) DK = AGED WIDOWER (5TH CLAIMANT) DL = REMARRIED WIDOW (4TH CLAIMANT) DM = SURVIVING DIVORCED HUSBAND (2ND CLAIMANT) DN = REMARRIED WIDOW (5TH CLAIMANT) DP = REMARRIED WIDOWER (2ND CLAIMANT) DQ = REMARRIED WIDOWER (3RD CLAIMANT) DR = REMARRIED WIDOWER (4TH CLAIMANT) DS = SURVIVING DIVORCED HUSBAND (3RD CLAIMANT) DT = REMARRIED WIDOWER (5TH CLAIMANT) DV = SURVIVING DIVORCED WIFE (3RD CLAIMANT) DW = SURVIVING DIVORCED WIFE (4TH CLAIMANT) DX = SURVIVING DIVORCED HUSBAND (4TH CLAIMANT) DY = SURVIVING DIVORCED WIFE (5TH CLAIMANT) DZ = SURVIVING DIVORCED HUSBAND (5TH CLAIMANT) E = MOTHER (WIDOW) (1ST CLAIMANT) E1 = SURVIVING DIVORCED MOTHER (1ST 1 GROUP HEALTH PLAN (GHP) MASTER RECORD POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ CLAIMANT) E2 = MOTHER (WIDOW) (2ND CLAIMANT) E3 = SURVIVING DIVORCED MOTHER (2ND CLAIMANT) E4 = FATHER (WIDOWER) (1ST CLAIMANT) E5 = SURVIVING DIVORCED FATHER (WIDOWER) (1ST CLAIMANT) E6 = FATHER (WIDOWER) (2ND CLAIMANT) E7 = MOTHER (WIDOW) (3RD CLAIMANT) E8 = MOTHER (WIDOW) (4TH CLAIMANT) E9 = SURVIVING DIVORCED FATHER (WIDOWER) (2ND CLAIMANT) EA = MOTHER (WIDOW) (5TH CLAIMANT) EB = SURVIVING DIVORCED MOTHER (3RD CLAIMANT) EC = SURVIVING DIVORCED MOTHER (4TH CLAIMANT) ED = SURVIVING DIVORCED MOTHER (5TH CLAIMANT EF = FATHER (WIDOWER) (3RD CLAIMANT) EG = FATHER (WIDOWER) (4TH CLAIMANT) EH = FATHER (WIDOWER) (5TH CLAIMANT) EJ = SURVIVING DIVORCED FATHER (3RD CLAIMANT) EK = SURVIVING DIVORCED FATHER (4TH CLAIMANT) EM = SURVIVING DIVORCED FATHER (5TH CLAIMANT) F1 = FATHER F2 = MOTHER F3 = STEPFATHER F4 = STEPMOTHER F5 = ADOPTING FATHER F6 = ADOPTING MOTHER F7 = SECOND ALLEGED FATHER F8 = SECOND ALLEGED MOTHER J1 = PRIMARY PROUTY ENTITLED TO HIB (LESS THAN 3 Q.C.) (GENERAL FUND) J2 = PRIMARY PROUTY ENTITLED TO HIB (OVER 2 Q.C.) (RSI TRUST FUND) J3 = PRIMARY PROUTY NOT ENTITLED TO HIB (LESS THAN 3 Q.C.) (GENERAL FUND) J4 = PRIMARY PROUTY NOT ENTITLED TO HIB (OVER 2 Q.C.) (RSI TRUST FUND) K1 = PROUTY WIFE ENTITLED TO HIB (LESS THAN 3 Q.C.) (GENERAL FUND) (1ST CLAIMANT) K2 = PROUTY WIFE ENTITLED TO HIB (OVER 2 Q.C.) (RSI TRUST FUND) (1ST CLAIMANT) K3 = PROUTY WIFE NOT ENTITLED TO HIB (LESS THAN 3 Q.C.) (GENERAL FUND) (1ST CLAIMANT) K4 = PROUTY WIFE NOT ENTITLED TO HIB (OVER 2 Q.C.) (RSI TRUST FUND) (1ST CLAIMANT) 1 GROUP HEALTH PLAN (GHP) MASTER RECORD POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ K5 = PROUTY WIFE ENTITLED TO HIB (LESS THAN 3 Q.C.) (GENERAL FUND) (2ND CLAIMANT) K6 = PROUTY WIFE ENTITLED TO HIB (OVER 2 Q.C.) (RSI TRUST FUND) (2ND CLAIMANT) K7 = PROUTY WIFE NOT ENTITLED TO HIB (LESS THAN 3 Q.C.) (GENERAL FUND) (2ND CLAIMANT) K8 = PROUTY WIFE NOT ENTITLED TO HIB (OVER 2 Q.C.) (RSI TRUST FUND) (2ND CLAIMANT) K9 = PROUTY WIFE ENTITLED TO HIB (LESS THAN 3 Q.C.) (GENERAL FUND) (3RD CLAIMANT) KA = PROUTY WIFE ENTITLED TO HIB (OVER 2 Q.C.) (RSI TRUST FUND) (3RD CLAIMANT) KB = PROUTY WIFE NOT ENTITLED TO HIB (LESS THAN 3 Q.C.) (GENERAL FUND) (3RD CLAIMANT) KC = PROUTY WIFE NOT ENTITLED TO HIB (OVER 2 Q.C.) (RSI TRUST FUND) (3RD CLAIMANT) KD = PROUTY WIFE ENTITLED TO HIB (LESS THAN 3 Q.C.) (GENERAL FUND) (4TH CLAIMANT) KE = PROUTY WIFE ENTITLED TO HIB (OVER 2 Q.C (4TH CLAIMANT) KF = PROUTY WIFE NOT ENTITLED TO HIB (LESS THAN 3 Q.C.)(4TH CLAIMANT) KG = PROUTY WIFE NOT ENTITLED TO HIB (OVER 2 Q.C.)(4TH CLAIMANT) KH = PROUTY WIFE ENTITLED TO HIB (LESS THAN 3 Q.C.)(5TH CLAIMANT) KJ = PROUTY WIFE ENTITLED TO HIB (OVER 2 Q.C.) (5TH CLAIMANT) KL = PROUTY WIFE NOT ENTITLED TO HIB (LESS THAN 3 Q.C.)(5TH CLAIMANT) KM = PROUTY WIFE NOT ENTITLED TO HIB (OVER 2 Q.C.) (5TH CLAIMANT) M = UNINSURED-NOT QUALIFIED FOR DEEMED HIB M1 = UNINSURED-QUALIFIED BUT REFUSED HIB T = UNINSURED-ENTITLED TO HIB UNDER DEEMED OR RENAL PROVISIONS TA = MQGE (PRIMARY CLAIMANT) TB = MQGE AGED SPOUSE (FIRST CLAIMANT) TC = MQGE DISABLED ADULT CHILD (FIRST CLAIMANT) TD = MQGE AGED WIDOW(ER) (FIRST CLAIMANT) TE = MQGE YOUNG WIDOW(ER) (FIRST CLAIMANT) TF = MQGE PARENT (MALE) TG = MQGE AGED SPOUSE (SECOND CLAIMANT) TH = MQGE AGED SPOUSE (THIRD CLAIMANT) TJ = MQGE AGED SPOUSE (FOURTH CLAIMANT) TK = MQGE AGED SPOUSE (FIFTH CLAIMANT) TL = MQGE AGED WIDOW(ER) (SECOND CLAIMANT) TM = MQGE AGED WIDOW(ER) (THIRD CLAIMANT) TN = MQGE AGED WIDOW(ER) (FOURTH CLAIMANT) TP = MQGE AGED WIDOW(ER) (FIFTH CLAIMANT) 1 GROUP HEALTH PLAN (GHP) MASTER RECORD POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ TQ = MQGE PARENT (FEMALE) TR = MQGE YOUNG WIDOW(ER) (SECOND CLAIMANT) TS = MQGE YOUNG WIDOW(ER) (THIRD CLAIMANT) TT = MQGE YOUNG WIDOW(ER) (FOURTH CLAIMANT) TU = MQGE YOUNG WIDOW(ER) (FIFTH CLAIMANT) TV = MQGE DISABLED WIDOW(ER) FIFTH CLAIMANT TW = MQGE DISABLED WIDOW(ER) FIRST CLAIMANT TX = MQGE DISABLED WIDOW(ER) SECOND CLAIMANT TY = MQGE DISABLED WIDOW(ER) THIRD CLAIMANT TZ = MQGE DISABLED WIDOW(ER) FOURTH CLAIMANT T2-T9 = DISABLED CHILD (SECOND TO NINTH CLAIMANT) W = DISABLED WIDOW, AGE 50 OR OVER (1ST CLAIMANT) W1 = DISABLED WIDOWER, AGE 50 OR OVER (1ST CLAIMANT) W2 = DISABLED WIDOW (2ND CLAIMANT) W3 = DISABLED WIDOWER (2ND CLAIMANT) W4 = DISABLED WIDOW (3RD CLAIMANT) W5 = DISABLED WIDOWER (3RD CLAIMANT) W6 = DISABLED SURVIVING DIVORCED WIFE (1ST CLAIMANT) W7 = DISABLED SURVIVING DIVORCED WIFE (2ND CLAIMANT) W8 = DISABLED SURVIVING DIVORCED WIFE (3RD CLAIMANT) W9 = DISABLED WIDOW (4TH CLAIMANT) WB = DISABLED WIDOWER (4TH CLAIMANT) WC = DISABLED SURVIVING DIVORCED WIFE (4TH CLAIMANT) WF = DISABLED WIDOW (5TH CLAIMANT) WG = DISABLED WIDOWER (5TH CLAIMANT) WJ = DISABLED SURVIVING DIVORCED WIFE (5TH CLAIMANT) WR = DISABLED SURVIVING DIVORCED HUSBAND (1ST CLAIMANT) WT = DISABLED SURVIVING DIVORCED HUSBAND (2ND CLAIMANT) RAILROAD RETIREMENT BOARD: NOTE: EMPLOYEE: A MEDICARE BENEFICIARY WHO IS STILL WORKING OR A WORKER WHO DIED BEFORE RETIREMENT ANNUITANT: A PERSON WHO RETIRED UNDER THE RAILROAD RETIREMENT ACT AFTER 03/01/37 PENSIONER: A PERSON WHO RETIRED PRIOR TO 03/01/37 AND WAS INCLUDED IN THE RAILROAD RETIREMENT ACT 10 = RETIREMENT - EMPLOYEE OR ANNUITANT 80 = RR PENSIONER (AGE OR DISABILITY) 1 GROUP HEALTH PLAN (GHP) MASTER RECORD POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ 14 = SPOUSE OF RR EMPLOYEE OR ANNUITANT (HUSBAND OR WIFE) 84 = SPOUSE OF RR PENSIONER 43 = CHILD OF RR EMPLOYEE 13 = CHILD OF RR ANNUITANT 17 = DISABLED ADULT CHILD OF RR ANNUITANT 46 = WIDOW/WIDOWER OF RR EMPLOYEE 16 = WIDOW/WIDOWER OF RR ANNUITANT 86 = WIDOW/WIDOWER OF RR PENSIONER 43 = WIDOW OF EMPLOYEE WITH A CHILD IN HER CARE 13 = WIDOW OF ANNUITANT WITH A CHILD IN HER CARE 83 = WIDOW OF PENSIONER WITH A CHILD IN HER CARE 45 = PARENT OF EMPLOYEE 15 = PARENT OF ANNUITANT 85 = PARENT OF PENSIONER 11 = SURVIVOR JOINT ANNUITANT (REDUCED BENEFITS TAKEN TO INSURE BENEFITS FOR SURVIVING SPOUSE) SOURCE: SSA AND RRB BENEFICIARY RECORD SYSTEMS **** GHP CROSS-REFERENCE GROUP 11 18 28 THE CROSS REFERRED CLAIM NUMBER OR THE BENEFICIARY'S BENEFICIARY CLAIM NUMBER OWN SOCIAL SECURITY NUMBER. GROUP 6. CROSS-REFERENCE BENEFICIARY CHAR 9 18 26 AN ADDITIONAL BENEFICIARY CLAIM ACCOUNT NUMBER CLAIM ACCOUNT NUMBER ASSOCIATED WITH THE MEDICARE BENEFICIARY. THE BENEFICIARY'S ENTITLEMENT HAS BEEN CROSS- REFERRED FROM THIS NUMBER TO THE BENEFICIARY'S ACTIVE CLAIM ACCOUNT NUMBER. STANDARD ALIAS: XREF_BENE_CLM_ACNT_NUM SAS ALIAS: XRFCAN EDIT-RULES: A NON NUMERIC IN THE FIRST POSITION INDICATES AN RRB NUMBER. SOURCE: SSA/RRB 7. CROSS-REFERENCE BENEFICIARY CHAR 2 27 28 THE BENEFICIARY IDENTIFICATION CODE ASSOCIATED WITH THE MEDI IDENTIFICATION CODE BENEFICIARY'S CROSS-REFERRED CLAIM ACCOUNT NUMBER CODES: SPACES = BENEFICIARY'S OWN SOCIAL SECURITY NUMBER ** = BENEFICIARY'S OWN SOCIAL SECURITY NUMBER SOCIAL SECURITY ADMINISTRATION: A = PRIMARY CLAIMANT B = AGED WIFE, AGE 62 OR OVER (1ST CLAIMANT) B1 = AGED HUSBAND, AGE 62 OR OVER (1ST 1 GROUP HEALTH PLAN (GHP) MASTER RECORD POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ CLAIMANT) B2 = YOUNG WIFE, WITH A CHILD IN HER CARE (1ST CLAIMANT) B3 = AGED WIFE (2ND CLAIMANT) B4 = AGED HUSBAND (2ND CLAIMANT) B5 = YOUNG WIFE (2ND CLAIMANT) B6 = DIVORCED WIFE, AGE 62 OR OVER (1ST CLAIMANT) B7 = YOUNG WIFE (3RD CLAIMANT) B8 = AGED WIFE (3RD CLAIMANT) B9 = DIVORCED WIFE (2ND CLAIMANT) BA = AGED WIFE (4TH CLAIMANT) BD = AGED WIFE (5TH CLAIMANT) BG = AGED HUSBAND (3RD CLAIMANT) BH = AGED HUSBAND (4TH CLAIMANT) BJ = AGED HUSBAND (5TH CLAIMANT) BK = YOUNG WIFE (4TH CLAIMANT) BL = YOUNG WIFE (5TH CLAIMANT) BN = DIVORCED WIFE (3RD CLAIMANT) BP = DIVORCED WIFE (4TH CLAIMANT) BQ = DIVORCED WIFE (5TH CLAIMANT) BR = DIVORCED HUSBAND (1ST CLAIMANT) BT = DIVORCED HUSBAND (2ND CLAIMANT) BW = YOUNG HUSBAND (2ND CLAIMANT) BY = YOUNG HUSBAND (1ST CLAIMANT) C1-C9,CA-CK = CHILD (INCLUDES MINOR, STUDENT OR DISABLED CHILD) D = AGED WIDOW, 60 OR OVER (1ST CLAIMANT) D1 = AGED WIDOWER, AGE 60 OR OVER (1ST CLAIMANT) D2 = AGED WIDOW (2ND CLAIMANT) D3 = AGED WIDOWER (2ND CLAIMANT) D4 = WIDOW (REMARRIED AFTER ATTAINMENT OF AGE 60) (1ST CLAIMANT) D5 = WIDOWER (REMARRIED AFTER ATTAINMENT OF AGE 60) (1ST CLAIMANT) D6 = SURVIVING DIVORCED WIFE, AGE 60 OR OVER (1ST CLAIMANT) D7 = SURVIVING DIVORCED WIFE (2ND CLAIMANT) D8 = AGED WIDOW (3RD CLAIMANT) D9 = REMARRIED WIDOW (2ND CLAIMANT) DA = REMARRIED WIDOW (3RD CLAIMANT) DD = AGED WIDOW (4TH CLAIMANT) DG = AGED WIDOW (5TH CLAIMANT) DH = AGED WIDOWER (3RD CLAIMANT) DJ = AGED WIDOWER (4TH CLAIMANT) DK = AGED WIDOWER (5TH CLAIMANT) DL = REMARRIED WIDOW (4TH CLAIMANT) DM = SURVIVING DIVORCED HUSBAND (2ND CLAIMANT) DN = REMARRIED WIDOW (5TH CLAIMANT) DP = REMARRIED WIDOWER (2ND CLAIMANT) DQ = REMARRIED WIDOWER (3RD CLAIMANT) DR = REMARRIED WIDOWER (4TH CLAIMANT) 1 GROUP HEALTH PLAN (GHP) MASTER RECORD POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ DS = SURVIVING DIVORCED HUSBAND (3RD CLAIMANT) DT = REMARRIED WIDOWER (5TH CLAIMANT) DV = SURVIVING DIVORCED WIFE (3RD CLAIMANT) DW = SURVIVING DIVORCED WIFE (4TH CLAIMANT) DX = SURVIVING DIVORCED HUSBAND (4TH CLAIMANT) DY = SURVIVING DIVORCED WIFE (5TH CLAIMANT) DZ = SURVIVING DIVORCED HUSBAND (5TH CLAIMANT) E = MOTHER (WIDOW) (1ST CLAIMANT) E1 = SURVIVING DIVORCED MOTHER (1ST CLAIMANT) E2 = MOTHER (WIDOW) (2ND CLAIMANT) E3 = SURVIVING DIVORCED MOTHER (2ND CLAIMANT) E4 = FATHER (WIDOWER) (1ST CLAIMANT) E5 = SURVIVING DIVORCED FATHER (WIDOWER) (1ST CLAIMANT) E6 = FATHER (WIDOWER) (2ND CLAIMANT) E7 = MOTHER (WIDOW) (3RD CLAIMANT) E8 = MOTHER (WIDOW) (4TH CLAIMANT) E9 = SURVIVING DIVORCED FATHER (WIDOWER) (2ND CLAIMANT) EA = MOTHER (WIDOW) (5TH CLAIMANT) EB = SURVIVING DIVORCED MOTHER (3RD CLAIMANT) EC = SURVIVING DIVORCED MOTHER (4TH CLAIMANT) ED = SURVIVING DIVORCED MOTHER (5TH CLAIMANT EF = FATHER (WIDOWER) (3RD CLAIMANT) EG = FATHER (WIDOWER) (4TH CLAIMANT) EH = FATHER (WIDOWER) (5TH CLAIMANT) EJ = SURVIVING DIVORCED FATHER (3RD CLAIMANT) EK = SURVIVING DIVORCED FATHER (4TH CLAIMANT) EM = SURVIVING DIVORCED FATHER (5TH CLAIMANT) F1 = FATHER F2 = MOTHER F3 = STEPFATHER F4 = STEPMOTHER F5 = ADOPTING FATHER F6 = ADOPTING MOTHER F7 = SECOND ALLEGED FATHER F8 = SECOND ALLEGED MOTHER J1 = PRIMARY PROUTY ENTITLED TO HIB (LESS THAN 3 Q.C.) (GENERAL FUND) J2 = PRIMARY PROUTY ENTITLED TO HIB (OVER 2 Q.C.) (RSI TRUST FUND) J3 = PRIMARY PROUTY NOT ENTITLED TO HIB (LESS THAN 3 Q.C.) (GENERAL FUND) 1 GROUP HEALTH PLAN (GHP) MASTER RECORD POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ J4 = PRIMARY PROUTY NOT ENTITLED TO HIB (OVER 2 Q.C.) (RSI TRUST FUND) K1 = PROUTY WIFE ENTITLED TO HIB (LESS THAN 3 Q.C.) (GENERAL FUND) (1ST CLAIMANT) K2 = PROUTY WIFE ENTITLED TO HIB (OVER 2 Q.C.) (RSI TRUST FUND) (1ST CLAIMANT) K3 = PROUTY WIFE NOT ENTITLED TO HIB (LESS THAN 3 Q.C.) (GENERAL FUND) (1ST CLAIMANT) K4 = PROUTY WIFE NOT ENTITLED TO HIB (OVER 2 Q.C.) (RSI TRUST FUND) (1ST CLAIMANT) K5 = PROUTY WIFE ENTITLED TO HIB (LESS THAN 3 Q.C.) (GENERAL FUND) (2ND CLAIMANT) K6 = PROUTY WIFE ENTITLED TO HIB (OVER 2 Q.C.) (RSI TRUST FUND) (2ND CLAIMANT) K7 = PROUTY WIFE NOT ENTITLED TO HIB (LESS THAN 3 Q.C.) (GENERAL FUND) (2ND CLAIMANT) K8 = PROUTY WIFE NOT ENTITLED TO HIB (OVER 2 Q.C.) (RSI TRUST FUND) (2ND CLAIMANT) K9 = PROUTY WIFE ENTITLED TO HIB (LESS THAN 3 Q.C.) (GENERAL FUND) (3RD CLAIMANT) KA = PROUTY WIFE ENTITLED TO HIB (OVER 2 Q.C.) (RSI TRUST FUND) (3RD CLAIMANT) KB = PROUTY WIFE NOT ENTITLED TO HIB (LESS THAN 3 Q.C.) (GENERAL FUND) (3RD CLAIMANT) KC = PROUTY WIFE NOT ENTITLED TO HIB (OVER 2 Q.C.) (RSI TRUST FUND) (3RD CLAIMANT) KD = PROUTY WIFE ENTITLED TO HIB (LESS THAN 3 Q.C.) (GENERAL FUND) (4TH CLAIMANT) KE = PROUTY WIFE ENTITLED TO HIB (OVER 2 Q.C (4TH CLAIMANT) KF = PROUTY WIFE NOT ENTITLED TO HIB (LESS THAN 3 Q.C.)(4TH CLAIMANT) KG = PROUTY WIFE NOT ENTITLED TO HIB (OVER 2 Q.C.)(4TH CLAIMANT) KH = PROUTY WIFE ENTITLED TO HIB (LESS THAN 3 Q.C.)(5TH CLAIMANT) KJ = PROUTY WIFE ENTITLED TO HIB (OVER 2 Q.C.) (5TH CLAIMANT) KL = PROUTY WIFE NOT ENTITLED TO HIB (LESS THAN 3 Q.C.)(5TH CLAIMANT) KM = PROUTY WIFE NOT ENTITLED TO HIB (OVER 2 Q.C.) (5TH CLAIMANT) M = UNINSURED-NOT QUALIFIED FOR DEEMED HIB M1 = UNINSURED-QUALIFIED BUT REFUSED HIB T = UNINSURED-ENTITLED TO HIB UNDER DEEMED OR RENAL PROVISIONS TA = MQGE (PRIMARY CLAIMANT) TB = MQGE AGED SPOUSE (FIRST CLAIMANT) 1 GROUP HEALTH PLAN (GHP) MASTER RECORD POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ TC = MQGE DISABLED ADULT CHILD (FIRST CLAIMANT) TD = MQGE AGED WIDOW(ER) (FIRST CLAIMANT) TE = MQGE YOUNG WIDOW(ER) (FIRST CLAIMANT) TF = MQGE PARENT (MALE) TG = MQGE AGED SPOUSE (SECOND CLAIMANT) TH = MQGE AGED SPOUSE (THIRD CLAIMANT) TJ = MQGE AGED SPOUSE (FOURTH CLAIMANT) TK = MQGE AGED SPOUSE (FIFTH CLAIMANT) TL = MQGE AGED WIDOW(ER) (SECOND CLAIMANT) TM = MQGE AGED WIDOW(ER) (THIRD CLAIMANT) TN = MQGE AGED WIDOW(ER) (FOURTH CLAIMANT) TP = MQGE AGED WIDOW(ER) (FIFTH CLAIMANT) TQ = MQGE PARENT (FEMALE) TR = MQGE YOUNG WIDOW(ER) (SECOND CLAIMANT) TS = MQGE YOUNG WIDOW(ER) (THIRD CLAIMANT) TT = MQGE YOUNG WIDOW(ER) (FOURTH CLAIMANT) TU = MQGE YOUNG WIDOW(ER) (FIFTH CLAIMANT) TV = MQGE DISABLED WIDOW(ER) FIFTH CLAIMANT TW = MQGE DISABLED WIDOW(ER) FIRST CLAIMANT TX = MQGE DISABLED WIDOW(ER) SECOND CLAIMANT TY = MQGE DISABLED WIDOW(ER) THIRD CLAIMANT TZ = MQGE DISABLED WIDOW(ER) FOURTH CLAIMANT T2-T9 = DISABLED CHILD (SECOND TO NINTH CLAIMANT) W = DISABLED WIDOW, AGE 50 OR OVER (1ST CLAIMANT) W1 = DISABLED WIDOWER, AGE 50 OR OVER (1ST CLAIMANT) W2 = DISABLED WIDOW (2ND CLAIMANT) W3 = DISABLED WIDOWER (2ND CLAIMANT) W4 = DISABLED WIDOW (3RD CLAIMANT) W5 = DISABLED WIDOWER (3RD CLAIMANT) W6 = DISABLED SURVIVING DIVORCED WIFE (1ST CLAIMANT) W7 = DISABLED SURVIVING DIVORCED WIFE (2ND CLAIMANT) W8 = DISABLED SURVIVING DIVORCED WIFE (3RD CLAIMANT) W9 = DISABLED WIDOW (4TH CLAIMANT) WB = DISABLED WIDOWER (4TH CLAIMANT) WC = DISABLED SURVIVING DIVORCED WIFE (4TH CLAIMANT) WF = DISABLED WIDOW (5TH CLAIMANT) WG = DISABLED WIDOWER (5TH CLAIMANT) WJ = DISABLED SURVIVING DIVORCED WIFE (5TH CLAIMANT) WR = DISABLED SURVIVING DIVORCED HUSBAND (1ST CLAIMANT) WT = DISABLED SURVIVING DIVORCED HUSBAND (2ND CLAIMANT) RAILROAD RETIREMENT BOARD: NOTE: 1 GROUP HEALTH PLAN (GHP) MASTER RECORD POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ EMPLOYEE: A MEDICARE BENEFICIARY WHO IS STILL WORKING OR A WORKER WHO DIED BEFORE RETIREMENT ANNUITANT: A PERSON WHO RETIRED UNDER THE RAILROAD RETIREMENT ACT AFTER 03/01/37 PENSIONER: A PERSON WHO RETIRED PRIOR TO 03/01/37 AND WAS INCLUDED IN THE RAILROAD RETIREMENT ACT 10 = RETIREMENT - EMPLOYEE OR ANNUITANT 80 = RR PENSIONER (AGE OR DISABILITY) 14 = SPOUSE OF RR EMPLOYEE OR ANNUITANT (HUSBAND OR WIFE) 84 = SPOUSE OF RR PENSIONER 43 = CHILD OF RR EMPLOYEE 13 = CHILD OF RR ANNUITANT 17 = DISABLED ADULT CHILD OF RR ANNUITANT 46 = WIDOW/WIDOWER OF RR EMPLOYEE 16 = WIDOW/WIDOWER OF RR ANNUITANT 86 = WIDOW/WIDOWER OF RR PENSIONER 43 = WIDOW OF EMPLOYEE WITH A CHILD IN HER CARE 13 = WIDOW OF ANNUITANT WITH A CHILD IN HER CARE 83 = WIDOW OF PENSIONER WITH A CHILD IN HER CARE 45 = PARENT OF EMPLOYEE 15 = PARENT OF ANNUITANT 85 = PARENT OF PENSIONER 11 = SURVIVOR JOINT ANNUITANT (REDUCED BENEFITS TAKEN TO INSURE BENEFITS FOR SURVIVING SPOUSE) SOURCE: SSA MBR UPDT SYS DRTS (HDURIC) 8. FILLER CHAR 7 29 35 9. DATE OF BIRTH PACK 3 36 38 THIS FIELD INDICATES THE BENEFICIARY'S DATE OF BIRTH. 5 DIGITS SIGNED STANDARD ALIAS: BENE_BIRTH_DT COBOL ALIAS: BIRTH-DT EDIT-RULES: YYDDD SOURCE: SSA AND RRB BENEFICIARY RECORD SYSTEMS 10. DATE OF DEATH PACK 3 39 41 THIS FIELD SHOWS THE BENEFICIARY'S DATE OF DEATH. 5 DIGITS SIGNED 1 GROUP HEALTH PLAN (GHP) MASTER RECORD POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ COBOL ALIAS: DEATH-DT EDIT-RULES: YYDDD 00000 = NO DATE OF DEATH YY999 = NO LONGER ON HISKEW, UNKNOWN REASON, ASSUMED DEAD, OR CROSS-REFERENCED OUT SOURCE: HIMASTER ENROLLMENT RECORD 11. FILLER CHAR 3 42 44 12. BENEFICIARY SEX CHAR 1 45 45 THE SEX OF A BENEFICIARY. IDENTIFICATION CODE STANDARD ALIAS: BENE_SEX_IDENT_CD COMMON ALIAS: SEX_CD SAS ALIAS: SEX_CD EDIT-RULES: REQUIRED FIELD CODES: 1 = MALE 2 = FEMALE 0 = UNKNOWN SOURCE: SSA,RRB,EDB 13. FILLER CHAR 7 46 52 14. BENEFICIARY GHO ENROLLMENT CHAR 2 53 54 STANDARD ALIAS: BENE_GHO_ENRLMT_STATE_CD STATE CODE CODES: 01 = ALABAMA 02 = ALASKA 03 = ARIZONA 04 = ARKANSAS 05 = CALIFORNIA 06 = COLORADO 07 = CONNECTICUT 08 = DELAWARE 09 = DISTRICT OF COLUMBIA 10 = FLORIDA 11 = GEORGIA 12 = HAWAII 13 = IDAHO 14 = ILLINOIS 15 = INDIANA 16 = IOWA 17 = KANSAS 18 = KENTUCKY 19 = LOUISIANA 1 GROUP HEALTH PLAN (GHP) MASTER RECORD POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ 20 = MAINE 21 = MARYLAND 22 = MASSACHUSETTS 23 = MICHIGAN 24 = MINNESOTA 25 = MISSISSIPPI 26 = MISSOURI 27 = MONTANA 28 = NEBRASKA 29 = NEVADA 30 = NEW HAMPSHIRE 31 = NEW JERSEY 32 = NEW MEXICO 33 = NEW YORK 34 = NORTH CAROLINA 35 = NORTH DAKOTA 36 = OHIO 37 = OKLAHOMA 38 = OREGON 39 = PENNSYLVANIA 40 = PUERTO RICO 41 = RHODE ISLAND 42 = SOUTH CAROLINA 43 = SOUTH DAKOTA 44 = TENNESSEE 45 = TEXAS 46 = UTAH 47 = VERMONT 48 = VIRGIN ISLANDS 49 = VIRGINIA 50 = WASHINGTON 51 = WEST VIRGINIA 52 = WISCONSIN 53 = WYOMING 54 = AFRICA 55 = CALIFORNIA; INSTITUTIONAL PROVIDER OF SERVICES (IPS) ONLY 56 = CANADA 57 = CENTRAL AMERICA AND WEST INDIES 58 = EUROPE 59 = MEXICO 60 = OCEANIA 61 = PHILIPPINES 62 = SOUTH AMERICA 63 = U.S. POSSESSIONS 64 = AMERICAN SAMOA 65 = GUAM 66 = SAIPAN 67 = TEXAS; INSTITUTIONAL PROVIDER OF SERVICES (IPS) ONLY 97 = NORTHERN MARIANAS 98 = GUAM 99 = WITH 000 COUNTY CODE IS AMERICAN SAMOA; OTHERWISE UNKNOWN 1 GROUP HEALTH PLAN (GHP) MASTER RECORD POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ 15. BENEFICIARY GHO ENROLLMENT CHAR 3 55 57 STANDARD ALIAS: BENE_GHO_ENRLMT_CNTY_CD COUNTY CODE 16. BENEFICIARY GHO ENROLLMENT CHAR 5 58 62 STANDARD ALIAS: BENE_GHO_ENRLMT_ZIP_CD ZIP CODE 17. CURRENT PART A ENTITLEMENT PACK 3 63 65 THIS DATE SPECIFIES THE FIRST DATE A BENEFICIARY DATE BECAME ENTITLED TO PART A BENEFITS. 5 DIGITS SIGNED EDIT-RULES: YYDDD ZEROS = NO PART A ENTITLEMENT SOURCE: EDB 18. CURRENT PART A TERMINATION PACK 3 66 68 THIS DATE SPECIFIES THE LAST DATE A BENEFICIARY IS DATE ENTITLED TO PART A BENEFITS. AFTER THIS DATE, PART A BENEFITS ARE TERMINATED. 5 DIGITS SIGNED EDIT-RULES: YYDDD ZEROS = NO PART A TERMINATION SOURCE: EDB 19. CURRENT PART B ENTITLEMENT PACK 3 69 71 THIS DATE SPECIFIES THE FIRST DATE A BENEFICIARY DATE BECAME ENTITLED TO PART B BENEFITS. 5 DIGITS SIGNED EDIT-RULES: YYDDD ZEROS = NO PART B ENTITLEMENT SOURCE: EDB 20. CURRENT PART B TERMINATION PACK 3 72 74 THIS DATE SPECIFIES THE LAST DATE A BENEFICIARY IS DATE ENTITLED TO PART B BENEFITS. AFTER THIS DATE, PART B BENEFITS ARE TERMINATED. 5 DIGITS SIGNED EDIT-RULES: YYDDD ZEROS = NO PART B TERMINATION 1 GROUP HEALTH PLAN (GHP) MASTER RECORD POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ SOURCE: EDB 21. BENEFICIARY PART B CHAR 1 75 75 THE REASON FOR ENTITLEMENT OR TERMINATION OF ENTITLEMENT STATUS CODE A BENEFICIARY'S PART B BENEFITS DURING A CURRENT PERIOD OF COVERAGE. STANDARD ALIAS: BENE_PTB_ENTLMT_STUS_CD SAS ALIAS: PTBST COMMON ALIAS: SOC EDIT-RULES: REQUIRED FOR UPDATE CODES: WHERE THE PART B ENTITLEMENT DATE IS PRESENT AND THE PART B TERMINATION DATE IS BLANK: G = ENTITLED DUE TO GOOD CAUSE Y = ENTITLED AND A PREMIUM IS PAYABLE. WHERE THE PART B ENTITLEMENT DATE IS PRESENT AND THE PART B TERMINATION DATE IS ALSO PRESENT: C = TERMINATED DUE TO DISABILITY CESSATION F = TERMINATED DUE TO INVALID OR VOIDED ENROLLMENT S = TERMINATED, NO LONGER ENTITLED UNDER END-STAGE RENAL DISEASE PROVISION T = TERMINATED FOR NON-PAYMENT OF PREMIUMS W = VOLUNTARILY WITHDRAWN FROM COVERAGE SOURCE: SSA/RRB 22. BENEFICIARY PART A CHAR 1 76 76 THE REASON FOR A BENEFICIARY'S ENTITLEMENT OR ENTITLEMENT STATUS CODE TERMINATION TO PART A BENEFITS DURING A PERIOD OF COVERAGE. STANDARD ALIAS: BENE_PTA_ENTLMT_STUS_CD SAS ALIAS: PTAST COMMON ALIAS: HOC EDIT-RULES: REQUIRED FOR UPDATE CODES: WHERE PART A ENTITLEMENT DATE IS PRESENT AND PART A TERMINATION DATE IS BLANK: E = FREE PART A ENTITLEMENT G = ENTITLED DUE TO GOOD CAUSE Y = PREMIUM PART A ENTITLEMENT 1 GROUP HEALTH PLAN (GHP) MASTER RECORD POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ WHERE PART A ENTITLEMENT DATE IS PRESENT AND PART A TERMINATION DATE IS ALSO PRESENT: C = TERMINATED FOR DISABILITY CESSATION S = TERMINATED, NO LONGER ENTITLED UNDER END-STAGE RENAL DISEASE PROVISION T = TERMINATED FOR NON-PAYMENT OF PREMIUMS W = VOLUNTARILY WITHDRAWN FROM COVERAGE X = FREE PART A TERMINATED OR REFUSED COVERAGE SOURCE: SSA/RRB 23. FILLER CHAR 19 77 95 24. CENTURY OF BIRTH CHAR 1 96 96 THIS FIELD SPECIFIES THE CENTURY IN WHICH A BENEFICIARY WAS BORN. COMMON ALIAS: DATA_INDICATOR#18 CODES: 0 = CURRENT CENTURY 1 = PRIOR CENTURY 25. FILLER CHAR 19 97 115 26. END STAGE RENAL DISEASE CHAR 1 116 116 THIS IS A NOTICE OF ESRD INVOLVEMENT INDICATOR (ESRD) COMMON ALIAS: CRD_INDICATOR CODES: 0 = NO ESRD 1 = ESRD STATUS 27. FILLER CHAR 35 117 151 28. BENEFICIARY SURNAME CHAR 12 152 163 THE LAST NAME OF THE MEDICARE BENEFICIARY. STANDARD ALIAS: BENE_SRNM_NAME 29. BENEFICIARY GIVEN NAME CHAR 7 164 170 THE FIRST NAME OF THE MEDICARE BENEFICIARY. STANDARD ALIAS: BENE_GVN_NAME 30. BENEFICIARY MIDDLE NAME CHAR 1 171 171 THE FIRST POSITION (LETTER) OF A BENEFICIARY'S MIDDLE NAME. STANDARD ALIAS: BENE_MDL_NAME SAS ALIAS: MDLNAME EDIT-RULES: OPTIONAL; MAY BE BLANK SOURCE: 1 GROUP HEALTH PLAN (GHP) MASTER RECORD POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ SSA/RRB 31. ENROLLMENT CODE CHAR 1 172 172 CODES: 0 = INACTIVE 1 = ACTIVE 32. FILLER CHAR 1 173 173 STANDARD ALIAS: FILLER SAS ALIAS: FILLER 33. HOSPICE INDICATOR CHAR 1 174 174 CODES: 1 = HOSPICE START DATE PRESENT 0 = NO HOSPICE START DATE PRESENT 34. MEDICAID INDICATOR CHAR 1 175 175 CODES: 1 = MEDICAID STATUS 0 = NO MEDICAID 35. WORKING AGED INDICATOR CHAR 1 176 176 CODES: 0 = NO WORKING AGED 1 = WORKING AGED STATUS 36. PRIOR CAN BIC INDICATOR CHAR 1 177 177 CODES: 0 = NO PRIOR CAN BIC 1 = PRIOR CAN BIC 37. FILLER CHAR 2 178 179 38. INSTITUTIONAL/NHC CHAR 1 180 180 CODES: INDICATOR 0 = NO INSTITUTIONAL 1 = INSTITUTIONAL STATUS 2 = NURSING HOME CERTIFIABLE STATUS **** GHP MEMBERSHIP GROUP 25 181 205 ONE TO SIX MEMBERSHIP PERIODS MAY BE PRESENT. THE CURRENT MEMBERSHIP PERIOD APPEARS FIRST. OCCURS: 6 TIMES 39. SEPARATOR/TERMINATOR CHAR 1 181 181 FIELD INDICATES GHP DATA TRAILER FOLLOWS OR END OF RECORD CODES: * = GHP MEMBERSHIP DATA FOLLOWS # = END OF RECORD 40. GHP STATUS CODE CHAR 1 182 182 THIS FIELD DENOTES THE BENEFICIARY'S CURRENT GHO MEMBERSHIP STATUS. CODES: A = ACTIVE D = DECEASED I = INACTIVE 41. GHP CONTRACT NUMBER CHAR 5 183 187 1 GROUP HEALTH PLAN (GHP) MASTER RECORD POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ 42. FILLER CHAR 2 188 189 43. PART B GHO ENROLLMENT DATE PACK 3 190 192 YEAR AND DAY OF YEAR OF EFFECTIVE PART B GHO MEMBERSHIP. 5 DIGITS SIGNED EDIT-RULES: YYDDD SOURCE: GHP MASTER FILE 44. PART B GHO DISENROLLMENT PACK 3 193 195 YEAR AND DAY OF YEAR OF EFFECTIVE PART B GHO DELETION. DATE 5 DIGITS SIGNED EDIT-RULES: YYDDD SOURCE: GHP MASTER FILE 45. PART A GHO ENROLLMENT DATE PACK 3 196 198 YEAR AND DAY OF YEAR OF EFFECTIVE PART A GHO MEMBERSHIP. 5 DIGITS SIGNED EDIT-RULES: YYDDD SOURCE: GHP MASTER FILE 46. PART A GHO DISENROLLMENT PACK 3 199 201 YEAR AND DAY OF YEAR OF EFFECTIVE PART A GHO DELETION. DATE 5 DIGITS SIGNED EDIT-RULES: YYDDD SOURCE: GHP MASTER FILE 47. FILLER CHAR 4 202 205