Coverage

extended healthcare

Sequence
9
9
RX Id
MDF12345
RX BIN
987654
RX Group
M35PT
RX PCN
234516
Period
23 May 2011 – 23 May 2012
Policy holder
Organization on file
Subscriber
Patient on file
Beneficiary
Patient on file

Details

Identifier
12345
Dependent
0
Relationship
self
Payor
Organization on file
Class
Group:
CB135
Name
Corporate Baker's Inc. Local #35
SubGroup:
123
Name
Trainee Part-time Benefits
Plan:
B37FC
Name
Full Coverage: Medical, Dental, Pharmacy, Vision, EHC
SubPlan:
P7
Name
Includes afterlife benefits
Class:
SILVER
Name
Silver: Family Plan spouse only
SubClass:
Tier2
Name
Low deductable, max $20 copay
Summary from source
A human-readable rendering of the coverage