HI 00825.913 Health Insurance Printout (HIPO)
The Items on the HIPO relevant to possible PSC action are as follows:
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1.
Account number and subscript
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2.
Last Name (up to six positions)
First Name (up to 11 positions)
Middle Initial (one position)
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4.
Cross-Reference Account Number and Subscript
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5.
Part A Current Entitlement Date
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6.
Part A Current Termination Date
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7.
Part A Current Option Code
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8.
Part A Previous Entitlement Date
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9.
Part A Previous Termination Date
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10.
Part A Previous Option Code
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12.
Date of Accretion (date HI record established)
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13.
Date of Last Action (date of last HI action)
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14.
Part B Current Entitlement Date
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15.
Part B Current Termination Date
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16.
Part B Curret Option Code
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17.
Part B Previous Entitlement Date
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18.
Part B Previous Termination Date
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19.
Part B Previous Option Code
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