HI 00825.913 Health Insurance Printout (HIPO)

The Items on the HIPO relevant to possible PSC action are as follows:

  1. Account number and subscript

  2. Last Name (up to six positions)

    First Name (up to 11 positions)

    Middle Initial (one position)

  3. Sex

  4. Cross-Reference Account Number and Subscript

  5. Part A Current Entitlement Date

  6. Part A Current Termination Date

  7. Part A Current Option Code

  8. Part A Previous Entitlement Date

  9. Part A Previous Termination Date

  10. Part A Previous Option Code

  11. Date of Birth

  12. Date of Accretion (date HI record established)

  13. Date of Last Action (date of last HI action)

  14. Part B Current Entitlement Date

  15. Part B Current Termination Date

  16. Part B Curret Option Code

  17. Part B Previous Entitlement Date

  18. Part B Previous Termination Date

  19. Part B Previous Option Code

  20. Date of Death

  21. Ledger Account Status


G-HI 00825.913

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HI 00825.913 - Health Insurance Printout (HIPO) - 04/06/1990
Batch run: 01/27/2009