| Label | Type | Description | Mandatory |
| Updated On | CURAM_DATETIME | The date on which the last update was made to the evidence. | No |
| Effective Date of Change | CURAM_DATE | Date which the evidence becomes effective | No |
| Approval Requested | CURAM_INDICATOR | Approval Requested | No |
|
| Updated By |
| Label | Type | Description | Mandatory |
| Updated By | USER_NAME | | No |
|
|
|
| Policyholder/ Employee Details |
| Label | Type | Description | Mandatory |
| Policyholder/ Employee Participant | FULL_NAME | Employee participant policyholder from the drop-down list of policyholders. This list contains participants and their social security numbers. If the participant does not have a social security number, no number is displayed. The list of participants includes all household members, existing case participant roles of type "medical insurance policy holder", "absent parent", "alien sponsor" where the sponsor type is "individual" and "alien sponsor spouse". For case participants who have not yet been recorded as a medical insurance policyholder, the system automatically creates a case participant role of type "medical insurance policyholder". | No |
|
| Policy Details |
| Label | Type | Description | Mandatory |
| Medical Insurance Type | EVD_MEDICAL_INSURANCE_TYPE | Type of medical insurance from the drop-down list of medical insurance types, e.g., major medical or basic hospital. | No |
| Policy Number | EVD_POLICY_NUMBER | Medical insurance policy or certificate number. | No |
| Premium | CURAM_AMOUNT | Monetary value of the amount payable for the medical insurance cover. | No |
| Frequency | FREQUENCY_CODE_STATIC | Frequency with which the insurance policy premium is paid from the drop-down list of frequencies. | No |
| Deductible | CURAM_AMOUNT | Monetary value of the deductible. A deductible is the amount which must be paid before the insurance company begins to pay medical bills. This is an annual amount per insured person. | No |
| Max Deductible | CURAM_AMOUNT | Monetary value of the maximum deductible to be paid per household per year. For example, the per person deductible might be $500; however, there may be a max deductible set at $1000 which represents the deductibles for 2 people. This is the most a household has to pay in deductibles. Once 2 of the household members pay the full deductible during the year, no more deductibles should be paid by the household for the rest of the year. | No |
| Policy Start Date | CURAM_DATE | Date on which coverage begins under the policy. | No |
| Policy End Date | CURAM_DATE | Date on which coverage ends under the policy. | No |
| Country Wide Coverage | CURAM_INDICATOR | This indicates whether or not the coverage under the medical insurance policy applies country wide. | No |
| State Of Coverage | EVD_ADDRESS_STATE | State of the medical insurance coverage from the drop-down list of US States. | No |
|
| Group Policy Details |
| Label | Type | Description | Mandatory |
| Employer | FULL_NAME | You can select the employer who provides the group policy from the organization's registered employers. To select the employer from the organization's registered employers, press the Search button to open the Employer Search pop-up window. On the Employer Search pop-up window, enter some or all of the employer search criteria and press the Search button to search for employers with matching details. Click the Select link on the appropriate row from the list of employers displayed to select the employers. The system automatically creates an additional case participant role of "group policy provider". | No |
| Group Policy Number | EVD_GROUP_POLICY_NUMBER | Group policy under which the employee is covered. Group policy schemes are provided by employers. | No |
|
| Insurance Company Details |
| Label | Type | Description | Mandatory |
| Insurance Company | FULL_NAME | This field allows the user to search for an insurance company from a list of registered service suppliers. The system automatically creates a case participant role of type "medical insurance provider". | No |
|
| Comments |
| Label | Type | Description | Mandatory |
| Comments | COMMENTS | | No |
|
