ASC X12 Version: 005010 | Transaction Set: 834 | TR3 ID: 005010X220
Example 6: Cancel a dependent
John Doe is canceling coverage for his over-age dependent, James, to be effective 8/1/1996.
Used to indicate the start of a transaction set and to specify a transaction set control number.
This is an original transaction uniquely identified by the sender with reference #12456. The transaction was created on 5/20/1998 at 12:00 Noon.
Master policy number (group ID).
Specifies the sponsor/sender's tax ID number.
Specifies the insurance company/receiver's tax ID number.
Beginning of Table 2. Indicates that the dependent (James Doe) is terminating all coverages.
John's subscriber ID number.
This is the group number assigned by the carrier.
The benefits under this plan are terminating 8/01/1996.
Dependent's name and SSN.
This is James' date of birth and gender.
End of transaction set. 12 segments were sent and the control number in the ST segment is 12345.