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Member ID: 53252345-01   Name: Brown, Sue              
Relationship: Wife   DOB: 01/01/1972   Group: G1234   Eff. Date: 01/01/2009   External ID: 9896695   Other Family Members: Yes
Coverage Selection
     
Subgroup  
Subgroup ID
Subgroup Name
Effective
Termination
S123 Acme Home Insurance Subgroup One 01/01/2009
1 - 1 of 1 items items per page
Class  
Class ID
Description
Effective
Termination
AC Active Class 01/01/2021
1 - 1 of 1 items items per page
     
Family Eligibility  
Effective
Category
Event
Family Level Indicator
Plan ID
Void Event
Rate Member As
Details
01/01/2021 Medical Select Family WDWM N Member
01/01/2021 Chiropractic Select Family WDWC N Member
1 - 2 of 2 items items per page
Member Eligibility  
Effective
Category
Event
Plan ID
Void Event
Rate Member As
Details
01/01/2021 Dental Select WDWD N Member
1 - 1 of 1 items items per page
Tom Brown   Identifier:53252345-00 Relationship:Subscrib Gender:Male Birth Date:01/01/1972
Category
From
Through
Eligible
Bill Eligible
Subgroup
Class
Plan
Product
Details
Medical 01/01/2021 1/02/2030 Yes Yes S1234 AC WDWM  
Chiropractic 01/01/2021 1/02/2030 Yes Yes S1234 AC WDWC  
Sue Brown   Identifier:53252345-01 Relationship:Wife Gender:Female Birth Date:01/01/1972
Category
From
Through
Eligible
Bill Eligible
Subgroup
Class
Plan
Product
Details
Medical 01/01/2021 1/02/2030 Yes Yes S1234 AC WDWM  
Dental 01/01/2021 1/02/2030 Yes Yes S1234 AC WDWD  
Chiropractic 01/01/2021 1/02/2030 Yes Yes S1234 AC WDWC  
John Brown   Identifier:53252345-02 Relationship:Son Gender:Male Birth Date:01/01/2011
Category
From
Through
Eligible
Bill Eligible
Subgroup
Class
Plan
Product
Details
Medical 01/01/2021 1/02/2030 Yes Yes S1234 AC WDWM  
Chiropractic 01/01/2021 1/02/2030 Yes Yes S1234 AC WDWC  
Mary Brown   Identifier:53252345-03 Relationship:Daughter Gender:Female Birth Date:01/01/2010
Category
From
Through
Eligible
Bill Eligible
Subgroup
Class
Plan
Product
Details
Medical 01/01/2021 1/02/2030 Yes Yes S1234 AC WDWM  
Chiropractic 01/01/2021 1/02/2030 Yes Yes S1234 AC WDWC  
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