| X0013 | COVERAGE-TYPE | 00 | 20991231 | 19010101 | S | Self Only | |
| X0013 | COVERAGE-TYPE | 01 | 20991231 | 19010101 | F | Family | |
| X0013 | COVERAGE-TYPE | 02 | 20030630 | 19010101 | M | Married | |
| X0013 | COVERAGE-TYPE | 03 | 20991231 | 19010101 | DM | Dual/Minor | |
| X0013 | COVERAGE-TYPE | 04 | 20991231 | 19010101 | DS | Dual/Spouse | |
| X0013 | COVERAGE-TYPE | 05 | 20991231 | 19010101 | W | Waived |