Subscriber

SubscriberId 237541  
First Name  
Last Name  
Middle Name  
Gender  
BirthDate  
Marital Status  
Address 1  
Address 2  
City  
State  
Zip Code  
HomePhone  
email  

                   

Coverages

Id BenefitType Plan CoverageLevel SubscriberPremium BillingPremium Volume OriginalEffectiveDate ChangeEffectiveDate TerminationDate TerminationReasonId
2505226 medical Medical - PPO Plus Plan EE 7.96 17.24 52.0 2010-07-04 2013-04-19