ADDENDUM 7--HEALTH PLAN PREMIUM PAYMENT

The transaction selected for the health plan premium payment is ASC X12N 820 - Payment Order/Remittance Advice Transaction Set (004010X061).

A. Implementation Guide and Source

The source of the implementation guide for the health plan premium payment transaction set is: Washington Publishing Company, 806 W. Diamond Ave., Suite 400, Gaithersburg, MD, 20878, Telephone 301-590-9337, FAX: 301-869-9460. The website address is http://www.wpc-edi.com/hipaa/

B. Data Elements

Account Number Qualifier

Adjustment Reason Code

Assigned Number

Billed Premium Amount

Contact Function Code

Contract or Invoice or Account Number

Country Code

Coverage Period Date

Credit/Debit Flag Code

Currency Code

Date Time Period Format Qualifier

Date/Time Qualifier

Depository Financial Institution (DFI) Identifier

Depository Financial Institution (DFI) ID Number Qualifier

Employee Identification Number

Entity Identifier Code

Exchange Rate

Funds Issued Date

Head Count

Identification Code Qualifier

Individual Identifier

Information Only Indicator Code

Information Receiver City

Information Receiver Last or Organization Name

Information Receiver State

Information Receiver ZIP Code

Insurance Policy or Plan Identifier

Line Item Control Number

Organization Premium Identification Code

Originating Company Identifier

Originating Company Supplemental Code

Payer Additional Name

Payer City Name

Payer Contact Name

Payer Identifier

Payer Name

Payer Process Date

Payer Second Address Line

Payer State Code

Payer ZIP Code

Payment Action Code

Payment Format Code

Payment Method Code

Payroll Processor Additional Name

Payroll Processor City Name

Payroll Processor Contact Name

Payroll Processor First Address Line

Payroll Processor Identifier

Payroll Processor Name

Payroll Processor Second Address Line

Payroll Processor State Code

Payroll Processor ZIP Code

Policy Level Individual Name

Premium Delivery Date

Premium Payment Amount

Premium Receiver First Address Line

Premium Receiver Reference Identifier

Premium Receiver Second Address Line

Receiver Account Number

Receiver Additional Name

Receiver Identifier

Reference Identification Qualifier

Sender Account Number

Trace Number

Trace Type Code

Transaction Handling Code

Transaction Segment Count

Transaction Set Control Number

Transaction Set Identifier Code

Unit or Basis for Measurement Code