HL7 IN1 Segment: Insurance

The IN1 segment carries a patient's insurance coverage: who the payer is, the health plan and policy/group numbers, the named insured and their relationship to the patient, the coverage period, and a long tail of benefit and billing detail. Where PID says who the patient is and GT1 says who guarantees the bill, IN1 says who pays the claim. A message may carry several IN1 segments — ordered by Set ID — to establish primary, secondary, and tertiary coverage.

Purpose

IN1 conveys a single insurance plan as it applies to the patient: the health plan ID, insurance company identity and contacts, group and policy numbers, the insured party and relationship, plan effective and expiration dates, assignment and coordination of benefits, and verification/authorization details. It is repeated per coverage; the Set ID and Coordination of Benefits Priority establish the payment order.

Used in

IN1 appears in financial and admission contexts: ADT (admit/update events that carry insurance), DFT (detail financial transactions), and BAR (billing account add/update). It is typically followed by an optional IN2 (and sometimes IN3) that extends the same coverage. See ADT.

Field-by-field reference

Source: the Vorro HL7 segment database (extracted from the official v2-to-FHIR IG). R = required (cardinality min ≥ 1). Repeat = field may repeat. Length is not carried by the FHIR source and is shown as —.

Seq	Name	Data Type	Length	Req	Repeat	Table #	Description
IN1-1	Set ID - IN1	SI	—	R	—	—	Sequence number; orders primary, secondary, tertiary coverage.
IN1-2	Health Plan ID	CWE	—	R	—	—	Identifies the specific health plan.
IN1-3	Insurance Company ID	CX	—	R	Y	—	Payer identifier(s) for the insurance company.
IN1-4	Insurance Company Name	XON	—	O	Y	—	Name(s) of the insurance company.
IN1-5	Insurance Company Address	XAD	—	O	Y	—	Mailing address(es) of the insurer.
IN1-6	Insurance Co Contact Person	XPN	—	O	Y	—	Contact person(s) at the insurer.
IN1-7	Insurance Co Phone Number	XTN	—	O	Y	—	Phone number(s) for the insurer.
IN1-8	Group Number	ST	—	O	—	—	Employer/group policy number.
IN1-9	Group Name	XON	—	O	Y	—	Name of the insured group.
IN1-10	Insured's Group Emp ID	CX	—	O	Y	—	Employer identifier for the insured's group.
IN1-11	Insured's Group Emp Name	XON	—	O	Y	—	Employer name for the insured's group.
IN1-12	Plan Effective Date	DT	—	O	—	—	Date coverage becomes effective.
IN1-13	Plan Expiration Date	DT	—	O	—	—	Date coverage expires.
IN1-14	Authorization Information	AUI	—	O	—	—	Authorization number, date, and source.
IN1-15	Plan Type	CWE	—	O	—	HL70086	Type of insurance plan (e.g. medical, dental).
IN1-16	Name Of Insured	XPN	—	O	Y	—	Name of the policy subscriber.
IN1-17	Insured's Relationship To Patient	CWE	—	O	—	—	Subscriber's relationship to the patient.
IN1-18	Insured's Date Of Birth	DTM	—	O	—	—	Date of birth of the insured.
IN1-19	Insured's Address	XAD	—	O	Y	—	Mailing address of the insured.
IN1-20	Assignment Of Benefits	CWE	—	O	—	HL70135	Whether benefits are assigned to the provider.
IN1-21	Coordination Of Benefits	CWE	—	O	—	HL70173	Coordination-of-benefits indicator.
IN1-22	Coord Of Ben. Priority	ST	—	O	—	—	Order in which this coverage pays.
IN1-23	Notice Of Admission Flag	ID	—	O	—	—	Whether admission notice is required.
IN1-24	Notice Of Admission Date	DT	—	O	—	—	Date admission notice was given.
IN1-25	Report Of Eligibility Flag	ID	—	O	—	—	Whether eligibility report is required.
IN1-26	Report Of Eligibility Date	DT	—	O	—	—	Date of the eligibility report.
IN1-27	Release Information Code	CWE	—	O	—	HL70093	Information-release authorization code.
IN1-28	Pre-Admit Cert (PAC)	ST	—	O	—	—	Pre-admission certification number.
IN1-29	Verification Date/Time	DTM	—	O	—	—	When coverage was verified.
IN1-30	Verification By	XCN	—	O	Y	—	Person who verified coverage.
IN1-31	Type Of Agreement Code	CWE	—	O	—	HL70098	Type of insurance agreement.
IN1-32	Billing Status	CWE	—	O	—	HL70022	Billing status of the coverage.
IN1-33	Lifetime Reserve Days	NM	—	O	—	—	Remaining lifetime reserve days.
IN1-34	Delay Before L.R. Day	NM	—	O	—	—	Days before lifetime reserve applies.
IN1-35	Company Plan Code	CWE	—	O	—	HL70042	Insurer-defined plan code.
IN1-36	Policy Number	ST	—	O	—	—	Individual policy/member number.
IN1-37	Policy Deductible	CP	—	O	—	—	Policy deductible amount.
IN1-38	Policy Limit - Amount	—	—	O	—	—	Maximum amount the policy pays.
IN1-39	Policy Limit - Days	NM	—	O	—	—	Maximum days the policy covers.
IN1-40	Room Rate - Semi-Private	—	—	O	—	—	Covered semi-private room rate.
IN1-41	Room Rate - Private	—	—	O	—	—	Covered private room rate.
IN1-42	Insured's Employment Status	CWE	—	O	—	—	Employment status of the insured.
IN1-43	Insured's Administrative Sex	CWE	—	O	—	—	Administrative sex of the insured.
IN1-44	Insured's Employer's Address	XAD	—	O	Y	—	Address of the insured's employer.
IN1-45	Verification Status	ST	—	O	—	—	Status of coverage verification.
IN1-46	Prior Insurance Plan ID	CWE	—	O	—	—	Identifier of a prior insurance plan.
IN1-47	Coverage Type	CWE	—	O	—	HL70309	Hospital, physician, or both.
IN1-48	Handicap	CWE	—	O	—	—	Handicap status of the insured.
IN1-49	Insured's ID Number	CX	—	O	Y	—	Subscriber/member ID number(s).
IN1-50	Signature Code	CWE	—	O	—	HL70139	Signature-on-file code.
IN1-51	Signature Code Date	DT	—	O	—	—	Date of the signature code.
IN1-52	Insured's Birth Place	ST	—	O	—	—	Birthplace of the insured.
IN1-53	VIP Indicator	CWE	—	O	—	—	VIP / special-handling flag for the insured.
IN1-54	External Health Plan Identifiers	CX	—	O	Y	—	External health plan identifier(s).
IN1-55	Insurance Action Code	ID	—	O	—	—	Add/update/delete action for the coverage.

Most-used fields

IN1-1 Set ID orders the coverages — 1 is primary, 2 secondary, and so on — and is how receivers know which IN1 to bill first.
IN1-2 Health Plan ID and IN1-3 Insurance Company ID identify the plan and payer; both are required and drive payer lookup.
IN1-8 Group Number and IN1-36 Policy Number (with IN1-49 Insured's ID Number) are the identifiers claims systems match the member on.
IN1-16 Name Of Insured and IN1-17 Insured's Relationship To Patient establish whether the patient is the subscriber or a dependent.
IN1-12 Plan Effective Date and IN1-13 Plan Expiration Date bound the coverage period used for eligibility.

Version differences (2.3 to 2.8.2)

2.3/2.4: the core insurance fields (IN1-1 through ~IN1-49) are stable; coded fields use CE.
2.5: many coded fields move from CE toward CWE; IN1-49 Insured's ID Number repeats.
2.7+: IN1-53 VIP Indicator, IN1-54 External Health Plan Identifiers, and IN1-55 Insurance Action Code added.
Receivers built for 2.3 ignore the trailing fields they do not recognize.

Common mistakes

Ignoring IN1-1 Set ID and IN1-22 Coordination Of Benefits Priority, then billing coverages in the wrong order.
Confusing IN1-16 Name Of Insured (the subscriber) with the patient when IN1-17 is not self.
Treating IN1-3 as a name instead of a structured CX payer identifier.
Dropping repetitions of IN1-49 Insured's ID Number when several member IDs are present.
Assuming exactly one IN1 — secondary and tertiary coverages arrive as additional IN1 segments.

Examples

Minimal valid IN1 (only the required fields):

IN1|1|HPID001|INS001

Fully-populated IN1 (primary commercial coverage):

IN1|1|HPID001|INS001|ACME HEALTH|500 PAYER WAY^^COLUMBUS^OH^43004||1-800-555-0100|GRP4488|ACME GROUP|||20260101|20261231||MED|DOE^JOHN^Q|SEL|19800101|123 MAIN ST^^COLUMBUS^OH^43004|Y|CO|1||||||||||||||POL77231||||||||M||HB||MBR55231

Annotated breakdown of the fully-populated example (selected fields):

IN1                              ← segment ID
1                                ← IN1-1  Set ID (primary coverage)
HPID001                          ← IN1-2  Health Plan ID
INS001                           ← IN1-3  Insurance Company ID
ACME HEALTH                      ← IN1-4  Insurance Company Name
GRP4488                          ← IN1-8  Group Number
20260101                         ← IN1-12 Plan Effective Date
20261231                         ← IN1-13 Plan Expiration Date
MED                              ← IN1-15 Plan Type
DOE^JOHN^Q                       ← IN1-16 Name Of Insured
SEL                              ← IN1-17 Insured's Relationship (self)
POL77231                         ← IN1-36 Policy Number
MBR55231                         ← IN1-49 Insured's ID Number

In-context inside an ADT^A01 (admit carrying insurance):

MSH|^~&|REG|MERCYGEN|EHR|MERCYGEN|20260609120000||ADT^A01^ADT_A01|MSG001|P|2.5.1
EVN|A01|20260609120000
PID|1||MR12345^^^MERCYGEN^MR||DOE^JOHN^Q||19800101|M
PV1|1|I|3WEST^301^A||||1234^SMITH^JANE^A^^^MD|||MED|||||||||V0001|||||||||||||||||||||||20260609120000
IN1|1|HPID001|INS001|ACME HEALTH||||GRP4488|||20260101|20261231||MED|DOE^JOHN^Q|SEL||||||||||||||||||||||POL77231||||||||||||||||MBR55231
IN1|2|HPID002|INS002|STATE MEDICAID||||GRP9000|||20260101|||MCR|DOE^JOHN^Q|SEL||||||||||||||||||||||POLMC889||||||||||||||||MBRMC889

In-context inside a DFT^P03 (post detail financial transaction):

MSH|^~&|BILL|MERCYGEN|FIN|MERCYGEN|20260612090000||DFT^P03^DFT_P03|MSG200|P|2.5.1
EVN|P03|20260612090000
PID|1||MR12345^^^MERCYGEN^MR||DOE^JOHN^Q||19800101|M
PV1|1|I||||||||MED|||||||||V0001
IN1|1|HPID001|INS001|ACME HEALTH||||GRP4488|||20260101|20261231||MED|DOE^JOHN^Q|SEL||||||||||||||||||||||POL77231||||||||||||||||MBR55231
FT1|1|||20260612|20260612|CG|99213^OFFICE VISIT^CPT|||1|||3WEST

Note: multiple IN1 segments, ordered by IN1-1 Set ID (and IN1-22 priority), establish primary, secondary, and tertiary coverage — the first example above carries a commercial primary and a Medicaid secondary.

FHIR mapping

Primary target resource: Coverage. IN1 maps the payer, the policy holder and subscriber, plan identifiers, plan type, relationship, and the coverage period. Official ConceptMap: Coverage.

Key Coverage mappings (from the IG):

IN1 field	FHIR target (Coverage)
IN1-2 Health Plan ID	`Coverage.identifier` (Identifier)
IN1-4 Insurance Company Name	`Coverage.payor[1]` → Organization (Reference)
IN1-5 Insurance Company Address	`Coverage.payor[1]` → Organization.address
IN1-10 Insured's Group Emp ID	`Coverage.policyHolder` → Organization.identifier; subscriberId extension
IN1-11 Insured's Group Emp Name	`Coverage.policyHolder[1]` → Organization (Reference)
IN1-12 Plan Effective Date	`Coverage.period.start`
IN1-13 Plan Expiration Date	`Coverage.period.end`
IN1-15 Plan Type	`Coverage.type` (CodeableConcept, PlanId vocab)
IN1-16 Name Of Insured	`Coverage.subscriber` → Patient / RelatedPerson (Reference)
IN1-17 Insured's Relationship To Patient	`Coverage.relationship` (CodeableConcept, Relationship vocab)
IN1-49 Insured's ID Number	subscriberId extension; `Coverage` Identifier

Unmapped fields: the IG ConceptMap does not publish Coverage targets for the contact, verification, benefit-detail, and account fields — IN1-6/7 (contacts), IN1-14 (authorization), IN1-20/21/22 (assignment/coordination of benefits), IN1-23 through IN1-35 (notices, eligibility, lifetime reserve, agreement, billing status), IN1-37 through IN1-48 (deductible, limits, room rates, employment, prior plan, coverage type, handicap), and IN1-50 through IN1-55 (signature, birthplace, VIP, external IDs, action code). These are typically handled by site-specific extensions or carried on related resources.

Engine considerations

Required in practice: IN1-1, IN1-2, and IN1-3 are standard-required; real interfaces also expect IN1-36/IN1-49 (policy/member ID) and IN1-12/13 (period) for eligibility.
Sequence coverages by IN1-1 Set ID and IN1-22 priority, not arrival order, before deciding the payer to bill first.
Preserve repetitions of IN1-3, IN1-49, and IN1-54 — payers and member IDs can legitimately repeat.
Keep IN1 paired with any following IN2/IN3 for the same Set ID so extended coverage data is not orphaned.

How Vorro parses and produces IN1

Vorro groups each IN1 (with its trailing IN2/IN3) into a single coverage, orders them by IN1-1 Set ID and IN1-22 priority, and indexes IN1-3 as the payer key. Subscriber identity is resolved from IN1-16/IN1-17 so dependent coverages reference the right policy holder. On the FHIR side Vorro emits a Coverage resource per IN1 with payor, subscriber, relationship, plan type, and period populated per the official ConceptMap, and carries unmapped financial detail as extensions.

IN2 — additional insurance information that extends IN1.
GT1 — the guarantor responsible for the bill.
ADT messages — where IN1 conveys coverage on admit and update.

Sources

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