<?xml version="1.0" encoding="UTF-8"?>
<!-- Created with Jaspersoft Studio version 7.0.3.final using JasperReports Library version 6.1.1  -->
<jasperReport xmlns="http://jasperreports.sourceforge.net/jasperreports" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://jasperreports.sourceforge.net/jasperreports http://jasperreports.sourceforge.net/xsd/jasperreport.xsd" name="IDCard" pageWidth="243" pageHeight="153" columnWidth="243" leftMargin="0" rightMargin="0" topMargin="0" bottomMargin="0" uuid="477346fd-960f-44d2-84f5-bd25202741fc">
	<property name="ireport.zoom" value="2.0"/>
	<property name="ireport.x" value="0"/>
	<property name="ireport.y" value="0"/>
	<subDataset name="LogoDataset" uuid="5f867a6e-5835-4d64-a042-be4308e843e6">
		<parameter name="LOGO_FILENAME" class="java.lang.String"/>
		<field name="filename" class="java.lang.String"/>
		<field name="image_stream" class="java.io.InputStream"/>
		<field name="aspect_ratio" class="java.lang.Float"/>
		<filterExpression><![CDATA[$F{filename}.equals($P{LOGO_FILENAME})]]></filterExpression>
	</subDataset>
	<parameter name="networkLogosList" class="java.util.List" isForPrompting="false"/>
	<field name="network_logo_filename" class="java.lang.String"/>
	<field name="provider_line_1" class="java.lang.String"/>
	<field name="provider_line_2" class="java.lang.String"/>
	<field name="provider_line_3" class="java.lang.String"/>
	<field name="provider_line_4" class="java.lang.String"/>
	<field name="provider_line_5" class="java.lang.String"/>
	<field name="provider_line_6" class="java.lang.String"/>
	<field name="provider_line_7" class="java.lang.String"/>
	<field name="provider_line_8" class="java.lang.String"/>
	<field name="provider_line_9" class="java.lang.String"/>
	<field name="provider_line_10" class="java.lang.String"/>
	<field name="provider_line_11" class="java.lang.String"/>
	<field name="claim_to_1" class="java.lang.String"/>
	<field name="claim_to_2" class="java.lang.String"/>
	<field name="claim_to_3" class="java.lang.String"/>
	<field name="claim_to_4" class="java.lang.String"/>
	<field name="claim_to_5" class="java.lang.String"/>
	<field name="claim_to_6" class="java.lang.String"/>
	<field name="claim_to_7" class="java.lang.String"/>
	<field name="claim_to_8" class="java.lang.String"/>
	<field name="claim_to_9" class="java.lang.String"/>
	<field name="claim_to_10" class="java.lang.String"/>
	<field name="claim_to_11" class="java.lang.String"/>
	<background>
		<band splitType="Stretch"/>
	</background>
	<title>
		<band splitType="Stretch"/>
	</title>
	<pageHeader>
		<band splitType="Stretch"/>
	</pageHeader>
	<columnHeader>
		<band splitType="Stretch"/>
	</columnHeader>
	<detail>
		<band height="153" splitType="Immediate">
			<rectangle>
				<reportElement x="1" y="10" width="122" height="90" uuid="e762ee84-c013-417b-a78f-54f6f1f6a1a3"/>
			</rectangle>
			<rectangle>
				<reportElement x="1" y="112" width="122" height="34" uuid="66e1721c-c7fd-40cf-8f45-10b5f6b4c22d"/>
			</rectangle>
			<rectangle>
				<reportElement x="128" y="10" width="106" height="136" uuid="ad8b04e0-5993-4f1c-b6b1-f2c11320be29">
					<property name="com.jaspersoft.studio.unit.width" value="px"/>
				</reportElement>
			</rectangle>
			<rectangle>
				<reportElement x="128" y="1" width="62" height="8" backcolor="#000000" uuid="5c229560-d2d4-4752-95a0-b562e786d29e">
					<property name="com.jaspersoft.studio.unit.width" value="px"/>
				</reportElement>
			</rectangle>
			<rectangle>
				<reportElement x="1" y="1" width="62" height="8" backcolor="#000000" uuid="014fd155-bf62-4aa6-8a1a-894c0b5855ac">
					<property name="com.jaspersoft.studio.unit.width" value="px"/>
				</reportElement>
			</rectangle>
			<rectangle>
				<reportElement x="1" y="103" width="62" height="8" backcolor="#000000" uuid="2a360f63-7815-4b72-9ff1-9339cc530b94">
					<property name="com.jaspersoft.studio.unit.width" value="px"/>
				</reportElement>
			</rectangle>
			<staticText>
				<reportElement x="3" y="1" width="39" height="10" forecolor="#FFFFFF" uuid="8417fc69-fdb9-483e-8c7f-9d5a0b91cbc5"/>
				<textElement>
					<font size="6" isBold="true" isUnderline="false"/>
				</textElement>
				<text><![CDATA[Eligibility]]></text>
			</staticText>
			<staticText>
				<reportElement x="3" y="103" width="58" height="11" forecolor="#FFFFFF" uuid="393d9b02-933b-46d8-850b-4d69d148aa86"/>
				<textElement>
					<font size="6" isBold="true" isUnderline="false" isPdfEmbedded="false"/>
				</textElement>
				<text><![CDATA[Utilization / Pre-Cert]]></text>
			</staticText>
			<staticText>
				<reportElement x="130" y="1" width="62" height="11" forecolor="#FFFFFF" uuid="5e18e17a-d437-434d-ad97-fe131a7f2850">
					<property name="com.jaspersoft.studio.unit.width" value="px"/>
				</reportElement>
				<textElement>
					<font size="6" isBold="true" isUnderline="false" isPdfEmbedded="false"/>
				</textElement>
				<text><![CDATA[Claims Submission]]></text>
			</staticText>
			<staticText>
				<reportElement x="1" y="11" width="122" height="17" uuid="75aa6426-2374-4c07-9556-63dab683cb11"/>
				<textElement textAlignment="Center" verticalAlignment="Middle">
					<font size="6" isBold="false" isItalic="false"/>
				</textElement>
				<text><![CDATA[To confirm eligibility, verify benefits,
or check claim:
]]></text>
			</staticText>
			<staticText>
				<reportElement x="1" y="28" width="122" height="17" uuid="8307c61b-9927-4bcc-a825-fec29b5ba605"/>
				<textElement textAlignment="Center" verticalAlignment="Middle">
					<font size="6" isBold="false" isItalic="false"/>
				</textElement>
				<text><![CDATA[Britton Benefit Services, LLC]]></text>
			</staticText>
			<staticText>
				<reportElement x="1" y="45" width="122" height="50" uuid="46c394a4-7df2-4f23-b17e-d8e186e99f5e"/>
				<textElement textAlignment="Center" verticalAlignment="Middle">
					<font size="6" isBold="false" isItalic="false"/>
				</textElement>
				<text><![CDATA[Call:
1.800.676.1182 (8am – 5pm)
Online:
www.bbstpa.com (24/7)
This card does not guarantee
eligibility or payment
]]></text>
			</staticText>
			<textField>
				<reportElement x="130" y="11" width="37" height="7" uuid="10b2b729-cb2f-4507-99d4-d3286e5ca8ed"/>
				<textElement verticalAlignment="Middle">
					<font size="5"/>
				</textElement>
				<textFieldExpression><![CDATA[$F{claim_to_1}]]></textFieldExpression>
			</textField>
			<textField>
				<reportElement x="130" y="16" width="37" height="7" uuid="0f23b912-da97-4297-b142-8c47d3332037"/>
				<textElement verticalAlignment="Middle">
					<font size="5"/>
				</textElement>
				<textFieldExpression><![CDATA[$F{claim_to_2}]]></textFieldExpression>
			</textField>
			<textField>
				<reportElement x="130" y="21" width="37" height="7" uuid="6664081c-30df-4e12-a563-e286fb71935a"/>
				<textElement verticalAlignment="Middle">
					<font size="5"/>
				</textElement>
				<textFieldExpression><![CDATA[$F{claim_to_3}]]></textFieldExpression>
			</textField>
			<textField>
				<reportElement x="130" y="26" width="37" height="7" uuid="e957833e-54e9-4145-b41b-1a72d0ddadf3"/>
				<textElement verticalAlignment="Middle">
					<font size="5"/>
				</textElement>
				<textFieldExpression><![CDATA[$F{claim_to_4}]]></textFieldExpression>
			</textField>
			<textField>
				<reportElement x="130" y="35" width="37" height="7" uuid="a49dbbb0-791e-4930-b99a-dfa39ee3e3d9"/>
				<textElement>
					<font size="5"/>
				</textElement>
				<textFieldExpression><![CDATA[$F{claim_to_5}]]></textFieldExpression>
			</textField>
			<textField>
				<reportElement x="130" y="40" width="37" height="7" uuid="0b0c6791-76a7-4a76-9695-59fff6544f8f"/>
				<textElement>
					<font size="5"/>
				</textElement>
				<textFieldExpression><![CDATA[$F{claim_to_6}]]></textFieldExpression>
			</textField>
			<textField>
				<reportElement x="130" y="45" width="37" height="7" uuid="f1ce64f0-b5fd-499e-a419-e0ef4b1e32e0"/>
				<textElement>
					<font size="5"/>
				</textElement>
				<textFieldExpression><![CDATA[$F{claim_to_7}]]></textFieldExpression>
			</textField>
			<textField>
				<reportElement x="130" y="50" width="37" height="7" uuid="2abffded-f4c1-4bfd-bf83-95550d8e1aa3"/>
				<textElement>
					<font size="5"/>
				</textElement>
				<textFieldExpression><![CDATA[$F{claim_to_8}]]></textFieldExpression>
			</textField>
			<textField>
				<reportElement x="130" y="59" width="37" height="7" uuid="ed2733a7-5906-4544-a4a6-1e4465c94f70">
					<property name="com.jaspersoft.studio.unit.width" value="px"/>
				</reportElement>
				<textElement>
					<font size="5"/>
				</textElement>
				<textFieldExpression><![CDATA[$F{claim_to_9}]]></textFieldExpression>
			</textField>
			<textField>
				<reportElement x="130" y="65" width="37" height="7" uuid="cc95f964-4572-46b1-b092-964c9f19e7f6"/>
				<textElement>
					<font size="5"/>
				</textElement>
				<textFieldExpression><![CDATA[$F{claim_to_10}]]></textFieldExpression>
			</textField>
			<textField>
				<reportElement x="130" y="71" width="37" height="7" uuid="6becfb6d-cb5b-4262-991d-e8d5bc9153c1"/>
				<textElement>
					<font size="5"/>
				</textElement>
				<textFieldExpression><![CDATA[$F{claim_to_11}]]></textFieldExpression>
			</textField>
			<componentElement>
				<reportElement x="130" y="96" width="100" height="49" uuid="68346dc5-8ea0-4119-846b-af63da9dc653"/>
				<jr:list xmlns:jr="http://jasperreports.sourceforge.net/jasperreports/components" xsi:schemaLocation="http://jasperreports.sourceforge.net/jasperreports/components http://jasperreports.sourceforge.net/xsd/components.xsd" printOrder="Vertical">
					<datasetRun subDataset="LogoDataset" uuid="f9c33856-e20c-4c2f-a9fe-8a2bbef32985">
						<datasetParameter name="LOGO_FILENAME">
							<datasetParameterExpression><![CDATA[$F{network_logo_filename}]]></datasetParameterExpression>
						</datasetParameter>
						<dataSourceExpression><![CDATA[new net.sf.jasperreports.engine.data.JRBeanCollectionDataSource($P{networkLogosList})]]></dataSourceExpression>
					</datasetRun>
					<jr:listContents height="46" width="100">
						<image hAlign="Center" vAlign="Middle" isUsingCache="true">
							<reportElement x="0" y="0" width="100" height="46" isPrintInFirstWholeBand="true" uuid="ea716b2c-5586-439d-8450-7302d49a5bd3"/>
							<imageExpression><![CDATA[$F{image_stream}]]></imageExpression>
						</image>
					</jr:listContents>
				</jr:list>
			</componentElement>
			<textField>
				<reportElement x="168" y="11" width="64" height="7" uuid="94749044-5ec6-4eb4-8f6d-e52ce5e215da">
					<property name="com.jaspersoft.studio.unit.width" value="px"/>
					<property name="com.jaspersoft.studio.unit.x" value="px"/>
				</reportElement>
				<textElement>
					<font size="5"/>
				</textElement>
				<textFieldExpression><![CDATA[$F{provider_line_1}]]></textFieldExpression>
			</textField>
			<textField>
				<reportElement x="168" y="16" width="64" height="7" uuid="25cbc687-a185-4894-97f4-11d57c8ad84c">
					<property name="com.jaspersoft.studio.unit.x" value="px"/>
					<property name="com.jaspersoft.studio.unit.width" value="px"/>
				</reportElement>
				<textElement>
					<font size="5"/>
				</textElement>
				<textFieldExpression><![CDATA[$F{provider_line_2}]]></textFieldExpression>
			</textField>
			<textField>
				<reportElement x="168" y="21" width="64" height="7" uuid="527837e8-6ecb-4eba-8b3c-c1fee8e58b52">
					<property name="com.jaspersoft.studio.unit.x" value="px"/>
					<property name="com.jaspersoft.studio.unit.width" value="px"/>
				</reportElement>
				<textElement>
					<font size="5"/>
				</textElement>
				<textFieldExpression><![CDATA[$F{provider_line_3}]]></textFieldExpression>
			</textField>
			<textField>
				<reportElement x="168" y="26" width="64" height="7" uuid="96e1ff12-6c27-4bd9-b706-050a283ea1a8">
					<property name="com.jaspersoft.studio.unit.x" value="px"/>
					<property name="com.jaspersoft.studio.unit.width" value="px"/>
				</reportElement>
				<textElement>
					<font size="5"/>
				</textElement>
				<textFieldExpression><![CDATA[$F{provider_line_4}]]></textFieldExpression>
			</textField>
			<textField>
				<reportElement x="168" y="35" width="64" height="7" uuid="c209866f-c8db-455d-8118-ae0aa51204a8">
					<property name="com.jaspersoft.studio.unit.x" value="px"/>
					<property name="com.jaspersoft.studio.unit.width" value="px"/>
				</reportElement>
				<textElement>
					<font size="5"/>
				</textElement>
				<textFieldExpression><![CDATA[$F{provider_line_5}]]></textFieldExpression>
			</textField>
			<textField>
				<reportElement x="168" y="40" width="64" height="7" uuid="22bcf3ce-6edc-4390-9c63-f169623fdf58">
					<property name="com.jaspersoft.studio.unit.x" value="px"/>
					<property name="com.jaspersoft.studio.unit.width" value="px"/>
				</reportElement>
				<textElement>
					<font size="5"/>
				</textElement>
				<textFieldExpression><![CDATA[$F{provider_line_6}]]></textFieldExpression>
			</textField>
			<textField>
				<reportElement x="168" y="45" width="64" height="7" uuid="b8bd2df8-9ad2-4cde-9c67-b0e32425c00b">
					<property name="com.jaspersoft.studio.unit.x" value="px"/>
					<property name="com.jaspersoft.studio.unit.width" value="px"/>
				</reportElement>
				<textElement>
					<font size="5"/>
				</textElement>
				<textFieldExpression><![CDATA[$F{provider_line_7}]]></textFieldExpression>
			</textField>
			<textField>
				<reportElement x="168" y="50" width="64" height="7" uuid="e5d86062-d78f-42b5-b578-cd14dcc071ca">
					<property name="com.jaspersoft.studio.unit.x" value="px"/>
					<property name="com.jaspersoft.studio.unit.width" value="px"/>
				</reportElement>
				<textElement>
					<font size="5"/>
				</textElement>
				<textFieldExpression><![CDATA[$F{provider_line_8}]]></textFieldExpression>
			</textField>
			<textField>
				<reportElement x="168" y="59" width="64" height="7" uuid="8b542cf4-f0e7-4019-90cf-4b3a826184bf">
					<property name="com.jaspersoft.studio.unit.x" value="px"/>
					<property name="com.jaspersoft.studio.unit.width" value="px"/>
				</reportElement>
				<textElement>
					<font size="5"/>
				</textElement>
				<textFieldExpression><![CDATA[$F{provider_line_9}]]></textFieldExpression>
			</textField>
			<textField>
				<reportElement x="168" y="64" width="64" height="7" uuid="b154a117-b385-4eac-b53a-51f349d2e9a6">
					<property name="com.jaspersoft.studio.unit.x" value="px"/>
					<property name="com.jaspersoft.studio.unit.width" value="px"/>
				</reportElement>
				<textElement>
					<font size="5"/>
				</textElement>
				<textFieldExpression><![CDATA[$F{provider_line_10}]]></textFieldExpression>
			</textField>
			<textField>
				<reportElement x="168" y="71" width="64" height="7" uuid="d30067fe-8185-4854-a4da-615d8bb59f4a">
					<property name="com.jaspersoft.studio.unit.x" value="px"/>
					<property name="com.jaspersoft.studio.unit.width" value="px"/>
				</reportElement>
				<textElement>
					<font size="5"/>
				</textElement>
				<textFieldExpression><![CDATA[$F{provider_line_11}]]></textFieldExpression>
			</textField>
			<staticText>
				<reportElement x="3" y="114" width="120" height="33" uuid="3c43b93c-3234-4df3-8deb-cd743c45bee5"/>
				<textElement textAlignment="Center">
					<font size="6"/>
				</textElement>
				<text><![CDATA[Pre-certification is required for
Inpatient Hospitalization
Call MedCost 1.800.722.2157
]]></text>
			</staticText>
			<staticText>
				<reportElement x="130" y="82" width="100" height="20" uuid="92607fc5-eae8-472b-95ce-fa64bf7f19fb">
					<property name="com.jaspersoft.studio.unit.width" value="px"/>
				</reportElement>
				<textElement textAlignment="Center">
					<font size="5"/>
				</textElement>
				<text><![CDATA[(800-824-7406) for provider look-up
www.medcost.com]]></text>
			</staticText>
		</band>
	</detail>
	<columnFooter>
		<band splitType="Stretch"/>
	</columnFooter>
	<pageFooter>
		<band splitType="Stretch"/>
	</pageFooter>
	<summary>
		<band splitType="Stretch"/>
	</summary>
</jasperReport>
