initial docker jasper build
This commit is contained in:
Jason Jordan
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<?xml version="1.0" encoding="UTF-8"?>
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<Context antiJARLocking="true" path="/BrittonReportServer">
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<Resource auth="Container"
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driverClassName="net.sourceforge.jtds.jdbc.Driver"
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factory="org.apache.tomcat.dbcp.dbcp.BasicDataSourceFactory"
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logAbandoned="true"
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maxActive="100"
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maxIdle="20"
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maxWait="50"
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name="jdbc/BrittonConnect"
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password="BSTIBOY"
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removeAbandonedTimeout="60"
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type="javax.sql.DataSource"
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url="jdbc:jtds:sqlserver://10.41.82.73:1433/BrittonConnect"
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username="BSTI"
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validationQuery="select 1"/>
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</Context>
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@@ -0,0 +1,42 @@
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<?xml version="1.0" encoding="UTF-8"?>
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<web-app xmlns="http://jcp.org"
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xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"
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xsi:schemaLocation="http://jcp.org
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http://jcp.org/web-app_3_1.xsd"
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version="3.1">
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<display-name>BrittonReportServer</display-name>
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<servlet>
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<servlet-name>idCardsServlet</servlet-name>
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<servlet-class>com.britton.servlets.JRIDCardsServlet</servlet-class>
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</servlet>
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<servlet-mapping>
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<servlet-name>idCardsServlet</servlet-name>
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<url-pattern>/IdCardsServlet</url-pattern>
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</servlet-mapping>
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<!-- <welcome-file-list>
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<welcome-file>index.html</welcome-file>
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<welcome-file>index.htm</welcome-file>
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<welcome-file>index.jsp</welcome-file>
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<welcome-file>default.html</welcome-file>
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<welcome-file>default.htm</welcome-file>
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<welcome-file>default.jsp</welcome-file>
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</welcome-file-list> -->
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<!-- <welcome-file-list>
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<welcome-file>index.jsp</welcome-file>
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</welcome-file-list>
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<session-config>
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<session-timeout>20</session-timeout>
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</session-config>
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<resource-ref>
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<description>GroupHealth DB Connection</description>
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<res-ref-name>jdbc/VHCS_HIPAA</res-ref-name>
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<res-type>javax.sql.DataSource</res-type>
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<res-auth>Container</res-auth>
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<res-sharing-scope>Shareable</res-sharing-scope>
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</resource-ref> -->
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</web-app>
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@@ -0,0 +1,17 @@
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<%--
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Document : index
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Created on : Nov 9, 2017, 4:10:38 PM
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Author : davidh
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--%>
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<%@page contentType="text/html" pageEncoding="UTF-8"%>
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<!DOCTYPE html>
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<html>
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<head>
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<meta http-equiv="Content-Type" content="text/html; charset=UTF-8">
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<title>Britton Benefits Report Server</title>
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</head>
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<body>
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<h1>Britton Benefits Report Server</h1>
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</body>
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</html>
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After Width: | Height: | Size: 25 KiB |
@@ -0,0 +1,724 @@
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<?xml version="1.0" encoding="UTF-8"?>
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<!-- Created with Jaspersoft Studio version 7.0.3.final using JasperReports Library version 6.1.1 -->
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<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="TestCheck" pageWidth="612" pageHeight="792" whenNoDataType="AllSectionsNoDetail" columnWidth="576" leftMargin="18" rightMargin="18" topMargin="18" bottomMargin="18" uuid="421ec09a-3a2e-455a-93fe-bc7e5c13f6fe">
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||||
<property name="ireport.zoom" value="1.5"/>
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||||
<property name="ireport.x" value="0"/>
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||||
<property name="ireport.y" value="0"/>
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||||
<parameter name="SUBREPORT_DIR" class="java.lang.String" isForPrompting="false">
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||||
<defaultValueExpression><![CDATA["C:\\ManualCheck\\"]]></defaultValueExpression>
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||||
</parameter>
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||||
<parameter name="Number" class="java.lang.Integer">
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||||
<defaultValueExpression><![CDATA[1001]]></defaultValueExpression>
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</parameter>
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<queryString>
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<![CDATA[Select 23451 as number,
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'' as class,
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||||
'01/01/2022' as date,
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||||
'1.00' as amount,
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||||
'One Dollar and 00/100' as amountAsText,
|
||||
'Joe Q. Public' as payee,
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||||
'100 West Test Street' as payeeAddress,
|
||||
'Joe Q Public' as patientName,
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'1' as patientNumber,
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||||
'01/01/2022' as incurredDate,
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||||
'600102' as planIdNumber,
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||||
'1' as divisionNumber,
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||||
'111' as remittanceAdviceNumber,
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'1' as vendorType]]>
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||||
</queryString>
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||||
<field name="number" class="java.lang.Integer"/>
|
||||
<field name="class" class="java.lang.String"/>
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||||
<field name="date" class="java.lang.String"/>
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||||
<field name="amount" class="java.math.BigDecimal"/>
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||||
<field name="amountAsText" class="java.lang.String"/>
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||||
<field name="payee" class="java.lang.String"/>
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||||
<field name="payeeAddress" class="java.lang.String"/>
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||||
<field name="patientName" class="java.lang.String"/>
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||||
<field name="patientNumber" class="java.lang.String"/>
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||||
<field name="incurredDate" class="java.lang.String"/>
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||||
<field name="planIdNumber" class="java.lang.String"/>
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||||
<field name="divisionNumber" class="java.lang.String"/>
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||||
<field name="remittanceAdviceNumber" class="java.lang.String"/>
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||||
<field name="vendorType" class="java.lang.String"/>
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||||
<background>
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||||
<band splitType="Stretch"/>
|
||||
</background>
|
||||
<title>
|
||||
<band splitType="Stretch"/>
|
||||
</title>
|
||||
<pageHeader>
|
||||
<band splitType="Stretch"/>
|
||||
</pageHeader>
|
||||
<columnHeader>
|
||||
<band splitType="Stretch"/>
|
||||
</columnHeader>
|
||||
<detail>
|
||||
<band height="752" splitType="Stretch">
|
||||
<image scaleImage="RetainShape" isUsingCache="false" onErrorType="Blank">
|
||||
<reportElement x="404" y="133" width="165" height="33" uuid="c7299e4c-a7a1-4cd8-b9e6-3e53bb3ca15e"/>
|
||||
<imageExpression><![CDATA["C:\\images\\CheckSIGs\\DACCSig.jpg"]]></imageExpression>
|
||||
</image>
|
||||
<rectangle>
|
||||
<reportElement x="13" y="660" width="173" height="80" uuid="e8845890-4a2a-41ed-bf11-5dc6c0c92e71"/>
|
||||
<graphicElement>
|
||||
<pen lineWidth="0.75"/>
|
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</graphicElement>
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</rectangle>
|
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<rectangle>
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<reportElement x="393" y="640" width="183" height="100" uuid="447e91fa-86e8-40f9-b656-582d8dac3822"/>
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<graphicElement>
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<pen lineWidth="0.75"/>
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</graphicElement>
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</rectangle>
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<rectangle>
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<reportElement x="203" y="640" width="173" height="100" uuid="bd7ace9e-3336-4019-8416-fe7382a6bc9b"/>
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<graphicElement>
|
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<pen lineWidth="0.75"/>
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</graphicElement>
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</rectangle>
|
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<staticText>
|
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<reportElement mode="Opaque" x="186" y="206" width="317" height="17" uuid="d929aad9-2f97-4ce2-966b-b149d1cd3e32"/>
|
||||
<textElement textAlignment="Center">
|
||||
<font fontName="MICR E13B 2.1" size="12" pdfEncoding="Identity-H" isPdfEmbedded="false"/>
|
||||
</textElement>
|
||||
<text><![CDATA[A053101121A 1340037382956C]]></text>
|
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</staticText>
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<staticText>
|
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<reportElement x="0" y="21" width="576" height="46" uuid="35b9d4b7-fe6c-4c46-9ee8-22bfb8d67c50"/>
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<textElement textAlignment="Center">
|
||||
<font fontName="Times New Roman" size="8" isBold="true" pdfFontName="Times-Bold"/>
|
||||
</textElement>
|
||||
<text><![CDATA[
|
||||
P.O. Box 400
|
||||
Kinston, NC 28502-0400]]></text>
|
||||
</staticText>
|
||||
<rectangle>
|
||||
<reportElement x="382" y="47" width="190" height="12" backcolor="#E5E5E5" uuid="42a4ff10-03ad-4004-8192-784e5cbef9e2"/>
|
||||
<graphicElement>
|
||||
<pen lineWidth="0.75"/>
|
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</graphicElement>
|
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</rectangle>
|
||||
<rectangle>
|
||||
<reportElement x="382" y="59" width="190" height="16" uuid="6aadd67e-7bbf-4b67-89d6-8baf6b23a4ad"/>
|
||||
<graphicElement>
|
||||
<pen lineWidth="0.75"/>
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||||
</graphicElement>
|
||||
</rectangle>
|
||||
<line>
|
||||
<reportElement x="482" y="47" width="1" height="28" uuid="1f2ff0ba-1740-49d2-a14e-98f50e08bc21"/>
|
||||
<graphicElement>
|
||||
<pen lineWidth="0.75"/>
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</graphicElement>
|
||||
</line>
|
||||
<staticText>
|
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<reportElement x="382" y="47" width="96" height="12" uuid="c875a525-62da-4f46-8b79-4cbacec4a1e4"/>
|
||||
<textElement textAlignment="Center" verticalAlignment="Middle">
|
||||
<font fontName="Times New Roman" isBold="true" pdfFontName="Times-Bold"/>
|
||||
</textElement>
|
||||
<text><![CDATA[DATE]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement x="484" y="47" width="85" height="12" uuid="a135a484-a68d-4ab6-8af6-2afc97b402e4"/>
|
||||
<textElement textAlignment="Center" verticalAlignment="Middle">
|
||||
<font fontName="Times New Roman" isBold="true" pdfFontName="Times-Bold"/>
|
||||
</textElement>
|
||||
<text><![CDATA[AMOUNT]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement x="470" y="97" width="103" height="20" uuid="355abf7b-913f-43cf-b007-f2585e309866"/>
|
||||
<textElement textAlignment="Center">
|
||||
<font fontName="Times New Roman" size="7" isBold="true" pdfFontName="Times-Bold"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Truist
|
||||
Kinston, NC 28501]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
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<reportElement x="21" y="133" width="42" height="53" uuid="4067c57d-2fb5-487f-880b-d5907efd9ac6"/>
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<textElement textAlignment="Left">
|
||||
<font fontName="Times New Roman" size="8" isBold="true" pdfFontName="Times-Bold"/>
|
||||
</textElement>
|
||||
<text><![CDATA[PAY TO
|
||||
THE
|
||||
ORDER
|
||||
OF]]></text>
|
||||
</staticText>
|
||||
<textField>
|
||||
<reportElement mode="Opaque" x="108" y="206" width="78" height="17" uuid="72a52a14-2dcc-4de4-ad6b-a3b12de3520a"/>
|
||||
<textElement>
|
||||
<font fontName="MICR E13B 2.1" size="12" pdfEncoding="Cp1252" isPdfEmbedded="false"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA["C"+$F{number}+"C"]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField pattern="">
|
||||
<reportElement x="382" y="59" width="96" height="16" uuid="a2174838-d3d9-4c5f-9d0e-12fa6bf594cf"/>
|
||||
<textElement textAlignment="Center" verticalAlignment="Middle">
|
||||
<font fontName="Times New Roman" size="9" isBold="true" pdfFontName="Times-Roman"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{date}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField pattern="¤ #,##0.00">
|
||||
<reportElement x="484" y="59" width="85" height="16" uuid="6b1e3ac3-af2c-41d8-a098-3c2f870a266c"/>
|
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<textElement textAlignment="Center" verticalAlignment="Middle">
|
||||
<font fontName="Times New Roman" size="9" isBold="true" pdfFontName="Times-Roman"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{amount}]]></textFieldExpression>
|
||||
</textField>
|
||||
<line>
|
||||
<reportElement x="379" y="158" width="193" height="1" uuid="0e8a6140-18cd-4f46-bcaf-8f5a0511e68f"/>
|
||||
<graphicElement>
|
||||
<pen lineWidth="0.75"/>
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||||
</graphicElement>
|
||||
</line>
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||||
<textField>
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||||
<reportElement x="22" y="97" width="447" height="20" uuid="d14c7ce7-6a85-4593-a2ce-9a7460b2c6bc"/>
|
||||
<textElement verticalAlignment="Middle">
|
||||
<font fontName="Times New Roman" size="10" isBold="true" isItalic="true" pdfFontName="Times-BoldItalic"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{amountAsText}]]></textFieldExpression>
|
||||
</textField>
|
||||
<line>
|
||||
<reportElement x="539" y="13" width="33" height="1" uuid="4bc34467-d06c-49f3-b125-a7300d5cac26"/>
|
||||
</line>
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<staticText>
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<reportElement x="0" y="4" width="576" height="25" uuid="eaa963df-e76f-4ab3-bfad-8da26d8ac27a"/>
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||||
<textElement textAlignment="Center">
|
||||
<font fontName="Times New Roman" size="16" isBold="true" pdfFontName="Times-Bold" isPdfEmbedded="false"/>
|
||||
</textElement>
|
||||
<text><![CDATA[DERMATOLOGY ASSOC OF COSTAL CAROLINA]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement x="537" y="4" width="37" height="25" uuid="ac80b5ee-6fc9-451a-8215-0c1107f3995b"/>
|
||||
<textElement textAlignment="Center">
|
||||
<font fontName="Times New Roman" size="8" isBold="true" pdfFontName="Times-Bold"/>
|
||||
</textElement>
|
||||
<text><![CDATA[66-30/531
|
||||
151]]></text>
|
||||
</staticText>
|
||||
<textField>
|
||||
<reportElement x="104" y="135" width="271" height="10" uuid="49d73eea-e55f-4773-8a23-79bb50c1130e"/>
|
||||
<textElement>
|
||||
<font fontName="Times New Roman" size="8" isBold="true" pdfFontName="Times-Bold"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{payee}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="104" y="145" width="271" height="43" uuid="27b235bc-ae5b-45cd-83e9-8154ad9147ca"/>
|
||||
<textElement>
|
||||
<font fontName="Times New Roman" size="8" isBold="true" pdfFontName="Times-Bold"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{payeeAddress}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="14" y="3" width="108" height="24" uuid="117ce21d-efc2-4990-b9b5-8cc9cf8d40af"/>
|
||||
<textElement textAlignment="Left">
|
||||
<font fontName="Times New Roman" size="18" isBold="true" pdfFontName="Times-Bold"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{number}]]></textFieldExpression>
|
||||
</textField>
|
||||
<staticText>
|
||||
<reportElement x="382" y="161" width="186" height="12" uuid="340936ab-e96a-4ab2-aa94-28a7920a35a0"/>
|
||||
<textElement textAlignment="Center">
|
||||
<font fontName="Times New Roman" size="6"/>
|
||||
</textElement>
|
||||
<text><![CDATA[AUTHORIZED SIGNATURE]]></text>
|
||||
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|
||||
<rectangle>
|
||||
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<pen lineWidth="0.75"/>
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<pen lineWidth="0.75"/>
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||||
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|
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<reportElement x="13" y="283" width="173" height="20" backcolor="#E5E5E5" uuid="57982c90-280f-4bbc-8bd9-96ea65da6a4b"/>
|
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|
||||
<pen lineWidth="0.75"/>
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|
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|
||||
<graphicElement>
|
||||
<pen lineWidth="0.75"/>
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||||
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|
||||
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|
||||
<rectangle>
|
||||
<reportElement x="393" y="263" width="183" height="20" backcolor="#E5E5E5" uuid="16581d11-8d4f-47f1-80f6-a0276281bfb5"/>
|
||||
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|
||||
<pen lineWidth="0.75"/>
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||||
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|
||||
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|
||||
<staticText>
|
||||
<reportElement x="13" y="283" width="173" height="20" uuid="fbde6546-e353-4de6-a295-43c99d4acc5c"/>
|
||||
<textElement textAlignment="Center" verticalAlignment="Middle">
|
||||
<font fontName="Times New Roman" isBold="true" pdfFontName="Times-Bold"/>
|
||||
</textElement>
|
||||
<text><![CDATA[CLAIMANT INFORMATION]]></text>
|
||||
</staticText>
|
||||
<staticText>
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<![CDATA[Select * From id_card_print_data Where $P!{dynamic_where}]]>
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<field name="primary_mb_member_key" class="java.lang.String"/>
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||||
<font size="6" isBold="true" isItalic="false"/>
|
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|
||||
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|
||||
]]></text>
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|
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<font size="6" isBold="true" isItalic="false"/>
|
||||
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|
||||
<text><![CDATA[Call:
|
||||
1.800.676.1182 (8am – 5pm)
|
||||
Online:
|
||||
www.bbstpa.com (24/7)
|
||||
This card does not guarantee
|
||||
eligibility or payment
|
||||
]]></text>
|
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<font size="5" isBold="true"/>
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|
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||||
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|
||||
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|
||||
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|
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<textElement verticalAlignment="Middle">
|
||||
<font size="5" isBold="true"/>
|
||||
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|
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<textFieldExpression><![CDATA[$F{claim_to_3}]]></textFieldExpression>
|
||||
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|
||||
<textField>
|
||||
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|
||||
<font size="5" isBold="true"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{claim_to_4}]]></textFieldExpression>
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||||
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|
||||
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|
||||
<font size="5" isBold="true"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{claim_to_5}]]></textFieldExpression>
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||||
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|
||||
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||||
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||||
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|
||||
<font size="5" isBold="true"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{claim_to_6}]]></textFieldExpression>
|
||||
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|
||||
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|
||||
<reportElement x="109" y="45" width="52" height="7" uuid="f1ce64f0-b5fd-499e-a419-e0ef4b1e32e0"/>
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||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{claim_to_7}]]></textFieldExpression>
|
||||
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|
||||
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|
||||
<reportElement x="109" y="50" width="52" height="7" uuid="2abffded-f4c1-4bfd-bf83-95550d8e1aa3"/>
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||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{claim_to_8}]]></textFieldExpression>
|
||||
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|
||||
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|
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<reportElement x="109" y="59" width="52" height="7" uuid="ed2733a7-5906-4544-a4a6-1e4465c94f70"/>
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|
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||||
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|
||||
<datasetRun subDataset="LogoDataset" uuid="1fed8c49-7871-4654-bedb-a4ffa01cc617">
|
||||
<datasetParameter name="LOGO_FILENAME">
|
||||
<datasetParameterExpression><![CDATA[$F{employer_logo_filename}]]></datasetParameterExpression>
|
||||
</datasetParameter>
|
||||
<dataSourceExpression><![CDATA[new net.sf.jasperreports.engine.data.JRBeanCollectionDataSource($P{employerLogosList})]]></dataSourceExpression>
|
||||
</datasetRun>
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||||
<jr:listContents height="27" width="88">
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<image scaleImage="RetainShape" hAlign="Center" isUsingCache="true">
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<reportElement x="0" y="0" width="88" height="27" isPrintInFirstWholeBand="true" uuid="7445dc43-933e-4b42-bef0-1772e9b85ba4">
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<!-- <printWhenExpression><![CDATA[$F{aspect_ratio} >= 1.20f]]></printWhenExpression> -->
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</reportElement>
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||||
<imageExpression><![CDATA[$F{image_stream}]]></imageExpression>
|
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</image>
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||||
<!-- <image scaleImage="FillFrame" isUsingCache="true">
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<reportElement x="20" y="0" width="45" height="27" isPrintInFirstWholeBand="true" uuid="7445dc43-933e-4b42-bef0-1772e9b85ba4">
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<printWhenExpression><![CDATA[$F{aspect_ratio} < 1.20f]]></printWhenExpression>
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</reportElement>
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<imageExpression><![CDATA[$F{image_stream}]]></imageExpression>
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</image> -->
|
||||
</jr:listContents>
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</jr:list>
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</componentElement>
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<staticText>
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<reportElement x="140" y="35" width="90" height="23" uuid="99f47ca3-1456-4fc7-bb08-a98f460120ce"/>
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<textElement textAlignment="Center" verticalAlignment="Middle">
|
||||
<font size="4.5" isBold="true" isItalic="false"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Administered by:
|
||||
Britton Benefit Services, LLC
|
||||
1.800.676.1182]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
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<reportElement x="4" y="1" width="56" height="11" forecolor="#FFFFFF" uuid="8bbea900-0c43-40d8-ad68-2f478aabd3c1">
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<property name="com.jaspersoft.studio.unit.width" value="px"/>
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</reportElement>
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<textElement>
|
||||
<font size="6" isBold="true" isUnderline="false" isPdfEmbedded="false"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Health Benefit Plan]]></text>
|
||||
</staticText>
|
||||
<rectangle>
|
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<reportElement x="138" y="1" width="44" height="8" backcolor="#000000" uuid="4ecd4a82-edd1-4166-abf9-85d66ebb8b37"/>
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</rectangle>
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<staticText>
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<reportElement x="141" y="1" width="41" height="11" forecolor="#FFFFFF" uuid="4ddf1be3-c752-46e0-8197-f4d64b5484b0"/>
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<textElement>
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<font size="6" isBold="true" isUnderline="false" isPdfEmbedded="false"/>
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</textElement>
|
||||
<text><![CDATA[Medical Plan]]></text>
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||||
</staticText>
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<staticText>
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<reportElement x="3" y="11" width="40" height="8" uuid="5c39d2a5-fb6b-427a-ade9-f09c04c1144c"/>
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<textElement>
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<font size="6" isBold="true"/>
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||||
</textElement>
|
||||
<text><![CDATA[Group #/ID:]]></text>
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||||
</staticText>
|
||||
<staticText>
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<reportElement x="3" y="18" width="19" height="8" uuid="26d1f156-d150-4837-9bba-1390a8199fb4"/>
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<textElement>
|
||||
<font size="6" isBold="true"/>
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||||
</textElement>
|
||||
<text><![CDATA[Name:]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
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<reportElement x="3" y="25" width="32" height="8" uuid="8c0fbf41-d7b6-482b-996d-0b48ee2b0ff7"/>
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<textElement>
|
||||
<font size="6" isBold="true"/>
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||||
</textElement>
|
||||
<text><![CDATA[Member #:]]></text>
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||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement x="3" y="32" width="50" height="8" uuid="da2ecd13-2381-494c-9d69-745b2496587e"/>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
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||||
</textElement>
|
||||
<text><![CDATA[Effective Date:]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement x="3" y="39" width="30" height="8" uuid="58ce6f59-01b7-457a-aee6-0be9d7ae868e"/>
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<textElement>
|
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<font size="6" isBold="true"/>
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||||
</textElement>
|
||||
<text><![CDATA[Employer:]]></text>
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||||
</staticText>
|
||||
<textField>
|
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<reportElement x="45" y="11" width="88" height="8" uuid="1361e8b7-6ea2-4f2b-a6fd-781b1fa521e8"/>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{group_number}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="22" y="18" width="111" height="8" uuid="c2877613-bc27-4175-b080-5ab67f1d781c"/>
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||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{full_name}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
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<reportElement x="35" y="25" width="98" height="8" uuid="acea13af-f269-47da-b9cc-ba0ea22df29f"/>
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<textElement>
|
||||
<font size="6" isBold="true"/>
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||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{primary_mb_member_key}]]></textFieldExpression>
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||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="45" y="32" width="88" height="8" uuid="eaa738bf-1ced-4c86-8a31-9acc09a88abe"/>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{medical_eff_date}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="33" y="39" width="100" height="15" uuid="f559a5a0-cd09-46e5-9a6c-0b4458ddd8b2"/>
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<textElement>
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<font size="6" isBold="true"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{employer_name}]]></textFieldExpression>
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</textField>
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<staticText>
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<reportElement x="3" y="57" width="76" height="8" uuid="cf1ce1ca-5cef-436c-b2d6-26bd3e1015b4"/>
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<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Covered Dependents:]]></text>
|
||||
</staticText>
|
||||
<textField>
|
||||
<reportElement x="4" y="64" width="63" height="7" uuid="848389f8-98f1-41da-962e-cc29aeac91d1"/>
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||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{dependent_1}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="4" y="71" width="63" height="7" uuid="adee7873-b80c-4be4-9568-533471bab640"/>
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||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{dependent_2}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="4" y="78" width="63" height="7" uuid="53ed1fe8-89ed-42a2-98bb-9ad75418f543"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{dependent_3}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="4" y="85" width="63" height="7" uuid="07c29443-8589-4e0f-a758-b69a34f38b07"/>
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||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{dependent_4}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="70" y="64" width="63" height="7" uuid="f906328d-53c5-4bb7-b4d4-4eba2261adfb"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{dependent_5}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="70" y="71" width="63" height="7" uuid="a15671c2-f677-4def-9d42-1e0553d43010"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{dependent_6}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="140" y="56" width="50" height="7" uuid="ded7012f-9a8d-4e97-876b-e34bc59241ef"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{benefit_desc_1}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="192" y="56" width="38" height="7" uuid="2a63ebda-6cf8-4f7a-927b-7cfa892e196d"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{benefit_1}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="140" y="62" width="50" height="7" uuid="aa510ad0-1a1e-4f24-b692-505794f4f159"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{benefit_desc_2}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="192" y="62" width="38" height="7" uuid="f501005d-ba2b-4747-92f4-1b3288d52f3a"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{benefit_2}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="140" y="68" width="50" height="7" uuid="fae8e590-1ffe-4e48-aef6-26a7e01c88af"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{benefit_desc_3}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="140" y="74" width="50" height="7" uuid="693746af-9ba2-4992-a270-397eaac04653"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{benefit_desc_4}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="192" y="68" width="38" height="7" uuid="27282b06-831e-40e5-93ee-ca77e3190dd5"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{benefit_3}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="192" y="74" width="38" height="7" uuid="fb423834-c0e0-4e68-8dd9-baa62eaa79a2"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{benefit_4}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="140" y="80" width="50" height="7" uuid="b0e3223c-1930-42db-82cc-d059e9b699b9"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{benefit_desc_5}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="192" y="98" width="38" height="7" uuid="bae3a6b6-1ca2-4ca6-9ba1-dd5fb9d1153f"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{benefit_8}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="140" y="98" width="50" height="7" uuid="8afd99dc-91b9-4416-806a-5f0e7eb83b1c">
|
||||
<property name="com.jaspersoft.studio.unit.height" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{benefit_desc_8}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="140" y="92" width="50" height="7" uuid="c88d8d15-070c-42ad-999c-2e013f399992"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{benefit_desc_7}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="140" y="86" width="50" height="7" uuid="8bfb12fe-aef3-4397-a026-1fe43ebce05e"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{benefit_desc_6}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="192" y="86" width="38" height="7" uuid="43a569a5-7de5-427a-986f-bc4af746be06"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{benefit_6}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="192" y="92" width="38" height="7" uuid="a26646b1-152c-44f2-9486-1bd1590683c3"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{benefit_7}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="192" y="80" width="38" height="7" uuid="b572b49b-7b9a-4f68-b7ef-11dfadd2dae4"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{benefit_5}]]></textFieldExpression>
|
||||
</textField>
|
||||
<componentElement>
|
||||
<reportElement x="17" y="97" width="88" height="46" 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="88">
|
||||
<image hAlign="Center" vAlign="Middle" isUsingCache="true">
|
||||
<reportElement x="0" y="0" width="88" 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="107" y="97" width="28" height="10" forecolor="#FFFFFF" uuid="46c394a4-7df2-4f23-b17e-d8e186e99f5e">
|
||||
<property name="com.jaspersoft.studio.unit.x" value="px"/>
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement textAlignment="Center">
|
||||
<font size="1"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[":WATERMARK:"+ $F{full_name_last_name_first} +":"]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField isBlankWhenNull="true">
|
||||
<reportElement x="192" y="104" width="38" height="7" uuid="e1932f2f-82d4-491b-a3a3-b8151ac539e2"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{benefit_9}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField isBlankWhenNull="true">
|
||||
<reportElement x="140" y="104" width="50" height="7" uuid="a064a7fd-da67-407f-838d-4d0a5b267843"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{benefit_desc_9}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField isBlankWhenNull="true">
|
||||
<reportElement x="140" y="110" width="50" height="7" uuid="ab233e66-e9cd-4224-8a46-bf57655ef118"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{benefit_desc_10}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField isBlankWhenNull="true">
|
||||
<reportElement x="192" y="110" width="38" height="7" uuid="286a851b-e65e-4fa2-bae1-161ed10a131c"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{benefit_10}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField isBlankWhenNull="true">
|
||||
<reportElement x="140" y="116" width="50" height="7" uuid="920cb788-6331-4e5c-8f8f-f94c8be5a994"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
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|
||||
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<font size="5" isBold="true"/>
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<field name="benefit_14" class="java.lang.String"/>
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<field name="dependent_8" class="java.lang.String"/>
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<field name="primary_mb_member_key" class="java.lang.String"/>
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|
||||
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||||
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||||
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<text><![CDATA[Utilization / Pre-Cert]]></text>
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||||
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|
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<font size="6" isBold="true" isUnderline="false" isPdfEmbedded="false"/>
|
||||
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||||
<text><![CDATA[Claims Submission]]></text>
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||||
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|
||||
<font size="6" isBold="true" isItalic="false"/>
|
||||
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|
||||
<text><![CDATA[To confirm eligibility, verify benefits, or check claim:
|
||||
]]></text>
|
||||
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|
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|
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|
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<text><![CDATA[Britton Benefit Services, LLC]]></text>
|
||||
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|
||||
<font size="6" isBold="true" isItalic="false"/>
|
||||
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|
||||
<text><![CDATA[Call:
|
||||
1.800.676.1182 (8am – 5pm)
|
||||
Online:
|
||||
www.bbstpa.com (24/7)
|
||||
This card does not guarantee
|
||||
eligibility or payment
|
||||
]]></text>
|
||||
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|
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|
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<font size="5" isBold="true"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{claim_to_1}]]></textFieldExpression>
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<reportElement x="109" y="16" width="52" height="7" uuid="0f23b912-da97-4297-b142-8c47d3332037"/>
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<textElement verticalAlignment="Middle">
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|
||||
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|
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<textFieldExpression><![CDATA[$F{claim_to_2}]]></textFieldExpression>
|
||||
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|
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|
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<textElement verticalAlignment="Middle">
|
||||
<font size="5" isBold="true"/>
|
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|
||||
<textFieldExpression><![CDATA[$F{claim_to_3}]]></textFieldExpression>
|
||||
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|
||||
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|
||||
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|
||||
<font size="5" isBold="true"/>
|
||||
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|
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|
||||
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|
||||
<font size="5" isBold="true"/>
|
||||
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|
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
<font size="5" isBold="true"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{claim_to_6}]]></textFieldExpression>
|
||||
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|
||||
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|
||||
<reportElement x="109" y="45" width="52" height="7" uuid="f1ce64f0-b5fd-499e-a419-e0ef4b1e32e0"/>
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|
||||
<font size="5" isBold="true"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{claim_to_7}]]></textFieldExpression>
|
||||
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|
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|
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|
||||
<font size="5" isBold="true"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{claim_to_8}]]></textFieldExpression>
|
||||
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|
||||
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|
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|
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|
||||
<font size="5" isBold="true"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{claim_to_9}]]></textFieldExpression>
|
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|
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|
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|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{claim_to_10}]]></textFieldExpression>
|
||||
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|
||||
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|
||||
<reportElement x="109" y="71" width="52" height="7" uuid="6becfb6d-cb5b-4262-991d-e8d5bc9153c1"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
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|
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<textFieldExpression><![CDATA[$F{claim_to_11}]]></textFieldExpression>
|
||||
</textField>
|
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|
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<reportElement x="163" y="11" width="67" height="7" uuid="94749044-5ec6-4eb4-8f6d-e52ce5e215da"/>
|
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<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
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<textFieldExpression><![CDATA[$F{provider_line_1}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="163" y="16" width="67" height="7" uuid="25cbc687-a185-4894-97f4-11d57c8ad84c"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{provider_line_2}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="163" y="21" width="67" height="7" uuid="527837e8-6ecb-4eba-8b3c-c1fee8e58b52"/>
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<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{provider_line_3}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="163" y="26" width="67" height="7" uuid="96e1ff12-6c27-4bd9-b706-050a283ea1a8"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{provider_line_4}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="163" y="35" width="67" height="7" uuid="c209866f-c8db-455d-8118-ae0aa51204a8"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{provider_line_5}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="163" y="40" width="67" height="7" uuid="22bcf3ce-6edc-4390-9c63-f169623fdf58"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{provider_line_6}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="163" y="45" width="67" height="7" uuid="b8bd2df8-9ad2-4cde-9c67-b0e32425c00b"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{provider_line_7}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="163" y="50" width="67" height="7" uuid="e5d86062-d78f-42b5-b578-cd14dcc071ca"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{provider_line_8}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="163" y="59" width="67" height="7" uuid="8b542cf4-f0e7-4019-90cf-4b3a826184bf"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{provider_line_9}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="163" y="64" width="67" height="7" uuid="b154a117-b385-4eac-b53a-51f349d2e9a6"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{provider_line_10}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="163" y="71" width="67" height="7" uuid="d30067fe-8185-4854-a4da-615d8bb59f4a"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{provider_line_11}]]></textFieldExpression>
|
||||
</textField>
|
||||
<rectangle>
|
||||
<reportElement x="106" y="92" width="125" height="42" uuid="1b74e177-da54-47c1-a801-ac0331d2cd11"/>
|
||||
</rectangle>
|
||||
<rectangle>
|
||||
<reportElement x="106" y="84" width="53" height="8" backcolor="#000000" uuid="6a6d5769-ee7e-439f-8d65-7de67cdcb16b"/>
|
||||
</rectangle>
|
||||
<staticText>
|
||||
<reportElement x="109" y="84" width="50" height="11" forecolor="#FFFFFF" uuid="fa26d6b7-51d2-4f9e-9d05-9a4513c66eed"/>
|
||||
<textElement>
|
||||
<font size="6" isBold="true" isUnderline="false" isPdfEmbedded="false"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Pharmacy Plan]]></text>
|
||||
</staticText>
|
||||
<image scaleImage="RetainShape">
|
||||
<reportElement x="160" y="95" width="69" height="21" uuid="36c204c6-c2f7-4613-863f-332cf50ff6cc"/>
|
||||
<imageExpression><![CDATA["./../../images/FairRxOs.jpg"]]></imageExpression>
|
||||
</image>
|
||||
<staticText>
|
||||
<reportElement x="108" y="95" width="21" height="8" uuid="40b57f3b-eeeb-4e38-857b-6bf290bb5ba5"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[RX Bin:]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement x="108" y="105" width="21" height="8" uuid="cc922142-d87a-4f04-b28b-413ad513e5e0"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[RX PCN:]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement x="108" y="115" width="21" height="8" uuid="4534f9a0-901a-402c-86ba-0b3109370e53"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[RX GRP:]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement x="132" y="95" width="27" height="8" uuid="abd7fb37-b19a-4691-869c-28a8c0b326ce"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[021841]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement x="132" y="105" width="27" height="8" uuid="84e6427e-950d-4c1a-877e-a342ec8009db"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[18000405]]></text>
|
||||
</staticText>
|
||||
<textField>
|
||||
<reportElement x="132" y="115" width="34" height="8" uuid="709713dc-5f48-40dc-957c-9f015b376b41"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{rx_group}]]></textFieldExpression>
|
||||
</textField>
|
||||
<staticText>
|
||||
<reportElement x="108" y="125" width="51" height="8" uuid="00b86af7-1cba-4c7a-a78b-cb0ffa476f88"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Customer Service:]]></text>
|
||||
</staticText>
|
||||
<textField>
|
||||
<reportElement x="166" y="115" width="63" height="8" uuid="0bce3d0c-c01b-4dfd-9638-19b94d75e73e"/>
|
||||
<textElement textAlignment="Center">
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{web_url}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="159" y="125" width="70" height="8" uuid="1193b1ef-31e9-4c43-bb51-236b67c21c81"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{customer_service}]]></textFieldExpression>
|
||||
</textField>
|
||||
<staticText>
|
||||
<reportElement x="3" y="96" width="93" height="9" uuid="71022051-2ec9-443d-81e2-5f7385ddeb7b"/>
|
||||
<textElement textAlignment="Center">
|
||||
<font fontName="SansSerif" size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Precertification]]></text>
|
||||
</staticText>
|
||||
<textField>
|
||||
<reportElement x="3" y="105" width="93" height="13" uuid="e414550a-a8d0-4313-9b57-e42ca3bb67ab"/>
|
||||
<textElement textAlignment="Center">
|
||||
<font fontName="SansSerif" size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA["Call Britton Benefit Services, LLC"]]></textFieldExpression>
|
||||
</textField>
|
||||
<image>
|
||||
<reportElement x="159" y="136" width="72" height="8" uuid="7da52da7-1e66-4ba2-ae1c-8ba65b8797c3">
|
||||
<printWhenExpression><![CDATA[$F{network_provider}.equals("Cigna")]]></printWhenExpression>
|
||||
</reportElement>
|
||||
<imageExpression><![CDATA["./../../images/LOGO - AFHC.jpg"]]></imageExpression>
|
||||
</image>
|
||||
<staticText>
|
||||
<reportElement x="1" y="135" width="154" height="8" uuid="4da0cb27-87c4-4f6c-8cde-4078ad224da6">
|
||||
<printWhenExpression><![CDATA[$F{network_provider}.equals("Cigna")]]></printWhenExpression>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5.5" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Benefits are not insured by Cigna Healthcare or affiliates]]></text>
|
||||
</staticText>
|
||||
<textField>
|
||||
<reportElement x="3" y="115" width="93" height="13" uuid="1d9c4616-e0bc-41e0-836d-8614c195b304"/>
|
||||
<textElement textAlignment="Center">
|
||||
<font fontName="SansSerif" size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA["1.800.676.1182 (8am-5pm)"]]></textFieldExpression>
|
||||
</textField>
|
||||
</band>
|
||||
</detail>
|
||||
<columnFooter>
|
||||
<band splitType="Stretch"/>
|
||||
</columnFooter>
|
||||
<pageFooter>
|
||||
<band splitType="Stretch"/>
|
||||
</pageFooter>
|
||||
<summary>
|
||||
<band splitType="Stretch"/>
|
||||
</summary>
|
||||
</jasperReport>
|
||||
@@ -0,0 +1,502 @@
|
||||
<?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" whenNoDataType="AllSectionsNoDetail" columnWidth="243" leftMargin="0" rightMargin="0" topMargin="0" bottomMargin="0" uuid="477346fd-960f-44d2-84f5-bd25202741fc">
|
||||
<property name="ireport.zoom" value="5.0"/>
|
||||
<property name="ireport.x" value="1955"/>
|
||||
<property name="ireport.y" value="0"/>
|
||||
<parameter name="family_id" class="java.lang.String"></parameter>
|
||||
<parameter name="sample_key" class="java.lang.String"></parameter>
|
||||
<parameter name="employer_logo" class="java.io.InputStream"/>
|
||||
<parameter name="employer_logo_ar" class="java.lang.Float"/>
|
||||
<parameter name="network_logo" class="java.io.InputStream"/>
|
||||
<parameter name="dynamic_where" class="java.lang.String">
|
||||
<defaultValueExpression><![CDATA[$P{sample_key} == null ? "family_id = '" + $P{family_id} + "'" : "sample_key = '" + $P{sample_key} + "'"]]></defaultValueExpression>
|
||||
</parameter>
|
||||
<queryString>
|
||||
<![CDATA[Select * From id_card_print_data Where $P!{dynamic_where}]]>
|
||||
</queryString>
|
||||
<field name="employer_name" class="java.lang.String"/>
|
||||
<field name="full_name" class="java.lang.String"/>
|
||||
<field name="medical_eff_date" 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"/>
|
||||
<field name="family_id" class="java.lang.String"/>
|
||||
<field name="group_number" class="java.lang.String"/>
|
||||
<field name="rx_group" class="java.lang.String"/>
|
||||
<field name="customer_service" class="java.lang.String"/>
|
||||
<field name="web_url" class="java.lang.String"/>
|
||||
<field name="dependent_1" class="java.lang.String"/>
|
||||
<field name="dependent_2" class="java.lang.String"/>
|
||||
<field name="dependent_3" class="java.lang.String"/>
|
||||
<field name="dependent_4" class="java.lang.String"/>
|
||||
<field name="dependent_5" class="java.lang.String"/>
|
||||
<field name="dependent_6" class="java.lang.String"/>
|
||||
<field name="benefit_desc_1" class="java.lang.String"/>
|
||||
<field name="benefit_1" class="java.lang.String"/>
|
||||
<field name="benefit_desc_2" class="java.lang.String"/>
|
||||
<field name="benefit_2" class="java.lang.String"/>
|
||||
<field name="benefit_desc_3" class="java.lang.String"/>
|
||||
<field name="benefit_3" class="java.lang.String"/>
|
||||
<field name="benefit_desc_4" class="java.lang.String"/>
|
||||
<field name="benefit_4" class="java.lang.String"/>
|
||||
<field name="benefit_desc_5" class="java.lang.String"/>
|
||||
<field name="benefit_5" class="java.lang.String"/>
|
||||
<field name="benefit_desc_6" class="java.lang.String"/>
|
||||
<field name="benefit_6" class="java.lang.String"/>
|
||||
<field name="benefit_desc_7" class="java.lang.String"/>
|
||||
<field name="benefit_7" class="java.lang.String"/>
|
||||
<field name="benefit_desc_8" class="java.lang.String"/>
|
||||
<field name="benefit_8" class="java.lang.String"/>
|
||||
<field name="benefit_desc_9" class="java.lang.String"/>
|
||||
<field name="benefit_9" class="java.lang.String"/>
|
||||
<field name="benefit_desc_10" class="java.lang.String"/>
|
||||
<field name="benefit_10" class="java.lang.String"/>
|
||||
<field name="benefit_desc_11" class="java.lang.String"/>
|
||||
<field name="benefit_11" class="java.lang.String"/>
|
||||
<field name="benefit_desc_12" class="java.lang.String"/>
|
||||
<field name="benefit_12" class="java.lang.String"/>
|
||||
<field name="benefit_desc_13" class="java.lang.String"/>
|
||||
<field name="benefit_13" class="java.lang.String"/>
|
||||
<field name="benefit_desc_14" class="java.lang.String"/>
|
||||
<field name="benefit_14" class="java.lang.String"/>
|
||||
<field name="primary_mb_member_key" class="java.lang.String"/>
|
||||
<field name="dependent_7" class="java.lang.String"/>
|
||||
<field name="dependent_8" 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="138" y="10" width="94" height="132" uuid="4a5b91ca-ebdb-45be-8c16-f6ab6529dae7">
|
||||
<property name="com.jaspersoft.studio.unit.height" value="px"/>
|
||||
</reportElement>
|
||||
</rectangle>
|
||||
<rectangle>
|
||||
<reportElement x="1" y="10" width="133" height="84" uuid="777f7302-b52c-48fd-9cf7-6bce02846f86"/>
|
||||
</rectangle>
|
||||
<rectangle>
|
||||
<reportElement x="1" y="1" width="61" height="8" backcolor="#000000" uuid="c654c4f4-6d8f-4678-9a39-99f7394d2690">
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
</rectangle>
|
||||
<image scaleImage="FillFrame">
|
||||
<reportElement x="141" y="12" width="88" height="27" isPrintInFirstWholeBand="true" uuid="7445dc43-933e-4b42-bef0-1772e9b85ba4">
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
<property name="com.jaspersoft.studio.unit.height" value="px"/>
|
||||
<printWhenExpression><![CDATA[$P{employer_logo_ar} >= 1.20f]]></printWhenExpression>
|
||||
</reportElement>
|
||||
<imageExpression><![CDATA[$P{employer_logo}]]></imageExpression>
|
||||
</image>
|
||||
<image scaleImage="FillFrame">
|
||||
<reportElement x="161" y="12" width="45" height="27" isPrintInFirstWholeBand="true" uuid="393d9b02-933b-46d8-850b-4d69d148aa86">
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
<property name="com.jaspersoft.studio.unit.height" value="px"/>
|
||||
<printWhenExpression><![CDATA[$P{employer_logo_ar} < 1.20f]]></printWhenExpression>
|
||||
</reportElement>
|
||||
<imageExpression><![CDATA[$P{employer_logo}]]></imageExpression>
|
||||
</image>
|
||||
<staticText>
|
||||
<reportElement x="140" y="35" width="90" height="23" uuid="99f47ca3-1456-4fc7-bb08-a98f460120ce"/>
|
||||
<textElement textAlignment="Center" verticalAlignment="Middle">
|
||||
<font size="4.5" isBold="true" isItalic="false"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Administered by:
|
||||
Britton Benefit Services, LLC
|
||||
1.800.676.1182]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement x="4" y="1" width="56" height="11" forecolor="#FFFFFF" uuid="8bbea900-0c43-40d8-ad68-2f478aabd3c1">
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="6" isBold="true" isUnderline="false" isPdfEmbedded="false"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Health Benefit Plan]]></text>
|
||||
</staticText>
|
||||
<rectangle>
|
||||
<reportElement x="138" y="1" width="44" height="8" backcolor="#000000" uuid="4ecd4a82-edd1-4166-abf9-85d66ebb8b37"/>
|
||||
</rectangle>
|
||||
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@@ -0,0 +1,119 @@
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<?xml version="1.0" encoding="UTF-8"?>
|
||||
<!-- Created with Jaspersoft Studio version 7.0.3.final using JasperReports Library version 6.1.1 -->
|
||||
<jasperReport xmlns="http://jasperreports.sourceforge.net/jasperreports" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://jasperreports.sourceforge.net/jasperreports http://jasperreports.sourceforge.net/xsd/jasperreport.xsd" name="IDCard" pageWidth="612" pageHeight="792" columnWidth="572" leftMargin="20" rightMargin="20" topMargin="20" bottomMargin="20" uuid="477346fd-960f-44d2-84f5-bd25202741fc">
|
||||
<!-- <property name="net.sf.jasperreports.export.pdf.metadata.title" value="![CDATA[$F{full_name_last_name_first}]]"/> -->
|
||||
<property name="net.sf.jasperreports.export.pdf.metadata.creator" value="Your App"/>
|
||||
<property name="net.sf.jasperreports.export.pdf.tagged" value="true"/>
|
||||
<parameter name="baseDir" class="java.lang.String"/>
|
||||
<parameter name="cardTemplate" class="java.lang.String"/>
|
||||
<field name="currentMemberCard" class="java.lang.Object">
|
||||
<fieldDescription><![CDATA[_THIS]]></fieldDescription>
|
||||
</field>
|
||||
<!-- <field name="full_name_last_name_first" class="java.lang.String"/> -->
|
||||
<background>
|
||||
<band splitType="Stretch"/>
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||||
</background>
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||||
<title>
|
||||
<band splitType="Stretch"/>
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||||
</title>
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||||
<pageHeader>
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||||
<band splitType="Stretch"/>
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||||
</pageHeader>
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||||
<columnHeader>
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||||
<band splitType="Stretch"/>
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||||
</columnHeader>
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||||
<detail>
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||||
<band height="700" splitType="Immediate">
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||||
<!-- <textField>
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||||
<reportElement x="115" y="97" width="10" height="10" forecolor="#FFFFFF" uuid="46c394a4-7df2-4f23-b17e-d8e186e99f5e"/>
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||||
<textElement>
|
||||
<font size="1"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[":WATERMARK:"+ $F{full_name_last_name_first} +":"]]></textFieldExpression>
|
||||
</textField> -->
|
||||
<!-- <textField> -->
|
||||
<!-- <reportElement x="0" y="0" width="1" height="1">
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||||
<property name="net.sf.jasperreports.export.pdf.rendering.mode" value="3"/>
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||||
</reportElement>
|
||||
<textFieldExpression><![CDATA["MEMBER_LNF:Jordan, Jason:"]]></textFieldExpression>
|
||||
</textField> -->
|
||||
<!-- <componentElement>
|
||||
<reportElement x="0" y="0" width="1" height="1" uuid="46c394a4-7df2-4f23-b17e-d8e186e99f5e"/>
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||||
<jr:genericElement xmlns:jr="http://jasperreports.sourceforge.net/jasperreports/components" xsi:schemaLocation="http://jasperreports.sourceforge.net/jasperreports/components http://jasperreports.sourceforge.net/xsd/components.xsd">
|
||||
<jr:genericElementType namespace="http://jasperreports.sourceforge.net/jasperreports/pdf" name="metadata"/>
|
||||
<jr:genericElementParameter name="key">
|
||||
<valueExpression><![CDATA["Member"]]></valueExpression>
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||||
</jr:genericElementParameter>
|
||||
<jr:genericElementParameter name="value">
|
||||
<valueExpression><![CDATA[$F{full_name_last_name_first}]]></valueExpression>
|
||||
</jr:genericElementParameter>
|
||||
</jr:genericElement>
|
||||
</componentElement> -->
|
||||
<!-- <textField isStretchWithOverflow="false" evaluationTime="Now" hyperlinkType="LocalAnchor" hyperlinkTarget="Self">
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||||
<reportElement x="0" y="0" width="1" height="1" uuid="46c394a4-7df2-4f23-b17e-d8e186e99f5e">
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||||
<property name="net.sf.jasperreports.export.pdf.tag.hidden" value="true"/>
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||||
</reportElement>
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||||
<box topPadding="0" leftPadding="0" bottomPadding="0" rightPadding="0"/>
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||||
<textElement>
|
||||
<font size="0"/>
|
||||
</textElement>
|
||||
<textFieldExpression class="java.lang.String"><![CDATA[""]]></textFieldExpression>
|
||||
<hyperlinkAnchorExpression><![CDATA[$F{full_name_last_name_first}]]></hyperlinkAnchorExpression>
|
||||
</textField> -->
|
||||
|
||||
<!-- <textField isStretchWithOverflow="true" isBlankWhenNull="true">
|
||||
<reportElement x="0" y="0" width="1" height="1" uuid="46c394a4-7df2-4f23-b17e-d8e186e99f5e">
|
||||
<property name="net.sf.jasperreports.export.pdf.tag.hidden" value="true"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="0"/>
|
||||
</textElement>
|
||||
<textFieldExpression class="java.lang.String">
|
||||
<![CDATA[$F{full_name_last_name_first}]]>
|
||||
</textFieldExpression>
|
||||
<anchorNameExpression><![CDATA[$F{full_name_last_name_first}]]></anchorNameExpression>
|
||||
<bookmarkLevelExpression><![CDATA[1]]></bookmarkLevelExpression>
|
||||
</textField> -->
|
||||
<!-- <textField isStretchWithOverflow="false" isBlankWhenNull="true" evaluationTime="Now" hyperlinkType="None" hyperlinkTarget="Self" >
|
||||
<reportElement x="0" y="0" width="0" height="0" key="digital_watermark">
|
||||
<property name="net.sf.jasperreports.print.create.bookmarks" value="true"/>
|
||||
</reportElement>
|
||||
<anchorNameExpression><![CDATA[$F{full_name_last_name_first}]]></anchorNameExpression>
|
||||
<bookmarkLevelExpression><![CDATA[1]]></bookmarkLevelExpression>
|
||||
</textField> -->
|
||||
<rectangle>
|
||||
<reportElement mode="Transparent" x="306" y="9" width="250" height="164" forecolor="#2A4B6F" uuid="7335a19a-8a74-445f-aaa4-e015e3c186f8"/>
|
||||
<graphicElement>
|
||||
<pen lineWidth="0.5" lineStyle="Dashed"/>
|
||||
</graphicElement>
|
||||
</rectangle>
|
||||
<rectangle>
|
||||
<reportElement mode="Transparent" x="45" y="9" width="250" height="164" forecolor="#2A4B6F" uuid="08937bdf-e64e-4836-b222-490c0843272b"/>
|
||||
<graphicElement>
|
||||
<pen lineWidth="0.5" lineStyle="Dashed"/>
|
||||
</graphicElement>
|
||||
</rectangle>
|
||||
<subreport>
|
||||
<reportElement x="314" y="14" width="243" height="153" uuid="4a5b91ca-ebdb-45be-8c16-f6ab6529dae7"/>
|
||||
<parametersMapExpression><![CDATA[$P{REPORT_PARAMETERS_MAP}]]></parametersMapExpression>
|
||||
<dataSourceExpression><![CDATA[new net.sf.jasperreports.engine.data.JRBeanCollectionDataSource(java.util.Collections.singletonList($F{currentMemberCard}))]]></dataSourceExpression>
|
||||
<subreportExpression><![CDATA[$P{baseDir} + "/" + $P{cardTemplate} + "/" + $P{cardTemplate} + "Front.jasper"]]></subreportExpression>
|
||||
</subreport>
|
||||
<subreport>
|
||||
<reportElement x="53" y="14" width="243" height="153" uuid="7445dc43-933e-4b42-bef0-1772e9b85ba4"/>
|
||||
<parametersMapExpression><![CDATA[$P{REPORT_PARAMETERS_MAP}]]></parametersMapExpression>
|
||||
<dataSourceExpression><![CDATA[new net.sf.jasperreports.engine.data.JRBeanCollectionDataSource(java.util.Collections.singletonList($F{currentMemberCard}))]]></dataSourceExpression>
|
||||
<subreportExpression><![CDATA[$P{baseDir} + "/" + $P{cardTemplate} + "/" + $P{cardTemplate} + "Back.jasper"]]></subreportExpression>
|
||||
</subreport>
|
||||
</band>
|
||||
</detail>
|
||||
<columnFooter>
|
||||
<band splitType="Stretch"/>
|
||||
</columnFooter>
|
||||
<pageFooter>
|
||||
<band splitType="Stretch"/>
|
||||
</pageFooter>
|
||||
<summary>
|
||||
<band splitType="Stretch"/>
|
||||
</summary>
|
||||
</jasperReport>
|
||||
@@ -0,0 +1,65 @@
|
||||
<?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="519" pageHeight="184" orientation="Landscape" columnWidth="519" leftMargin="0" rightMargin="0" topMargin="0" bottomMargin="0" uuid="477346fd-960f-44d2-84f5-bd25202741fc">
|
||||
<parameter name="family_id" class="java.lang.String"/>
|
||||
<parameter name="baseDir" class="java.lang.String"/>
|
||||
<parameter name="cardTemplate" class="java.lang.String"/>
|
||||
<queryString>
|
||||
<![CDATA[SELECT 1 AS dummy_field]]>
|
||||
</queryString>
|
||||
<background>
|
||||
<band splitType="Stretch"/>
|
||||
</background>
|
||||
<title>
|
||||
<band splitType="Stretch"/>
|
||||
</title>
|
||||
<pageHeader>
|
||||
<band splitType="Stretch"/>
|
||||
</pageHeader>
|
||||
<columnHeader>
|
||||
<band splitType="Stretch"/>
|
||||
</columnHeader>
|
||||
<detail>
|
||||
<band height="184" splitType="Immediate">
|
||||
<rectangle>
|
||||
<reportElement mode="Transparent" x="265" y="9" width="250" height="164" forecolor="#2A4B6F" uuid="7335a19a-8a74-445f-aaa4-e015e3c186f8"/>
|
||||
<graphicElement>
|
||||
<pen lineWidth="0.5" lineStyle="Dashed"/>
|
||||
</graphicElement>
|
||||
</rectangle>
|
||||
<rectangle>
|
||||
<reportElement mode="Transparent" x="4" y="9" width="250" height="164" forecolor="#2A4B6F" uuid="08937bdf-e64e-4836-b222-490c0843272b"/>
|
||||
<graphicElement>
|
||||
<pen lineWidth="0.5" lineStyle="Dashed"/>
|
||||
</graphicElement>
|
||||
</rectangle>
|
||||
<subreport>
|
||||
<reportElement x="273" y="14" width="243" height="153" uuid="4a5b91ca-ebdb-45be-8c16-f6ab6529dae7"/>
|
||||
<parametersMapExpression><![CDATA[$P{REPORT_PARAMETERS_MAP}]]></parametersMapExpression>
|
||||
<subreportParameter name="family_id">
|
||||
<subreportParameterExpression><![CDATA[$P{family_id}]]></subreportParameterExpression>
|
||||
</subreportParameter>
|
||||
<connectionExpression><![CDATA[$P{REPORT_CONNECTION}]]></connectionExpression>
|
||||
<subreportExpression><![CDATA[$P{baseDir} + "/" + $P{cardTemplate} + "/" + $P{cardTemplate} + "Front.jasper"]]></subreportExpression>
|
||||
</subreport>
|
||||
<subreport>
|
||||
<reportElement x="12" y="14" width="243" height="153" uuid="7445dc43-933e-4b42-bef0-1772e9b85ba4"/>
|
||||
<parametersMapExpression><![CDATA[$P{REPORT_PARAMETERS_MAP}]]></parametersMapExpression>
|
||||
<subreportParameter name="family_id">
|
||||
<subreportParameterExpression><![CDATA[$P{family_id}]]></subreportParameterExpression>
|
||||
</subreportParameter>
|
||||
<connectionExpression><![CDATA[$P{REPORT_CONNECTION}]]></connectionExpression>
|
||||
<subreportExpression><![CDATA[$P{baseDir} + "/" + $P{cardTemplate} + "/" + $P{cardTemplate} + "Back.jasper"]]></subreportExpression>
|
||||
</subreport>
|
||||
</band>
|
||||
</detail>
|
||||
<columnFooter>
|
||||
<band splitType="Stretch"/>
|
||||
</columnFooter>
|
||||
<pageFooter>
|
||||
<band splitType="Stretch"/>
|
||||
</pageFooter>
|
||||
<summary>
|
||||
<band splitType="Stretch"/>
|
||||
</summary>
|
||||
</jasperReport>
|
||||
@@ -0,0 +1,878 @@
|
||||
<?xml version="1.0" encoding="UTF-8"?>
|
||||
<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="612" pageHeight="792" columnWidth="572" leftMargin="20" rightMargin="20" topMargin="20" bottomMargin="20" uuid="477346fd-960f-44d2-84f5-bd25202741fc">
|
||||
<property name="ireport.zoom" value="5.0"/>
|
||||
<property name="ireport.x" value="1387"/>
|
||||
<property name="ireport.y" value="0"/>
|
||||
<parameter name="FamilyId" class="java.lang.String">
|
||||
<defaultValueExpression><![CDATA["198621286"]]></defaultValueExpression>
|
||||
</parameter>
|
||||
<parameter name="BackImage" class="java.lang.String">
|
||||
<defaultValueExpression><![CDATA["C:\\images\\All_3_Logo.png"]]></defaultValueExpression>
|
||||
</parameter>
|
||||
<queryString>
|
||||
<![CDATA[Select * From HLIDCardEggData Where FamilyId = $P{FamilyId}]]>
|
||||
</queryString>
|
||||
<field name="ID" class="java.lang.Integer"/>
|
||||
<field name="Facility" class="java.lang.String"/>
|
||||
<field name="Division" class="java.lang.String"/>
|
||||
<field name="FullName" class="java.lang.String"/>
|
||||
<field name="SSN" class="java.lang.String"/>
|
||||
<field name="MedicalCoverage" class="java.lang.String"/>
|
||||
<field name="MedicalEffDate" class="java.lang.String"/>
|
||||
<field name="MedicalGroupNum" class="java.lang.String"/>
|
||||
<field name="DentalCoverage" class="java.lang.String"/>
|
||||
<field name="DentalEffDate" class="java.lang.String"/>
|
||||
<field name="DentalGroupNum" class="java.lang.String"/>
|
||||
<field name="CardType" class="java.lang.String"/>
|
||||
<field name="ProviderCode" class="java.lang.String"/>
|
||||
<field name="ProviderLine1" class="java.lang.String"/>
|
||||
<field name="ProviderLine2" class="java.lang.String"/>
|
||||
<field name="ProviderLine3" class="java.lang.String"/>
|
||||
<field name="ProviderLine4" class="java.lang.String"/>
|
||||
<field name="ProviderLine5" class="java.lang.String"/>
|
||||
<field name="ProviderLine6" class="java.lang.String"/>
|
||||
<field name="ProviderLine7" class="java.lang.String"/>
|
||||
<field name="ProviderLine8" class="java.lang.String"/>
|
||||
<field name="ProviderLine9" class="java.lang.String"/>
|
||||
<field name="ProviderLine10" class="java.lang.String"/>
|
||||
<field name="ProviderLine11" class="java.lang.String"/>
|
||||
<field name="MailTo" class="java.lang.String"/>
|
||||
<field name="MailTo2" class="java.lang.String"/>
|
||||
<field name="ClaimTo1" class="java.lang.String"/>
|
||||
<field name="ClaimTo2" class="java.lang.String"/>
|
||||
<field name="ClaimTo3" class="java.lang.String"/>
|
||||
<field name="ClaimTo4" class="java.lang.String"/>
|
||||
<field name="ClaimTo5" class="java.lang.String"/>
|
||||
<field name="ClaimTo6" class="java.lang.String"/>
|
||||
<field name="ClaimTo7" class="java.lang.String"/>
|
||||
<field name="ClaimTo8" class="java.lang.String"/>
|
||||
<field name="ClaimTo9" class="java.lang.String"/>
|
||||
<field name="ClaimTo10" class="java.lang.String"/>
|
||||
<field name="ClaimTo11" class="java.lang.String"/>
|
||||
<field name="ContactLine1" class="java.lang.String"/>
|
||||
<field name="ContactLine2" class="java.lang.String"/>
|
||||
<field name="ContactLine3" class="java.lang.String"/>
|
||||
<field name="GroupNumber" class="java.lang.String"/>
|
||||
<field name="FamilyId" class="java.lang.String"/>
|
||||
<field name="GroupNo" class="java.lang.String"/>
|
||||
<field name="RXGroupID" class="java.lang.String"/>
|
||||
<field name="HelpDesk" class="java.lang.String"/>
|
||||
<field name="CustomerService" class="java.lang.String"/>
|
||||
<field name="WebUrl" class="java.lang.String"/>
|
||||
<field name="Expr1" class="java.lang.String"/>
|
||||
<field name="Line3" class="java.lang.String"/>
|
||||
<field name="Dependent1" class="java.lang.String"/>
|
||||
<field name="Dependent2" class="java.lang.String"/>
|
||||
<field name="Dependent3" class="java.lang.String"/>
|
||||
<field name="Dependent4" class="java.lang.String"/>
|
||||
<field name="Dependent5" class="java.lang.String"/>
|
||||
<field name="Dependent6" class="java.lang.String"/>
|
||||
<field name="BenDesc1" class="java.lang.String"/>
|
||||
<field name="Ben1" class="java.lang.String"/>
|
||||
<field name="BenDesc2" class="java.lang.String"/>
|
||||
<field name="Ben2" class="java.lang.String"/>
|
||||
<field name="BenDesc3" class="java.lang.String"/>
|
||||
<field name="Ben3" class="java.lang.String"/>
|
||||
<field name="BenDesc4" class="java.lang.String"/>
|
||||
<field name="Ben4" class="java.lang.String"/>
|
||||
<field name="BenDesc5" class="java.lang.String"/>
|
||||
<field name="Ben5" class="java.lang.String"/>
|
||||
<field name="BenDesc6" class="java.lang.String"/>
|
||||
<field name="Ben6" class="java.lang.String"/>
|
||||
<field name="BenDesc7" class="java.lang.String"/>
|
||||
<field name="Ben7" class="java.lang.String"/>
|
||||
<field name="BenDesc8" class="java.lang.String"/>
|
||||
<field name="Ben8" class="java.lang.String"/>
|
||||
<field name="BenDesc9" class="java.lang.String"/>
|
||||
<field name="Ben9" class="java.lang.String"/>
|
||||
<field name="BenDesc10" class="java.lang.String"/>
|
||||
<field name="Ben10" class="java.lang.String"/>
|
||||
<field name="BenDesc11" class="java.lang.String"/>
|
||||
<field name="Ben11" class="java.lang.String"/>
|
||||
<field name="BenDesc12" class="java.lang.String"/>
|
||||
<field name="Ben12" class="java.lang.String"/>
|
||||
<field name="BenDesc13" class="java.lang.String"/>
|
||||
<field name="Ben13" class="java.lang.String"/>
|
||||
<field name="BenDesc14" class="java.lang.String"/>
|
||||
<field name="Ben14" class="java.lang.String"/>
|
||||
<field name="PLPlanKey" class="java.lang.Integer"/>
|
||||
<field name="PrimaryMBMemberKey" class="java.lang.Integer"/>
|
||||
<field name="PPOLookup1" class="java.lang.String"/>
|
||||
<field name="PPOLookup2" class="java.lang.String"/>
|
||||
<field name="Precert1" class="java.lang.String"/>
|
||||
<field name="Precert2" class="java.lang.String"/>
|
||||
<field name="Precert3" class="java.lang.String"/>
|
||||
<field name="Precert4" class="java.lang.String"/>
|
||||
<field name="Precert5" class="java.lang.String"/>
|
||||
<field name="Precert6" class="java.lang.String"/>
|
||||
<field name="Dependent7" class="java.lang.String"/>
|
||||
<field name="Dependent8" 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="166" splitType="Immediate">
|
||||
<rectangle>
|
||||
<reportElement uuid="7335a19a-8a74-445f-aaa4-e015e3c186f8" mode="Transparent" x="296" y="1" width="250" height="164" forecolor="#00CCFF"/>
|
||||
<graphicElement>
|
||||
<pen lineWidth="0.5" lineStyle="Dashed"/>
|
||||
</graphicElement>
|
||||
</rectangle>
|
||||
<rectangle>
|
||||
<reportElement uuid="4a5b91ca-ebdb-45be-8c16-f6ab6529dae7" x="439" y="15" width="102" height="146"/>
|
||||
</rectangle>
|
||||
<rectangle>
|
||||
<reportElement uuid="08937bdf-e64e-4836-b222-490c0843272b" mode="Transparent" x="35" y="1" width="250" height="164" forecolor="#00CCFF"/>
|
||||
<graphicElement>
|
||||
<pen lineWidth="0.5" lineStyle="Dashed"/>
|
||||
</graphicElement>
|
||||
</rectangle>
|
||||
<rectangle>
|
||||
<reportElement uuid="e762ee84-c013-417b-a78f-54f6f1f6a1a3" x="41" y="15" width="100" height="71"/>
|
||||
</rectangle>
|
||||
<rectangle>
|
||||
<reportElement uuid="66e1721c-c7fd-40cf-8f45-10b5f6b4c22d" x="41" y="97" width="100" height="49"/>
|
||||
</rectangle>
|
||||
<rectangle>
|
||||
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||||
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||||
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||||
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||||
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||||
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||||
www.bbstpa.com (24/7)
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||||
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||||
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||||
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||||
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||||
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||||
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||||
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||||
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|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
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|
||||
<text><![CDATA[Covered Dependents:]]></text>
|
||||
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|
||||
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|
||||
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|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{Dependent1}]]></textFieldExpression>
|
||||
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|
||||
<textField>
|
||||
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|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{Dependent2}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
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|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{Dependent3}]]></textFieldExpression>
|
||||
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|
||||
<textField>
|
||||
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|
||||
<textElement>
|
||||
<font size="5"/>
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||||
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|
||||
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|
||||
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|
||||
<textField>
|
||||
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|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
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|
||||
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|
||||
<textField>
|
||||
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|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{Dependent6}]]></textFieldExpression>
|
||||
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|
||||
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|
||||
<reportElement uuid="36c204c6-c2f7-4613-863f-332cf50ff6cc" x="202" y="100" width="76" height="21"/>
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||||
<imageExpression><![CDATA["C:\\images\\FairRxOs.jpg"]]></imageExpression>
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|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
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|
||||
<text><![CDATA[RX Bin:]]></text>
|
||||
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|
||||
<staticText>
|
||||
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|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
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|
||||
<text><![CDATA[RX PCN:]]></text>
|
||||
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|
||||
<staticText>
|
||||
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|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[RX GRP:]]></text>
|
||||
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|
||||
<staticText>
|
||||
<reportElement uuid="abd7fb37-b19a-4691-869c-28a8c0b326ce" x="175" y="101" width="27" height="8"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[021841]]></text>
|
||||
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|
||||
<staticText>
|
||||
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||||
<textElement>
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||||
<font size="5" isBold="true"/>
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||||
</textElement>
|
||||
<text><![CDATA[18000405]]></text>
|
||||
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||||
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||||
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||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{RXGroupID}]]></textFieldExpression>
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||||
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||||
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|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
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|
||||
<text><![CDATA[Customer Service:]]></text>
|
||||
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|
||||
<textField>
|
||||
<reportElement uuid="0bce3d0c-c01b-4dfd-9638-19b94d75e73e" x="205" y="120" width="73" height="8"/>
|
||||
<textElement textAlignment="Center">
|
||||
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||||
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|
||||
<textFieldExpression><![CDATA[$F{WebUrl}]]></textFieldExpression>
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||||
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|
||||
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||||
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||||
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|
||||
<font size="5" isBold="true"/>
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||||
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|
||||
<textFieldExpression><![CDATA[$F{CustomerService}]]></textFieldExpression>
|
||||
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|
||||
<textField>
|
||||
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|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{BenDesc1}]]></textFieldExpression>
|
||||
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|
||||
<textField>
|
||||
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|
||||
<textElement>
|
||||
<font size="5"/>
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||||
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|
||||
<textFieldExpression><![CDATA[$F{Ben1}]]></textFieldExpression>
|
||||
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|
||||
<textField>
|
||||
<reportElement uuid="aa510ad0-1a1e-4f24-b692-505794f4f159" x="441" y="68" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{BenDesc2}]]></textFieldExpression>
|
||||
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|
||||
<textField>
|
||||
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|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{Ben2}]]></textFieldExpression>
|
||||
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|
||||
<textField>
|
||||
<reportElement uuid="fae8e590-1ffe-4e48-aef6-26a7e01c88af" x="441" y="75" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{BenDesc3}]]></textFieldExpression>
|
||||
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|
||||
<textField>
|
||||
<reportElement uuid="693746af-9ba2-4992-a270-397eaac04653" x="441" y="82" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{BenDesc4}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="27282b06-831e-40e5-93ee-ca77e3190dd5" x="496" y="75" width="43" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{Ben3}]]></textFieldExpression>
|
||||
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|
||||
<textField>
|
||||
<reportElement uuid="fb423834-c0e0-4e68-8dd9-baa62eaa79a2" x="496" y="82" width="43" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{Ben4}]]></textFieldExpression>
|
||||
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|
||||
<textField>
|
||||
<reportElement uuid="b0e3223c-1930-42db-82cc-d059e9b699b9" x="441" y="89" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{BenDesc5}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="bae3a6b6-1ca2-4ca6-9ba1-dd5fb9d1153f" x="496" y="110" width="43" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{Ben8}]]></textFieldExpression>
|
||||
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|
||||
<textField>
|
||||
<reportElement uuid="8afd99dc-91b9-4416-806a-5f0e7eb83b1c" x="441" y="110" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{BenDesc8}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="c88d8d15-070c-42ad-999c-2e013f399992" x="441" y="103" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{BenDesc7}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="8bfb12fe-aef3-4397-a026-1fe43ebce05e" x="441" y="96" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{BenDesc6}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="43a569a5-7de5-427a-986f-bc4af746be06" x="496" y="96" width="43" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{Ben6}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="a26646b1-152c-44f2-9486-1bd1590683c3" x="496" y="103" width="43" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{Ben7}]]></textFieldExpression>
|
||||
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|
||||
<textField>
|
||||
<reportElement uuid="b572b49b-7b9a-4f68-b7ef-11dfadd2dae4" x="496" y="89" width="43" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Ben5}]]></textFieldExpression>
|
||||
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|
||||
<staticText>
|
||||
<reportElement uuid="71022051-2ec9-443d-81e2-5f7385ddeb7b" x="43" y="99" width="54" height="9"/>
|
||||
<textElement>
|
||||
<font fontName="Microsoft Sans Serif" size="5" isBold="true"/>
|
||||
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|
||||
<text><![CDATA[Precertification]]></text>
|
||||
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|
||||
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|
||||
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|
||||
<textElement textAlignment="Left">
|
||||
<font fontName="Microsoft Sans Serif" size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA["Call Britton Benefit Services, LLC"]]></textFieldExpression>
|
||||
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|
||||
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|
||||
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|
||||
<textElement>
|
||||
<font fontName="Microsoft Sans Serif" size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{ProviderCode}.equals("1")?"S":""]]></textFieldExpression>
|
||||
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|
||||
<image hAlign="Center">
|
||||
<reportElement uuid="ea716b2c-5586-439d-8450-7302d49a5bd3" x="303" y="103" width="100" height="51"/>
|
||||
<imageExpression><![CDATA["C:\\images\\CignaLogo.png"]]></imageExpression>
|
||||
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|
||||
<image>
|
||||
<reportElement uuid="7da52da7-1e66-4ba2-ae1c-8ba65b8797c3" x="191" y="147" width="189" height="8"/>
|
||||
<imageExpression><![CDATA["C:\\images\\LOGO - AFHC.jpg"]]></imageExpression>
|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
<text><![CDATA[Benefits are not insured by Cigna or affiliates]]></text>
|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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||||
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|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{Ben9}]]></textFieldExpression>
|
||||
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|
||||
<textField isBlankWhenNull="true">
|
||||
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|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{BenDesc9}]]></textFieldExpression>
|
||||
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|
||||
<textField isBlankWhenNull="true">
|
||||
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|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{BenDesc10}]]></textFieldExpression>
|
||||
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|
||||
<textField isBlankWhenNull="true">
|
||||
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|
||||
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|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{Ben10}]]></textFieldExpression>
|
||||
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|
||||
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|
||||
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|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{BenDesc11}]]></textFieldExpression>
|
||||
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|
||||
<textField isBlankWhenNull="true">
|
||||
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|
||||
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|
||||
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|
||||
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|
||||
<textFieldExpression><![CDATA[$F{Ben11}]]></textFieldExpression>
|
||||
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|
||||
<textField isBlankWhenNull="true">
|
||||
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|
||||
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|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{BenDesc12}]]></textFieldExpression>
|
||||
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|
||||
<textField isBlankWhenNull="true">
|
||||
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|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{Ben12}]]></textFieldExpression>
|
||||
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|
||||
<textField isBlankWhenNull="true">
|
||||
<reportElement uuid="a8518713-b138-4ffe-aa62-0569c1d9a994" x="441" y="145" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{BenDesc13}]]></textFieldExpression>
|
||||
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|
||||
<textField isBlankWhenNull="true">
|
||||
<reportElement uuid="26483625-94c7-40e6-bde9-c9be49a05cb5" x="496" y="145" width="43" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{Ben13}]]></textFieldExpression>
|
||||
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|
||||
<textField isBlankWhenNull="true">
|
||||
<reportElement uuid="34bf0565-21e2-4f28-b7e9-8002d413c604" x="441" y="152" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{BenDesc14}]]></textFieldExpression>
|
||||
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|
||||
<textField isBlankWhenNull="true">
|
||||
<reportElement uuid="34649417-951f-406a-8ab8-b30d019d5017" x="496" y="152" width="43" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{Ben14}]]></textFieldExpression>
|
||||
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|
||||
<textField>
|
||||
<reportElement uuid="bb76fe99-8d7a-4089-b690-86be4c3c289d" x="371" y="83" width="63" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Dependent7}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="36c1c7bb-72e0-4cfe-bdf6-f2aeb9fd7a61" x="371" y="90" width="63" height="7"/>
|
||||
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||||
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||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
1.800.676.1182 (8am – 5pm)
|
||||
Online:
|
||||
www.bbstpa.com (24/7)
|
||||
This card does not guarantee
|
||||
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|
||||
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|
||||
<textFieldExpression><![CDATA[$F{ProviderLine1}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="25cbc687-a185-4894-97f4-11d57c8ad84c" x="206" y="21" width="70" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{ProviderLine2}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="527837e8-6ecb-4eba-8b3c-c1fee8e58b52" x="206" y="26" width="70" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{ProviderLine3}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="96e1ff12-6c27-4bd9-b706-050a283ea1a8" x="206" y="31" width="70" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{ProviderLine4}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="c209866f-c8db-455d-8118-ae0aa51204a8" x="206" y="40" width="70" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{ProviderLine5}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="22bcf3ce-6edc-4390-9c63-f169623fdf58" x="206" y="45" width="70" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{ProviderLine6}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="b8bd2df8-9ad2-4cde-9c67-b0e32425c00b" x="206" y="50" width="70" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{ProviderLine7}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="e5d86062-d78f-42b5-b578-cd14dcc071ca" x="206" y="55" width="70" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{ProviderLine8}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="8b542cf4-f0e7-4019-90cf-4b3a826184bf" x="206" y="64" width="70" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{ProviderLine9}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="b154a117-b385-4eac-b53a-51f349d2e9a6" x="206" y="69" width="70" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{ProviderLine10}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="d30067fe-8185-4854-a4da-615d8bb59f4a" x="206" y="76" width="70" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{ProviderLine11}]]></textFieldExpression>
|
||||
</textField>
|
||||
<staticText>
|
||||
<reportElement uuid="8bbea900-0c43-40d8-ad68-2f478aabd3c1" x="305" y="6" width="50" height="11" forecolor="#FFFFFF"/>
|
||||
<textElement>
|
||||
<font size="6" isUnderline="false" isPdfEmbedded="false"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Health Benefit Plan]]></text>
|
||||
</staticText>
|
||||
<rectangle>
|
||||
<reportElement uuid="4ecd4a82-edd1-4166-abf9-85d66ebb8b37" x="439" y="6" width="44" height="8" backcolor="#000000"/>
|
||||
</rectangle>
|
||||
<staticText>
|
||||
<reportElement uuid="4ddf1be3-c752-46e0-8197-f4d64b5484b0" x="442" y="6" width="41" height="11" forecolor="#FFFFFF"/>
|
||||
<textElement>
|
||||
<font size="6" isUnderline="false" isPdfEmbedded="false"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Medical Plan]]></text>
|
||||
</staticText>
|
||||
<rectangle>
|
||||
<reportElement uuid="1b74e177-da54-47c1-a801-ac0331d2cd11" x="146" y="97" width="133" height="49"/>
|
||||
</rectangle>
|
||||
<rectangle>
|
||||
<reportElement uuid="6a6d5769-ee7e-439f-8d65-7de67cdcb16b" x="146" y="89" width="53" height="8" backcolor="#000000"/>
|
||||
</rectangle>
|
||||
<staticText>
|
||||
<reportElement uuid="fa26d6b7-51d2-4f9e-9d05-9a4513c66eed" x="149" y="89" width="50" height="11" forecolor="#FFFFFF"/>
|
||||
<textElement>
|
||||
<font size="6" isUnderline="false" isPdfEmbedded="false"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Pharmacy Plan]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement uuid="5c39d2a5-fb6b-427a-ade9-f09c04c1144c" x="304" y="16" width="40" height="8"/>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Group #/ID:]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement uuid="26d1f156-d150-4837-9bba-1390a8199fb4" x="304" y="23" width="19" height="8"/>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Name:]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement uuid="8c0fbf41-d7b6-482b-996d-0b48ee2b0ff7" x="304" y="30" width="32" height="8"/>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Member #:]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement uuid="da2ecd13-2381-494c-9d69-745b2496587e" x="304" y="37" width="50" height="8"/>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Effective Date:]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement uuid="58ce6f59-01b7-457a-aee6-0be9d7ae868e" x="304" y="44" width="30" height="8"/>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Employer:]]></text>
|
||||
</staticText>
|
||||
<textField>
|
||||
<reportElement uuid="1361e8b7-6ea2-4f2b-a6fd-781b1fa521e8" x="346" y="16" width="88" height="8"/>
|
||||
<textElement>
|
||||
<font size="6"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{GroupNo}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="c2877613-bc27-4175-b080-5ab67f1d781c" x="323" y="23" width="111" height="8"/>
|
||||
<textElement>
|
||||
<font size="6"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{FullName}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="acea13af-f269-47da-b9cc-ba0ea22df29f" x="336" y="30" width="98" height="8"/>
|
||||
<textElement>
|
||||
<font size="6"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{PrimaryMBMemberKey}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="eaa738bf-1ced-4c86-8a31-9acc09a88abe" x="346" y="37" width="88" height="8"/>
|
||||
<textElement>
|
||||
<font size="6"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{MedicalEffDate}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="f559a5a0-cd09-46e5-9a6c-0b4458ddd8b2" x="334" y="44" width="100" height="15"/>
|
||||
<textElement>
|
||||
<font size="6"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Division}]]></textFieldExpression>
|
||||
</textField>
|
||||
<staticText>
|
||||
<reportElement uuid="cf1ce1ca-5cef-436c-b2d6-26bd3e1015b4" x="304" y="62" width="76" height="8"/>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Covered Dependents:]]></text>
|
||||
</staticText>
|
||||
<textField>
|
||||
<reportElement uuid="848389f8-98f1-41da-962e-cc29aeac91d1" x="305" y="69" width="63" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Dependent1}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="adee7873-b80c-4be4-9568-533471bab640" x="305" y="76" width="63" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Dependent2}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="53ed1fe8-89ed-42a2-98bb-9ad75418f543" x="305" y="83" width="63" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Dependent3}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="07c29443-8589-4e0f-a758-b69a34f38b07" x="305" y="90" width="63" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Dependent4}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="f906328d-53c5-4bb7-b4d4-4eba2261adfb" x="371" y="69" width="63" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Dependent5}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="a15671c2-f677-4def-9d42-1e0553d43010" x="371" y="76" width="63" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Dependent6}]]></textFieldExpression>
|
||||
</textField>
|
||||
<image scaleImage="RetainShape">
|
||||
<reportElement uuid="36c204c6-c2f7-4613-863f-332cf50ff6cc" x="202" y="100" width="76" height="21"/>
|
||||
<imageExpression><![CDATA["C:\\images\\FairRxOs.jpg"]]></imageExpression>
|
||||
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|
||||
<staticText>
|
||||
<reportElement uuid="40b57f3b-eeeb-4e38-857b-6bf290bb5ba5" x="148" y="101" width="25" height="8"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[RX Bin:]]></text>
|
||||
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|
||||
<staticText>
|
||||
<reportElement uuid="cc922142-d87a-4f04-b28b-413ad513e5e0" x="148" y="110" width="31" height="8"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[RX PCN:]]></text>
|
||||
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|
||||
<staticText>
|
||||
<reportElement uuid="4534f9a0-901a-402c-86ba-0b3109370e53" x="148" y="120" width="31" height="8"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[RX GRP:]]></text>
|
||||
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|
||||
<staticText>
|
||||
<reportElement uuid="abd7fb37-b19a-4691-869c-28a8c0b326ce" x="175" y="101" width="27" height="8"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[021841]]></text>
|
||||
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|
||||
<staticText>
|
||||
<reportElement uuid="84e6427e-950d-4c1a-877e-a342ec8009db" x="175" y="110" width="27" height="8"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[18000405]]></text>
|
||||
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|
||||
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|
||||
<reportElement uuid="709713dc-5f48-40dc-957c-9f015b376b41" x="175" y="120" width="49" height="8"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{RXGroupID}]]></textFieldExpression>
|
||||
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|
||||
<staticText>
|
||||
<reportElement uuid="00b86af7-1cba-4c7a-a78b-cb0ffa476f88" x="148" y="134" width="58" height="8"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Customer Service:]]></text>
|
||||
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|
||||
<textField>
|
||||
<reportElement uuid="0bce3d0c-c01b-4dfd-9638-19b94d75e73e" x="205" y="120" width="73" height="8"/>
|
||||
<textElement textAlignment="Center">
|
||||
<font size="5" isBold="true"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{WebUrl}]]></textFieldExpression>
|
||||
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|
||||
<textField>
|
||||
<reportElement uuid="1193b1ef-31e9-4c43-bb51-236b67c21c81" x="205" y="134" width="73" height="8"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{CustomerService}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="ded7012f-9a8d-4e97-876b-e34bc59241ef" x="441" y="61" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{BenDesc1}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="2a63ebda-6cf8-4f7a-927b-7cfa892e196d" x="496" y="61" width="43" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Ben1}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="aa510ad0-1a1e-4f24-b692-505794f4f159" x="441" y="68" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{BenDesc2}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="f501005d-ba2b-4747-92f4-1b3288d52f3a" x="496" y="68" width="43" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Ben2}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="fae8e590-1ffe-4e48-aef6-26a7e01c88af" x="441" y="75" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{BenDesc3}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="693746af-9ba2-4992-a270-397eaac04653" x="441" y="82" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{BenDesc4}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="27282b06-831e-40e5-93ee-ca77e3190dd5" x="496" y="75" width="43" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Ben3}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="fb423834-c0e0-4e68-8dd9-baa62eaa79a2" x="496" y="82" width="43" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Ben4}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="b0e3223c-1930-42db-82cc-d059e9b699b9" x="441" y="89" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{BenDesc5}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="bae3a6b6-1ca2-4ca6-9ba1-dd5fb9d1153f" x="496" y="110" width="43" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Ben8}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="8afd99dc-91b9-4416-806a-5f0e7eb83b1c" x="441" y="110" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{BenDesc8}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="c88d8d15-070c-42ad-999c-2e013f399992" x="441" y="103" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{BenDesc7}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="8bfb12fe-aef3-4397-a026-1fe43ebce05e" x="441" y="96" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{BenDesc6}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="43a569a5-7de5-427a-986f-bc4af746be06" x="496" y="96" width="43" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Ben6}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="a26646b1-152c-44f2-9486-1bd1590683c3" x="496" y="103" width="43" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Ben7}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="b572b49b-7b9a-4f68-b7ef-11dfadd2dae4" x="496" y="89" width="43" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Ben5}]]></textFieldExpression>
|
||||
</textField>
|
||||
<staticText>
|
||||
<reportElement uuid="71022051-2ec9-443d-81e2-5f7385ddeb7b" x="43" y="99" width="54" height="9"/>
|
||||
<textElement>
|
||||
<font fontName="Microsoft Sans Serif" size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Precertification]]></text>
|
||||
</staticText>
|
||||
<textField>
|
||||
<reportElement uuid="e414550a-a8d0-4313-9b57-e42ca3bb67ab" x="43" y="105" width="93" height="13"/>
|
||||
<textElement textAlignment="Left">
|
||||
<font fontName="Microsoft Sans Serif" size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA["Call Britton Benefit Services, LLC"]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="cc80102a-5811-4dc6-8d44-606d736bddc7" x="148" y="140" width="8" height="7"/>
|
||||
<textElement>
|
||||
<font fontName="Microsoft Sans Serif" size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{ProviderCode}.equals("1")?"S":""]]></textFieldExpression>
|
||||
</textField>
|
||||
<image hAlign="Center">
|
||||
<reportElement uuid="ea716b2c-5586-439d-8450-7302d49a5bd3" x="303" y="103" width="100" height="51"/>
|
||||
<imageExpression><![CDATA["C:\\images\\CignaLogo.png"]]></imageExpression>
|
||||
</image>
|
||||
<image>
|
||||
<reportElement uuid="7da52da7-1e66-4ba2-ae1c-8ba65b8797c3" x="191" y="147" width="189" height="8"/>
|
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<imageExpression><![CDATA["C:\\images\\LOGO - AFHC.jpg"]]></imageExpression>
|
||||
</image>
|
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<staticText>
|
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<reportElement uuid="4da0cb27-87c4-4f6c-8cde-4078ad224da6" x="41" y="147" width="160" height="8"/>
|
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<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Benefits are not insured by Cigna or affiliates]]></text>
|
||||
</staticText>
|
||||
<textField>
|
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<reportElement uuid="1d9c4616-e0bc-41e0-836d-8614c195b304" x="43" y="115" width="93" height="13"/>
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<textElement textAlignment="Left">
|
||||
<font fontName="Microsoft Sans Serif" size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA["1.800.676.1182"]]></textFieldExpression>
|
||||
</textField>
|
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<textField isBlankWhenNull="true">
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<reportElement uuid="e1932f2f-82d4-491b-a3a3-b8151ac539e2" x="496" y="117" width="43" height="7"/>
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<textElement>
|
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<font size="5"/>
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</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Ben9}]]></textFieldExpression>
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</textField>
|
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<textField isBlankWhenNull="true">
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<reportElement uuid="a064a7fd-da67-407f-838d-4d0a5b267843" x="441" y="117" width="52" height="7"/>
|
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<textElement>
|
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<font size="5"/>
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</textElement>
|
||||
<textFieldExpression><![CDATA[$F{BenDesc9}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField isBlankWhenNull="true">
|
||||
<reportElement uuid="ab233e66-e9cd-4224-8a46-bf57655ef118" x="441" y="124" width="52" height="7"/>
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<textElement>
|
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<font size="5"/>
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||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{BenDesc10}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField isBlankWhenNull="true">
|
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<reportElement uuid="286a851b-e65e-4fa2-bae1-161ed10a131c" x="496" y="124" width="43" height="7"/>
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<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Ben10}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField isBlankWhenNull="true">
|
||||
<reportElement uuid="920cb788-6331-4e5c-8f8f-f94c8be5a994" x="441" y="131" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{BenDesc11}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField isBlankWhenNull="true">
|
||||
<reportElement uuid="30aeb39b-dc3b-41a1-9d68-642c0f9bcb97" x="496" y="131" width="43" height="7"/>
|
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<textElement>
|
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<font size="5"/>
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</textElement>
|
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<textFieldExpression><![CDATA[$F{Ben11}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField isBlankWhenNull="true">
|
||||
<reportElement uuid="f8c77d6d-09fd-4b82-aae0-e9d6fdc2d30f" x="441" y="138" width="52" height="7"/>
|
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<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{BenDesc12}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField isBlankWhenNull="true">
|
||||
<reportElement uuid="d29a0a9b-974d-43c6-bb2a-9a299abffc63" x="496" y="138" width="43" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Ben12}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField isBlankWhenNull="true">
|
||||
<reportElement uuid="a8518713-b138-4ffe-aa62-0569c1d9a994" x="441" y="145" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{BenDesc13}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField isBlankWhenNull="true">
|
||||
<reportElement uuid="26483625-94c7-40e6-bde9-c9be49a05cb5" x="496" y="145" width="43" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Ben13}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField isBlankWhenNull="true">
|
||||
<reportElement uuid="34bf0565-21e2-4f28-b7e9-8002d413c604" x="441" y="152" width="52" height="7"/>
|
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<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{BenDesc14}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField isBlankWhenNull="true">
|
||||
<reportElement uuid="34649417-951f-406a-8ab8-b30d019d5017" x="496" y="152" width="43" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Ben14}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="bb76fe99-8d7a-4089-b690-86be4c3c289d" x="371" y="83" width="63" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Dependent7}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="36c1c7bb-72e0-4cfe-bdf6-f2aeb9fd7a61" x="371" y="90" width="63" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Dependent8}]]></textFieldExpression>
|
||||
</textField>
|
||||
</band>
|
||||
</detail>
|
||||
<columnFooter>
|
||||
<band splitType="Stretch"/>
|
||||
</columnFooter>
|
||||
<pageFooter>
|
||||
<band splitType="Stretch"/>
|
||||
</pageFooter>
|
||||
<summary>
|
||||
<band splitType="Stretch"/>
|
||||
</summary>
|
||||
</jasperReport>
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||||
@@ -0,0 +1,109 @@
|
||||
<?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">
|
||||
<!-- <parameter name="jasper_batch_id" class="java.lang.String" /> -->
|
||||
<parameter name="baseDir" class="java.lang.String" />
|
||||
<parameter name="cardTemplate" class="java.lang.String" />
|
||||
<field name="currentMemberCard" class="java.lang.Object">
|
||||
<fieldDescription><![CDATA[_THIS]]></fieldDescription>
|
||||
</field>
|
||||
<!-- <parameter name="employer_logo" class="java.io.InputStream"/>
|
||||
<parameter name="employer_logo_ar" class="java.lang.Float"/>
|
||||
<parameter name="network_logo" class="java.io.InputStream"/> -->
|
||||
<!-- <queryString>
|
||||
<![CDATA[Select family_id From id_card_print_data Where jasper_batch_id = $P{jasper_batch_id}]]>
|
||||
</queryString> -->
|
||||
<background>
|
||||
<band splitType="Stretch"/>
|
||||
</background>
|
||||
<title>
|
||||
<band splitType="Stretch"/>
|
||||
</title>
|
||||
<pageHeader>
|
||||
<band splitType="Stretch"/>
|
||||
</pageHeader>
|
||||
<columnHeader>
|
||||
<band splitType="Stretch"/>
|
||||
</columnHeader>
|
||||
<!-- <group name="CardGroup" isStartNewPage="true">
|
||||
<groupExpression><![CDATA[$F{Card_ID}]]></groupExpression>
|
||||
<groupHeader>
|
||||
<band height="153">
|
||||
<subreport>
|
||||
<reportElement x="0" y="0" width="243" height="153" isPrintInFirstWholePage="true" uuid="4a5b91ca-ebdb-45be-8c16-f6ab6529dae7"/>
|
||||
<parametersMapExpression><![CDATA[$P{REPORT_PARAMETERS_MAP}]]></parametersMapExpression>
|
||||
<dataSourceExpression><![CDATA[new net.sf.jasperreports.engine.data.JRBeanCollectionDataSource($P{memberCardsDataList})]]></dataSourceExpression>
|
||||
<subreportExpression><![CDATA[$P{baseDir} + "/" + $P{cardTemplate} + "/" + $P{cardTemplate} + "Front.jasper"]]></subreportExpression>
|
||||
</subreport>
|
||||
</band>
|
||||
</groupHeader>
|
||||
<groupFooter>
|
||||
<band height="153">
|
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<subreport>
|
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<reportElement x="0" y="0" width="243" height="153" isPrintInFirstWholePage="true" uuid="4a5b91ca-ebdb-45be-8c16-f6ab6529dae7"/>
|
||||
<parametersMapExpression><![CDATA[$P{REPORT_PARAMETERS_MAP}]]></parametersMapExpression>
|
||||
<dataSourceExpression><![CDATA[new net.sf.jasperreports.engine.data.JRBeanCollectionDataSource($P{memberCardsDataList})]]></dataSourceExpression>
|
||||
<subreportExpression><![CDATA[$P{baseDir} + "/" + $P{cardTemplate} + "/" + $P{cardTemplate} + "Back.jasper"]]></subreportExpression>
|
||||
</subreport>
|
||||
</band>
|
||||
</groupFooter>
|
||||
</group> -->
|
||||
<!-- <group name="CardFront" isStartNewPage="true">
|
||||
<groupExpression><![CDATA[$V{REPORT_COUNT}]]></groupExpression>
|
||||
<groupHeader>
|
||||
<band height="153">
|
||||
<subreport>
|
||||
<reportElement x="0" y="0" width="243" height="153" isPrintInFirstWholePage="true" uuid="4a5b91ca-ebdb-45be-8c16-f6ab6529dae7"/>
|
||||
<parametersMapExpression><![CDATA[$P{REPORT_PARAMETERS_MAP}]]></parametersMapExpression>
|
||||
<dataSourceExpression><![CDATA[new net.sf.jasperreports.engine.data.JRBeanCollectionDataSource($P{memberCardsDataList})]]></dataSourceExpression>
|
||||
<subreportExpression><![CDATA[$P{baseDir} + "/" + $P{cardTemplate} + "/" + $P{cardTemplate} + "Front.jasper"]]></subreportExpression>
|
||||
</subreport>
|
||||
</band>
|
||||
</groupHeader>
|
||||
</group>
|
||||
<group name="CardBack" isStartNewPage="true">
|
||||
<groupExpression><![CDATA[$V{REPORT_COUNT}]]></groupExpression>
|
||||
<groupHeader>
|
||||
<band height="153">
|
||||
<subreport>
|
||||
<reportElement x="0" y="0" width="243" height="153" isPrintInFirstWholePage="true" uuid="4a5b91ca-ebdb-45be-8c16-f6ab6529dae7"/>
|
||||
<parametersMapExpression><![CDATA[$P{REPORT_PARAMETERS_MAP}]]></parametersMapExpression>
|
||||
<dataSourceExpression><![CDATA[new net.sf.jasperreports.engine.data.JRBeanCollectionDataSource($P{memberCardsDataList})]]></dataSourceExpression>
|
||||
<subreportExpression><![CDATA[$P{baseDir} + "/" + $P{cardTemplate} + "/" + $P{cardTemplate} + "Back.jasper"]]></subreportExpression>
|
||||
</subreport>
|
||||
</band>
|
||||
</groupHeader>
|
||||
</group> -->
|
||||
<detail>
|
||||
<band height="153" splitType="Stretch">
|
||||
<!-- Subreport 1: Front Side -->
|
||||
<subreport>
|
||||
<reportElement x="0" y="0" width="243" height="153"/>
|
||||
<parametersMapExpression><![CDATA[$P{REPORT_PARAMETERS_MAP}]]></parametersMapExpression>
|
||||
<!-- <dataSourceExpression><![CDATA[new net.sf.jasperreports.engine.data.JRBeanCollectionDataSource($P{memberCardsDataList})]]></dataSourceExpression> -->
|
||||
<dataSourceExpression><![CDATA[new net.sf.jasperreports.engine.data.JRBeanCollectionDataSource(java.util.Collections.singletonList($F{currentMemberCard}))]]></dataSourceExpression>
|
||||
<!-- <dataSourceExpression><![CDATA[((net.sf.jasperreports.engine.data.JRBeanCollectionDataSource)$F{memberCardData}).cloneDataSource()]]></dataSourceExpression> -->
|
||||
<subreportExpression><![CDATA[$P{baseDir} + "/" + $P{cardTemplate} + "/" + $P{cardTemplate} + "Front.jasper"]]></subreportExpression>
|
||||
</subreport>
|
||||
</band>
|
||||
<band height="153" splitType="Stretch">
|
||||
<subreport>
|
||||
<reportElement x="0" y="0" width="243" height="153"/>
|
||||
<parametersMapExpression><![CDATA[$P{REPORT_PARAMETERS_MAP}]]></parametersMapExpression>
|
||||
<!-- <dataSourceExpression><![CDATA[new net.sf.jasperreports.engine.data.JRBeanCollectionDataSource($P{memberCardsDataList})]]></dataSourceExpression> -->
|
||||
<dataSourceExpression><![CDATA[new net.sf.jasperreports.engine.data.JRBeanCollectionDataSource(java.util.Collections.singletonList($F{currentMemberCard}))]]></dataSourceExpression>
|
||||
<!-- <dataSourceExpression><![CDATA[((net.sf.jasperreports.engine.data.JRBeanCollectionDataSource)$P{REPORT_DATA_SOURCE}).cloneDataSource()]]></dataSourceExpression> -->
|
||||
<subreportExpression><![CDATA[$P{baseDir} + "/" + $P{cardTemplate} + "/" + $P{cardTemplate} + "Back.jasper"]]></subreportExpression>
|
||||
</subreport>
|
||||
</band>
|
||||
</detail>
|
||||
<columnFooter>
|
||||
<band splitType="Stretch"/>
|
||||
</columnFooter>
|
||||
<pageFooter>
|
||||
<band splitType="Stretch"/>
|
||||
</pageFooter>
|
||||
<summary>
|
||||
<band splitType="Stretch"/>
|
||||
</summary>
|
||||
</jasperReport>
|
||||
@@ -0,0 +1,54 @@
|
||||
<?xml version="1.0" encoding="UTF-8"?>
|
||||
<!-- Created with Jaspersoft Studio version 7.0.3.final using JasperReports Library version 6.1.1 -->
|
||||
<jasperReport xmlns="http://jasperreports.sourceforge.net/jasperreports" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://jasperreports.sourceforge.net/jasperreports http://jasperreports.sourceforge.net/xsd/jasperreport.xsd" name="IDCard" pageWidth="243" pageHeight="153" columnWidth="243" leftMargin="0" rightMargin="0" topMargin="0" bottomMargin="0" uuid="477346fd-960f-44d2-84f5-bd25202741fc">
|
||||
<parameter name="family_id" class="java.lang.String" />
|
||||
<parameter name="baseDir" class="java.lang.String" />
|
||||
<parameter name="cardTemplate" class="java.lang.String" />
|
||||
<queryString><![CDATA[SELECT 1 AS dummy_field]]></queryString>
|
||||
<background>
|
||||
<band splitType="Stretch"/>
|
||||
</background>
|
||||
<title>
|
||||
<band splitType="Stretch"/>
|
||||
</title>
|
||||
<pageHeader>
|
||||
<band splitType="Stretch"/>
|
||||
</pageHeader>
|
||||
<columnHeader>
|
||||
<band splitType="Stretch"/>
|
||||
</columnHeader>
|
||||
<detail>
|
||||
<band height="153" splitType="Immediate">
|
||||
<subreport>
|
||||
<reportElement x="0" y="0" width="243" height="153" uuid="4a5b91ca-ebdb-45be-8c16-f6ab6529dae7"/>
|
||||
<parametersMapExpression><![CDATA[$P{REPORT_PARAMETERS_MAP}]]></parametersMapExpression>
|
||||
<subreportParameter name="family_id">
|
||||
<subreportParameterExpression><![CDATA[$P{family_id}]]></subreportParameterExpression>
|
||||
</subreportParameter>
|
||||
<connectionExpression><![CDATA[$P{REPORT_CONNECTION}]]></connectionExpression>
|
||||
<subreportExpression><![CDATA[$P{baseDir} + "/" + $P{cardTemplate} + "/" + $P{cardTemplate} + "Front.jasper"]]></subreportExpression>
|
||||
</subreport>
|
||||
</band>
|
||||
<band height="153" splitType="Immediate">
|
||||
<property name="isStartNewPage" value="true"/>
|
||||
<subreport>
|
||||
<reportElement x="0" y="0" width="243" height="153" uuid="7445dc43-933e-4b42-bef0-1772e9b85ba4"/>
|
||||
<parametersMapExpression><![CDATA[$P{REPORT_PARAMETERS_MAP}]]></parametersMapExpression>
|
||||
<subreportParameter name="family_id">
|
||||
<subreportParameterExpression><![CDATA[$P{family_id}]]></subreportParameterExpression>
|
||||
</subreportParameter>
|
||||
<connectionExpression><![CDATA[$P{REPORT_CONNECTION}]]></connectionExpression>
|
||||
<subreportExpression><![CDATA[$P{baseDir} + "/" + $P{cardTemplate} + "/" + $P{cardTemplate} + "Back.jasper"]]></subreportExpression>
|
||||
</subreport>
|
||||
</band>
|
||||
</detail>
|
||||
<columnFooter>
|
||||
<band splitType="Stretch"/>
|
||||
</columnFooter>
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<field name="provider_line_11" class="java.lang.String"/>
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<field name="claim_to_2" class="java.lang.String"/>
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<field name="claim_to_3" class="java.lang.String"/>
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<field name="claim_to_4" class="java.lang.String"/>
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<field name="rx_group" class="java.lang.String"/>
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<field name="customer_service" class="java.lang.String"/>
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<field name="web_url" class="java.lang.String"/>
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<field name="benefit_1" class="java.lang.String"/>
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<field name="benefit_2" class="java.lang.String"/>
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<field name="benefit_4" class="java.lang.String"/>
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<field name="benefit_9" class="java.lang.String"/>
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<field name="benefit_11" class="java.lang.String"/>
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<field name="benefit_desc_12" class="java.lang.String"/>
|
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<field name="benefit_12" class="java.lang.String"/>
|
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<field name="benefit_desc_13" class="java.lang.String"/>
|
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<field name="benefit_13" class="java.lang.String"/>
|
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<field name="benefit_desc_14" class="java.lang.String"/>
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<field name="benefit_14" class="java.lang.String"/>
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<font size="6" isUnderline="false" isPdfEmbedded="false"/>
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|
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Britton Benefit Services, LLC
|
||||
1.800.676.1182]]></text>
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<font size="5"/>
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<textElement verticalAlignment="Middle">
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<font size="5"/>
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<textElement verticalAlignment="Middle">
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<font size="5"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{claim_to_3}]]></textFieldExpression>
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</textField>
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<textField>
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<reportElement x="112" y="26" width="52" height="7" uuid="e957833e-54e9-4145-b41b-1a72d0ddadf3"/>
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<textElement verticalAlignment="Middle">
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<font size="5"/>
|
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</textElement>
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<textFieldExpression><![CDATA[$F{claim_to_4}]]></textFieldExpression>
|
||||
</textField>
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<textField>
|
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<reportElement x="112" y="35" width="52" height="7" uuid="a49dbbb0-791e-4930-b99a-dfa39ee3e3d9"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{claim_to_5}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
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<reportElement x="112" y="40" width="52" height="7" uuid="0b0c6791-76a7-4a76-9695-59fff6544f8f"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{claim_to_6}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="112" y="45" width="52" height="7" uuid="f1ce64f0-b5fd-499e-a419-e0ef4b1e32e0"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{claim_to_7}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="112" y="50" width="52" height="7" uuid="2abffded-f4c1-4bfd-bf83-95550d8e1aa3"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{claim_to_8}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="112" y="59" width="52" height="7" uuid="ed2733a7-5906-4544-a4a6-1e4465c94f70"/>
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||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{claim_to_9}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
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<reportElement x="112" y="65" width="52" height="7" uuid="cc95f964-4572-46b1-b092-964c9f19e7f6"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{claim_to_10}]]></textFieldExpression>
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||||
</textField>
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||||
<textField>
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||||
<reportElement x="112" y="71" width="52" height="7" uuid="6becfb6d-cb5b-4262-991d-e8d5bc9153c1"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{claim_to_11}]]></textFieldExpression>
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||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="166" y="11" width="70" height="7" uuid="94749044-5ec6-4eb4-8f6d-e52ce5e215da"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{provider_line_1}]]></textFieldExpression>
|
||||
</textField>
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||||
<textField>
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||||
<reportElement x="166" y="16" width="70" height="7" uuid="25cbc687-a185-4894-97f4-11d57c8ad84c"/>
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<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{provider_line_2}]]></textFieldExpression>
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||||
</textField>
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||||
<textField>
|
||||
<reportElement x="166" y="21" width="70" height="7" uuid="527837e8-6ecb-4eba-8b3c-c1fee8e58b52"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{provider_line_3}]]></textFieldExpression>
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||||
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||||
<textField>
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<reportElement x="166" y="26" width="70" height="7" uuid="96e1ff12-6c27-4bd9-b706-050a283ea1a8"/>
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<textElement>
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||||
<font size="5"/>
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||||
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||||
<textFieldExpression><![CDATA[$F{provider_line_4}]]></textFieldExpression>
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||||
<textField>
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<reportElement x="166" y="35" width="70" height="7" uuid="c209866f-c8db-455d-8118-ae0aa51204a8"/>
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<font size="5"/>
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<textFieldExpression><![CDATA[$F{provider_line_5}]]></textFieldExpression>
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<font size="5"/>
|
||||
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|
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<textFieldExpression><![CDATA[$F{provider_line_6}]]></textFieldExpression>
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||||
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<font size="5"/>
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||||
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<textFieldExpression><![CDATA[$F{provider_line_7}]]></textFieldExpression>
|
||||
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||||
<textField>
|
||||
<reportElement x="166" y="50" width="70" height="7" uuid="e5d86062-d78f-42b5-b578-cd14dcc071ca"/>
|
||||
<textElement>
|
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<font size="5"/>
|
||||
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|
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<textFieldExpression><![CDATA[$F{provider_line_8}]]></textFieldExpression>
|
||||
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|
||||
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|
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|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{provider_line_9}]]></textFieldExpression>
|
||||
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||||
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<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{provider_line_10}]]></textFieldExpression>
|
||||
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|
||||
<textField>
|
||||
<reportElement x="166" y="71" width="70" height="7" uuid="d30067fe-8185-4854-a4da-615d8bb59f4a"/>
|
||||
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|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{provider_line_11}]]></textFieldExpression>
|
||||
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|
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|
||||
<font size="6" isUnderline="false" isPdfEmbedded="false"/>
|
||||
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|
||||
<text><![CDATA[Medical Plan]]></text>
|
||||
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|
||||
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|
||||
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|
||||
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|
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|
||||
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|
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|
||||
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|
||||
<font size="6" isUnderline="false" isPdfEmbedded="false"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Pharmacy Plan]]></text>
|
||||
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|
||||
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|
||||
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|
||||
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|
||||
<datasetRun subDataset="LogoDataset" uuid="1fed8c49-7871-4654-bedb-a4ffa01cc617">
|
||||
<datasetParameter name="LOGO_FILENAME">
|
||||
<datasetParameterExpression><![CDATA[$F{employer_logo_filename}]]></datasetParameterExpression>
|
||||
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|
||||
<dataSourceExpression><![CDATA[new net.sf.jasperreports.engine.data.JRBeanCollectionDataSource($P{employerLogosList})]]></dataSourceExpression>
|
||||
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|
||||
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|
||||
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|
||||
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|
||||
<imageExpression><![CDATA[$F{image_stream}]]></imageExpression>
|
||||
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|
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|
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|
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|
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|
||||
<font size="5" isBold="true"/>
|
||||
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|
||||
<text><![CDATA[RX Bin:]]></text>
|
||||
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|
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|
||||
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|
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|
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<font size="5" isBold="true"/>
|
||||
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|
||||
<text><![CDATA[RX PCN:]]></text>
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||||
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|
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|
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|
||||
<font size="5" isBold="true"/>
|
||||
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|
||||
<text><![CDATA[RX GRP:]]></text>
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||||
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|
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|
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<font size="5" isBold="true"/>
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||||
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|
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|
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|
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@@ -0,0 +1,234 @@
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|
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|
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|
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|
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|
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|
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|
||||
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|
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|
||||
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|
||||
Online:
|
||||
www.bbstpa.com (24/7)
|
||||
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||||
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|
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|
||||
Britton Benefit Services, LLC
|
||||
604 North Queen Street
|
||||
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|
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|
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<font size="6" isBold="true"/>
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<text><![CDATA[Member Id:]]></text>
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<text><![CDATA[Effective Date:]]></text>
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|
||||
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|
||||
Online:
|
||||
www.bbstpa.com (24/7)
|
||||
This card does not guarantee
|
||||
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|
||||
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||||
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||||
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|
||||
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|
||||
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|
||||
<textElement>
|
||||
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|
||||
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|
||||
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|
||||
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|
||||
<staticText>
|
||||
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|
||||
<textElement>
|
||||
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|
||||
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|
||||
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|
||||
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|
||||
<staticText>
|
||||
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|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
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|
||||
<text><![CDATA[Policy #:]]></text>
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||||
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|
||||
<staticText>
|
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|
||||
<textElement>
|
||||
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|
||||
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|
||||
<text><![CDATA[Effective Date:]]></text>
|
||||
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|
||||
<staticText>
|
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|
||||
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|
||||
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|
||||
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|
||||
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|
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|
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|
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|
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|
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|
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|
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|
||||
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|
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|
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|
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<textField>
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|
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<textElement>
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<font size="6"/>
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<textElement>
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|
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|
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|
||||
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|
||||
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|
||||
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|
||||
<textField>
|
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|
||||
<textElement>
|
||||
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|
||||
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|
||||
<textFieldExpression><![CDATA[$F{dependent_2}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
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|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{dependent_3}]]></textFieldExpression>
|
||||
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|
||||
<textField>
|
||||
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|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{dependent_4}]]></textFieldExpression>
|
||||
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|
||||
<textField>
|
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<font size="5"/>
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||||
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|
||||
<textFieldExpression><![CDATA[$F{dependent_5}]]></textFieldExpression>
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||||
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||||
<textField>
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||||
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||||
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|
||||
<textFieldExpression><![CDATA[$F{dependent_6}]]></textFieldExpression>
|
||||
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<image scaleImage="RetainShape">
|
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||||
<imageExpression><![CDATA["./../../images/FairRxOs.jpg"]]></imageExpression>
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<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
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|
||||
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||||
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<staticText>
|
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<textElement>
|
||||
<font size="5" isBold="true"/>
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||||
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|
||||
<text><![CDATA[RX PCN:]]></text>
|
||||
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|
||||
<staticText>
|
||||
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<textElement>
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||||
<font size="5" isBold="true"/>
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||||
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||||
<text><![CDATA[RX GRP:]]></text>
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||||
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|
||||
<staticText>
|
||||
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||||
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<font size="5" isBold="true"/>
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||||
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|
||||
<text><![CDATA[021841]]></text>
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||||
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||||
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<property name="com.jaspersoft.studio.unit.width" value="px"/>
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||||
<property name="com.jaspersoft.studio.unit.x" value="px"/>
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||||
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|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
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||||
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|
||||
<text><![CDATA[18000405]]></text>
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||||
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|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{rx_group}]]></textFieldExpression>
|
||||
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|
||||
<staticText>
|
||||
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|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
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|
||||
<text><![CDATA[Member Services:]]></text>
|
||||
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|
||||
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|
||||
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|
||||
<font size="5" isBold="true"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{web_url}]]></textFieldExpression>
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||||
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|
||||
<font size="5" isBold="true"/>
|
||||
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|
||||
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|
||||
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|
||||
<textField>
|
||||
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|
||||
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|
||||
<font size="5"/>
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||||
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|
||||
<textFieldExpression><![CDATA[$F{benefit_desc_1}]]></textFieldExpression>
|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
<textField>
|
||||
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||||
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|
||||
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|
||||
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|
||||
<textFieldExpression><![CDATA[$F{benefit_desc_2}]]></textFieldExpression>
|
||||
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|
||||
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|
||||
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||||
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|
||||
<font size="5"/>
|
||||
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|
||||
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||||
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||||
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||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{benefit_desc_4}]]></textFieldExpression>
|
||||
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|
||||
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|
||||
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|
||||
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|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{benefit_3}]]></textFieldExpression>
|
||||
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|
||||
<textField>
|
||||
<reportElement x="184" y="86" width="46" height="7" uuid="fb423834-c0e0-4e68-8dd9-baa62eaa79a2"/>
|
||||
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|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{benefit_4}]]></textFieldExpression>
|
||||
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|
||||
<textField>
|
||||
<reportElement x="138" y="92" width="46" height="7" uuid="b0e3223c-1930-42db-82cc-d059e9b699b9"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{benefit_desc_5}]]></textFieldExpression>
|
||||
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|
||||
<textField>
|
||||
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|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{benefit_8}]]></textFieldExpression>
|
||||
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|
||||
<textField>
|
||||
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|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{benefit_desc_8}]]></textFieldExpression>
|
||||
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|
||||
<textField>
|
||||
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|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{benefit_desc_7}]]></textFieldExpression>
|
||||
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|
||||
<textField>
|
||||
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|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{benefit_desc_6}]]></textFieldExpression>
|
||||
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|
||||
<textField>
|
||||
<reportElement x="184" y="98" width="46" height="7" uuid="43a569a5-7de5-427a-986f-bc4af746be06"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{benefit_6}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="184" y="104" width="46" height="7" uuid="a26646b1-152c-44f2-9486-1bd1590683c3"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{benefit_7}]]></textFieldExpression>
|
||||
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|
||||
<textField>
|
||||
<reportElement x="184" y="92" width="46" height="7" uuid="b572b49b-7b9a-4f68-b7ef-11dfadd2dae4"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{benefit_5}]]></textFieldExpression>
|
||||
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|
||||
<rectangle>
|
||||
<reportElement x="136" y="130" width="96" height="16" uuid="002ddfe1-3306-4180-a53f-2e73a62166bd"/>
|
||||
</rectangle>
|
||||
<rectangle>
|
||||
<reportElement x="136" y="122" width="47" height="8" backcolor="#000000" uuid="db5ddcca-b080-4f85-a149-213bfee625b1"/>
|
||||
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|
||||
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|
||||
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|
||||
<textElement>
|
||||
<font size="6" isBold="true" isUnderline="false" isPdfEmbedded="false"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Dental Plan]]></text>
|
||||
</staticText>
|
||||
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|
||||
<reportElement x="138" y="131" width="92" height="13" uuid="065b6096-3261-4ea9-aedd-51c5d7687cc0"/>
|
||||
<textElement>
|
||||
<font size="7"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{dental_coverage}]]></textFieldExpression>
|
||||
</textField>
|
||||
</band>
|
||||
</detail>
|
||||
<columnFooter>
|
||||
<band splitType="Stretch"/>
|
||||
</columnFooter>
|
||||
<pageFooter>
|
||||
<band splitType="Stretch"/>
|
||||
</pageFooter>
|
||||
<summary>
|
||||
<band splitType="Stretch"/>
|
||||
</summary>
|
||||
</jasperReport>
|
||||
@@ -0,0 +1,871 @@
|
||||
<?xml version="1.0" encoding="UTF-8"?>
|
||||
<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="612" pageHeight="792" columnWidth="572" leftMargin="20" rightMargin="20" topMargin="20" bottomMargin="20" uuid="477346fd-960f-44d2-84f5-bd25202741fc">
|
||||
<property name="ireport.zoom" value="5.0"/>
|
||||
<property name="ireport.x" value="1150"/>
|
||||
<property name="ireport.y" value="0"/>
|
||||
<parameter name="FamilyId" class="java.lang.String">
|
||||
<defaultValueExpression><![CDATA["198621286"]]></defaultValueExpression>
|
||||
</parameter>
|
||||
<parameter name="BackImage" class="java.lang.String">
|
||||
<defaultValueExpression><![CDATA["C:\\images\\All_3_Logo.png"]]></defaultValueExpression>
|
||||
</parameter>
|
||||
<queryString>
|
||||
<![CDATA[Select * From HLIDCardEggData Where FamilyId = $P{FamilyId}]]>
|
||||
</queryString>
|
||||
<field name="ID" class="java.lang.Integer"/>
|
||||
<field name="Facility" class="java.lang.String"/>
|
||||
<field name="Division" class="java.lang.String"/>
|
||||
<field name="FullName" class="java.lang.String"/>
|
||||
<field name="SSN" class="java.lang.String"/>
|
||||
<field name="MedicalCoverage" class="java.lang.String"/>
|
||||
<field name="MedicalEffDate" class="java.lang.String"/>
|
||||
<field name="MedicalGroupNum" class="java.lang.String"/>
|
||||
<field name="DentalCoverage" class="java.lang.String"/>
|
||||
<field name="DentalEffDate" class="java.lang.String"/>
|
||||
<field name="DentalGroupNum" class="java.lang.String"/>
|
||||
<field name="CardType" class="java.lang.String"/>
|
||||
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|
||||
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|
||||
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||||
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||||
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||||
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||||
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||||
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||||
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||||
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||||
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||||
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||||
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||||
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|
||||
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|
||||
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|
||||
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||||
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|
||||
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|
||||
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||||
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||||
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||||
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||||
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||||
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||||
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|
||||
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|
||||
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||||
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|
||||
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|
||||
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||||
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||||
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||||
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||||
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||||
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||||
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||||
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||||
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||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
<field name="Ben6" class="java.lang.String"/>
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||||
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||||
<field name="Ben7" class="java.lang.String"/>
|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
<field name="Ben10" class="java.lang.String"/>
|
||||
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|
||||
<field name="Ben11" class="java.lang.String"/>
|
||||
<field name="BenDesc12" class="java.lang.String"/>
|
||||
<field name="Ben12" class="java.lang.String"/>
|
||||
<field name="BenDesc13" class="java.lang.String"/>
|
||||
<field name="Ben13" class="java.lang.String"/>
|
||||
<field name="BenDesc14" class="java.lang.String"/>
|
||||
<field name="Ben14" class="java.lang.String"/>
|
||||
<field name="PLPlanKey" class="java.lang.Integer"/>
|
||||
<field name="PrimaryMBMemberKey" class="java.lang.Integer"/>
|
||||
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|
||||
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|
||||
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|
||||
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|
||||
<field name="Precert3" class="java.lang.String"/>
|
||||
<field name="Precert4" class="java.lang.String"/>
|
||||
<field name="Precert5" class="java.lang.String"/>
|
||||
<field name="Precert6" class="java.lang.String"/>
|
||||
<field name="Dependent7" class="java.lang.String"/>
|
||||
<field name="Dependent8" class="java.lang.String"/>
|
||||
<background>
|
||||
<band splitType="Stretch"/>
|
||||
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|
||||
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|
||||
<band splitType="Stretch"/>
|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
<band splitType="Stretch"/>
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||||
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||||
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||||
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||||
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||||
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||||
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||||
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||||
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||||
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||||
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||||
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||||
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||||
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|
||||
Britton Benefit Services, LLC
|
||||
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||||
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||||
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||||
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||||
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|
||||
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|
||||
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|
||||
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||||
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||||
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||||
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||||
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||||
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||||
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||||
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||||
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|
||||
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|
||||
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||||
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||||
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||||
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||||
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||||
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||||
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||||
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||||
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|
||||
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||||
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|
||||
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||||
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|
||||
<reportElement uuid="4ecd4a82-edd1-4166-abf9-85d66ebb8b37" x="41" y="6" width="44" height="8" backcolor="#000000"/>
|
||||
</rectangle>
|
||||
<staticText>
|
||||
<reportElement uuid="4ddf1be3-c752-46e0-8197-f4d64b5484b0" x="44" y="6" width="41" height="11" forecolor="#FFFFFF"/>
|
||||
<textElement>
|
||||
<font size="6" isUnderline="false" isPdfEmbedded="false"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Medical Plan]]></text>
|
||||
</staticText>
|
||||
<rectangle>
|
||||
<reportElement uuid="1b74e177-da54-47c1-a801-ac0331d2cd11" x="146" y="97" width="133" height="49"/>
|
||||
</rectangle>
|
||||
<rectangle>
|
||||
<reportElement uuid="6a6d5769-ee7e-439f-8d65-7de67cdcb16b" x="146" y="89" width="53" height="8" backcolor="#000000"/>
|
||||
</rectangle>
|
||||
<staticText>
|
||||
<reportElement uuid="fa26d6b7-51d2-4f9e-9d05-9a4513c66eed" x="149" y="89" width="50" height="11" forecolor="#FFFFFF"/>
|
||||
<textElement>
|
||||
<font size="6" isUnderline="false" isPdfEmbedded="false"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Pharmacy Plan]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement uuid="5c39d2a5-fb6b-427a-ade9-f09c04c1144c" x="304" y="16" width="40" height="8"/>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Group #/ID:]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement uuid="26d1f156-d150-4837-9bba-1390a8199fb4" x="304" y="23" width="19" height="8"/>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Name:]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement uuid="8c0fbf41-d7b6-482b-996d-0b48ee2b0ff7" x="304" y="30" width="32" height="8"/>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Member #:]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement uuid="da2ecd13-2381-494c-9d69-745b2496587e" x="304" y="37" width="50" height="8"/>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Effective Date:]]></text>
|
||||
</staticText>
|
||||
<textField>
|
||||
<reportElement uuid="1361e8b7-6ea2-4f2b-a6fd-781b1fa521e8" x="346" y="16" width="88" height="8"/>
|
||||
<textElement>
|
||||
<font size="6"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{GroupNo}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="c2877613-bc27-4175-b080-5ab67f1d781c" x="323" y="23" width="111" height="8"/>
|
||||
<textElement>
|
||||
<font size="6"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{FullName}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="acea13af-f269-47da-b9cc-ba0ea22df29f" x="336" y="30" width="98" height="8"/>
|
||||
<textElement>
|
||||
<font size="6"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{PrimaryMBMemberKey}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="eaa738bf-1ced-4c86-8a31-9acc09a88abe" x="346" y="37" width="88" height="8"/>
|
||||
<textElement>
|
||||
<font size="6"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{MedicalEffDate}]]></textFieldExpression>
|
||||
</textField>
|
||||
<staticText>
|
||||
<reportElement uuid="cf1ce1ca-5cef-436c-b2d6-26bd3e1015b4" x="304" y="62" width="76" height="8"/>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Covered Dependents:]]></text>
|
||||
</staticText>
|
||||
<textField>
|
||||
<reportElement uuid="848389f8-98f1-41da-962e-cc29aeac91d1" x="305" y="69" width="63" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Dependent1}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="adee7873-b80c-4be4-9568-533471bab640" x="305" y="76" width="63" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Dependent2}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="53ed1fe8-89ed-42a2-98bb-9ad75418f543" x="305" y="83" width="63" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Dependent3}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="07c29443-8589-4e0f-a758-b69a34f38b07" x="305" y="90" width="63" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Dependent4}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="f906328d-53c5-4bb7-b4d4-4eba2261adfb" x="371" y="69" width="63" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Dependent5}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="a15671c2-f677-4def-9d42-1e0553d43010" x="371" y="76" width="63" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Dependent6}]]></textFieldExpression>
|
||||
</textField>
|
||||
<image scaleImage="RetainShape" hAlign="Center">
|
||||
<reportElement uuid="36c204c6-c2f7-4613-863f-332cf50ff6cc" x="202" y="100" width="76" height="21"/>
|
||||
<imageExpression><![CDATA["C:\\images\\HealthBusLogo.jpg"]]></imageExpression>
|
||||
</image>
|
||||
<staticText>
|
||||
<reportElement uuid="40b57f3b-eeeb-4e38-857b-6bf290bb5ba5" x="148" y="101" width="25" height="8"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[RX Bin:]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement uuid="cc922142-d87a-4f04-b28b-413ad513e5e0" x="148" y="110" width="31" height="8"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[RX PCN:]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement uuid="4534f9a0-901a-402c-86ba-0b3109370e53" x="148" y="120" width="31" height="8"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[RX GRP:]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement uuid="abd7fb37-b19a-4691-869c-28a8c0b326ce" x="175" y="101" width="27" height="8"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[024144]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement uuid="84e6427e-950d-4c1a-877e-a342ec8009db" x="175" y="110" width="27" height="8"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[healthbus]]></text>
|
||||
</staticText>
|
||||
<textField>
|
||||
<reportElement uuid="709713dc-5f48-40dc-957c-9f015b376b41" x="175" y="120" width="49" height="8"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{RXGroupID}]]></textFieldExpression>
|
||||
</textField>
|
||||
<staticText>
|
||||
<reportElement uuid="00b86af7-1cba-4c7a-a78b-cb0ffa476f88" x="148" y="134" width="58" height="8"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Customer Service:]]></text>
|
||||
</staticText>
|
||||
<textField>
|
||||
<reportElement uuid="0bce3d0c-c01b-4dfd-9638-19b94d75e73e" x="205" y="120" width="73" height="8"/>
|
||||
<textElement textAlignment="Center">
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{WebUrl}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="1193b1ef-31e9-4c43-bb51-236b67c21c81" x="205" y="134" width="73" height="8"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{CustomerService}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="ded7012f-9a8d-4e97-876b-e34bc59241ef" x="43" y="61" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{BenDesc1}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="2a63ebda-6cf8-4f7a-927b-7cfa892e196d" x="98" y="61" width="43" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Ben1}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="aa510ad0-1a1e-4f24-b692-505794f4f159" x="43" y="68" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{BenDesc2}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="f501005d-ba2b-4747-92f4-1b3288d52f3a" x="98" y="68" width="43" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Ben2}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="fae8e590-1ffe-4e48-aef6-26a7e01c88af" x="43" y="75" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{BenDesc3}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="693746af-9ba2-4992-a270-397eaac04653" x="43" y="82" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{BenDesc4}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="27282b06-831e-40e5-93ee-ca77e3190dd5" x="98" y="75" width="43" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Ben3}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="fb423834-c0e0-4e68-8dd9-baa62eaa79a2" x="98" y="82" width="43" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Ben4}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="b0e3223c-1930-42db-82cc-d059e9b699b9" x="43" y="89" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{BenDesc5}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="bae3a6b6-1ca2-4ca6-9ba1-dd5fb9d1153f" x="98" y="110" width="43" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Ben8}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="8afd99dc-91b9-4416-806a-5f0e7eb83b1c" x="43" y="110" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{BenDesc8}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="c88d8d15-070c-42ad-999c-2e013f399992" x="43" y="103" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{BenDesc7}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="8bfb12fe-aef3-4397-a026-1fe43ebce05e" x="43" y="96" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{BenDesc6}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="43a569a5-7de5-427a-986f-bc4af746be06" x="98" y="96" width="43" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Ben6}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="a26646b1-152c-44f2-9486-1bd1590683c3" x="98" y="103" width="43" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Ben7}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="b572b49b-7b9a-4f68-b7ef-11dfadd2dae4" x="98" y="89" width="43" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Ben5}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="cc80102a-5811-4dc6-8d44-606d736bddc7" x="148" y="140" width="8" height="7"/>
|
||||
<textElement>
|
||||
<font fontName="Microsoft Sans Serif" size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{ProviderCode}.equals("1")?"S":""]]></textFieldExpression>
|
||||
</textField>
|
||||
<image hAlign="Center">
|
||||
<reportElement uuid="ea716b2c-5586-439d-8450-7302d49a5bd3" x="303" y="103" width="100" height="51"/>
|
||||
<imageExpression><![CDATA["C:\\images\\CignaLogo.png"]]></imageExpression>
|
||||
</image>
|
||||
<image>
|
||||
<reportElement uuid="7da52da7-1e66-4ba2-ae1c-8ba65b8797c3" x="191" y="149" width="189" height="8"/>
|
||||
<imageExpression><![CDATA["C:\\images\\LOGO - AFHC.jpg"]]></imageExpression>
|
||||
</image>
|
||||
<staticText>
|
||||
<reportElement uuid="4da0cb27-87c4-4f6c-8cde-4078ad224da6" x="414" y="156" width="132" height="8"/>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Benefits are not insured by Cigna or affiliates]]></text>
|
||||
</staticText>
|
||||
<textField isBlankWhenNull="true">
|
||||
<reportElement uuid="e1932f2f-82d4-491b-a3a3-b8151ac539e2" x="98" y="117" width="43" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Ben9}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField isBlankWhenNull="true">
|
||||
<reportElement uuid="a064a7fd-da67-407f-838d-4d0a5b267843" x="43" y="117" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{BenDesc9}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField isBlankWhenNull="true">
|
||||
<reportElement uuid="ab233e66-e9cd-4224-8a46-bf57655ef118" x="43" y="124" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{BenDesc10}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField isBlankWhenNull="true">
|
||||
<reportElement uuid="286a851b-e65e-4fa2-bae1-161ed10a131c" x="98" y="124" width="43" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Ben10}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField isBlankWhenNull="true">
|
||||
<reportElement uuid="920cb788-6331-4e5c-8f8f-f94c8be5a994" x="43" y="131" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{BenDesc11}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField isBlankWhenNull="true">
|
||||
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|
||||
Britton Benefit Services, LLC
|
||||
604 North Queen Street
|
||||
Kinston, NC 28502
|
||||
1.800.676.1182]]></text>
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|
||||
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|
||||
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<text><![CDATA[Call:
|
||||
1.800.676.1182 (8am – 5pm)
|
||||
Online:
|
||||
www.bbstpa.com (24/7)
|
||||
This card does not guarantee
|
||||
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|
||||
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||||
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||||
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|
||||
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|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{ClaimTo6}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
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|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{ClaimTo7}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
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|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{ClaimTo8}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
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|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{ClaimTo9}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="cc95f964-4572-46b1-b092-964c9f19e7f6" x="171" y="70" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{ClaimTo10}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
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|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{ClaimTo11}]]></textFieldExpression>
|
||||
</textField>
|
||||
<image scaleImage="RetainShape" hAlign="Center" vAlign="Middle">
|
||||
<reportElement uuid="ece00572-ba7a-4374-9eed-447db3b11a5c" x="174" y="101" width="100" height="49"/>
|
||||
<imageExpression><![CDATA["c:\\images\\MedCostLogo.png"]]></imageExpression>
|
||||
</image>
|
||||
<textField>
|
||||
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|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{ProviderLine1}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
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|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{ProviderLine2}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
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|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{ProviderLine3}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="96e1ff12-6c27-4bd9-b706-050a283ea1a8" x="227" y="31" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{ProviderLine4}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="c209866f-c8db-455d-8118-ae0aa51204a8" x="227" y="40" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{ProviderLine5}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="22bcf3ce-6edc-4390-9c63-f169623fdf58" x="227" y="45" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{ProviderLine6}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="b8bd2df8-9ad2-4cde-9c67-b0e32425c00b" x="227" y="50" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{ProviderLine7}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="e5d86062-d78f-42b5-b578-cd14dcc071ca" x="227" y="55" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{ProviderLine8}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="8b542cf4-f0e7-4019-90cf-4b3a826184bf" x="227" y="64" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{ProviderLine9}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="b154a117-b385-4eac-b53a-51f349d2e9a6" x="227" y="69" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{ProviderLine10}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="d30067fe-8185-4854-a4da-615d8bb59f4a" x="227" y="76" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{ProviderLine11}]]></textFieldExpression>
|
||||
</textField>
|
||||
<staticText>
|
||||
<reportElement uuid="8bbea900-0c43-40d8-ad68-2f478aabd3c1" x="305" y="6" width="50" height="11" forecolor="#FFFFFF"/>
|
||||
<textElement>
|
||||
<font size="6" isUnderline="false" isPdfEmbedded="false"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Health Benefit Plan]]></text>
|
||||
</staticText>
|
||||
<rectangle>
|
||||
<reportElement uuid="4ecd4a82-edd1-4166-abf9-85d66ebb8b37" x="439" y="6" width="44" height="8" backcolor="#000000"/>
|
||||
</rectangle>
|
||||
<staticText>
|
||||
<reportElement uuid="4ddf1be3-c752-46e0-8197-f4d64b5484b0" x="442" y="6" width="41" height="11" forecolor="#FFFFFF"/>
|
||||
<textElement>
|
||||
<font size="6" isUnderline="false" isPdfEmbedded="false"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Medical Plan]]></text>
|
||||
</staticText>
|
||||
<rectangle>
|
||||
<reportElement uuid="1b74e177-da54-47c1-a801-ac0331d2cd11" x="302" y="100" width="133" height="51"/>
|
||||
</rectangle>
|
||||
<rectangle>
|
||||
<reportElement uuid="6a6d5769-ee7e-439f-8d65-7de67cdcb16b" x="302" y="92" width="53" height="8" backcolor="#000000"/>
|
||||
</rectangle>
|
||||
<staticText>
|
||||
<reportElement uuid="fa26d6b7-51d2-4f9e-9d05-9a4513c66eed" x="305" y="92" width="50" height="11" forecolor="#FFFFFF"/>
|
||||
<textElement>
|
||||
<font size="6" isUnderline="false" isPdfEmbedded="false"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Pharmacy Plan]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement uuid="5c39d2a5-fb6b-427a-ade9-f09c04c1144c" x="304" y="16" width="40" height="8"/>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Group #/ID:]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement uuid="26d1f156-d150-4837-9bba-1390a8199fb4" x="304" y="23" width="30" height="8"/>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Name:]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement uuid="8c0fbf41-d7b6-482b-996d-0b48ee2b0ff7" x="304" y="30" width="30" height="8"/>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Member Id:]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement uuid="da2ecd13-2381-494c-9d69-745b2496587e" x="304" y="37" width="50" height="8"/>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Effective Date:]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement uuid="58ce6f59-01b7-457a-aee6-0be9d7ae868e" x="304" y="44" width="40" height="8"/>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Division:]]></text>
|
||||
</staticText>
|
||||
<textField>
|
||||
<reportElement uuid="1361e8b7-6ea2-4f2b-a6fd-781b1fa521e8" x="346" y="16" width="88" height="8"/>
|
||||
<textElement>
|
||||
<font size="6"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{MedicalGroupNum}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="c2877613-bc27-4175-b080-5ab67f1d781c" x="346" y="23" width="88" height="8"/>
|
||||
<textElement>
|
||||
<font size="6"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{FullName}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="acea13af-f269-47da-b9cc-ba0ea22df29f" x="346" y="30" width="88" height="8"/>
|
||||
<textElement>
|
||||
<font size="6"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{PBEntityKey}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="eaa738bf-1ced-4c86-8a31-9acc09a88abe" x="346" y="37" width="88" height="8"/>
|
||||
<textElement>
|
||||
<font size="6"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{MedicalEffDate}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="f559a5a0-cd09-46e5-9a6c-0b4458ddd8b2" x="346" y="44" width="88" height="18"/>
|
||||
<textElement>
|
||||
<font size="6"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Division}]]></textFieldExpression>
|
||||
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|
||||
<staticText>
|
||||
<reportElement uuid="cf1ce1ca-5cef-436c-b2d6-26bd3e1015b4" x="304" y="61" width="76" height="8"/>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Covered Dependents:]]></text>
|
||||
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|
||||
<textField>
|
||||
<reportElement uuid="848389f8-98f1-41da-962e-cc29aeac91d1" x="305" y="67" width="63" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Dependent1}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="adee7873-b80c-4be4-9568-533471bab640" x="305" y="74" width="63" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Dependent2}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="53ed1fe8-89ed-42a2-98bb-9ad75418f543" x="305" y="81" width="63" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Dependent3}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="07c29443-8589-4e0f-a758-b69a34f38b07" x="371" y="67" width="63" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Dependent4}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="f906328d-53c5-4bb7-b4d4-4eba2261adfb" x="371" y="74" width="63" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Dependent5}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="a15671c2-f677-4def-9d42-1e0553d43010" x="371" y="81" width="63" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Dependent6}]]></textFieldExpression>
|
||||
</textField>
|
||||
<image scaleImage="RetainShape">
|
||||
<reportElement uuid="36c204c6-c2f7-4613-863f-332cf50ff6cc" x="358" y="101" width="76" height="23"/>
|
||||
<imageExpression><![CDATA["C:\\images\\FairRxOs.jpg"]]></imageExpression>
|
||||
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|
||||
<staticText>
|
||||
<reportElement uuid="40b57f3b-eeeb-4e38-857b-6bf290bb5ba5" x="304" y="104" width="25" height="8"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[RX Bin:]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement uuid="cc922142-d87a-4f04-b28b-413ad513e5e0" x="304" y="114" width="31" height="8"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[RX PCN:]]></text>
|
||||
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|
||||
<staticText>
|
||||
<reportElement uuid="4534f9a0-901a-402c-86ba-0b3109370e53" x="304" y="124" width="31" height="8"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[RX GRP:]]></text>
|
||||
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|
||||
<staticText>
|
||||
<reportElement uuid="abd7fb37-b19a-4691-869c-28a8c0b326ce" x="331" y="104" width="27" height="8"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[021841]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement uuid="84e6427e-950d-4c1a-877e-a342ec8009db" x="331" y="114" width="27" height="8"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[18000405]]></text>
|
||||
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|
||||
<textField>
|
||||
<reportElement uuid="709713dc-5f48-40dc-957c-9f015b376b41" x="331" y="124" width="49" height="8"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{RXGroupID}]]></textFieldExpression>
|
||||
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|
||||
<staticText>
|
||||
<reportElement uuid="7b18791f-3c29-416d-b094-4f517a6ca3f5" x="304" y="134" width="58" height="8"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Member Services:]]></text>
|
||||
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|
||||
<textField>
|
||||
<reportElement uuid="0bce3d0c-c01b-4dfd-9638-19b94d75e73e" x="361" y="124" width="73" height="8"/>
|
||||
<textElement textAlignment="Center">
|
||||
<font size="5" isBold="true"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{WebUrl}]]></textFieldExpression>
|
||||
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|
||||
<textField>
|
||||
<reportElement uuid="f480f962-5cc4-4619-a5a9-91030432780e" x="361" y="134" width="73" height="8"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{HelpDesk}]]></textFieldExpression>
|
||||
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|
||||
<staticText>
|
||||
<reportElement uuid="3c43b93c-3234-4df3-8deb-cd743c45bee5" x="43" y="119" width="120" height="33"/>
|
||||
<textElement textAlignment="Center">
|
||||
<font size="6"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Pre-certification is required for
|
||||
Inpatient Hospitalization
|
||||
Call MedCost 1.800.722.2157
|
||||
]]></text>
|
||||
</staticText>
|
||||
<rectangle>
|
||||
<reportElement uuid="002ddfe1-3306-4180-a53f-2e73a62166bd" x="439" y="135" width="102" height="16"/>
|
||||
</rectangle>
|
||||
<rectangle>
|
||||
<reportElement uuid="db5ddcca-b080-4f85-a149-213bfee625b1" x="439" y="127" width="53" height="8" backcolor="#000000"/>
|
||||
</rectangle>
|
||||
<staticText>
|
||||
<reportElement uuid="f453b523-e229-4fde-9a39-7a3d8bea048a" x="441" y="127" width="50" height="11" forecolor="#FFFFFF"/>
|
||||
<textElement>
|
||||
<font size="6" isUnderline="false" isPdfEmbedded="false"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Dental Plan]]></text>
|
||||
</staticText>
|
||||
<textField>
|
||||
<reportElement uuid="065b6096-3261-4ea9-aedd-51c5d7687cc0" x="441" y="136" width="98" height="13"/>
|
||||
<textElement>
|
||||
<font size="7"/>
|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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||||
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|
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|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{ProviderLine6}]]></textFieldExpression>
|
||||
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|
||||
<textField>
|
||||
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|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{ProviderLine7}]]></textFieldExpression>
|
||||
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|
||||
<textField>
|
||||
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|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{ProviderLine8}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
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|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{ProviderLine9}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
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|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{ProviderLine10}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="d30067fe-8185-4854-a4da-615d8bb59f4a" x="227" y="76" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{ProviderLine11}]]></textFieldExpression>
|
||||
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|
||||
<staticText>
|
||||
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|
||||
<textElement>
|
||||
<font size="6" isUnderline="false" isPdfEmbedded="false"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Health Benefit Plan]]></text>
|
||||
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|
||||
<rectangle>
|
||||
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|
||||
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|
||||
<staticText>
|
||||
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|
||||
<textElement>
|
||||
<font size="6" isUnderline="false" isPdfEmbedded="false"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Medical Plan]]></text>
|
||||
</staticText>
|
||||
<rectangle>
|
||||
<reportElement uuid="1b74e177-da54-47c1-a801-ac0331d2cd11" x="302" y="100" width="133" height="51"/>
|
||||
</rectangle>
|
||||
<rectangle>
|
||||
<reportElement uuid="6a6d5769-ee7e-439f-8d65-7de67cdcb16b" x="302" y="92" width="53" height="8" backcolor="#000000"/>
|
||||
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|
||||
<staticText>
|
||||
<reportElement uuid="fa26d6b7-51d2-4f9e-9d05-9a4513c66eed" x="305" y="92" width="50" height="11" forecolor="#FFFFFF"/>
|
||||
<textElement>
|
||||
<font size="6" isUnderline="false" isPdfEmbedded="false"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Pharmacy Plan]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement uuid="5c39d2a5-fb6b-427a-ade9-f09c04c1144c" x="304" y="16" width="40" height="8"/>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Group #/ID:]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement uuid="26d1f156-d150-4837-9bba-1390a8199fb4" x="304" y="23" width="30" height="8"/>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Name:]]></text>
|
||||
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|
||||
<staticText>
|
||||
<reportElement uuid="8c0fbf41-d7b6-482b-996d-0b48ee2b0ff7" x="304" y="30" width="30" height="8"/>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
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||||
</textElement>
|
||||
<text><![CDATA[Policy #:]]></text>
|
||||
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|
||||
<staticText>
|
||||
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|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Effective Date:]]></text>
|
||||
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|
||||
<staticText>
|
||||
<reportElement uuid="58ce6f59-01b7-457a-aee6-0be9d7ae868e" x="304" y="44" width="40" height="8"/>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Employer:]]></text>
|
||||
</staticText>
|
||||
<textField>
|
||||
<reportElement uuid="1361e8b7-6ea2-4f2b-a6fd-781b1fa521e8" x="346" y="16" width="88" height="8"/>
|
||||
<textElement>
|
||||
<font size="6"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{GroupNo}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="c2877613-bc27-4175-b080-5ab67f1d781c" x="346" y="23" width="88" height="8"/>
|
||||
<textElement>
|
||||
<font size="6"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{FullName}]]></textFieldExpression>
|
||||
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|
||||
<textField>
|
||||
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|
||||
<textElement>
|
||||
<font size="6"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{PrimaryMBMemberKey}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="eaa738bf-1ced-4c86-8a31-9acc09a88abe" x="346" y="37" width="88" height="8"/>
|
||||
<textElement>
|
||||
<font size="6"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{MedicalEffDate}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="f559a5a0-cd09-46e5-9a6c-0b4458ddd8b2" x="346" y="44" width="88" height="18"/>
|
||||
<textElement>
|
||||
<font size="6"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{Division}]]></textFieldExpression>
|
||||
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|
||||
<staticText>
|
||||
<reportElement uuid="cf1ce1ca-5cef-436c-b2d6-26bd3e1015b4" x="304" y="61" width="76" height="8"/>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Covered Dependents:]]></text>
|
||||
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|
||||
<textField>
|
||||
<reportElement uuid="848389f8-98f1-41da-962e-cc29aeac91d1" x="305" y="67" width="63" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{Dependent1}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="adee7873-b80c-4be4-9568-533471bab640" x="305" y="74" width="63" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{Dependent2}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="53ed1fe8-89ed-42a2-98bb-9ad75418f543" x="305" y="81" width="63" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Dependent3}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="07c29443-8589-4e0f-a758-b69a34f38b07" x="371" y="67" width="63" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Dependent4}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="f906328d-53c5-4bb7-b4d4-4eba2261adfb" x="371" y="74" width="63" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{Dependent5}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="a15671c2-f677-4def-9d42-1e0553d43010" x="371" y="81" width="63" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Dependent6}]]></textFieldExpression>
|
||||
</textField>
|
||||
<image scaleImage="RetainShape">
|
||||
<reportElement uuid="36c204c6-c2f7-4613-863f-332cf50ff6cc" x="355" y="101" width="79" height="23"/>
|
||||
<imageExpression><![CDATA["C:\\images\\FairRxOs.jpg"]]></imageExpression>
|
||||
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|
||||
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|
||||
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|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
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|
||||
<text><![CDATA[RX Bin:]]></text>
|
||||
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|
||||
<staticText>
|
||||
<reportElement uuid="cc922142-d87a-4f04-b28b-413ad513e5e0" x="304" y="114" width="25" height="8"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
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|
||||
<text><![CDATA[RX PCN:]]></text>
|
||||
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|
||||
<staticText>
|
||||
<reportElement uuid="4534f9a0-901a-402c-86ba-0b3109370e53" x="304" y="124" width="31" height="8"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
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|
||||
<text><![CDATA[RX GRP:]]></text>
|
||||
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|
||||
<staticText>
|
||||
<reportElement uuid="abd7fb37-b19a-4691-869c-28a8c0b326ce" x="331" y="104" width="27" height="8"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
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|
||||
<text><![CDATA[021841]]></text>
|
||||
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|
||||
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|
||||
<reportElement uuid="84e6427e-950d-4c1a-877e-a342ec8009db" x="331" y="114" width="27" height="8"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
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|
||||
<text><![CDATA[18000405]]></text>
|
||||
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|
||||
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|
||||
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|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{RXGroupID}]]></textFieldExpression>
|
||||
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|
||||
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|
||||
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|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
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|
||||
<text><![CDATA[Member Services:]]></text>
|
||||
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|
||||
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|
||||
<reportElement uuid="0bce3d0c-c01b-4dfd-9638-19b94d75e73e" x="361" y="124" width="73" height="8"/>
|
||||
<textElement textAlignment="Center">
|
||||
<font size="5" isBold="true"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{WebUrl}]]></textFieldExpression>
|
||||
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|
||||
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|
||||
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|
||||
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|
||||
<font size="5" isBold="true"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{HelpDesk}]]></textFieldExpression>
|
||||
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|
||||
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|
||||
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|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{BenDesc1}]]></textFieldExpression>
|
||||
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|
||||
<textField>
|
||||
<reportElement uuid="2a63ebda-6cf8-4f7a-927b-7cfa892e196d" x="487" y="73" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{Ben1}]]></textFieldExpression>
|
||||
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|
||||
<textField>
|
||||
<reportElement uuid="aa510ad0-1a1e-4f24-b692-505794f4f159" x="441" y="79" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{BenDesc2}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="f501005d-ba2b-4747-92f4-1b3288d52f3a" x="487" y="79" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{Ben2}]]></textFieldExpression>
|
||||
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|
||||
<textField>
|
||||
<reportElement uuid="fae8e590-1ffe-4e48-aef6-26a7e01c88af" x="441" y="85" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{BenDesc3}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="693746af-9ba2-4992-a270-397eaac04653" x="441" y="91" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{BenDesc4}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="27282b06-831e-40e5-93ee-ca77e3190dd5" x="487" y="85" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Ben3}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="fb423834-c0e0-4e68-8dd9-baa62eaa79a2" x="487" y="91" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
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|
||||
<textFieldExpression><![CDATA[$F{Ben4}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="b0e3223c-1930-42db-82cc-d059e9b699b9" x="441" y="97" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{BenDesc5}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="bae3a6b6-1ca2-4ca6-9ba1-dd5fb9d1153f" x="487" y="115" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Ben8}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="8afd99dc-91b9-4416-806a-5f0e7eb83b1c" x="441" y="115" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{BenDesc8}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="c88d8d15-070c-42ad-999c-2e013f399992" x="441" y="109" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{BenDesc7}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="8bfb12fe-aef3-4397-a026-1fe43ebce05e" x="441" y="103" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{BenDesc6}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="43a569a5-7de5-427a-986f-bc4af746be06" x="487" y="103" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Ben6}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="a26646b1-152c-44f2-9486-1bd1590683c3" x="487" y="109" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Ben7}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement uuid="b572b49b-7b9a-4f68-b7ef-11dfadd2dae4" x="487" y="97" width="52" height="7"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{Ben5}]]></textFieldExpression>
|
||||
</textField>
|
||||
<staticText>
|
||||
<reportElement uuid="3c43b93c-3234-4df3-8deb-cd743c45bee5" x="43" y="119" width="120" height="33"/>
|
||||
<textElement textAlignment="Center">
|
||||
<font size="6"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Pre-certification is required for
|
||||
Inpatient Hospitalization.
|
||||
Call MedCost 1.800.722.2157]]></text>
|
||||
</staticText>
|
||||
<rectangle>
|
||||
<reportElement uuid="002ddfe1-3306-4180-a53f-2e73a62166bd" x="439" y="135" width="102" height="16"/>
|
||||
</rectangle>
|
||||
<rectangle>
|
||||
<reportElement uuid="db5ddcca-b080-4f85-a149-213bfee625b1" x="439" y="127" width="53" height="8" backcolor="#000000"/>
|
||||
</rectangle>
|
||||
<staticText>
|
||||
<reportElement uuid="f453b523-e229-4fde-9a39-7a3d8bea048a" x="441" y="127" width="50" height="11" forecolor="#FFFFFF"/>
|
||||
<textElement>
|
||||
<font size="6" isUnderline="false" isPdfEmbedded="false"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Dental Plan]]></text>
|
||||
</staticText>
|
||||
<textField>
|
||||
<reportElement uuid="065b6096-3261-4ea9-aedd-51c5d7687cc0" x="441" y="136" width="98" height="13"/>
|
||||
<textElement>
|
||||
<font size="7"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{DentalCoverage}]]></textFieldExpression>
|
||||
</textField>
|
||||
</band>
|
||||
</detail>
|
||||
<columnFooter>
|
||||
<band splitType="Stretch"/>
|
||||
</columnFooter>
|
||||
<pageFooter>
|
||||
<band splitType="Stretch"/>
|
||||
</pageFooter>
|
||||
<summary>
|
||||
<band splitType="Stretch"/>
|
||||
</summary>
|
||||
</jasperReport>
|
||||
Reference in New Issue
Block a user