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<?xml version="1.0" encoding="UTF-8"?>
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<property name="ireport.zoom" value="5.0"/>
<property name="ireport.x" value="1910"/>
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<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 = $P{FamilyId}]]>
</queryString>
<field name="ID" class="java.lang.Integer"/>
<field name="Facility" class="java.lang.String"/>
<field name="Division" class="java.lang.String"/>
<field name="FullName" class="java.lang.String"/>
<field name="SSN" class="java.lang.String"/>
<field name="MedicalCoverage" class="java.lang.String"/>
<field name="MedicalEffDate" class="java.lang.String"/>
<field name="MedicalGroupNum" class="java.lang.String"/>
<field name="DentalCoverage" class="java.lang.String"/>
<field name="DentalEffDate" class="java.lang.String"/>
<field name="DentalGroupNum" class="java.lang.String"/>
<field name="CardType" class="java.lang.String"/>
<field name="ProviderCode" class="java.lang.String"/>
<field name="ProviderLine1" class="java.lang.String"/>
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<field name="MailTo" class="java.lang.String"/>
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<field name="ContactLine1" class="java.lang.String"/>
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<field name="GroupNumber" class="java.lang.String"/>
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<field name="GroupNo" class="java.lang.String"/>
<field name="RXGroupID" class="java.lang.String"/>
<field name="HelpDesk" class="java.lang.String"/>
<field name="CustomerService" class="java.lang.String"/>
<field name="WebUrl" class="java.lang.String"/>
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<field name="PLPlanKey" class="java.lang.Integer"/>
<field name="PrimaryMBMemberKey" class="java.lang.Integer"/>
<field name="PPOLookup1" class="java.lang.String"/>
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<field name="Precert1" class="java.lang.String"/>
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<text><![CDATA[Eligibility]]></text>
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<text><![CDATA[Utilization / Pre-Cert]]></text>
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<imageExpression><![CDATA[$F{PLPlanKey}==3?"C:\\images\\TandemLocLogo.png":
$F{PLPlanKey}==4?"C:\\images\\PRFaulkLogo.jpg":
$F{PLPlanKey}==5?"C:\\images\\graceChurch.jpg":
$F{PLPlanKey}==13?"C:\\images\\ovationlogo12.jpg":
$F{PLPlanKey}==19?"C:\\images\\BeamLogo.png":
$F{PLPlanKey}==20?"C:\\images\\anewgo.png":
$F{PLPlanKey}==39?"C:\\images\\HeritagePicture2.jpg":
$F{PLPlanKey}==48?"C:\\images\\HandT.png":
$F{PLPlanKey}==49?"C:\\images\\Panhandle.jpg":
$F{PLPlanKey}==50?"C:\\images\\DeepSouth.png":
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$F{PLPlanKey}==65?"C:\\images\\AqualisLogo.png":
$F{PLPlanKey}==67?"C:\\images\\MedicalDataSystemsLogo.png":
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</textElement>
<text><![CDATA[Claims Submission]]></text>
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<textElement textAlignment="Center" verticalAlignment="Middle">
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<text><![CDATA[Administered by:
Britton Benefit Services, LLC
1.800.676.1182]]></text>
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<text><![CDATA[To confirm eligibility, verify benefits,
or check claim:
]]></text>
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<text><![CDATA[Britton Benefit Services, LLC]]></text>
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<text><![CDATA[Call:
1.800.676.1182 (8am 5pm)
Online:
www.bbstpa.com (24/7)
This card does not guarantee
eligibility or payment
]]></text>
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<textFieldExpression><![CDATA[$F{ClaimTo10}]]></textFieldExpression>
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<text><![CDATA[Health Benefit Plan]]></text>
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<text><![CDATA[Medical Plan]]></text>
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<text><![CDATA[Pharmacy Plan]]></text>
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<text><![CDATA[Group #/ID:]]></text>
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<text><![CDATA[Name:]]></text>
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<text><![CDATA[Effective Date:]]></text>
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<text><![CDATA[Covered Dependents:]]></text>
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<text><![CDATA[RX Bin:]]></text>
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<text><![CDATA[RX PCN:]]></text>
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<text><![CDATA[RX GRP:]]></text>
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<text><![CDATA[021841]]></text>
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<text><![CDATA[18000405]]></text>
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<text><![CDATA[Customer Service:]]></text>
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