In a coverage record, which element represents the insured individual?

• A. Subscriber
• B. Payer
• C. Plan
• D. Service Area

Answer: (A)

In a coverage record, the person whose policy is in force—the policyholder—is identified by the subscriber field. The subscriber is the insured individual whose eligibility, benefits, and contract terms drive the coverage. The payer represents the insurance company issuing the policy, not the person insured. The plan specifies the particular policy or benefit design, and the service area indicates where the coverage applies or which network is available. If the patient is a dependent, the subscriber would be the policyholder separate from the patient, linked to the coverage record.