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MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL F1 Parent (father) F2 Parent (mother) F3 Parent (stepfather) F4 Parent (stepmother) F5 Parent (adopting father) F6 Parent (adopting mother) F7 Parent (2nd alleged father) F8 Parent (2nd alleged mother) J1 Primary Prouty entitled to HIB (less than 3 qualifying quarters (QQs) (General Fund) J2 Primary Prouty entitled to HIB (over 2 QQs) (Retirement and Survivors Insurance (RSI) Trust Fund) J3 Primary Prouty not entitled to HIB (less than 3 QQs) (General Fund) J4 Primary Prouty not entitled to HIB (over 2 QQs) (RSI Trust Fund) K1 Prouty wife entitled to HIB (less than 3 QQs) (General Fund) (1st claimant) K2 Prouty wife entitled to HIB (over 2 QQs) (RSI Trust Fund) (1st claimant) K3 Prouty wife not entitled to HIB (less than 3 QQs) (General Fund) (1st claimant) K4 Prouty wife not entitled to HIB (over 2 QQs) (RSI Trust Fund) (1st claimant) K5 Prouty wife entitled to HIB (less than 3 QQs) (General Fund) (2nd claimant) K6 Prouty wife entitled to HIB (over 2 QQs) (RSI Trust Fund) (2nd claimant) K7 Prouty wife not entitled to HIB (less than 3 QQs) (General Fund) (2nd claimant) Prouty wife not entitled to HIB (less than 3 QQs) (RSI Trust Fund) (2nd K8 claimant) K9 Prouty wife entitled to HIB (less than 3 QQs) (General Fund) (3rd claimant) KA Prouty wife entitled to HIB (over 2 QQs) (RSI Trust Fund) (3rd claimant) Prouty wife not entitled to HIB (less than 3 QQs) (General Fund) (3rd KB claimant) KC Prouty wife not entitled to HIB (over 2 QQs) (RSI Trust Fund) (3rd claimant) Prouty wife not entitled to HIB (less than 3 QQs) (General Fund) (4th KD claimant) KE Prouty wife entitled to HIB (over 2 QQs) (RSI Trust Fund) (4th claimant) Prouty wife not entitled to HIB (less than 3 QQs) (General Fund) (4th KF claimant) KG Prouty wife not entitled to HIB (over 2 QQs) (RSI Trust Fund) (4th claimant) KH Prouty wife entitled to HIB (less than 3 QQs) (General Fund) (5th claimant) KJ Prouty wife entitled to HIB (over 2 QQs) (RSI Trust Fund) (5th claimant) Prouty wife not entitled to HIB (less than 3 QQs) (General Fund) (5th KL claimant) KM Prouty wife not entitled to HIB (over 2 QQs) (RSI Trust Fund) (5th claimant) M Uninsured beneficiary (not qualified for automatic HIB)

Division of Welfare and Supportive Services APPENDIX E Medical Assistance Manual MEDICAL ASSISTANCE PROGRAM MANUAL MTL 02/13 01 Nov 13 BIC CODE VALUES