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member relationship code

mbr_rel_cd
member·Updated Jun 12, 2026

Definition

ISO-11179 Definition

A standardized code identifying the relationship of a health plan member to the primary subscriber or policyholder. Common relationship codes follow X12 EDI standards: 18 for self, 01 for spouse, 19 for child, 53 for life partner, and 34 for other adult dependent. Relationship codes drive dependent eligibility rules, coordination of benefits sequencing, and premium tier assignment.

In CMS enrollment systems, relationship codes determine Medicare beneficiary category assignments. Healthcare data teams use mbr_rel_cd in enrollment tables to validate dependent eligibility, apply correct cost-sharing rules, and identify family structures for population health segmentation and pediatric quality measure calculations.

Standard Abbreviation

mbr_rel_cd

Category

member

Production DDL — DIM_MEMBER

DIM_MEMBER.sql
CREATE OR REPLACE TABLE DIM_MEMBER (
    mbr_key           INTEGER        NOT NULL  -- surrogate key,
    mbr_id            VARCHAR(50)    NOT NULL  -- member identifier,
    mbr_first_nm      VARCHAR(100)             -- first name,
    mbr_last_nm       VARCHAR(100)             -- last name,
    mbr_birth_dt      DATE                     -- date of birth,
    mbr_gndr_cd       CHAR(1)                  -- gender code M/F/U,
    mbr_age           SMALLINT                 -- age in years,
    mbr_state_cd      CHAR(2)                  -- state code,
    mbr_zip_cd        VARCHAR(10)              -- zip code,
    mbr_elig_ind      BOOLEAN                  -- eligibility indicator,
    mbr_enrl_dt       DATE                     -- enrollment date,
    mbr_term_dt       DATE                     -- termination date,
    mbr_plan_cd       VARCHAR(20)              -- plan code,
    mbr_dual_elig_cd  VARCHAR(10)              -- dual eligibility code,
    load_dt           TIMESTAMP_NTZ  NOT NULL  -- load timestamp
);

Standard Snowflake DDL for the canonical member table. Convert to BigQuery or Databricks →

Why This Term Matters

Member and enrollment data governs who receives care and who pays for it — making it foundational to every downstream healthcare analytics workflow. Data engineers who understand member terminology build eligibility pipelines that prevent coverage gaps, correctly identify dual-eligible members, and support accurate risk adjustment submissions to CMS. Enrollment errors directly affect capitation payments and can trigger CMS corrective action plans.

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