EDI 111 Individual Insurance Policy and Client Information

Functional Group IF

X12N Insurance Subcommittee

This Draft Standard for Trial Use contains the format and establishes the data contents of the Individual Insurance Policy and Client Information Transaction Set (111) for use within the context of an Electronic Data Interchange (EDI) environment. This standard can be used to exchange policy and client information among organizations administering individual life and health insurance contracts and their trading partners (e.g., agents, brokers). It is not intended to be used for group insurance.

Heading

1. 0100 · ST · Transaction Set Header · Max 1 · Mandatory

   To indicate the start of a transaction set and to assign a control number

2. 0200 · BHT · Beginning of Hierarchical Transaction · Max 1 · Mandatory

   To define the business hierarchical structure of the transaction set and identify the business application purpose and reference data, i.e., number, date, and time

3. 1000 Loop Mandatory Repeat >1

   1. 0300 · NM1 · Individual or Organizational Name · Max 1 · Mandatory

      To supply the full name of an individual or organizational entity

      The 1000 loop provides information about the sending and receiving parties.

   2. 0400 · N3 · Address Information · Max 3 · Optional

      To specify the location of the named party

   3. 0500 · N4 · Geographic Location · Max 1 · Optional

      To specify the geographic place of the named party

   4. 0600 · REF · Reference Identification · Max 9 · Optional

      To specify identifying information

   5. 0700 · PER · Administrative Communications Contact · Max 3 · Optional

      To identify a person or office to whom administrative communications should be directed

Detail

1. 2000 Loop Mandatory Repeat >1

   1. 0100 · HL · Hierarchical Level · Max 1 · Mandatory

      To identify dependencies among and the content of hierarchically related groups of data segments

      The structure of the transaction is defined in BHT01 at 1/0200.

   2. 0200 · REF · Reference Identification · Max >1 · Optional

      To specify identifying information

   3. 0300 · ASI · Action or Status Indicator · Max >1 · Optional

      To indicate the action to be taken with the information provided or the status of the entity described

   4. 0400 · LQ · Industry Code · Max >1 · Optional

      Code to transmit standard industry codes

   5. 0500 · C3 · Currency · Max 1 · Optional

      To specify the currency being used in the transaction set

   6. 0600 · DMG · Demographic Information · Max 1 · Optional

      To supply demographic information

   7. 0700 · LUI · Language Use · Max 1 · Optional

      To specify language, type of usage, and proficiency or fluency

   8. 0800 · N4 · Geographic Location · Max >1 · Optional

      To specify the geographic place of the named party

   9. 0900 · BLI · Baseline Item Data · Max 1 · Optional

      To specify basic item data: item identification, quantity, and price

   10. 1000 · LIN · Item Identification · Max >1 · Optional

       To specify basic item identification data

   11. 1100 · UDA · Underwriting Condition · Max >1 · Optional

       To specify the condition under which insurance coverage is offered

   12. 1200 · SPA · Status of Product or Activity · Max >1 · Optional

       To indicate the details and status of a product or product activity

   13. 1300 · DTP · Date or Time or Period · Max >1 · Optional

       To specify any or all of a date, a time, or a time period

   14. 1400 · BLN · Balance Information · Max >1 · Optional

       To provide specific balance information for financial account reporting

   15. 1500 · QTY · Quantity · Max >1 · Optional

       To specify quantity information

   16. 1600 · AMT · Monetary Amount · Max >1 · Optional

       To indicate the total monetary amount

   17. 1700 · RPA · Rate Amounts or Percents · Max >1 · Optional

       To identify rate amounts or percents for a specific cost or other line item

   18. 2100 Loop Optional Repeat >1

       1. 1800 · PDL · Payment Details · Max 1 · Mandatory

          To transmit information required to establish payment or remittance activity

       2. 1900 · REF · Reference Identification · Max >1 · Optional

          To specify identifying information

   19. 2200 Loop Optional Repeat >1

       1. 2000 · III · Information · Max 1 · Mandatory

          To report information

       2. 2100 · DTP · Date or Time or Period · Max >1 · Optional

          To specify any or all of a date, a time, or a time period

   20. 2300 Loop Optional Repeat >1

       1. 2200 · AM1 · Informational Values · Max 1 · Mandatory

          To specify a code and the amount or quantity or percentage associated with it

          The 2300 loop can be used to provide additional information at the level of the specific policy, coverage, component, account, etc., being described.

       2. 2300 · III · Information · Max >1 · Optional

          To report information

       3. 2350 · SPA · Status of Product or Activity · Max >1 · Optional

          To indicate the details and status of a product or product activity

       4. 2400 · DTP · Date or Time or Period · Max >1 · Optional

          To specify any or all of a date, a time, or a time period

       5. 2500 · AMT · Monetary Amount · Max >1 · Optional

          To indicate the total monetary amount

       6. 2600 · QTY · Quantity · Max >1 · Optional

          To specify quantity information

       7. 2700 · RPA · Rate Amounts or Percents · Max >1 · Optional

          To identify rate amounts or percents for a specific cost or other line item

       8. 2800 · BLN · Balance Information · Max >1 · Optional

          To provide specific balance information for financial account reporting

       9. 2900 · REF · Reference Identification · Max >1 · Optional

          To specify identifying information

   21. 2400 Loop Optional Repeat >1

       1. 3000 · NM1 · Individual or Organizational Name · Max 1 · Mandatory

          To supply the full name of an individual or organizational entity

       2. 3100 · N2 · Additional Name Information · Max 3 · Optional

          To specify additional names

       3. 3200 · COM · Communication Contact Information · Max >1 · Optional

          To specify a communication contact number

       4. 2450 Loop Optional Repeat >1

          1. 3300 · N3 · Address Information · Max 1 · Mandatory

             To specify the location of the named party

          2. 3400 · N4 · Geographic Location · Max 1 · Optional

             To specify the geographic place of the named party

          3. 3500 · DTP · Date or Time or Period · Max >1 · Optional

             To specify any or all of a date, a time, or a time period

   22. 2500 Loop Optional Repeat >1

       1. 3600 · NX1 · Property or Entity Identification · Max 1 · Mandatory

          To define the attributes of a property or an entity

          The 2500 loop provides details about the role(s) played by a client at the given level. For example, this could contain specifics for the owner of a policy, or for a beneficiary for a given coverage.

       2. 3700 · REF · Reference Identification · Max >1 · Optional

          To specify identifying information

       3. 3800 · BEN · Beneficiary or Owner Information · Max 1 · Optional

          To supply beneficiary, co-participant, and owner information

       4. 3900 · III · Information · Max >1 · Optional

          To report information

       5. 4000 · AM1 · Informational Values · Max >1 · Optional

          To specify a code and the amount or quantity or percentage associated with it

       6. 4100 · IN1 · Individual Identification · Max >1 · Optional

          To provide identification of an individual or entity

          The IN1 segment identifies parties related to the client in the given role. For example, if the client is a beneficiary, the IN1 segment could be used to provide the reference number for the trustee for that beneficiary.

2. 4200 · SE · Transaction Set Trailer · Max 1 · Mandatory

   To indicate the end of the transaction set and provide the count of the transmitted segments (including the beginning (ST) and ending (SE) segments)