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Transaction Set
in
X12 Release 004030

111 Individual Insurance Policy and Client Information

Functional Group IF

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

Sequence
Segment
Name
Max use
0100
Transaction Set HeaderMandatory
Max 1
To indicate the start of a transaction set and to assign a control number
0200
Beginning of Hierarchical TransactionMandatory
Max 1
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
1000 Loop
Repeat >1
0300
Individual or Organizational NameMandatory
Max 1
To supply the full name of an individual or organizational entity
The 1000 loop provides information about the sending and receiving parties.
0400
Address Information
Max 3
To specify the location of the named party
0500
Geographic Location
Max 1
To specify the geographic place of the named party
0600
Reference Identification
Max 9
To specify identifying information
0700
Administrative Communications Contact
Max 3
To identify a person or office to whom administrative communications should be directed

Detail

Sequence
Segment
Name
Max use
2000 Loop
Repeat >1
0100
Hierarchical LevelMandatory
Max 1
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.
0200
Reference Identification
Max >1
To specify identifying information
0300
Action or Status Indicator
Max >1
To indicate the action to be taken with the information provided or the status of the entity described
0400
Industry Code
Max >1
Code to transmit standard industry codes
0500
Currency
Max 1
To specify the currency being used in the transaction set
0600
Demographic Information
Max 1
To supply demographic information
0700
Language Use
Max 1
To specify language, type of usage, and proficiency or fluency
0800
Geographic Location
Max >1
To specify the geographic place of the named party
0900
Baseline Item Data
Max 1
To specify basic item data: item identification, quantity, and price
1000
Item Identification
Max >1
To specify basic item identification data
1100
Underwriting Condition
Max >1
To specify the condition under which insurance coverage is offered
1200
Status of Product or Activity
Max >1
To indicate the details and status of a product or product activity
1300
Date or Time or Period
Max >1
To specify any or all of a date, a time, or a time period
1400
Balance Information
Max >1
To provide specific balance information for financial account reporting
1500
Quantity
Max >1
To specify quantity information
1600
Monetary Amount
Max >1
To indicate the total monetary amount
1700
Rate Amounts or Percents
Max >1
To identify rate amounts or percents for a specific cost or other line item
2100 Loop
Repeat >1
1800
Payment Details
Max 1
To transmit information required to establish payment or remittance activity
1900
Reference Identification
Max >1
To specify identifying information
2200 Loop
Repeat >1
2000
Information
Max 1
To report information
2100
Date or Time or Period
Max >1
To specify any or all of a date, a time, or a time period
2300 Loop
Repeat >1
2200
Informational Values
Max 1
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.
2300
Information
Max >1
To report information
2350
Status of Product or Activity
Max >1
To indicate the details and status of a product or product activity
2400
Date or Time or Period
Max >1
To specify any or all of a date, a time, or a time period
2500
Monetary Amount
Max >1
To indicate the total monetary amount
2600
Quantity
Max >1
To specify quantity information
2700
Rate Amounts or Percents
Max >1
To identify rate amounts or percents for a specific cost or other line item
2800
Balance Information
Max >1
To provide specific balance information for financial account reporting
2900
Reference Identification
Max >1
To specify identifying information
2400 Loop
Repeat >1
3000
Individual or Organizational Name
Max 1
To supply the full name of an individual or organizational entity
3100
Additional Name Information
Max 3
To specify additional names
3200
Communication Contact Information
Max >1
To specify a communication contact number
2450 Loop
Repeat >1
3300
Address Information
Max 1
To specify the location of the named party
3400
Geographic Location
Max 1
To specify the geographic place of the named party
3500
Date or Time or Period
Max >1
To specify any or all of a date, a time, or a time period
2500 Loop
Repeat >1
3600
Property or Entity Identification
Max 1
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.
3700
Reference Identification
Max >1
To specify identifying information
3800
Beneficiary or Owner Information
Max 1
To supply beneficiary, co-participant, and owner information
3900
Information
Max >1
To report information
4000
Informational Values
Max >1
To specify a code and the amount or quantity or percentage associated with it
4100
Individual Identification
Max >1
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.
4200
Transaction Set TrailerMandatory
Max 1
To indicate the end of the transaction set and provide the count of the transmitted segments (including the beginning (ST) and ending (SE) segments)
Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference and Mapping Guides are provided for marketing purposes and are free of charge. All names, logos, and brands of third parties listed on our site are trademarks of their respective owners (including “X12”, which is a trademark of X12 Incorporated). Stedi, Inc. and its products and services are not endorsed by, sponsored by, or affiliated with these third parties. Our use of these names, logos, and brands is for identification purposes only, and does not imply any such endorsement, sponsorship, or affiliation.
Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference and Mapping Guides are provided for marketing purposes and are free of charge. All names, logos, and brands of third parties listed on our site are trademarks of their respective owners (including “X12”, which is a trademark of X12 Incorporated). Stedi, Inc. and its products and services are not endorsed by, sponsored by, or affiliated with these third parties. Our use of these names, logos, and brands is for identification purposes only, and does not imply any such endorsement, sponsorship, or affiliation.