| Sequence | Field | Length | Type | Description/Example |
|---|---|---|---|---|
| 1 | Employee Number or Social Security Number | Emp # - 6 or SSN - 9 | Numeric | 001511 or 123456789 |
| 2 | Company Code | 5 | Alphanumeric | Aetna |
| 3 | Plan Number | 20 | Numeric | 4566778559 |
| 4 | Plan Type | 1 | Alpha | C (Emp and children), E (Employee only), F (Emp and family), S (Emp and spouse) |
| 5 | Employee Insurance ID | 20 | Numeric | 12345678910 |
| 6 | Covered Individual First Name | 17 | Alphanumeric | William |
| 7 | Covered Individual Middle Name | 14 | Alphanumeric | Michael |
| 8 | Covered Individual Last Name | 25 | Alphanumeric | Anderson |
| 9 | Covered Individual Generation Code | Alphanumeric | Ex. JR, SR, II, etc. | |
| 10 | Coverage Begin Date | 8 | Numeric | YYYYMMDD; Ex: 20140901 |
| 11 | Coverage End Date | 8 | Numeric | YYYYMMDD; 20150901 |
| 12 | Relation | 1 | Alpha | C (Child), E (Employee self), S (Spouse) |
| 13 | Social Security Number | 9 | Numeric | 123456789 |
| 14 | Date of Birth | 8 | Numeric | YYYYMMDD; Ex: 19691016 |
Notes:
The uploaded file type must be in the comma-delimited text (.txt) or comma-separated values (.csv) format.
The Length field provides the maximum number of allowed characters.
Columns 1-5 contain plan data.
Columns 6-13 contain coverage data.
The employee number, insurance company code, plan number, and plan type are required.
If coverage data (columns 6-13) exists, the covered individual’s first and last name are required.