Eligibility

field name object type validation description primary key member string required a key that defines the uniqueness of this member an example might be memberkey+coverageproduct+coverageeffectivedate group block of business id group string required identifier for corresponding block of business, account, or root level division group id group string required identifier for corresponding client/group group name group string required name of group group tin group string required tin (tax id) of group group hierarchy 1 group string optional first level breakdown of group (location) group hierarchy 1 description group string optional description of first level breakdown group hierarchy 2 group string optional second level breakdown of group (division) group hierarchy 2 description group string optional description of second level breakdown group hierarchy 3 group string optional third level breakdown of group group hierarchy 3 description group string optional description of third level breakdown group funding arrangment group string optional self funded, fully insured, etc plan id plan string required identifier code for the plan plan name plan string required friendly name of the plan plan tpa id plan string strongly recommended id of the third party administrator (tpa) for member plan tpa name plan string strongly recommended name of the third party administrator (tpa) for member plan network id plan string strongly recommended id of the network for member plan network name plan string strongly recommended name of the network for member plan type plan enum optional the type of plan the member is enrolled in ppo, hdhp, epo, hmo, pos, other subscriber primary key subscriber string required the primary key used as the memberprimarykey for the subscriber a row will be considered a subscriber when this subscriberprimarykey matches this memberprimarykey subscriber employer id subscriber string optional employee identifier of subscriber subscriber employment status subscriber enum strongly recommended only applies when row is subscriber employment status of subscriber a,d,f,p,s,t,u = active,terminated,full time,part time,self employed,temporary,unemployed subscriber date of hire subscriber yyyymmdd strongly recommended date that the subscriber was hired hours worked per week subscriber string optional hours per week worked by employee member id member string required member identifier (or subscriber if subscriberprimarykey is equivalent to primarykey) often shared among a family this member will be considered the subscriber if the subscriberprimarykey is equal to this row's primarykey) member alternate id member string optional alternative identifier of member member employer id member string optional employee identifier of subscriber member employment status member enum strongly recommended only applies when row is subscriber employment status of subscriber a,d,f,p,s,t,u = active,terminated,full time,part time,self employed,temporary,unemployed member person code member string required person code corresponding to this member often 00 for member and 01, 02, 03, etc for dependents in the order they were registered member relationship member enum required member's relationship to subscriber e g , su = subscriber/self, sp = spouse, ch = child, de = other dependent, etc member ssn member ssn strongly recommended ssn for member some vendors will not be able to accept a family without at least a subscriber ssn member first name member string required first name of member member middle name member string required middle name of member member last name member string required last name of member member preferred first name member string optional preferred first name of member, if applicable and known member prefix member string optional prefix (e g , mr , mrs , dr ) for member member suffix member string optional suffix (e g , jr , sr , iii) for member member pronoun member string optional pronoun (e g , he, she, they) for member member gender member enum required gender of member f, m, o, u = female, male, other, unknown member sex member enum required sex of member f, m, o, u = female, male, other, unknown member marital status member enum optional marital status of the member s single this indicates that the individual has never been married m married this signifies that the individual is married d divorced this indicates that the individual is legally divorced w widowed this signifies that the individual's spouse has died u unmarried this is sometimes used as a broader category that may include single, divorced, or widowed individuals a separated member date of birth member yyyymmdd required date of birth of member member date of death member yyyymmdd optional date of death for member member address type member enum recommended residential, correspondence, other member address line 1 member string required address line 1 of member member address line 2 member string optional address line 2 of member member address line 3 member string optional address line 3 of member member city member string required city of member member state member enum required two character state code conforming to the iso 3166 2\ us subdivision codes such as al, ak, az, ar, ca, co, etc member postal code member string required postal code of member may include 5 or 10 characters (9 digits, plus dash) member postal code 4 member string optional last 4 digits of member address extended zip code member county member string optional county of member member country member enum required two character country code conforming to iso 3166 1 alpha 2 member alternate address type member string optional residential, correspondence, other member alternate address line 1 member string optional address line 1 of member alternate address member alternate address line 2 member string optional address line 2 of member alternate address member alternate address line 3 member string optional address line 3 of member alternate address member alternate address city member string optional city of member alternate address member alternate address state member string optional two character state code conforming to the iso 3166 2\ us subdivision codes such as al, ak, az, ar, ca, co, etc for member alternate address member alternate address postal code member string optional postal code of member alternate address may include 6 or 10 characters member alternate address postal code 4 member string optional last 4 digits of member alternate address extended zip code member alternate address county member string optional county of member member alternate address country member enum required two character country code conforming to iso 3166 1 alpha 2 member email member string strongly recommended email address of member member alternate email member string optional alternate email address of member member phone number member numeric strongly recommended phone number of member member phone number type member enum strongly recommended type of phone number for member member alternate phone number member numeric optional alternate phone number of member member alternate phone number type member enum optional type of alternate phone number for member member preferred communication type member enum optional member's preferred communication method values hp = home phone, wp = work phone, te = telephone, mb = mobile phone, em = email member preferred language member string strongly recommended preferred language of member member tobacco use indicator member enum optional indicator of tobacco use for member y,n,u,c,s,d = tobacco user, non tobacco user, unknown, tobacco cession, smokeless tobacco user, dual tobacco user member primary care provider name member string optional member's pcp name (first and last name) coverage primary key coverage string required uniquely identifies the coverage may be a compound id like memberkey+coverageproduct+coverageeffectivedate coverage product coverage enum required coverage product of member mm = medical, rx = prescription drug, vi = vision, de = dental, fx = flex coverage status coverage enum required coverage status of member a,d,h,i,p,r,s,t = active,deceased,hold,inactive,pending,retired,suspended,terminated coverage level coverage enum required code indicating the coverage level sub, fam, ssp, sch, scn = subscriber only, family, subscriber + spouse, subscriber + child, subscriber + children coverage effective date coverage yyyymmdd required effective date of coverage for member coverage termination date coverage yyyymmdd required if this active coverage range is being terminated termination date of coverage for member required if this active coverage range is being terminated coverage area code coverage string optional area code of coverage for member coverage cobra coc event date coverage yyyymmdd optional date of cobra coc (consolidated omnibus budget reconciliation act continuation of coverage) event for member coverage cobra coc exp date coverage yyyymmdd optional expiration date of cobra coc (consolidated omnibus budget reconciliation act continuation of coverage) for member coverage cob coverage enum strongly recommended coordination of benefits information for member p,s,t,u,n = primary, secondary, tertiary, unknown, none coverage medicare indicator coverage string optional indicator of medicare coverage for member coverage disability indicator coverage string strongly recommended indicator of disability status for member coverage cob other plan code coverage string optional plan code for other coverage of member including medicare custom 1 private eligibility string optional custom field custom 2 private eligibility string optional custom field custom 3 private eligibility string optional custom field custom 4 private eligibility string optional custom field custom 5 private eligibility string optional custom field custom 6 private eligibility string optional custom field custom 7 private eligibility string optional custom field custom 8 private eligibility string optional custom field custom 9 private eligibility string optional custom field custom 10 private eligibility string optional custom fieldv