111 Individual Insurance Policy and Client Information

Functional Group IF

X12N Insurance Subcommittee

This X12 Transaction Set 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

Position
Segment
Name
Max use
  1. To indicate the start of a transaction set and to assign a control number

  2. 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. To supply the full name of an individual or organizational entity

      The 1000 loop provides information about the sending and receiving parties.
    2. To specify the location of the named party

    3. To specify the geographic place of the named party

    4. To specify identifying information

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

Detail

Position
Segment
Name
Max use
  1. 2000 Loop Mandatory
    Repeat >1
    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.
    2. To specify identifying information

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

    4. Code to transmit standard industry codes

    5. To specify the currency being used in the transaction set

    6. To supply demographic information

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

    8. To specify the geographic place of the named party

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

    10. To specify basic item identification data

    11. To specify the condition under which insurance coverage is offered

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

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

    14. To provide specific balance information for financial account reporting

    15. To specify quantity information

    16. To indicate the total monetary amount

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

    18. 2100 Loop Optional
      Repeat >1
      1. To transmit information required to establish payment or remittance activity

      2. To specify identifying information

    19. 2200 Loop Optional
      Repeat >1
      1. To report information

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

    20. 2300 Loop Optional
      Repeat >1
      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.
      2. To report information

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

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

      5. To indicate the total monetary amount

      6. To specify quantity information

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

      8. To provide specific balance information for financial account reporting

      9. To specify identifying information

    21. 2400 Loop Optional
      Repeat >1
      1. To supply the full name of an individual or organizational entity

      2. To specify additional names

      3. To specify a communication contact number

      4. 2450 Loop Optional
        Repeat >1
        1. To specify the location of the named party

        2. To specify the geographic place of the named party

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

    22. 2500 Loop Optional
      Repeat >1
      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.
      2. To specify identifying information

      3. To supply beneficiary, co-participant, and owner information

      4. To report information

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

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

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