Product: X12 EDI

Transaction: 267

Article Link: http://help.truecommerce.com/en/articles/10220814-x12-267-individual-life-annuity-and-disability-application

267 - Individual Life, Annuity and Disability Application

FUNCTIONAL GROUP=AD

This X12 Transaction Set contains the format and establishes the data contents of the Individual Life, Annuity and Disability Application Transaction Set (267) for use within the context of an Electronic Data Interchange (EDI) environment. The transaction set is used to transmit new business application information among distributors (agents, broker/dealers, etc.), insurance companies and reinsurance companies for the purpose of underwriting an individual life, annuity or disability contract.

SCHEMA

ST

Segment	Name	Position
ST	Transaction Set Header	0100
BGN	Beginning Segment	0200
DTP	Date or Time or Period	0300

NM1

Segment	Name	Position
NM1	Individual or Organizational Name	0400
N3	Party Location	0500
N4	Geographic Location	0600
REF	Reference Information	0700
PER	Administrative Communications Contact	0800

N1

Segment	Name	Position
N1	Party Identification	0010
N2	Additional Name Information	0015
N3	Party Location	0020
N4	Geographic Location	0025
N9	Extended Reference Information	0030
DTM	Date/Time Reference	0040

ACT

Segment	Name	Position
ACT	Account Identification	0050
ASI	Action or Status Indicator	0100
PER	Administrative Communications Contact	0150
C3	Currency Identifier	0200
LUI	Language Use	0250
DTP	Date or Time or Period	0300
BLI	Basic Baseline Item Data	0350
LIN	Item Identification	0400
PDL	Payment Details	0450
AM1	Informational Values	0500
AMT	Monetary Amount Information	0550
QTY	Quantity Information	0575
YNQ	Yes/No Question	0600
REF	Reference Information	0650

LQ

Segment	Name	Position
LQ	Industry Code Identification	0660
N4	Geographic Location	0670
LUI	Language Use	0680

SI

Segment	Name	Position
SI	Service Characteristic Identification	0700
AMT	Monetary Amount Information	0750
DTP	Date or Time or Period	0800
REF	Reference Information	0850
NM1	Individual or Organizational Name	0900
N4	Geographic Location	0950
MSG	Message Text	1000

PID

Segment	Name	Position
PID	Product/Item Description	1050
BLI	Basic Baseline Item Data	1100
SPA	Status of Product or Activity	1150
UD	Underwriting Status	1200
AMT	Monetary Amount Information	1250
AM1	Informational Values	1300
PDL	Payment Details	1350
QTY	Quantity Information	1400
DTP	Date or Time or Period	1450
MSG	Message Text	1500

INV

Segment	Name	Position
INV	Investment Vehicle Selection	1550
AM1	Informational Values	1600
DTP	Date or Time or Period	1650
QTY	Quantity Information	1700
LIN	Item Identification	1750
RPA	Rate Amounts or Percents	1800

BEN

Segment	Name	Position
BEN	Beneficiary or Owner Information	1850
NM1	Individual or Organizational Name	1900
N2	Additional Name Information	1950
N3	Party Location	2000
N4	Geographic Location	2050
REF	Reference Information	2100
DTP	Date or Time or Period	2150
III	Information	2200
QTY	Quantity Information	2250
AMT	Monetary Amount Information	2270
LUI	Language Use	2300
MSG	Message Text	2350

ENT

Segment	Name	Position
ENT	Entity	2400
NX1	Property or Entity Identification	2410
REF	Reference Information	2450
LIN	Item Identification	2500
DMG	Demographic Information	2550
DMA	Additional Demographic Information	2600
IND	Additional Individual Demographic Information	2620
LUI	Language Use	2650
ERI	Entity Relationship	2670
DTP	Date or Time or Period	2700
AMT	Monetary Amount Information	2720
AM1	Informational Values	2750
RPA	Rate Amounts or Percents	2770
YNQ	Yes/No Question	2800
QTY	Quantity Information	2850
MSG	Message Text	2900

NM1

Segment	Name	Position
NM1	Individual or Organizational Name	2950
N2	Additional Name Information	3000
REF	Reference Information	3050
AM1	Informational Values	3070

N3

Segment	Name	Position
N3	Party Location	3100
N4	Geographic Location	3150
COM	Communication Contact Information	3200
DTP	Date or Time or Period	3250
QTY	Quantity Information	3270

LQ

Segment	Name	Position
LQ	Industry Code Identification	3300
SPA	Status of Product or Activity	3350
DTP	Date or Time or Period	3400
MSG	Message Text	3450

NM1

Segment	Name	Position
NM1	Individual or Organizational Name	3500
N3	Party Location	3550
N4	Geographic Location	3600
REF	Reference Information	3650
COM	Communication Contact Information	3700
LUI	Language Use	3750
DTP	Date or Time or Period	3800
MSG	Message Text	3850

BEN

Segment	Name	Position
BEN	Beneficiary or Owner Information	3900
NM1	Individual or Organizational Name	3950
N2	Additional Name Information	4000
N3	Party Location	4050
N4	Geographic Location	4100
REF	Reference Information	4150
DTP	Date or Time or Period	4200
III	Information	4250
QTY	Quantity Information	4300
AMT	Monetary Amount Information	4320
LUI	Language Use	4350
MSG	Message Text	4400

PID

Segment	Name	Position
PID	Product/Item Description	4450
BLI	Basic Baseline Item Data	4500
SPA	Status of Product or Activity	4550
AMT	Monetary Amount Information	4600
QTY	Quantity Information	4650
DTP	Date or Time or Period	4700
YNQ	Yes/No Question	4720
MSG	Message Text	4750

PDL

Segment	Name	Position
PDL	Payment Details	4800
REF	Reference Information	4850

INV

Segment	Name	Position
INV	Investment Vehicle Selection	4900
AM1	Informational Values	4950
DTP	Date or Time or Period	5000
RPA	Rate Amounts or Percents	5050

BEN

Segment	Name	Position
BEN	Beneficiary or Owner Information	5100
NM1	Individual or Organizational Name	5150
N2	Additional Name Information	5200
N3	Party Location	5250
N4	Geographic Location	5300
REF	Reference Information	5350
DTP	Date or Time or Period	5400
III	Information	5450
QTY	Quantity Information	5500
AMT	Monetary Amount Information	5520
LUI	Language Use	5550
MSG	Message Text	5600

UC

Segment	Name	Position
UC	Underwriting Category	5650

HL

Segment	Name	Position
HL	Hierarchical Level	5700
UQS	Underwriting Question	5750
YNQ	Yes/No Question	5800
NM1	Individual or Organizational Name	5850
N3	Party Location	5900
N4	Geographic Location	5950
COM	Communication Contact Information	6000
DTP	Date or Time or Period	6050
QTY	Quantity Information	6100
MSG	Message Text	6150
AM1	Informational Values	6200
AMT	Monetary Amount Information	6250
III	Information	6300
EC	Employment Class	6350
EMS	Employment Position	6400
EMP	Employer	6450
PCT	Percent Amounts	6500
SOI	Source of Income	6550
LIN	Item Identification	6600
REF	Reference Information	6650
ASL	Asset Liability	6700
TOA	Type of Activity	6750
TOV	Vehicle Use Information	6800
VEH	Vehicle Information	6850
CDS	Case Description	6900
CED	Administration of Justice Event Description	6950
SIN	Substance Use	7000
UCS	Underwriting Considerations	7050
FH	Family History	7100
SPA	Status of Product or Activity	7150
MPI	Military Personnel Information	7200

PWK

Segment	Name	Position
PWK	Paperwork	7250
NM1	Individual or Organizational Name	7300
N4	Geographic Location	7350
REF	Reference Information	7400
DTP	Date or Time or Period	7450
SPA	Status of Product or Activity	7500

EFI

Segment	Name	Position
EFI	Electronic Format Identification	7550
BIN	Binary Data Segment	7600

LX

Segment	Name	Position
LX	Transaction Set Line Number	7650

PDL

Segment	Name	Position
PDL	Payment Details	7700
REF	Reference Information	7750
LS	Loop Header	7780

AMT

Segment	Name	Position
AMT	Monetary Amount Information	7800
N1	Party Identification	7850
N3	Party Location	7900
N4	Geographic Location	7950
LIN	Item Identification	8000
DTP	Date or Time or Period	8050
QTY	Quantity Information	8100
MSG	Message Text	8150

AM1

Segment	Name	Position
AM1	Informational Values	8155

INV

Segment	Name	Position
INV	Investment Vehicle Selection	8160
QTY	Quantity Information	8165
DTP	Date or Time or Period	8170
RPA	Rate Amounts or Percents	8175
LE	Loop Trailer	8190

K2

Segment	Name	Position
K2	Administrative Message	8200
DTP	Date or Time or Period	8250
NM1	Individual or Organizational Name	8300
SE	Transaction Set Trailer	8350

COMMENTS

Notes
2/0010	The N1 loop repeats for each company or intermediate distributor.
2/0050	The ACT loop repeats for each individual application.
2/0600	The YNQ segment is used to report answers to application questions identified in YNQ01.
2/0660	The LQ loop is used to report jurisdictional information about the application.
2/0700	The SI loop is used to report policy options being exercised.
2/1050	The PID loop is used to report coverages at the contract level.
2/1850	The BEN loop is used to report beneficiary information that relates only to the coverage's reported in the PID loop.
2/2400	The ENT loop repeats for each entity associated with the policy.
2/2720	The AMT segment is used to report financial information for the entity that is not related to a specific product.
2/2770	The RPA segment is used to allocate commissions that are independent of the product.
2/2800	The YNQ segment reports answers to entity-related questions identified in YNQ01.
2/2950	The NM1 loop identifies the entity.
2/3300	The LQ loop reports underwriting requirements.
2/3500	The NM1 loop identifies information sources for underwriting requirements.
2/3900	The BEN loop is used to report beneficiary information that relates only to a specific entity in the ENT loop.
2/4450	The PID loop is used to report on coverages, service features and riders that relate to a specific entity in the ENT loop.
2/5100	The BEN loop is used to report beneficiary information that relates only to a coverage, service feature or rider in the PID loop.
2/5650	The UC loop is used to report additional risk assessment information.
2/5700	The HL segment is used to build the varying levels of detail that can be reported in the UC loop for different kinds of risk assessment information.
2/5800	The YNQ segment is used to report answers to risk assessment questions.
2/5850	The NM1 segment is used to identify parties related to risk assessment information.
2/7250	The PWK segment is used to report status and disposition of required forms.
2/7300	The NM1 segment identifies the person completing or signing a form.
2/7550	The EFI loop is used to transmit images of required forms and signatures.
2/7650	The LX loop is used to report payments made with the application or in the future.
2/7850	The N1 segment is used to identify payees or payers.
2/8155	The AM1 loop is used to report tax status of payment subtotals.
2/8300	The NM1 segment identifies the originator of the administrative message.

rev 29/11/2024