Physical Interface BCBS Paperless Enrollment · Physical Interface – BCBS Paperless Enrollment ... former health insurance carrier 353 2SPACES not used by BCBS Medicare (HCFA)

ANCHOR User Interface Review Physical Interface – BCBS Paperless Enrollment

HP-SLED Page 1 of 4 1/7/2011

Physical Interface

BCBS Paperless Enrollment

Description: This batch utility is run on a weekly basis to extract all retirees who have enrolled or cancelled coverage since the last report. This information should be sent as a text file to BCBS Rhode Island. File disposition: ANCHOR will produce this file and store it on the server. ERSRI will transfer the file to OLIS or BCBS at their discretion by the method/media of their choice (refer to VBCBS for transmission options). Control Report: The control report produced with this file will display counts of records, grouped by source type and activity code. Example: Source Activity Count ---------- ----------- ------- B add 383 B cnc 347 C add 210 C cnc 32 Data Rules: File Format: Text file, no delimiters ALL TEXT IN FILE TO BE UPPERCASE. The file consists of records 400 characters in length. Rule 1: Find new policies created since the last extract. Select all policies where the Enrollment Transmittal Date is null and the ‘Bill by Carrier’ indicator is false or null. Write the ‘add’ activity record(s)[rule 2] to the extract for the policy owner (‘S’ – subscriber record) and set the enrollment transmittal date for that policy (in the LOB database) equal to the current business date. Rule 2: Extract AT LEAST one record for each healthcare policy being initiated (new enrollments). Extract one record for the policy holder, and one record for each covered individual on that policy. For each covered individual, write a ‘D’ – dependent record to the extract. Rule 3: If the write of the subscriber or any dependents for a policy fail, do not update the transmittal date and write an error to the control report. Rule 4: Find policies that have had end dates put on them since the last extract. Select all policies with an end date AND the Enddate Transmittal Date is null. Write the ‘cnc’ activity record to the extract and update the enddate transmittal date to the current business date. Extract one record for each healthcare policy being cancelled (the subscriber record).



BCBS Item Name Req

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Valid Values Description Data Rule

source identifier Yes 1 5 ‘PENSb’ Source Identifier

Where b stands for Blank. It is always ‘PENSb’

source type Yes 6 1 'b', 'c'

carrier code of the policy being reported, 'b' for BCBS, 'c' for CHip

record type Yes 7 1 's', 'd'

record type being reported.

'S' for subscriber, 'd' for dependent; report at least one record for each policy; if coverage is for family, report one dependent record for each covered individual

activity code Yes 8 3'add', 'chg','cnc'

activity being reported

'add' = new coverage(policy) being reported, 'cnc' =cancel exisiting policy; Always an 'add' or 'cnc', ERSRI will never report 'changes'

subscriber id number No 11 15 SPACES BCBS ID number spaces

dependent number No 26 3 SPACES BCBS ID number spaces

subscriber social security number Yes 29 9

If 'record type' is 's' or 'd', populate with policy holder SSN.

dependent social security number Yes 38 9

If 'record type' is 'd', populate with covered individual SSN.

group number -- right justified 47 6

group number that identifies ERSRI

Carrier_Grp_Id from BE_HC_Pkg; Right justified

subgroup number -- right justified 53 3 Always Blanks; Right justified

new group number -- right justified 56 6 SPACES

only used by BCBS for 'changes' which we will not report - always pop. W/ SPACES

new subgroup number -- right justified 62 3SPACES

only used by BCBS for 'changes' which we will not report - always pop. W/ SPACES



group package number 65 3

identifier for 'Healthmate' or 'Plan65', etc.

Carrier package Id from be_hc_pln_ref

last name 68 15 Last name of person being reported; truncated

current first name 83 10 First name of person being reported; truncated

new first name 93 10 SPACES

used by BCBS for changes only, always SPACES

middle initial 103 1 Middle Initial; truncated

title (jr, sr, iii, etc.) 104 3 Name suffix of person being reported

sex code 107 1 'm', 'f'

relationship code 108 3

relationship of reported person to policy holder

sub' = subscriber, 'sps' = spouse, 'chd' = child, 'stu' = student, 'hcd' = handicap; from ANCHOR database 'family relationship', dependent child = chd; dependent adult = hcd

marital status 111 1 'm', 's'

marital status of person being reported

if rel. code = 'sps' then 'm'; if child, stu, hcd then 's'; for subscriber, indicate actual marital status.

subscriber contract type 112 3 'ind', 'fam' policy coverage

coverage of the policy being reported; Individual or Family

two-person indicator 115 1 SPACES not used by ERSRI

current date of birth (yyyymmdd) 116 8

new date of birth (yyyymmdd) 124 8 SPACES not used by ERSRI

subscriber address 1 Yes 132 25 Address Line 1

subscriber address 2 Yes 157 25 Address Line 2

subscriber address 3 (foreign address use only) No 182 25

Address Line 3, only if foreign address

city No 207 16 not for foreign addresses

state No 223 2 not for foreign addresses

zip No 225 5 not for foreign addresses

pharmacy number No 230 10 From the Policy; with leading ZERO’s

PCP number No 240 10 From the Policy; with leading zeroes

effective date (yyyymmdd) Yes 250 8 Start date of policy in ANCHOR



termination reason Yes 258 2 'd', 'ml', 'dv', 'oi', 'oa', 'sr', 'nc'

always use 'ml' indicating a voluntary cancellation of coverage

employee number No 260 9 SPACES not used by ERSRI

department number No 269 4SPACES not used by ERSRI

current health insurance indicator 273 2SPACES not used by BCBS

current dental insurance indicator 275 1SPACES not used by BCBS

cob id number 276 15 SPACES not used by BCBS

subscriber phone number 291 10 999999999 only pop if record type is 's' subscriber

filler 301 49SPACES

primary care physician cancel indicator 350 1SPACES not used by ERSRI

pharmacy cancel indicator 351 1SPACES not used by ERSRI

effective change date indicator 352 1SPACES not used by BCBS

former health insurance carrier 353 2SPACES not used by BCBS

Medicare (HCFA) identification number 355 12999999999999

Medicare number of covered individual

CHiP division (group) number 367 10 SPACES not used by BCBS

employer status 377 2 SPACES not used by BCBS

employee hire date (yyyymmdd) 379 8 SPACES not used by BCBS

filler 388 12SPACES filler

ANCHOR Billing Rec File

HP‐SLED Page 1 of 1 1/7/2011

Physical Interface

Billing Rec File

Description:

This batch utility is monthly, after the pension run, to extract all retirees who had a payroll deduction for

Medicare Complete . This file is extracted from the file created by the batch utility ‘Extract Healthcare

information’.

Data Rules:

1.File Format: Text file, comma delimited

File Layout:

Last name: Char(30)

First name: Char(20)

Social security Number: Char(9)

Months being paid: Char(60)

Amount being paid: Char(10)

Package code : Char(5)

ANCHOR User Interface Review Physical Interface - COBRA Expiration File


Physical Interface

PI-COBRA Expiration File

Description: The COBRA Expiration File is used for creating the COBRA Expiration Letters. The COBRA Expiration File is generated through an SQR process that reads the information from a temporary table in the database and creates a text file. This text file will be used to generate the COBRA Expiration Letters to be sent to the recipients. Data Rules: The following information must be reported on the file:

Field Datatype Position Format Comments First Name, Middle Initial, Last Name

Alphanumeric 51 char from position 1 to 51;

20 char First Name + 1 char Middle Initial + 34 char Last Name

Address 1 Alphanumeric 30 char from position 52 to 82;

Address 2 Alphanumeric 30 char from position 83 to 113

Address 3 Alphanumeric 30 char from position 114 to 144

City Alphanumeric 28 char from position 145 to 173;

State Alphanumeric 2 char from position 174 to 175;

Zip 5 Numeric 5 char from position 176 to 180;

99999

Zip 4 Numeric 4 char from position 181 to 184;

9999

Province Alphanumeric 20 char from position 185 to 205;

Postal Code Alphanumeric 10 char from position 206 to 216;

Country Alphanumeric 30 char from position 217 to 247;

Greeting Alphanumeric 40 char from position 248 to 288;

Termination Date

Numeric 6 char from position 289 to 295

mm/cc/yy

User First Name, User Middle Initial, User Last Name

Alphanumeric 51 char from position 296 to 347

20 char User First Name + 1 char User Middle Initial + 34 char User Last Name

User Title Alphanumeric 51 char from position 348 to 399

ANCHOR User Interface Review Physical Interface - COBRA Expiration File


ANCHOR Dental-record format


State of Rhode Island payment file layout Field Name Field Type Field Length Example Group Code Character 4 8350 Sub Location Character 4 0104 SSN Character 9 XXXXXXXXX Contract Character 3 IND or FAM Last_Name Character 24 Espo First_Name Character 20 Anthony Begin_Date Character 8 20060501 End_Date Character 8 20060601 Premium Numeric 6,2 23.83 Retro_Premium Numeric 6,2 47.66 - 2 months coverage

ANCHOR Eligibility Rec File


Physical Interface

Eligibility Rec File

Description:

This batch utility is monthly, after the pension run, to extract all retirees who had a payroll deduction for

United‐Medicate Complete HMO. This file is extracted from the file created by the batch utility ‘Extract

Healthcare information’.

Data Rules:

File Format: Text file, comma delimited

1. Termination date would be blank if there is no end date

2. If the permanent address is not present the temporary address would be displayed.

Layout:

Last name: Char(30)

First name: Char(20)

Social security Number: Char(9)

Billing period date: Char(8)

Termination date :Char(8)

Street Address :Char(30)

City: Char(20)

State : Char(2)

Zip code 5 :Char(5)

Group number: Char(5)

ANCHOR Healthcare Information File


Description

Pos

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Valid Values Description data rules

Subscriber Record :

Group/Sub-Group Numbers

1 9

Carrier_Grp_id from BE_HC_pkg char(6) + Carrier_Sub_Grp_id from BE_HC_pkg char(3)

Package Number 10 3

Carrier_Pkg_id from be_hc_pln_ref.

Owner SSN 13 13

Will list the owner SSN

We will just retain the 13 field length but it will only by 9 char

Subscriber Social Security Number

26 9

Socail Security Number SSN of the subscriber

Subscriber Contract Type

35 3

'FAM', 'IND'

policy coverage 'FAM' if family, 'IND' if Individual

Relationship Code

38 3 SUB' always 'SUB'

Last Name 41 15 truncate if necessary First Name 56 10 truncate if necessary Middle Initial 66 1 Marital Status : M = Married

67 1

'M','S','D','W','P'

if a spouse policy, 'M'; if a retiree policy, if spouse relationship exists, 'M', else, 'S'; divorced, widowed and seperated not used in ANCHOR

Date-of-Birth : 68 8

CCYYMMDD Date of birth of the policy person

Billing Period : From Date

76 8

CCYYMMDD

1st day of the month following the pension run (9/26/2002 pension run deducts premiums for October, so start date = 10/01/2002)

Billing Period : Thru Date

84 8

CCYYMMDD

Last day of the month following the pension run (9/26/2002 pension run deducts premiums for October, so end date = 10/31/2002)



premium amount 92 10

99999999V99

Regular Health care deduction amount

if item type is 'Healthcare - retiree', 'Healthcare - spouse', Dental, Vision, pharmacy regardless of coverage (family or individual) put the pyrl_adj_hist amount here

Tier 1 subsidy amount

102 10

99999999V99

Regular basic state subsidy amount

'Basic' state subsidy - the fixed subsidy amount

Tier 2 subsidy amount

112 10

99999999V99 Regular state subsidy amount

the graduated subsidy amount that is based on service credit, etc.

Tier 2 Subsidy category

122 10

'0','10','20','30','40','50','60','70','80','90','100'

Subsidy percentage

The percentage subsidy determined when the premiums were calculated.

Retro premium amount

132 10

99999999V99 Retro Health Care Deductions

if item type is 'Retro Healthcare Retiree', 'Retro Healthcare Spouse', 'retro vision', 'retro dental' or 'retro pharm', regardless of coverage (family or individual) put the pyrl_adj_hist amount here

Retro Subsidy Amount Tier 1

142 10

99999999V99

Retro deduction basic state subsidy amount

If a retro premium was deducted, this represents the First (Tier 1 / Basic) subsidy amount of the retro premium

Retro Subsidy Amount Tier 2

152 10

99999999V99

Retro deduction state subsidy amount

If a retro premium was deducted, this represents the Tier 2 subsidy amount (variable) of the retro premium

RetroPayment Health Care Amount

162 10

99999999V99 Retro Payments for Health Care

if item type is 'Retro Payment Healthcare Retiree', 'Retro Payment Healthcare Spouse', 'retro payment vision', 'retro payment dental' or 'retro payment pharm', regardless of coverage (family or individual) put the



pyrl_adj_hist/fnc_item amount here

Retro Payment Subsidy Amount Tier 1

172 10

99999999V99

Retro payment basic state subsidy amount

If a retro payment premium amount represents the First (Tier 1 / Basic) subsidy amount of the premium amount deducted

Retro Payment Subsidy Amount Tier 2

182 10

99999999V99

Retro payment State Subsidy amount

If a retro payment premium amount represents the Tier 2 subsidy amount (variable) of the premium amount deducted

Rule # 192 5

char(5) Rule Cli Cd from BE_HC_Rule_Ref

Client rule code from plan healthcare rule table

Rule Description 197 80

Rule Description from BE_HC_Rule_Ref

client rule description from healthcare rule table

record type 277 2

'HC','V','D','P'

Is this a record for Health, Vision, Dental or Pharmacy? (what was the payroll deduction type?)

Payroll Date 279 10 CCYYMMDD

date of last pension payroll

Policy Owner 289 1

'1','2' 1 = retiree; 2 = spouse

Vendor 290 4 9999

vendor org_id associated with the associated policy

Billed By Carrier 294 1 boolean

Retirement Plan 295 8

the retirement plan the retiree is part of (ERS, MERS, JDGS, STPL)

plan_cli_cd from be_pln (policy - rcpnt_acct - bene_acct - plan)

Benefit Structure 303 4 client cd from bene_struc_ref (policy



- rcpnt_acct - bene_acct - bene_struc_ref)

Employee Group 307 4

emp group from bene_struc_ref (policy - rcpnt_acct - bene_acct - bene_struc_ref)

Retirement Type 311 2

Retirement Type of the benefit account

ERSRI healthcare plan ID

313 8

HealthCare plan Id

ERSRI Healthcare Plan Name

321

40

Health Care plan name

Owner sex

361

1

Employer start date

362

8

CCYYMMDD

Date of retirement

370

8

CCYYMMDD

Service credit

378 5

999V99

Recipient Gender

383

1

Recipient DoB

384

8

CCYYMMDD

Policy start date

392

8

CCYYMMDD

Health care contribution percentage

400

5

999V99

this field will show the health care percentage that the retiree will be paying

If a policy is a family policy then there will a record for every covered individual in the policy, for all the dependent records premium amount,Tier 1 subsidy amount,Tier 2 subsidy amount,Tier 2 Subsidy category,Retro premium amount,Retro Subsidy Amount Tier 1,Retro Subsidy Amount Tier 2,RetroPayment Health Care Amount,Retro Payment Subsidy Amount Tier 1,Retro Payment Subsidy Amount Tier 2 will be showns as ZERO And Rule #,Rule Description,Vendor,Billed By Carrier,Retirement Plan,Benefit Structure,Employee Group,Retirement Type,ERSRI healthcare plan ID,ERSRI Healthcare Plan Name will be have the value that of the subscriber details

ANCHOR Medicare Billing File Layout


Column Headings Field Name: Identifies what specific data should be placed in this field. Position Start: Indicates the starting position of the field. Position End: Indicates the ending position of the field. Field Length: Indicates the maximum number of bytes for the data.

Identifies whether the field should be completed for the employee, dependent, or both. The following codes are used in this field: E = Indicates field is required for employee (subscriber) record D = Indicates field is required for dependent B = Indicates field is required for both employee and dependent

Required: Identifies if the customer is required to populate this field with data. The following codes are used in this field: R = Required: The customer is required to populate this field as noted. O = Optional: The customer can determine through their eligibility process if they want to populate this field. C = Conditional: The customer may be required to populate these fields based on the values in other fields.

Description: Defines the "Field Name". Values In: Specifies the Gateway Standard Format values that the customer will use to

populate fields.

Header Record Requirements:

The header record must be the very first record on the file, and the format must be as follows:

Field Name Position

Start Position End

Field Length

Field Type

Required Description Values In

Header Filler 1 19 19 R Filler area must be spaces. Blank Header Detail record Count

20 27 8 R Total number of detail records excluding the Header Record.

Must be a right justified, zero filled, numeric value.

Header Filler 28 R Must be a pipe delimiter. A carriage return should immediately follow the pipe delimiter. No spaces or added characters should be sent between the pipe and the return.

|

Member Record Requirements

Fields highlighted in yellow are required fields and must be sent on the file. All data should be left justified. No default or filler values should be placed in trailing spaces. All uppercase character data is preferred, but it some instances it is required. Fields requiring uppercase data are noted. Your Electronic Eligibility Analyst will advise you if any of the filler fields should be populated. Field Name Position

Start Position End

Field Length

Field Type


Version Indicator 1 5 5 B R Indicates layout version submitted.

Use code: V1.20



Field Name Position Start

Position End

Field Length

Field Type


Submission Group ID

6 13 8 B R The 4-8 character ID assigned by the Electronic Eligibility Analyst for this submission group. The submission group ID must be in all capital letters.

Your Electronic Eligibility Analyst will inform you of this code.

14 25 12 B R LEAVE BLANK Blank Relationship Code

26 27 2 B R Identifies if the record is for an employee or dependent. Note: If a relationship code of 20 (student) is sent, UHG will generate a Student Status Verification letter that will be mailed to the member. Do not use relationship code 20 if UHG is not verifying student status for your group.

18= Employee 01= Spouse 19= Child 20= Student 34= Retiree 02= Surviving Spouse 38= Collateral Dep 23= Sponsored Dep 09= Stepchild 21= Handicapped Dep 22= Handicapped Student 35= New Born 53= Life Partner 36= Other

Employee ID 28 38 11 B R The unique employee identifier. (See eligibility guide for information on alternate identification numbers.)

Subscriber social security number should be used. Format: 00 + 9-digit SSN

39 42 4 B R LEAVE BLANK Blank Member Social Security Number

43 53 11 B O The member's Social Security Number. If unknown this field must be Leave Blank. Duplicate SSN's are not permitted.

Member's social security number. Format: 00 + 9-digit SSN

54 57 4 B R LEAVE BLANK Blank Former EE ID *not commonly used

58 72 15 E O If the employee ID is changing the prior employee ID is entered in this field for reporting.

The prior employee ID Format: 00 + 9-digit SSN

Personnel ID *not commonly used

73 83 11 E O Personnel ID number

84 88 5 B R LEAVE BLANK Blank Employment Date

89 96 8 E R The date the employee started work with the company.

YYYYMMDD

97 108 12 B R LEAVE BLANK Blank Member Last Name

109 128 20 B R The member's last name. No punctuation should be included.

Member's last name

Member First Name

129 140 12 B R The member's first name. Note: Due to system constraints, do not include middle name or middle initial in this field. No punctuation should be included.

Member's first name

141 148 8 B R LEAVE BLANK Blank Member Middle Initial

149 149 1 B O The member's middle initial. Member's middle initial

150 168 19 B R LEAVE BLANK Blank Member Birth Date

169 176 8 B R The member's date of birth. YYYYMMDD

177 188 12 B R LEAVE BLANK Blank




Position End

Field Length

Field Type


Member Gender 189 189 1 B R The member's gender. M = Male F = Female U = Unknown

Member Marital Status

190 190 1 B

R The member's marital status. B= Registered Domestic Partner D= Divorced I= Single M= Married R= Unreported S= Separated W= Widowed U= Unmarried/Unknown

COB Flag *not commonly used

191 191 1 B O Indicates if member has other coverage. If used should only be sent for new enrollees and then the information should be dropped from the file

Y = Yes other coverage N or Blank = No other coverage

COB Date *not commonly used

192 211 20 B O Start date of Coordination of Benefits (COB). If used should only be sent for new enrollees and then the information should be dropped from the file.

YYYYMMDD

Language *not commonly used

212 214 3 E O Indicates primary language of member.

Field should be left blank

Permanent Street Address 1

215 246 32 B R Member's street address. This field is required for all members. No punctuation should be included. Both subscribers and dependents must have a permanent address passed on your file.

Member's primary street address


247 278 32 B O The member's second line of street address (Apt Number, PO Box, Care of Address, Etc.). No punctuation should be included. This is an optional field and should be used only if Permanent Street address 1 is completed.

Member's secondary street address

Permanent City 279 298 20 B R The member's city. This field is required for all members. No punctuation should be included. Both subscribers and their dependents must have a permanent city passed on your file.

Member's city address

Permanent State 299 300 2 B R The member's state. No punctuation should be included. Must be in all capital letters.

Member's state address

Permanent Zip Code

301 315 15 B R 5-digit zip code and 4-digit zip code extension. The 5-digit zip code is a required field for domestic addresses; the zip code extension is optional and can be left blank. Note: Do not include a dash (-) between the 5 digit zip code and the 4 digit zip code extension.

5-digit zip code and 4-digit zip code extension. Canadian zip code format: Canadian alphanumeric codes must have a space between the third and fourth byte of the postal code in this field. For example, A9A_9A9.




Position End

Field Length

Field Type


Permanent Country Code

316 317 2 B R The Country the employee resides in. For a complete listing of country codes use the following web address – http://www.iso.ch/iso/en/prods-services/iso3166ma/02iso-3166-code-lists/index.html

Must be 2 characters in length. For example, USA = US.

318 318 1 B R LEAVE BLANK Blank Mailing Street Address 1

319 350 32 B C Member's mailing street address. The Mailing address fields should be used if the member has a mailing address different from that of the Permanent address. No punctuation should be included.

Member's primary mailing street address

Mailing Street Address 2

351 382 32 B C The member's second line of mailing street address (Apt Number, PO Box, Care of Address, Etc.). This is an optional field and should be used only if street address 1 is completed. No punctuation should be included.

Member's secondary mailing street address.

Mailing City 383 402 20 B C Member's mailing city. No punctuation should be included.

Member's mailing city.

Mailing State 403 404 2 B C Member's mailing state. No punctuation should be included. Must be in all capital letters.

Member's mailing state

Mailing Zip Code 405 419 15 B C 5-digit zip code and 4-digit zip code extension. The 5-digit zip code is a required field for domestic addresses; the zip code extension is optional and can be left blank. Note: Do not include a dash (-) between the 5 digit zip code and the 4 digit zip code extension.


Mailing Country Code

420 421 2 B C The Country the employee resides in. For a complete listing of country codes use the following web address – http://www.iso.ch/iso/en/prods-services/iso3166ma/02iso-3166-code-lists/index.html


422 422 1 B R LEAVE BLANK Blank Home Phone Number

423 432 10 B R Members 10 digit home phone number. No dashes or spaces allowed.

Members home phone number.

Death Date 433 440 8 E C Members death date YYYYMMDD 441 452 12 B R LEAVE BLANK Blank




Position End

Field Length

Field Type


XREF/Payee Indicator

453 454 2 E C This field should be completed only if this record is for a survivor situation, or if sending an opt-out EE w/opt-in dependents. The code is used to indicate whom the XREF name/number belongs to.

01 = spouse 11 = Surviving Dependent 18 = Self 20 = Military

XREF/Payee Last Name

455 474 20 E C Last name of survivor. This field should only be completed if the payee indicator field is populated.

Survivor's last name

XREF/Payee First Name

475 486 12 E C First name of survivor. This field should be only completed if the payee indicator field is populated.

Survivor's first name

487 494 8 B R LEAVE BLANK Blank XREF/Payee SSN 495 505 11 E C Social Security Number of

survivor. This field should only be completed if the payee indicator field is populated.

Survivor's social security number Format: 00 + 9-digit SSN.

506 509 4 B R LEAVE BLANK Blank Special Util 4 510 521 12 E C Utility field that will feed data

to TOPS. Blank or customer specific data.

Sub-Department Nbr *not commonly used

522 529 8 E C The Sub-Department number sorts employees on the invoice within employer's specific sub-departments.

This field should be left blank.

Retirement Date 530 537 8 B C The date the member retires. This is required field for members with a retiree status.

YYYYMMDD

538 545 8 B R LEAVE BLANK Blank Primary Physician MPIN/Location

546 559 14 B C Member's primary care physician identification number.

Primary Care Physician identification number Format:0000+7-digit MPIN+0+2-digit Location Code. For example: 00001234567012

560 561 2 B R LEAVE BLANK Blank Primary Physician Start Date

562 569 8 B C The date the member’s primary physician became or will become effective.

YYYYMMDD

570 581 12 B R LEAVE BLANK Blank Primary Physician Stop Date *not commonly used

582 589 8 B O The date the member is no longer covered by this primary physician.

YYYYMMDD

590 601 12 B R LEAVE BLANK Blank Primary Physician IPA *not commonly used

602 606 5 B O The independent practice association number of the primary care physician.

Independent practice association number

Primary Physician Current Patient Indicator

607 608 2 B O Indicates if the member is a current patient of the primary care physician.

25= Established Patient 26= Not Established Patient 72= Unknown

Filler Field 609 609 1 Blank Blank Filler Field 610 629 20 Blank Blank




Position End

Field Length

Field Type


Filler Field 630 649 20 Blank Blank Special Util 2 650 669 20 Utility field that will feed data

to UBH. Blank or customer specific data.

Special Util 3 670 689 20 Utility filed that will feed data to Billing.

Blank or customer specific data.

Salary Year 690 693 4 E C CCYY Salary 694 703 10 E C Salary In Area OOP

704 708 5 E C

Salary Out Area OOP

709 713 5 E C

Salary In Area Ded

714 718 5 E C

Salary Out Area Ded

719 723 5 E C

Com-Util1 724 731 8 B O For future or customer specific field requirements.


Member Utility1 740 747 8 B O For future or customer specific field requirements.

Special Utility1 748 755 8 B O For future or customer specific field requirements.

Coverage 1 Coverage Type

756 758 3 B R Field used for first coverage type selected by member. Coverage type must be passed with all capital letters. Note: Normally Coverage type 1 is for Medical Coverage. MM is the recommended code for medical coverage. AK may be used for stand-alone (S) coverage such as OPTUM.

Product Codes: EXM= Executive Medical DCP= Dental Capitation DEN= Dental EPO= Exclusive Provider Organization HE= Hearing AG= Preventative Care HMO= Health Maintenance Organization MM= Major Medical IND = Indemnity AS= Accident and Sickness MOD= Mail Order Drug PDG= Prescription Drug RX2= Mail Order Drug and Prescription Drug POS= Point of Service PPO= Preferred Provider Plan PRA= Practitioners VIS= Vision AK= Mental Health LTC= Long Term Care LTD= Long Term Disability STD= Short Term Disability UR= Utilization Review BLF= Basic Life SLF= Supplemental Life DEL= Dependent Life SAD= Supplemental AD&D

Coverage 1 Coverage Start Date

759 766 8 B R The date the member's coverage becomes effective with UHG.

YYYYMMDD





Position End

Field Length

Field Type


Coverage 1 Coverage End Date

779 786 8 B C The date member's coverage is cancelled or will be cancelled. Note: A Coverage End Date should only be passed if a member is terminating this coverage type with UHC. Coverage End Dates may not be more than 30-days in the future, and once a member terminates all coverage types and a term date is passed that member must be dropped off the file.

YYYYMMDD

787 798 12 B R LEAVE BLANK Blank Coverage 1 Coverage Paid Thru Date

799 806 8 B C The date in which the member has paid thru his/her COBRA coverage. This field only should be used in COBRA situations.

YYYYMMDD

807 818 12 B R LEAVE BLANK Blank Coverage 1 Structure Field 1

819 825 7 B R Seven-digit customer number assigned by UHG. The entry will be the same for all records on the file.

Seven digit Customer Number. NOTE: Must be seven digits long. If shorter than seven digits pre-fill with zeros to make the number seven digits.


829 835 7 B R Policy Number of Customer. This number along with the plan variation code and reporting code make up the account structure.

Seven digit Policy Number NOTE: Must be seven digits long. If shorter than seven digits pre-fill with zeros to make the number seven digits.


839 842 4 B R Four digit numeric Plan Variation code within account structure. NOTE: The Plan Variation and Reporting Code can be found in your copy of the Account Structure for this group. Your Client Services Manager can provide you with a copy of this structure.

Plan Variation Code For example: 0004


849 852 4 B R Four digit numeric reporting code within the account structure. NOTE: The Plan Variation and Reporting Code can be found in your copy of the Account Structure for this group. Your Client Services Manager can provide you with a copy of this structure.

Reporting Code For example: 0004


859 860 2 B C The Plan Code field is required for plans with Embedded Vision Coverage.

Blanks = No Embedded Vision VE = Embedded Vision




Position End

Field Length

Field Type



869 878 10 B C Field is reserved for customer specific structure data.

Blank or Customer specific data.

Coverage 1 Structure Field 7












Coverage 1 Members Covered

919 921 3 B O The code indicates which members of the family are covered for this particular coverage. All members of the family should have the same Members Coverage Code. THIS IS AN OPTIONAL FIELD BECAUSE UHG DERIVES THE INFORMATION BASED ON THE ACTIVE FAMILY MEMBERS IN OUR SYSTEM.

CHD= Children Only SD1= Employee and 1 Dep ECH= Employee and Children EMP= Employee Only ESP= Employee and Spouse FAM= Family SPO= Spouse Only CH1 = Child Only SPC= Spouse and Children SS1 = Subscriber, Spouse + 1 Dependent

Coverage 1 COBRA Indicator/Cancel Reason

922 923 2 B C This field is used to indicate that the coverage being reported is being continued as a result of a COBRA election. Your Electronic Eligibility Analyst will provide you with the appropriate code to use.

TC = UHC Administered TY = Customer Administered NC = No HIPAA Cert Produced.

Coverage 1 Elig Util-1

924 931 8 B O For future or customer specific field requirements.





Coverage 1 Elig Long Util-1


Coverage 1 Life Flat Amount

968 974 7 E C The flat amount of the life benefit.

Dollar amount of life benefit

Coverage 1 Life Benefit Factor

975 978 4 E C Value salary amount is multiplied by to determine dollar amount of benefit.

Benefit factor dollar amount

Coverage 1 Rider Dep Flag

979 979 1 E C Indicates whether the subscriber selected the dependent coverage rider.

Y= Dependent Rider was selected N= Dependent Rider was not selected Blank= Dependent coverage not available

Coverage 1 Rider Critical Illness

980 980 1 E C Indicates whether the subscriber selected the critical illness rider.

Y= Critical Illness Rider was selected N= Critical Illness Rider was not selected Blank= Critical Illness coverage not available

UHG 3005 File Format Specifications

Version 1.20

April 8, 2005

ANCHOR


Overview

The UHG 3005 file format was created in order to standardize the processing of electronic eligibility

information as it passes through Employer eServices Electronic Eligibility Management System. This

standardization will allow customers to benefit from all of the processing benefits of Employer eServices

Electronic Eligibility Management System, as well as provide UnitedHealth Group with a more streamlined

mapping procedure. The format encompasses processing requirements and incorporates the use of HIPAA

input values to allow UnitedHealth Group to remain strategic and flexible within the market place.

In the event that there are governmental or industry changes to the data that UnitedHealth Group is

required to collect, UnitedHealth Group may modify the UHG 3005 file format. If that occurs,

UnitedHealth Group would require the customer to change to the new version of the UHG 3005 file format

within a calendar year. This customer change is required because the Electronic Eligibility Management

System will not support more than two active versions of the format.

The following pages provide detailed specifications on the format of the information that should be passed

on the file. The format of the file provides for demographic information to be passed first, with coverage

information following. The Employer eServices Electronic Eligibility Management System can currently

process up to 4 coverage types. Coverage blocks 5-10 are not currently utilized, and are in dark gray on

the file specifications starting on page 19. The UHG 3005 file format has been designed to accommodate

future enhancements to our system.

There are five categories of information that may be included on each record:

Member Identification Information

Address Information

Survivor Information

Primary Physician Information

Coverage Information

These categories of information are described below.

Member Identification Information

This category includes information specific to the member such as relationship code, social security

number, employment date, full name, and date of birth. This information will uniquely identify each

member of the family on the UnitedHealth Group eligibility system. Please note that middle initials or

names may not be sent in the first name field as it creates a claim matching issue when a claim is

processed for the member.

The following special characters are acceptable within the following fields:

First name & Payee First name: - ' () . , Hyphen, apostrophe, parentheses, period and comma. These

characters will be converted to a space in our system.

Middle name: no special characters are allowed.

Last name & Payee Last name: - ' Hyphen and apostrophe. These characters will load directly into our

system as is. The following characters will be converted to a space in our system: . , / * ~ () # % > < "

Period, comma, slash, asterisk, tilde, parentheses, pound, percentage, greater than, less than, and quote.

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Address Information

The UnitedHealth Group Eligibility System has the ability to store up to 2 addresses for each family, one

permanent and one mailing address. Every record on your file must have the permanent address field(s)

populated. This includes both employee and dependent records. The mailing address field(s) should only

be populated if it is different from the permanent address field(s).

In addition to the standard postal state abbreviations, AP and AE are also valid when used with 'APO' in

the state field.

Foreign Address Processing

UnitedHealth Group prefers that foreign members be passed with the employer’s domestic HR mailing

address as the expatriate’s permanent address.

In the event that this is not an option, UnitedHealth Group has a special handling procedure for

expatriates. If a foreign address is passed on your electronic file, we will load a UnitedHealth Group

internal mailing address for the mailing address of the member, and the members foreign address in a

permanent address field in our system. All member correspondence, including claim payments, EOB's,

and ID cards, are routed internally for special handling of the member's mail. Mail is then re-mailed to the

member's foreign address, with the correct postage affixed.

Note: Puerto Rico and the Virgin Islands are U.S. Territories, therefore those addresses are considered

domestic. However, Canadian addresses are considered foreign addresses.

Survivor Information

UnitedHealth Group requires that surviving member's coverage continue to be passed on the file under the

deceased employee's identification number, along with the deceased employee's record. The four survivor

information fields are:

XREF/Payee Indicator position 453

XREF/Payee Last Name 455

XREF/Payee First Name 475

XREF/Payee SSN 495

These fields are used only for deceased employee records. When the Payee Indicator field is populated,

UnitedHealth Group will direct all correspondence (ID cards, Explanations of Benefits, etc.) to the Payee

name. The XREF data is passed on the deceased employee's record only, along with a date of death

(position 433). No XREF data is to be passed on the surviving dependent records.

Each member continuing coverage after the employee's death should be passed on the file along with the

deceased employee's record. The relationship code (position 26) for each member continuing coverage

must be populated with the appropriate code:

02 (surviving spouse)

19 (child)

The XREF/Payee Indicator (position 453) should be populated with a 01 (surviving spouse) or 11

(surviving dependent).

ANCHOR


The employee identification number for the entire family will continue to be the deceased employee’s

identification number, and the XREF/Payee's social security number will be used as a cross-reference. If a

claim is submitted under either the employee identification number or the XREF/Payee's social security

number, this family’s record will be retrieved. Continuing the coverage under the deceased employee

record allows for accurate claim history to be maintained for the family.

Primary Physician Information

If Primary Physician information will be passed on your eligibility file for new enrollees in a gatekeeper

(managed care) medical plan, please pass the following fields:

Primary Physician MPIN & Location Code

Primary Physician Start Date


Coverage Data

While the layout provides for up to 3005 bytes, the file format should be treated as a variable length file

based on the number of coverage types/blocks being passed on the file. You should adjust your file length

based on the maximum number of coverage types that will be passed for each member. With the

exception of the header record, each record for every member should end at the same byte. For example,

if you send Medical and RX coverage for every member on the file, then you should adjust your record

length to be 1206 bytes as position 1206 follows the last field related to coverage type two. Instead of

sending spaces out to position 3005 at the end of each record, we require that you truncate the record

and send an "end of record indicator". The end of record indicator is a pipe (|). Each record on your file

must have an end of record indicator as the last character, and this indicator must not appear anywhere

other than at the end of each record.

Please use the following guidelines when programming your file based on the coverage types you will be

passing on your file to UnitedHealth Group:

One Coverage Type: Each record would end in Position 0981 with a pipe delimiter (|).

Two Coverage Types: Each record would end in Position 1206 with a pipe delimiter (|).

Three Coverage Types: Each record would end in Position 1431 with a pipe delimiter (|).

Four Coverage Types: Each record would end in Position 1656 with a pipe delimiter (|).

Your Account Management Team will supply the account structure (policy number, plan variation &

reporting codes) to you.

ANCHOR


Fields & Descriptions

The following pages describe the file format in detail. If you have any questions regarding the file

specifications, please contact your deployment analyst.

Column Headings

Field Name: Identifies what specific data should be placed in this field.

Position Start: Indicates the starting position of the field.

Position End: Indicates the ending position of the field.

Field Length: Indicates the maximum number of bytes for the data.

Field Type: Identifies whether the field should be completed for the employee, dependent, or

both. The following codes are used in this field:

E = Indicates field is required for employee (subscriber) record

D = Indicates field is required for dependent

B = Indicates field is required for both employee and dependent

Required: Identifies if the customer is required to populate this field with data. The following

codes are used in this field:

R = Required: The customer is required to populate this field as noted.

O = Optional: The customer can determine through their eligibility process if they

want to populate this field.

C = Conditional: The customer may be required to populate these fields based on the

values in other fields.

Description: Defines the "Field Name".

Values In: Specifies the Gateway Standard Format values that the customer will use to populate

fields.

File Name Requirements

Your file name must be formatted as follows:

SUBMITID.U.YYYYMMDDHHMM.gsf

SUBMITID = Submitter ID or Submission Group name (8 characters maximum). All capital letters are

required. Your Electronic Eligibility Analyst will provide you with the Submitter ID.

U = Indicates the UnitedHealth Group UNET system platform. The U must be a capital letter.

YYYYMMDDHHMM = The Date and time stamp is the creation time and date of the file. It must be

supplied by the customer on every file submitted for processing. The date and time stamp, along with the

Submitter ID, creates the unique customer file name, which will be linked to the Employer eServices

Electronic Eligibility Management System to provide eligibility statistics to the customer.

gsf = Is the file extension used to denote the UHG 3005 Format. All lowercase letters are required.

Header Record Requirements:

The header record must be the very first record on the file, and the format must be as follows:

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Position End

Field Length

Field Type


Header Filler 1 17 17 R Filler area must be spaces. Blank

Header Detail record Count

18 25 8 R Total number of detail records excluding the Header Record.

Must be a right justified, zero filled, numeric value.

Header Filler 26 R Must be a pipe delimiter. A carriage return should immediately follow the pipe delimiter. No spaces or added characters should be sent between the pipe and the return.

|

Member Record Requirements

Fields highlighted in yellow are required fields and must be sent on the file. All data should be left

justified. No default or filler values should be placed in trailing spaces. All uppercase character data is

preferred, but it some instances it is required. Fields requiring uppercase data are noted. Your Electronic

Eligibility Analyst will advise you if any of the filler fields should be populated.

Note: Attached is a sample of the UHG 3005 file format, with the header record and member records.

The file is best viewed with TextPad or UltraEdit.

Field Name Position

Start

Position

End

Field

Length

Field

Type


Version Indicator 1 5 5 B R Indicates layout version submitted.

Use code: V1.20

Submission Group ID

6 13 8 B R The 4-8 character ID assigned by the Electronic Eligibility Analyst for this submission group. The submission group ID must be in all capital letters.

Your Electronic Eligibility Analyst will inform you of this code.


Relationship Code

26 27 2 B R Identifies if the record is for an employee or dependent. Note: If a relationship code of 20 (student) is sent, UHG will generate a Student Status Verification letter that will be mailed to the member. Do not use relationship code 20 if UHG is not verifying student status for your group.

18= Employee 01= Spouse 19= Child 20= Student 34= Retiree 02= Surviving Spouse 38= Collateral Dep 23= Sponsored Dep 09= Stepchild 21= Handicapped Dep 22= Handicapped Student 35= New Born 53= Life Partner 36= Other

Employee ID 28 38 11 B R The unique employee identifier. (See eligibility guide for information on alternate identification numbers.)

Subscriber social security number should be used. Format: 00 + 9-digit SSN


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Position End

Field Length

Field Type


Member Social Security Number

43 53 11 B O The member's Social Security Number. If unknown this field must be Leave Blank. Duplicate SSN's are not permitted.

Member's social security number. Format: 00 + 9-digit SSN


Former EE ID *not commonly used

58 72 15 E O If the employee ID is changing the prior employee ID is entered in this field for reporting.

The prior employee ID Format: 00 + 9-digit SSN

Personnel ID *not commonly used

73 83 11 E O Personnel ID number


Employment Date

89 96 8 E R The date the employee started work with the company.

YYYYMMDD


Member Last Name

109 128 20 B R The member's last name. No punctuation should be included.

Member's last name

Member First Name

129 140 12 B R The member's first name. Note: Due to system constraints, do not include middle name or middle initial in this field. No punctuation should be included.

Member's first name


Member Middle Initial

149 149 1 B O The member's middle initial. Member's middle initial


Member Birth Date

169 176 8 B R The member's date of birth. YYYYMMDD


Member Gender 189 189 1 B R The member's gender. M = Male F = Female U = Unknown

Member Marital Status

190 190 1 B

R The member's marital status. B= Registered Domestic Partner D= Divorced I= Single M= Married R= Unreported S= Separated W= Widowed U= Unmarried/Unknown

COB Flag *not commonly used

191 191 1 B O Indicates if member has other coverage. If used should only be sent for new enrollees and then the information should be dropped from the file

Y = Yes other coverage N or Blank = No other coverage

COB Date *not commonly used

192 211 20 B O Start date of Coordination of Benefits (COB). If used should only be sent for new enrollees and then the information should be dropped from the file.

YYYYMMDD

Language *not commonly used

212 214 3 E O Indicates primary language of member.

Field should be left blank

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Position End

Field Length

Field Type



215 246 32 B R Member's street address. This field is required for all members. No punctuation should be included. Both subscribers and dependents must have a permanent address passed on your file.

Member's primary street address


247 278 32 B O The member's second line of street address (Apt Number, PO Box, Care of Address, Etc.). No punctuation should be included. This is an optional field and should be used only if Permanent Street address 1 is completed.

Member's secondary street address

Permanent City 279 298 20 B R The member's city. This field is required for all members. No punctuation should be included. Both subscribers and their dependents must have a permanent city passed on your file.

Member's city address

Permanent State 299 300 2 B R The member's state. No punctuation should be included. Must be in all capital letters.

Member's state address

Permanent Zip Code

301 315 15 B R 5-digit zip code and 4-digit zip code extension. The 5-digit zip code is a required field for domestic addresses; the zip code extension is optional and can be left blank. Note: Do not include a dash (-) between the 5 digit zip code and the 4 digit zip code extension.


Permanent Country Code

316 317 2 B R The Country the employee resides in. For a complete listing of country codes use the following web address – http://www.iso.ch/iso/en/pro

ds-services/iso3166ma/02iso-3166-code-lists/index.html




319 350 32 B C Member's mailing street address. The Mailing address fields should be used if the member has a mailing address different from that of the Permanent address. No punctuation should be included.

Member's primary mailing street address


351 382 32 B C The member's second line of mailing street address (Apt Number, PO Box, Care of Address, Etc.). This is an optional field and should be used only if street address 1 is completed. No punctuation should be included.

Member's secondary mailing street address.

http://www.iso.ch/iso/en/prods-services/iso3166ma/02iso-3166-code-lists/index.html



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Position End

Field Length

Field Type


Mailing City 383 402 20 B C Member's mailing city. No punctuation should be included.

Member's mailing city.

Mailing State 403 404 2 B C Member's mailing state. No punctuation should be included. Must be in all capital letters.

Member's mailing state

Mailing Zip Code 405 419 15 B C 5-digit zip code and 4-digit zip code extension. The 5-digit zip code is a required field for domestic addresses; the zip code extension is optional and can be left blank. Note: Do not include a dash (-) between the 5 digit zip code and the 4 digit zip code extension.


Mailing Country Code

420 421 2 B C The Country the employee resides in. For a complete listing of country codes use the following web address – http://www.iso.ch/iso/en/prods-services/iso3166ma/02iso-3166-code-lists/index.html



Home Phone Number

423 432 10 B R Members 10 digit home phone number. No dashes or spaces allowed.

Members home phone number.

Death Date 433 440 8 E C Members death date YYYYMMDD


XREF/Payee Indicator

453 454 2 E C This field should be completed only if this record is for a survivor situation, or if sending an opt-out EE w/opt-in dependents. The code is used to indicate whom the XREF name/number belongs to.

01 = spouse 11 = Surviving Dependent 18 = Self 20 = Military

XREF/Payee Last Name

455 474 20 E C Last name of survivor. This field should only be completed if the payee indicator field is populated.

Survivor's last name

XREF/Payee First Name

475 486 12 E C First name of survivor. This field should be only completed if the payee indicator field is populated.

Survivor's first name


XREF/Payee SSN 495 505 11 E C Social Security Number of survivor. This field should only be completed if the payee indicator field is populated.

Survivor's social security number Format: 00 + 9-digit SSN.


Special Util 4 510 521 12 E C Utility field that will feed data to TOPS.


Sub-Department Nbr *not commonly used

522 529 8 E C The Sub-Department number sorts employees on the invoice within employer's specific sub-departments.

This field should be left blank.




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Position End

Field Length

Field Type


Retirement Date 530 537 8 B C The date the member retires. This is required field for members with a retiree status.

YYYYMMDD


Primary Physician MPIN/Location

546 559 14 B C Member's primary care physician identification number.

Primary Care Physician identification number Format:0000+7-digit MPIN+0+2-digit Location Code. For example: 00001234567012


Primary Physician Start Date

562 569 8 B C The date the member’s primary physician became or will become effective.

YYYYMMDD


Primary Physician Stop Date *not commonly

used

582 589 8 B O The date the member is no longer covered by this primary physician.

YYYYMMDD


Primary Physician IPA *not commonly used

602 606 5 B O The independent practice association number of the primary care physician.

Independent practice association number


607 608 2 B O Indicates if the member is a current patient of the primary care physician.

25= Established Patient 26= Not Established Patient 72= Unknown

Filler Field 609 609 1 Blank Blank



Special Util 2 650 669 20 Utility field that will feed data to UBH.


Special Util 3 670 689 20 Utility filed that will feed data to Billing.


Salary Year 690 693 4 E C CCYY

Salary 694 703 10 E C

Salary In Area OOP

704 708 5 E C

Salary Out Area OOP

709 713 5 E C

Salary In Area Ded

714 718 5 E C

Salary Out Area Ded

719 723 5 E C



Member Utility1 740 747 8 B O For future or customer specific field requirements.

Special Utility1 748 755 8 B O For future or customer specific field requirements.

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Position End

Field Length

Field Type



756 758 3 B R Field used for first coverage type selected by member. Coverage type must be passed with all capital letters. Note: Normally Coverage type 1 is for Medical Coverage. MM is the recommended code for medical coverage.

AK may be used for stand-alone (S) coverage such as OPTUM.

Product Codes: EXM= Executive Medical DCP= Dental Capitation DEN= Dental EPO= Exclusive Provider Organization HE= Hearing AG= Preventative Care HMO= Health Maintenance Organization

MM= Major Medical IND = Indemnity AS= Accident and Sickness MOD= Mail Order Drug PDG= Prescription Drug RX2= Mail Order Drug and Prescription Drug POS= Point of Service PPO= Preferred Provider Plan PRA= Practitioners VIS= Vision AK= Mental Health LTC= Long Term Care LTD= Long Term Disability STD= Short Term Disability UR= Utilization Review BLF= Basic Life SLF= Supplemental Life DEL= Dependent Life SAD= Supplemental AD&D


759 766 8 B R The date the member's coverage becomes effective with UHG.

YYYYMMDD



779 786 8 B C The date member's coverage is cancelled or will be cancelled. Note: A Coverage End Date should only be passed if a member is terminating this coverage type with UHC. Coverage End Dates may not be more than 30-days in the future, and once a member terminates all coverage types and a term date is passed that member must be dropped off the file.

YYYYMMDD


Coverage 1 Coverage Paid Thru Date


YYYYMMDD


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Position End

Field Length

Field Type















849 852 4 B R Four digit numeric reporting code within the account structure. NOTE: The Plan Variation and Reporting Code

can be found in your copy of the Account Structure for this group. Your Client Services Manager can provide you with a copy of this structure.






















ANCHOR



Position End

Field Length

Field Type






922 923 2 B C This field is used to indicate that the coverage being reported is being continued as a result of a COBRA election. Your Electronic Eligibility Analyst will provide you with the appropriate code to use.

TC = UHC Administered TY = Customer Administered NC = No HIPAA Cert Produced.





















ANCHOR



Position End

Field Length

Field Type



981 983 3 B R Field used for second coverage type selected by member. Coverage type must be passed with all capital letters. Note: If Rx coverage is offered usually PDG or RX2 is sent for coverage 2.

*If a second coverage is not being offered a pipe delimiter can be sent in position 981 with a carriage return immediately following in position 982. NO OTHER INFORMATION SHOULD BE SENT ON THIS MEMBER’S LINE AFTER THE PIPE DELIMITER. Skip all other fields and start a new line for the next member covered.

Product Codes: EXM= Executive Medical DCP= Dental Capitation DEN= Dental EPO= Exclusive Provider Organization HE= Hearing AG= Preventative Care HMO= Health Maintenance Organization

MM= Major Medical IND = Indemnity AS= Accident and Sickness MOD= Mail Order Drug PDG= Prescription Drug RX2= Mail Order Drug and Prescription Drug POS= Point of Service PPO= Preferred Provider Plan PRA= Practitioners VIS= Vision AK= Mental Health LTC= Long Term Care LTD= Long Term Disability STD= Short Term Disability UR= Utilization Review BLF= Basic Life SLF= Supplemental Life DEL= Dependent Life SAD= Supplemental AD&D


984 991 8 B R The date member's coverage becomes effective.

YYYYMMDD



1004 1011 8 B C The date member's coverage is cancelled or will be cancelled.

YYYYMMDD




YYYYMMDD






ANCHOR



Position End

Field Length

Field Type











1074 1077 4 B R Four digit numeric reporting code within the account structure. NOTE: The Plan Variation and Reporting Code can be found in your copy of the Account Structure for this group. Your Client Services Manager can provide you with a copy of this structure.

























ANCHOR



Position End

Field Length

Field Type



1147 1148 2 B C This field is used to indicate that the coverage being reported is being continued as a result of a COBRA election.

TC = UHC Administered TY = Customer Administered NC = No HIPAA Cert Produced


1149 1156 8 B O


1157 1164 8 B O

Coverage 2

Elig Util-3

1165 1172 8 B O


1173 1192 20 B O













ANCHOR



Position End

Field Length

Field Type



1206 1208 3 B R Field used for first member’s coverage type. Note: Coverage Type must be entered with all capital letters. Note: Usually Coverage 3 is used for Dental (DEN) or Vision (VIS) Coverage. Talk

to your Electronic Eligibility Analyst if you have a question about which code to use.

*If a third coverage is not being offered a pipe delimiter can be sent in position 1206 with a carriage return immediately following in position 1207. NO OTHER INFORMATION SHOULD BE SENT ON THIS MEMBER’S LINE AFTER THE PIPE DELIMITER. Skip all other fields and start a new line for the next member covered

Product Codes: EXM= Executive Medical DCP= Dental Capitation DEN= Dental EPO= Exclusive Provider Organization HE= Hearing AG= Preventative Care HMO= Health Maintenance

Organization MM= Major Medical IND = Indemnity AS= Accident and Sickness MOD= Mail Order Drug PDG= Prescription Drug RX2= Mail Order Drug and Prescription Drug POS= Point of Service PPO= Preferred Provider Plan PRA= Practitioners VIS= Vision AK= Mental Health LTC= Long Term Care LTD= Long Term Disability STD= Short Term Disability UR= Utilization Review BLF= Basic Life SLF= Supplemental Life DEL= Dependent Life SAD= Supplemental AD&D



YYYYMMDD




YYYYMMDD




YYYYMMDD






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Position End

Field Length

Field Type







1289 1292 4 B R Four-digit numeric Plan Variation code within account structure.

Plan Variation Code



1299 1302 4 B R Four digit numeric reporting code within the account structure.

Reporting Code























CHD= Children Only SD1= Employee and 1 Dep ECH= Employee and Children EMP= Employee Only ESP= Employee and Spouse FAM= Family SPO= Spouse Only CH1 = Child Only SPC= Spouse and

Children SS1 = Subscriber, Spouse + 1 Dependent





1374 1381 8 B O

Coverage 3

Elig Util-2

1382 1389 8 B O


1390 1397 8 B O


1398 1417 20 B O




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Position End

Field Length

Field Type












1431 1433 3 B R Field used for first member’s coverage type. Note: Coverage Type must be entered with all capital letters. Note: Usually Coverage 4 is used for Dental (DEN), Vision (VIS), or Optum (Mental Health Coverage). Talk to your Electronic Eligibility Analyst if you have a question about which code to use. *If a fourth coverage is not being offered a pipe delimiter can be sent in position 1431 with a carriage return immediately following in position 1432. NO OTHER INFORMATION SHOULD BE SENT ON THIS MEMBER’S LINE AFTER THE PIPE DELIMITER. Skip all other fields and start a new line for the next member covered.




YYYYMMDD




YYYYMMDD


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Position End

Field Length

Field Type




YYYYMMDD




Seven digit Customer Number.




Seven digit Policy Number




Plan Variation Code




Reporting Code









Coverage 4

Structure Field 7

1554 1563 10 B C Field is reserved for customer

specific structure data.

Blank or Customer

specific data.

















1599 1606 8 B O

ANCHOR



Position End

Field Length

Field Type



1607 1614 8 B O


1615 1622 8 B O


1623 1642 20 B O












Y= Critical Illness Rider was selected N= Critical Illness Rider was not selected

Blank= Critical Illness coverage not available


1656 1658 3 B R Field used for first member’s coverage type. Note: Coverage Type must be entered with all capital letters. *If a second coverage is not being offered a pipe delimiter can be sent in position 1656 with a carriage return immediately following in position 91657. NO OTHER INFORMATION SHOULD BE SENT ON THIS MEMBER’S LINE AFTER THE PIPE DELIMITER. Skip all other fields and start a new line for the next member covered

Product Codes: EXM= Executive Medical DCP= Dental Capitation DEN= Dental EPO= Exclusive Provider Organization HE= Hearing AG= Preventative Care HMO= Health Maintenance Organization MM= Major Medical IND = Indemnity AS= Accident and Sickness MOD= Mail Order Drug PDG= Prescription Drug RX2= Mail Order Drug and Prescription Drug POS= Point of Service PPO= Preferred Provider Plan PRA= Practitioners VIS= Vision AK= Mental Health LTC= Long Term Care LTD= Long Term Disability STD= Short Term Disability UR= Utilization Review BLF= Basic Life

SLF= Supplemental Life DEL= Dependent Life SAD= Supplemental AD&D



YYYYMMDD

ANCHOR



Position End

Field Length

Field Type




YYYYMMDD



YYYYMMDD









Plan Variation Code



Reporting Code



Blank = No Embedded Vision VE = Embedded Vision



CES: Blank or Customer out of pocket amount.



CES: Blanks or Customer deductible amount.











1819 1821 3 B O The code indicates which members of the family are covered for this particular coverage. All members of the family should have the same

Members Coverage Code. THIS IS AN OPTIONAL FIELD BECAUSE UHG DERIVES THE INFORMATION BASED ON THE ACTIVE FAMILY MEMBERS IN OUR SYSTEM.

CHD= Children Only SD1= Employee and 1 Dep ECH= Employee and Children

EMP= Employee Only ESP= Employee and Spouse FAM= Family SPO= Spouse Only CH1 = Child Only SPC= Spouse and Children SS1 = Subscriber, Spouse + 1 Dependent





1824 1831 8 B O


1832 1839 8 B O

ANCHOR



Position End

Field Length

Field Type



1840 1847 8 B O


1848 1867 20 B O














1881 1883 3 B R Field used for first member’s coverage type. Note: Coverage Type must be entered with all capital letters.




YYYYMMDD



YYYYMMDD

ANCHOR



Position End

Field Length

Field Type




YYYYMMDD









Plan Variation Code



Reporting Code


























2049 2056 8 B O


2057 2064 8 B O


2065 2072 8 B O


2073 2092 20 B O

ANCHOR



Position End

Field Length

Field Type
















Product Codes: EXM= Executive Medical DCP= Dental Capitation DEN= Dental EPO= Exclusive Provider Organization HE= Hearing AG= Preventative Care HMO= Health Maintenance Organization MM= Major Medical IND = Indemnity AS= Accident and Sickness MOD= Mail Order Drug PDG= Prescription Drug RX2= Mail Order Drug and Prescription Drug POS= Point of Service PPO= Preferred Provider Plan PRA= Practitioners VIS= Vision AK= Mental Health LTC= Long Term Care LTD= Long Term

Disability STD= Short Term Disability UR= Utilization Review BLF= Basic Life SLF= Supplemental Life DEL= Dependent Life SAD= Supplemental AD&D



YYYYMMDD



YYYYMMDD

ANCHOR



Position End

Field Length

Field Type




YYYYMMDD









Plan Variation Code



Reporting Code


























2274 2281 8 B O


2282 2289 8 B O


2290 2297 8 B O


2298 2317 20 B O

ANCHOR



Position End

Field Length

Field Type




















YYYYMMDD



YYYYMMDD

ANCHOR



Position End

Field Length

Field Type




YYYYMMDD









Plan Variation Code



Reporting Code


























2499 2506 8 B O


2507 2514 8 B O


2515 2522 8 B O


2523 2542 20 B O

ANCHOR



Position End

Field Length

Field Type




















YYYYMMDD



YYYYMMDD

ANCHOR



Position End

Field Length

Field Type




YYYYMMDD









Plan Variation Code



Reporting Code


























2724 2731 8 B O


2732 2739 8 B O


2740 2747 8 B O


2748 2767 20 B O

ANCHOR



Position End

Field Length

Field Type




















YYYYMMDD



YYYYMMDD

ANCHOR



Position End

Field Length

Field Type




YYYYMMDD



Seven digit Customer Number






Plan Variation Code



Reporting Code


























2949 2956 8 B O


2957 2964 8 B O


2965 2972 8 B O


2973 2992 20 B O

ANCHOR



Position End

Field Length

Field Type














ANCHOR Health care Supplemental NCPJ


Interface: Generate Health care ,Supplemental, NCPJ

Description:

Generates files for Health care ,Supplemental, NCPJ

Data Rules: The data file is comma delimited. The data file is fixed column and variable length. i.e if a column (field)

is empty or spaces there will be only a comma (no space).

GL‐REC.

02 GL‐STATUS PIC X(3).

02 GL‐COMMA01 PIC X.

02 GL‐SET‐OF‐BOOKS‐ID PIC 1.


02 GL‐USER‐JE‐SOURCE‐NAME PIC X(18).


02 GL‐USER‐JE‐CATEGORY‐NAME PIC X(12).


02 GL‐ACTUAL‐FLAG PIC X.

02 GL‐COMMA04A PIC X.

02 GL‐ACCOUNTING‐DATE.

03 GL‐ACCOUNTING‐DATE‐DD PIC 99.

03 GL‐ACCOUNTING‐DATE‐DASH1 PIC X.

03 GL‐ACCOUNTING‐DATE‐MON PIC XXX.

03 GL‐ACCOUNTING‐DATE‐DASH2 PIC X.

03 GL‐ACCOUNTING‐DATE‐YY PIC 99.

ANCHOR Health care Supplemental NCPJ



02 GL‐SEGMENT1 PIC X(2).








02 GL‐AMOUNT‐AREA.

03 GL‐ENTERED‐DR PIC X(6).


03 GL‐ENTERED‐DR PIC X(5).


02 FILLER REDEFINES GL‐AMOUNT‐AREA.

03 GL‐ENTERED‐CR PIC X(14).



02 GL‐COST‐CENTER PIC X(13).

ANCHOR User Interface Review Physical Interface – Annual Benefit Recipient Statements File


Physical Interface

Annual Benefit Recipient Statements File

Description: This file contains benefit summary data for retirees and benefit recipients. Data Rules: This is not a delimited file. All fields need to be appropriately padded to occupy their full length. Rule 1: Extract all benefit recipients who are in "Estimated", "Final" or “Suspended” status. RT-SSN: SSN of the retiree; char(9); RT-LAST-NAME: Last name of the retiree; char(30); RT-MID-INIT: Middle Initial of the retiree; char(1); RT-FIRST-NAME: First name of the retiree; char(20) RT-RETIRE-TYPE: Type of Retirement; Service, Disability, Survivor Benefit; char(12); RT-RETIRE-SUB-TYPE: Sub-type of retirement; Accidental, Ordinary; char(10); RT-DOB: Date of Birth of the retiree; MMDDCCYY; RT-DOD: Date of Death of the retiree; MMDDCCYY; Rule: Retiree’s date of death will only be populated on a survivor’s file, not on a retiree’s. Otherwise it will be blank. RT-RETIRE-DATE: Date of retirement; MMDDCCYY; RT-RETIRE-OPTION: Retirement option in which the benefits are paid; char(2); RT-SURV-1-SSN: SSN of the first survivor; char(9); RT-SURV-1-NAME: Name of the first survivor; concatenated last name, middle initial, first name; char (51); RT-SURV-1-DOB: Date of Birth of the first survivor; MMDDCCYY; RT-SURV-2-SSN: SSN of the second survivor; char(9); RT-SURV-2-NAME: Name of the second survivor; concatenated last name, middle initial, first name; char (51); RT-SURV-2-DOB: Date of Birth of the second survivor; MMDDCCYY; RT-SURV-3-SSN: SSN of the third survivor; char(9); RT-SURV-3-NAME: Name of the third survivor; concatenated last name, middle initial, first name; char (51); RT-SURV-3-DOB: Date of Birth of the third survivor; MMDDCCYY; RT-BASE-PENSION-AMT: Current monthly base pension amount; 99,999.99; RT-GROSS-PENSION-AMT: Current monthly gross pension amount; 99,999.99; RT-MTHLY-SSA-AMT: Current monthly Social Security Allowance amount; 99,999.99; RT-MTHLY-SUPP-AMT: Current monthly Supplemental amount; 99,999.99; RT-QDRO-1-SSN: SSN of the first QDRO recipient; char(9); RT-QDRO-1-NAME: Name of the first QDRO recipient; concatenated last name, middle initial, first name char(51); RT-MTHLY-QDRO-1-AMT: Current monthly QDRO-1 amount; 99,999.99; RT-QDRO-2-SSN: SSN of the second QDRO recipient; char(9); RT-QDRO-2-NAME: Name of the second QDRO recipient; concatenated last name, middle initial, first name char(51); RT-MTHLY-QDRO-2-AMT: Current monthly QDRO-2 amount; 99,999.99; RT-QDRO-3-SSN: SSN of the third QDRO recipient; char(9);

ANCHOR User Interface Review Physical Interface – Annual Benefit Recipient Statements File


RT-QDRO-3-NAME: Name of the third QDRO recipient; concatenated last name, middle initial, first name char(51); RT-MTHLY-QDRO-3-AMT: Current monthly QDRO-3 amount; 99,999.99; RT-MTHLY-ADHOC-ADJ-AMT: Current monthly Adhoc adjustment amount; 99,999.99; RT-MTHLY-CONT-ADJ-AMT: Current monthly Continuing adjustment amount; 99,999.99; RT-MTHLY-LEGIS-ADJ-AMT: Current monthly Legislative adjustment amount; 99,999.99; RT-FED-TAX-AMT: Current Federal Tax withheld amount; 99,999.99; RT-ST-TAX-AMT: Current State Tax withheld amount; 99,999.99; RT-RECIP-MRTL-STAT: Marital Status of the benefit recipient; char(7); RT-RECIP-TAX-EXEMPTS: Tax exemptions of the benefit recipient; numeric(1); RT-INDV-HLTH-INS: Current Individual Health Insurance amount; 99,999.99; RT-DNTL-INS: Current Dental Insurance amount; 99,999.99; RT-VSN-INS: Current Vision Insurance amount; 99,999.99; RT-FAM-HLTH-INS: Current Family Health Insurance amount; 99,999.99; RT-BLUE-HMO-INS: Current BlueChip HMO Insurance amount; 99,999.99; RT-GRP-LIFE-INS: Current Group Life Insurance amount; 99,999.99; RT-OPTN-LIFE-INS: Current Optional Life Insurance amount; 99,999.99; RT-CRDT-UNION-DED: Current Credit Union deduction amount; 99,999.99; RT-UNION-DUES: Current Union Dues amount; 99,999.99; RT-CANCER-INS: Current Cancer Insurance amount; 99,999.99; RT-COLG-BND-FUND: Current College Bound Fund amount; 99,999.99; RT-LONG-TRM-CARE: Current Long Term Care amount; 99,999.99; RT-FAM-COURT: Current Family Court amount; 99,999.99; RT-AFLAC: Current AFLAC amount; 99,999.99; RT-LEGIS-DTH-BNFT-FEE: Current Legislative Death Benefit Maintenance Fee; 99,999.99; RT-SECA: Current SECA (State Employees Charitable Association) amount; 99,999.99; RT-COBRA-FEE: Current COBRA Administration Fee; 99,999.99; RT-MISC-DED: Current Miscellaneous deduction amount; 99,999.99; RT-NET-PENSION-AMT: Current monthly net pension amount; 99,999.99;

ANCHOR User Interface Review Physical Interface – Vision Enrollment Informaiton


Physical Interface

Credit Union Interface

Description: This batch utility is monthly, after the pension run, to extract all retirees who had a payroll deduction for the Credit Union. This information should be sent as a text file to Rhode Island State Employee’s Credit Union. File disposition: ANCHOR will produce this file and store it on the server. ERSRI will transfer the file to OLIS or the credit Union at their discretion by the method/media of their choice. Control Report: The control report produced with this file will display counts of records, grouped by source type and activity code. Example: Count Current Deductions ------- ------------------------ 6758 756,874.32 Data Rules: File Format: Text file, no delimiters The file consists of records 80 characters in length. Rule 1: Extract recipient and deduction information for all recipients who had a credit union deduction for the current period.

Description

Req

uir

ed

Pos

itio

n

Len

gth

Valid Values/Format

Description data rules

Record Type Yes 1 3

“065” Constant Filler No 4 2

Spaces Constant SSN Yes 6 9 000000000 SSN SSN of recipient Filler No 15 8

Spaces Constant FirstTwo Yes 23 2

First two Characters of last name

First two characters of last name

Filler Yes 25 7 Spaces Constant

ANCHOR User Interface Review Physical Interface – Vision Enrollment Informaiton


Deduction amount Yes 32 7

999999{

Curly brace must exist as last digit. $25.00 deduction amount would be right justified, spaces on the left” 250{“

Filler Yes 39 42 Spaces Constant

Beneficiary Management System 600 Byte Input Record Description

Field Field Positions Field Field Field Criteria Edit Edit Edit Edit No Length From To Type Description Criteria Schedule Type Message

6/23/2011 1:59 PM

1 2 1 2 N RECORD TYPE. 47 47 All H 0001 BAD RECORD TYPE OR

CONTROL NO 2 1 3 3 N FILLER Default to zeroes N/A N/A N/A N/A

3 6 4 9 N ALTERNATE CONTROL Default to zeros. N/A N/A N/A N/A

4 8 10 17 N FILLER Default to zeros. N/A N/A N/A N/A

5 8 18 25 N EFFECTIVE DATE OF ENROLLEE RECORD

CCYYMMDD

NUMERIC Not = zeros

All H 0030 INVALID EFFECTIVE DATE OF ENROLLEE

6 10 26 35 N ENROLLEE SSN / CERT

Right justify, zero fill. NUMERIC not = zeros

All H 0031 INVALID SSN/CERT

7 2 36 37 N ENROLLEE STATUS

00=Active 07=retired

26=deceased 40=terminated

00, 07,26,40

‘26’ or ‘40’ and enrollee on file

All

D, T

H

H

0032 INVALID ENROLLEE STATUS 0048 - INVALID STATUS ENROLLEE NOT ON FILE

8 6 38 43 N DATE OF HIRE YYMMDD Default is zeros

NUMERIC A,R S 0033 INVALID DATE OF HIRE

9 2 44 45 A DOH-CENTURY CC, left justify, zero fill N/A N/A N/A N/A

10 1 46 46 N FILLER Default to zeros. N/A N/A N/A N/A

11 3 47 49 N PLAN NUMBER- Default to zeros N/A N/A N/A N/A

12 1 50 50 N SEX M=MALE F=FEMALE

M, F, SPACE A,R S 0034 INVALID SEX CODE

13 8 51 58 N ENROLLEE BIRTH DATE

CCYYMMDD Default is zeros

NUMERIC Not = zeros

A,R S 0035 INVALID BIRTH DATE

14 26 59 84 A ENROLLEE NAME.

Left justify, space fill. Uppercase only. Use the following format:

JOHNSON,JOHN A SMITH JR, J A

SMITH IV, JOHN A WILLIS-SMITH, J A

Not = spaces All H 0036 INVALID ENROLLEE NAME

15 11 85 95 N Filler Default to zeros. N/A N/A N/A N/A

16 6 96 101 N SPOUSE BIRTH DATE YYMMDD Default is zeros

NUMERIC Not = zeros

A,R S 0035 INVALID BIRTH DATE

17 1 102 102 N Filler Default to zeros. N/A N/A N/A N/A

18 1 103 103 A ENROLLEE SMOKING STATUS

N = Non Smoker S = Smoker

N, S, SPACE A,R S 0041 INVALID SMOKING CODE

19 1 104 104 A EOI REQUIRED FLAG Y=YES, Default is spaces. Y, SPACE N/A N/A N/A

20 1 105 105 N EARNINGS TYPE 0 = DEFAULT 1 = ANNUAL

0,1, 2,3 A, R S 0037 INVALID EARNINGS TYPE



6/23/2011 1:59 PM

21 7 106 112 N EARNINGS Whole $$ amt of enrollee’s earnings. Right justify and zero

fill. Required if benefits are calculated using earnings.

Default is zeros. Earnings $25,500.50 Report as : 0025500

NUMERIC

A, R S 0038 INVALID EARNINGS AMOUNT

22 8 113 120

N DATE LAST WORKED

CCYYMMDD Default is zeros.

Numeric IF not = zeros, must be = or > effective date of enrollee record.

A, R S 0039 INVALID DATE LAST WORKED

23 2 121 122 A SPOUSE DOB-CENTURY CC, left justify, zero fill N/A N/A N/A N/A

24 1 123 123 A SPOUSE SMOKING STATUS N = Non Smoker S = Smoker

N, S, SPACE A,R S 0041 INVALID SMOKING CODE

25 7 124 130 A FILLER Default is spaces. N/A N/A N/A N/A

26 35 131 165 A MAILING ADDRESS LINE 1 -. Left justify , space fill. Default is spaces. Must be uppercase.

N/A A, R, T N/A N/A

27 35 166 200 A MAILING ADDRESS LINE 2 Left justify , space fill. Default is spaces. Must be uppercase.

N/A A, R, T N/A N/A

28 8 201 208 A CUSTOMER SPECIFIC

Left justify , space fill. Default is spaces. Must be uppercase.

N/A A, R, T N/A N/A

29 9 209 217 A TOTAL REQUESTED EE COVG (TRM3)-PENDING EOI APPROVAL

Right justify, zero fill. Whole $$ amt of enrollee’s benefit. Default

is zeros. Benefit: $25,500.50 Report as : 0025500

Numeric, If EOI REQUIRED FLAG is spaces/invalid, this field won’t be edited.

A, R S 0043 INVALID COVERAGE AMOUNT

30 9 218 226 A TOTAL REQUESTED SP COVG (TRM4) - PENDING EOI APPROVAL

Right justify, zero fill. Whole $$ amt of spouse’s benefit. Default is zeros. Benefit: $25,500.50 Report as : 0025500



31 9 227 235 A TOTAL REQUESTED CH COVG (TRM5)- PENDING EOI APPROVAL

Right justify, zero fill. Whole $$ amt of child’s benefit. Default is zeros. Benefit: $25,500.50 Report as : 0025500



32 21 236 256 A MAILING ADDRESS CITY Left justify , space fill. Default is spaces. Must be uppercase.

N/A A, R, T N/A N/A

33 2 257 258 A MAILING ADDRESS STATE. Left justify , space fill. Default is spaces. Must be uppercase.

N/A A, R, T N/A N/A



6/23/2011 1:59 PM

34 9 259 267 A MAILING ADDRESS ZIP CODE

Left justify , space fill. Default is spaces.

If reported, must be numeric.

A, R, T S 0040 INVALID ZIP CODE

35 1 268 268 A

HOURLY/SALARY INDICATOR

1 = Hourly 2= Salaried

Default is spaces.

N/A N/A N/A N/A

36 11 269 279 A WORK TELEPHONE NUMBER

Default is spaces. Phone no: 1-(123)456-7890 Report as: 11234567890

. N/A N/A N/A

37 11 280 290 A HOME TELEPHONE NUMBER -

Default is spaces. Phone no: 1-(123)456-7890 Report as: 11234567890

. N/A N/A N/A

38 22 291 312 A FILLER Default is spaces. N/A N/A N/A N/A

39 288 313 600 LIFE COVERAGE AREA

See Below See Below

The section below OCCURS 8 TIMES in the Life Coverage Area. 4 A COVERAGE CODE -

If occurrence is used should contain covg code(see table below) Default is spaces .

Valid coverage code or spaces. A, R H

0024 INVALID COVG CODE

8 N COVERAGE EFFECTIVE DATE

CCYYMMDD Default is zeros.

Numeric IF not = zeros, must be = or > date of hire. If covg code is spaces or invalid, this field will not be edited.

A, R S 0019 INVALID COVG EFF-DATE

7 N CONTROL NUMBER Right justify, zero fill. NUMERIC valid CSA

All H 0002 BAD CONTROL NO.

3 N SUFFIX Right justify, zero fill. NUMERIC A,R H 0020 INVALID SUFFIX

5 N ACCOUNT Right justify, zero fill. NUMERIC A,R H 0021 INVALID ACCT

9 N COVERAGE BENEFIT AMOUNT

Right justify, zero fill. Whole $$ amt of enrollee’s

benefit. Default is zeros.

Benefit: $25,500.50 Report as : 0025500

Numeric If covg code is spaces or invalid, this field will not be edited.




6/23/2011 1:59 PM

NOTES - EDIT TYPE - EDIT SCHEDULE - H = HARD EDIT - Record will not be processed. A - Edit is performed if Enrollee Status is 00. Error message will be displayed on error report. R - Edit is performed if Enrollee Status is 07. D - Edit is performed if Enrollee Status is 27. S = SOFT EDIT - Record will be processed. T - Edit is performed if Enrollee Status is 40. Error message will be displayed on error report. ALL- Edit is performed if Enrollee Status is equal to ‘00’ , ‘07’, ‘26’ or ‘40’.

Coverage Codes Description TRM1 Basic Non-contributory Employee Life Insurance TRM3 Supplemental Employee Contributory Life Insurance TRME Executive Term Life TRM7 Basic Spouse Life Insurance TRM8 Basic Child Life Insurance TRM4 Supplemental Spouse contributory Life Insurance ADD1 Basic Employee Non-Contributory Accidental Death & Dismemberment Insurance TRM5 Supplemental Child Contributory Life Insurance ADD3 Supplemental Employee Accidental Death and Dismemberment Insurance ADD6 Supplemental Family Accidental Death and Dismemberment Insurance STD1 Basic non-contributory Short Term Disability LTD1 Basic non-contributory Long Term Disability STDV Voluntary contributory Short Term Disability LTDV Voluntary contributory Long Term Disability ADD7 Supplemental Employee and Spouse Accidental Death ADD8 Supplemental Employee and Child Accidental Death

File Notes: This is a standard text file (extension .txt) with each record having a fixed length of 600 bytes, ending in a carriage return. Large files may be zipped (extension.zip) Shaded fields are mandatory for any file. Non-shaded fields can be filled w/default values (see field criteria column). Some non-shaded fields may be required, depending upon plan design and the nature of services being provided by Aetna.



6/23/2011 1:59 PM

All data should be transmitted in Upper case. This is mandatory.

ANCHOR User Interface Review Physical Interface - Payroll Check for Direct Deposit


Physical Interface

Payroll Check for Direct Deposit

Description: This file will provide the direct deposit notifications for each benefit recipient and will be sent to the Treasury Office for printing. Data Rules: Rule 1: YTD totals will include Retroactive payments. Rule 2: Multiple checks will be generated for each benefit recipient that receives money from multiple plans. Rule 3: Benefit Recipients can receive multiple checks from the same plan if they have several accounts. For example, if a benefit recipient has their own retirement account and a survivor account under the same plan, they will receive two benefit checks. Rule 4: Dollar signs will not be included in the check tape. Rule 5: If any of the address line does not exist it will be left as blank. Following data will be printed on the check stub:

Payroll Check Item Name P

osit

ion

Len

gth

Sample/Valid Values Description Data Rule

Name 1 55 John,Wright L JR Name of the recipient receiving the check

Last Name+ ‘,’ + First Name +’ ‘ + Middle initial+ ‘ ‘ + Suffix. Left aligned and filled with spaces for rest of the length

Current Date 56 10 10282002 Business date MMDDCCYY

Check Number 66 10 9999999999

Unique number generated automatically on each payroll run

Numeric. Right Aligned. Packed with Zero's in front for the remaining characters.

Check effective date 76 10 10302002

The date that is Two days after the payroll run date MMDDCCYY

Address line 1 86 60 Line 1 in Address

Alphanumeric. Left Aligned. Filled with spaces for the remaining characters in the end







Address line 4 266 60

Line 4 in Address .(for Foreign: CityName or Province name Postal code)


Address line 5

326 60 City,State Zipcode – ZipPlus.(for Foreign: Country. )


Address line 6

386 60 Reserve


Bank name 446 40 ABN Amro Name of the Recipient bank


Destination Account number 486 17 9999999

Recipient Bank Account Number

Alphanumeric. Right Aligned. Filled with zeros in the front for the remaining characters.

Destination routing number 503 9 99999999 Recipient Bank Routing Number Alphanumeric.

Account prefix 512 20 Checking or Savings Recipient Bank Account Type


Item1 Amount 532 8 12345.12 First Positive Item in the check


Item1 Description 540 40 Taxable Base Benefit Item description

Alphabetic. Left Aligned. Filled with spaces for the remaining characters in the end

Item2 Amount 580 8 12345.12 Second Positive item in the check


Item2 Description 588 40 Non Taxable Base Benefit Item description


Item3 Amount 628 8 12345.12 Third Positive item in the check


Item3 Description 636 40 COLA Item description


Item4 Amount 676 8 12345.12 Fourth Positive item in the check


Item4 Description 684 40 Supplimental Item description




Item5 Amount 724 8 12345.12 Fifth Positive item in the check


Item5 Description 732 40 Adhoc Item description


Item6 Amount 772 8 12345.12 Sixth Positive item in the check


Item6 Description 780 40 Legislative Item description


Item7 Amount 820 8 12345.12 Seventh Positive item in the check


Item7 Description 828 40 Continual Item description


Item8 Amount 868 8 12345.12 Eighth Positive item in the check


Item8 Description 876 40 Teachers Survivor benefit Item description


Item9 Amount 916 8 12345.12 Ninth Positive item in the check


Item9 Description 924 40 RetroPymt Taxable Benefit Item description


Item10 Amount 964 8 12345.12 Tenth Positive item in the check


Item10 Description 972 40 RetroPymt Non Taxable Benefit Item description


Gross Pay 1012 11 1234567.12

Sum of all the positive items for the month. Some of the item may not get printed due to space crunch, but the gross amount will sum up all the positive amount including those that does not appear on the check


Item11 Amount 1023 8 12345.12 First deduction item in the check




Item11 Description 1031 40 Federal Tax Item description


Item12 Amount 1071 8 12345.12 Second deduction item in the check


Item12 Description 1079 40 State Tax Item description


Item13 Amount 1119 8 12345.12 Third deduction item in the check


Item13 Description 1127 40 Item description


Item14 Amount 1167 8 12345.12 fourth deduction item in the check


Item14 Description 1175 40 Health Insurance Recipient" Item description


Item15 Amount 1215 8 12345.12 Fifth deduction item in the check


Item135Description 1223 40 Health Insurance Spouse Item description


Item16 Amount 1263 8 12345.12 Sixth deduction item in the check


Item16 Description 1271 40 Group life insurance Item description


Item17 Amount 1311 8 12345.12 Seventh deduction item in the check


Item17 Description 1319 40 Cancer insurance Item description


Item18 Amount 1359 8 12345.12 Eighth deduction item in the check


Item18 Description 1367 40 Credit union Item description


Item19 Amount 1407 8 12345.12 Ninth deduction item in the check




Item19 Description 1415 40 Union Dues Item description


Item20 Amount 1455 8 12345.12 Tenth deduction item in the check


Item20 Description 1463 40 AFLAC Item description Alphabetic. Filled with spaces for the remaining characters

Item21 Amount 1503 8 12345.12 Eleventh deduction item in the check


Item21 Description 1511 40 Family Court Item description Alphabetic. Filled with spaces for the remaining characters

Item22Amount 1551 8 12345.12 Twelfth deduction item in the check


Item22 Description 1559 40 Long term Care Item description


Item23 Amount 1599 8 12345.12 Thirteenth deduction item in the check


Item23 Description 1607 40 College bound Fund Item description


Item24 Amount 1647 8 12345.12 Fourteenth deduction item in the check


Item24 Description 1655 40 Abc Deduction Item description


Item25 Amount 1695 8 12345.12 Fifteenth deduction item in the check




Item26 Amount 1743 8 12345.12 Sixteenth deduction item in the check




Item27 Amount 1791 8 12345.12 Seventeenth deduction item in the check






Item28 Amount 1839 8 12345.12 Eighteenth deduction item in the check




YTD Item03 1887 11 1234567.12 Year to date item amount












Gross YTD Pay 1953 11 123456789.1 Year to date Gross Amount




























YTD Item21 2096 11 1234567.12 Year to date item amount Numeric. Filled with spaces for the remaining characters.


Net Check 2118 11 1234567.12

Net Amount = Gross Amount – Deductions(Including Federal Tax and Stat Tax).


Check Message1 2129 160 Abc xxxxxxxxxxxxxx

Check Messages for the recipient


Check Message2 2289 160

Abc xxxxxxxxxxxxxxx




Abc xxxxxxxxxxxxxxx




Abc xxxxxxxxxxxxxxx




Abc xxxxxxxxxxxxxxx




Abc xxxxxxxxxxxxxxx




Abc xxxxxxxxxxxxxxx




Abc xxxxxxxxxxxxxxx




Abc xxxxxxxxxxxxxxx


Alphabetic. Filled with spaces for the remaining characters




Abc xxxxxxxxxxxxxxx



Marital Federal 3729 40

"Single"or"Married"or"Divorced"or"Unknown"or"Widowed" Federal Tax Marital status


Marital State 3769 40

"Single"or"Married"or"Divorced"or"Unknown"or"Widowed" State Tax Marital status


Exemptions Federal 3809 2

"01" or"02" or any number

Number of exemptions for Federal Tax


Exemptions State 3811 2 "01" or"02" or any number

Number of exemptions for State Tax


Additional Federal 3813 4 Blank Federal tax Additional


Additional State 3817 4 Blank State tax Additional


Order of Positive Items that may appear in the Check:

1. Taxable Benefit 2. Non Taxable Benefit 3. COLA 4. Supplemental 5. Adhoc Benefit Adjustment 6. Continuous Benefit Adjustment 7. Legislative Benefit Adjustment 8. Teacher Survivor Benefit Amt 9. Lumpsum COLA Adjustment 10. RetroPymt Adj Taxable Base 11. RetroPymt Adj Non-Taxable Base 12. RetroPymt COLA 13. RetroPymt Supplemental 14. RetroPymt Adhoc Benefit Adj 15. RetroPymt Continuing Bnft Adj 16. RetroPymt Legislative Bnft Adj 17. RetroPymt Tchr Surv Bnft 18. RetroPymt Lumpsum COLA 19. RetroPymt Family Court 20. Retro Health Insurance – Recipient 21. Retro Health Insurance – Spouse 22. Retro Health Insurance Recipient Vision 23. Retro Health Insurance Recipient Dental 24. Retro Health Ins Recipient Prescription 25. Retro Health Insurance Spouse Vision 26. Retro Health Insurance Spouse Dental 27. Retro Health Insurance Spouse Prescription 28. RetroPymt Cancer Insurance 29. RetroPymt Long Term Care



30. RetroPymt AFLAC 31. RetroPymt IRS Levy 32. RetroPymt Legislator Death Benefit Maintenance Fee 33. RetroPymt Account Receivable 34. RetroPymt Group Life Insurance 35. RetroPymt Optional Life Insurance 36. RetroPymt Credit Union Deduction 37. RetroPymt College Bound Fund 38. RetroPymt Union Dues 39. RetroPymt SECA 40. RetroPymt Federal Tax 41. RetroPymt State Tax

If any of the items does not exist for a recipient then the next preceding item will be shown.

Order of Deductions that may appear in the Check: 1. Family Court 2. Health Insurance – Recipient 3. Health Insurance – Spouse 4. Health Insurance Recipient Vision 5. Health Insurance Recipient Dental 6. Health Ins Recipient Prescription 7. Health Insurance Spouse Vision 8. Health Insurance Spouse Dental 9. Health Insurance Spouse Prescription 10. Cancer Insurance 11. Long Term Care 12. AFLAC 13. IRS Levy 14. Legislator Death Benefit Maintenance Fee 15. Account Receivable 16. Group Life Insurance 17. Optional Life Insurance 18. Credit Union Deduction 19. College Bound Fund 20. Union Dues 21. SECA 22. Miscellaneous 23. Federal Tax 24. State Tax If any of the items does not exist for a recipient then the next preceding item will be shown.

ANCHOR User Interface Review Physical Interface - Payroll Check


Physical Interface

Payroll Check

Description: This file will provide the check details for each benefit recipient and will be sent to the Treasury Office for printing. Data Rules: Rule 1: YTD totals will include Retroactive payments. Rule 2: Multiple checks will be generated for each benefit recipient that receives money from multiple plans. Rule 3: Benefit Recipients can receive multiple checks from the same plan if they have several accounts. For example, if a benefit recipient has their own retirement account and a survivor account under the same plan, they will receive two benefit checks. Rule 4: Dollar signs will not be included in the check tape. Rule 5: The file will be sorted by pull-check indicator for each benefit recipient i.e. the benefit checks for recipients with pull-check indicator set to ‘True’ will appear first. Rule 6: If any of the address line does not exist it will be left as blank. Following data will be printed on the check stub:

Payroll Check Item Name P

osit

ion

Len

gth

Sample/Valid Values Description Data Rule

Name 1 55 John,Wright L JR Name of the recipient receiving the check

Last Name+ ‘,’ + First Name +’ ‘ + Middle initial+ ‘ ‘ + Suffix. Left aligned and filled with spaces for rest of the length

Current Date 56 10 10282002 Business date MMDDCCYY

Check Number 66 10 9999999999

Unique number generated automatically on each payroll run


Check effective date 76 10 10302002

The date that is Two days after the payroll run date MMDDCCYY









Address line 4 266 60

Line 4 in Address .(for Foreign: CityName or Province name Postal code)


Address line 5

326 60 City,State Zipcode – ZipPlus.(for Foreign: Country. )


Address line 6

386 60 Reserve


Bank name 446 40 Spaces Name of the Recipient bank Blank for Paper Checks

Destination Account number 486 17 Spaces

Recipient Bank Account Number Blank for Paper Checks

Destination routing number 503 9 Spaces

Recipient Bank Routing Number Blank for Paper Checks

Account prefix 512 20 Spaces Recipient Bank Account Type Blank for Paper Checks

Item1 Amount 532 8 12345.12 First Positive Item in the check


Item1 Description 540 40 Taxable Base Benefit Item description


Item2 Amount 580 8 12345.12 Second Positive item in the check


Item2 Description 588 40 Non Taxable Base Benefit Item description


Item3 Amount 628 8 12345.12 Third Positive item in the check


Item3 Description 636 40 COLA Item description


Item4 Amount 676 8 12345.12 Fourth Positive item in the check


Item4 Description 684 40 Supplemental Item description


Item5 Amount 724 8 12345.12 Fifth Positive item in the check




Item5 Description 732 40 Adhoc Item description


Item6 Amount 772 8 12345.12 Sixth Positive item in the check


Item6 Description 780 40 Legislative Item description


Item7 Amount 820 8 12345.12 Seventh Positive item in the check


Item7 Description 828 40 Continual Item description


Item8 Amount 868 8 12345.12 Eighth Positive item in the check


Item8 Description 876 40 Teachers Survivor benefit Item description


Item9 Amount 916 8 12345.12 Ninth Positive item in the check


Item9 Description 924 40 RetroPymt Taxable Benefit Item description


Item10 Amount 964 8 12345.12 Tenth Positive item in the check


Item10 Description 972 40 RetroPymt Non Taxable Benefit Item description


Gross Pay 1012 11 1234567.12

Sum of all the positive items for the month. Some of the item may not get printed due to space crunch, but the gross amount will sum up all the positive amount including those that does not appear on the check


Item11 Amount 1023 8 12345.12 First deduction item in the check


Item11 Description 1031 40 Federal Tax Item description




Item12 Amount 1071 8 12345.12 Second deduction item in the check


Item12 Description 1079 40 State Tax Item description


Item13 Amount 1119 8 12345.12 Third deduction item in the check


Item13 Description 1127 40 Item description


Item14 Amount 1167 8 12345.12 fourth deduction item in the check


Item14 Description 1175 40 Health Insurance Recipient" Item description


Item15 Amount 1215 8 12345.12 Fifth deduction item in the check


Item135Description 1223 40 Health Insurance Spouse Item description


Item16 Amount 1263 8 12345.12 Sixth deduction item in the check


Item16 Description 1271 40 Group life insurance Item description


Item17 Amount 1311 8 12345.12 Seventh deduction item in the check


Item17 Description 1319 40 Cancer insurance Item description


Item18 Amount 1359 8 12345.12 Eighth deduction item in the check


Item18 Description 1367 40 Credit union Item description


Item19 Amount 1407 8 12345.12 Ninth deduction item in the check


Item19 Description 1415 40 Union Dues Item description




Item20 Amount 1455 8 12345.12 Tenth deduction item in the check


Item20 Description 1463 40 AFLAC Item description Alphabetic. Filled with spaces for the remaining characters

Item21 Amount 1503 8 12345.12 Eleventh deduction item in the check


Item21 Description 1511 40 Family Court Item description Alphabetic. Filled with spaces for the remaining characters

Item22Amount 1551 8 12345.12 Twelfth deduction item in the check


Item22 Description 1559 40 Long term Care Item description


Item23 Amount 1599 8 12345.12 Thirteenth deduction item in the check


Item23 Description 1607 40 College bound Fund Item description


Item24 Amount 1647 8 12345.12 Fourteenth deduction item in the check




Item25 Amount 1695 8 12345.12 Fifteenth deduction item in the check




Item26 Amount 1743 8 12345.12 Sixteenth deduction item in the check




Item27 Amount 1791 8 12345.12 Seventeenth deduction item in the check




Item28 Amount 1839 8 12345.12 Eighteenth deduction item in the check


















Gross YTD Pay 1953 11 123456789.1 Year to date Gross Amount






























Net Check 2118 11 1234567.12

Net Amount = Gross Amount – Deductions(Including Federal Tax and Stat Tax).


Check Message1 2129 160 Abc xxxxxxxxxxxxxx




Abc xxxxxxxxxxxxxxx




Abc xxxxxxxxxxxxxxx




Abc xxxxxxxxxxxxxxx




Abc xxxxxxxxxxxxxxx




Abc xxxxxxxxxxxxxxx




Abc xxxxxxxxxxxxxxx




Abc xxxxxxxxxxxxxxx




Abc xxxxxxxxxxxxxxx




Abc xxxxxxxxxxxxxxx





Marital Federal 3729 40

"Single"or"Married"or"Divorced"or"Unknown"or"Widowed" Federal Tax Marital status


Marital State 3769 40

"Single"or"Married"or"Divorced"or"Unknown"or"Widowed" State Tax Marital status


Exemptions Federal 3809 2

"01" or"02" or any number

Number of exemptions for Federal Tax


Exemptions State 3811 2 "01" or"02" or any number

Number of exemptions for State Tax


Additional Federal 3813 4 Blank Federal tax Additional


Additional State 3817 4 Blank State tax Additional


Order of Positive Items that may appear in the Check:

1. Taxable Benefit 2. Non Taxable Benefit 3. COLA 4. Supplemental 5. Adhoc Benefit Adjustment 6. Continuous Benefit Adjustment 7. Legislative Benefit Adjustment 8. Teacher Survivor Benefit Amt 9. Lumpsum COLA Adjustment 10. RetroPymt Adj Taxable Base 11. RetroPymt Adj Non-Taxable Base 12. RetroPymt COLA 13. RetroPymt Supplemental 14. RetroPymt Adhoc Benefit Adj 15. RetroPymt Continuing Bnft Adj 16. RetroPymt Legislative Bnft Adj 17. RetroPymt Tchr Surv Bnft 18. RetroPymt Lumpsum COLA 19. RetroPymt Family Court 20. Retro Health Insurance – Recipient 21. Retro Health Insurance – Spouse 22. Retro Health Insurance Recipient Vision 23. Retro Health Insurance Recipient Dental 24. Retro Health Ins Recipient Prescription 25. Retro Health Insurance Spouse Vision 26. Retro Health Insurance Spouse Dental 27. Retro Health Insurance Spouse Prescription 28. RetroPymt Cancer Insurance 29. RetroPymt Long Term Care 30. RetroPymt AFLAC 31. RetroPymt IRS Levy



32. RetroPymt Legislator Death Benefit Maintenance Fee 33. RetroPymt Account Receivable 34. RetroPymt Group Life Insurance 35. RetroPymt Optional Life Insurance 36. RetroPymt Credit Union Deduction 37. RetroPymt College Bound Fund 38. RetroPymt Union Dues 39. RetroPymt SECA 40. RetroPymt Federal Tax 41. RetroPymt State Tax

If any of the items does not exist for a recipient then the next preceding item will be shown.

Order of Deductions that may appear in the Check: 1. Family Court 2. Health Insurance – Recipient 3. Health Insurance – Spouse 4. Health Insurance Recipient Vision 5. Health Insurance Recipient Dental 6. Health Ins Recipient Prescription 7. Health Insurance Spouse Vision 8. Health Insurance Spouse Dental 9. Health Insurance Spouse Prescription 10. Cancer Insurance 11. Long Term Care 12. AFLAC 13. IRS Levy 14. Legislator Death Benefit Maintenance Fee 15. Account Receivable 16. Group Life Insurance 17. Optional Life Insurance 18. Credit Union Deduction 19. College Bound Fund 20. Union Dues 21. SECA 22. Miscellaneous 23. Federal Tax 24. State Tax If any of the items does not exist for a recipient then the next preceding item will be shown.

ANCHOR IRS Reporting Tape delimited file


Report:PI‐IRSReportingTapedelimitedfile

Description: The 1099r Print tape is generated through an SQR process that reads the information from a temporary table in the data base and prints the information out on a tape for 1099R printing, with tilde as the delimiter . This file will later be used to be merged in the word document . This file is similar to the report Weekly 1099R Batch Job, except that it has one additional column for the State Tax With Held amount.

Data Rules: Page Break: N/A Sort By: N/A Note: The file will not have any delimiter separating the various columns.

Field # Field Name Size Contents 1 Gross 11 Gross Amount 2 Taxable

11 Taxable Amount

3 payer_Tin

9 Payer Tin number

4 payee_ssn

9 Payee SSN

5 withheld

11 Fed tax withheld

6 totalpercent

5 Distribution %

7 payer_name

33 Payer Name

8 payer_addr1

28 Payer Address

9 payer_city

10 Payer City

10 payer_st

2 Payer City

11 payerzip

5 Payer Zip

12 payerzip4

4 Payer Zip 4

13 payeefst

20 Payee First name

14 payee_m_name

20 Payee Middle Name

15 payeelast

20 Payee Last name

16 payee_addr

30 Payee Address

17 payee_city

28 Payee City

18 payeest

2 Payee State

ANCHOR IRS Reporting Tape delimited file


Field # Field Name Size Contents 19 payeezip

5 Payee Zip

20 payeeaccountno

9 Payee Account number

21 distcode

9 Distribution code

22 taxdefer

1 Tax deference

23 totaldist

1 Distribution indicator

24 corrind

4 1 -Correction indicator

25 stwithheld 11 State tax withheld

ANCHOR User Interface Review Tape - Regular 1099R IRS Reporting Tape


Tape PI-Regular 1099R IRS Reporting Tape



Contents

Report: PI- Regular 1099R IRS Reporting Tape .....................................Description: ................................................................................................................................................ 3 Data Rules: ................................................................................................................................................. 4

Record 1: Transmitter T Record ............................................................................................................. 4 Record 2: Payer “A” ............................................................................................................................... 5 Record 3: Payee “B” ............................................................................................................................... 6 Record 4: Payer “C” ............................................................................................................................... 9 Record 5: End of Transmissions “F” Record ........................................................................................ 10



Report: PI- Regular 1099R IRS Reporting Tape

Description: This is the Annual IRS Reporting tape for regular 1099R's. The 1099R reporting tape is generated through an SQR process that reads the information from a temporary table in the database and prints the information out on a tape for the IRS. The 1099R reporting Tape is created only if the run is an actual run. If the job is requested on a trial basis, do not create a tape.



Data Rules: Page Break: N/A Sort By: N/A Note: The file will not have any delimiter separating the various columns.

Record 1: Transmitter T Record Field # Field Name Size Contents

1 Record Type 1 Enter a T. From Table E_IRS1099R_tape_ref 2 Payment Year 4 Enter the appropriate tax year (e.g., 1999, 2000,

2001, etc.). 3 Prior Year Data Indicator 1 Enter a P for Prior Year or enter a blank. 4 Transmitter’s TIN 9 From Table TP_Anl_N_Daily 1099R.tax_id_nr 5 Transmitter Control Code 5 From Table BE_IRS1099R_tape_ref. 6 Replacement Alpha Character 2 Enter blanks unless replacing data (refer to IRS

Publication 1220 if replacing data). 7 Blank 5 Enter blanks. 8 Test File Indicator 1 Enter blank unless sending a test file in which

case enter T. 9 Foreign Entity Indicator 1 Enter a blank. 10 Transmitter Name 40 From Table BE_IRS1099R_tape_ref. 11 Transmitter Name (continuation) 40 Enter blanks. 12 Company Name 40 From Table BE_IRS1099R_tape_ref. 13 Company Name (continuation) 40 Enter blanks. 14 Company Mailing Address 40 From Table BE_IRS1099R_tape_ref. 15 Company City 40 From Table BE_IRS1099R_tape_ref. 16 Company State 2 From Table BE_IRS1099R_tape_ref. 17 Company Zip Code 9 From Table BE_IRS1099R_tape_ref. 18 Blank 15 Enter blanks. 19 Total Number of Payees 8 Enter the total number of payee ‘B’ records

reported on the file. 20 Contact Name 40 From Table BE_IRS1099R_tape_ref. 21 Contact’s Phone Number and Extension 15 From Table BE_IRS1099R_tape_ref. 22 Magnetic Tape File Indicator 2 From Table BE_IRS1099R_tape_ref. 23 Electronic File Name 15 Enter blanks. 24 Blank 373 Enter blanks. 25 Blank 2 Enter blanks or carriage return/line feed

(CR/LF) characters.

Total Record Length 750



Record 2: Payer “A” Field # Field Name Size Contents

1 Record Type 1 Enter an A. From Table E_IRS1099R_tape_ref. 2 Payment Year 4 Enter the appropriate tax year (e.g., 1999, 2000,

2001, etc.). 3 Blank 6 Enter blanks. 4 Payer’s Taxpayer Identification Number

(TIN) 9 From Table BE_IRS1099R_tape_ref.

5 Payer Name Control 4 Enter blanks. 6 Last Filing Indicator 1 Enter blank. 7 Combined Federal/State Filer 1 Enter blank. 8 Type of Return 1 Enter a 9. From Table BE_IRS1099R_tape_ref. 9 Amount Codes 12 Enter 12459 and seven (7) spaces to the right of

the 9. From Table BE_IRS1099R_tape_ref. 10 Blank 8 Enter blanks. 11 Original File Indicator 1 Enter a 1 unless this is a replacement or a

correction file. If a replacement or correction file, enter a blank.

12 Replacement File Indicator 1 Enter a blank unless this is a replacement file. If a replacement file, enter a 1.

13 Correction File Indicator 1 Enter a blank unless this is a correction file. If a correction file, enter a 1.

14 Blank 1 Enter a blank. 15 Foreign Entity Indicator 1 Enter a blank. 16 First Payer Name Line 40 From Table BE_IRS1099R_tape_ref. 17 Second Payer Name Line 40 Enter blanks. 18 Transfer Agent Indicator 1 Enter a 0. From Table BE_IRS1099R_tape_ref. 19 Payer Shipping Address 40 From Table BE_IRS1099R_tape_ref. 20 Payer City 40 From Table BE_IRS1099R_tape_ref. 21 Payer State 2 From Table BE_IRS1099R_tape_ref. 22 Payer Zip Code 9 From Table BE_IRS1099R_tape_ref. 23 Payer’s Phone Number and Extension 15 From Table BE_IRS1099R_tape_ref. 24 Blank 509 Enter blanks. 25 Blank 2 Enter blanks or carriage return/line feed

(CR/LF) characters.




Record 3: Payee “B” Field # Field Name Size Contents

1 Record Type 1 Enter B. From Table BE_IRS1099R_tape_ref. 2 Payment Year 4 Enter the appropriate tax year (e.g., 1999, 2000,

2001, etc.). From Table BE_IRS1099R.clndr_yr_nr.

3 Corrected Return Indicator 1 Enter a blank unless correction file (refer to IRS Publication 1220 page 39) From Table BE_IRS1099R.crrctd_in.

4 Name Control 4 Enter blanks. 5 Type of TIN 1 Enter 2 for a payment to an individual. Enter 1

for a payment to an organization (e.g., estate or trust).

6 Payee’s Taxpayer Identification Number (TIN)

9 Enter recipient’s Social Security Number or enter organization’s TIN where applicable. From Table BE_IRS1099R.ss_nr.

7 Payer’s Account Number for Payee 20 Enter applicable recipient account id. 8 Payer’s Office Code 4 Enter blanks. 9 Blank 10 Enter blanks. 10 Payment Amount 1 12 Box – 1: Enter calendar year-to-date gross

benefit amount. From Table BE_IRS1099R.gross_bene_amt.

11 Payment Amount 2 12 Box – 2: Enter calendar year-to-date taxable benefit amount. From Table BE_IRS1099R.taxable_amt

12 Payment Amount 3 12 Enter zeroes. From Table BE_IRS1099R_tape_ref.

13 Payment Amount 4 12 Box – 4: Enter calendar year-to-date federal tax withholding amount. From Table BE_IRS1099R.fed_tax_wthld_amt.

14 Payment Amount 5 12 Box 9b - Enter the after-tax employee contributions recovered tax-free during the applicable calendar year (calendar year-to-date non-taxable benefit amount which is equal to the gross benefit amount minus the taxable benefit amount). From Table BE_IRS1099R.exclsn_amt.




18 Payment Amount 9 12 Enter the after-tax employee contributions to be recovered tax-free in future years if this is the first year that the recipient received benefits (or enter zeroes if there are performance issues associated with extracting this data). Always enter zeroes for lump sum distributions. From Table BE_IRS1099R.tot_empe_cntrb.

19 Payment Amount A 12 Enter zeroes. From Table BE_IRS1099R_tape_ref.



Field # Field Name Size Contents 20 Payment Amount B 12 Enter zeroes. From Table

BE_IRS1099R_tape_ref. 21 Payment Amount C 12 Enter zeroes. From Table

BE_IRS1099R_tape_ref. 22 Reserved 48 Enter blanks. 23 Foreign Country Indicator 1 Enter a 1 where applicable or enter a blank.

Note use a free format for the payee city, state, and ZIP code when the foreign address indicator is used.

24 First Payee Name Line 40 Enter the name of the recipient. From Table BE_IRS1099R.full_nm.

25 Second Payee Name Line 40 Enter blanks. 26 Blank 40 Enter blanks. 27 Payee Mailing Address 40 Enter mailing address of recipient. From Table

TP_Anl_N_Daily_1099R.rcpnt_addr_ln1, TP_Anl_N_Daily_1099R.rcpnt_addr_ln2.

28 Blank 40 Enter blanks. 29 Payee City 40 Enter the city, town, or post office. From Table

TP_Anl_N_Daily_1099R.city. 30 Payee State 2 Enter the valid U.S. Postal Service state

abbreviation for states or the appropriate postal identifier. From Table TP_Anl_N_Daily_1099R.state.

31 Payee Zip Code 9 Enter the valid nine digit ZIP Code assigned by the U.S. Postal Service. From Table TP_Anl_N_Daily_1099R.zip.

32 Blank 45 Enter blanks. 33 Blank 1 Enter blank. 34 Document Specific Distribution code 2 Box – 7: Enter the appropriate distribution

code(s). Codes currently used include 1 (refunds only), 2, 3 (annuitants only), 4, 7, G (refunds only), and H (refunds only) (refer to IRS Publication 1220 pages 58, 59, IRS Pub. Instructions for Forms 1099 pages 35 and 36, and Use Case - Batch Program – Extract 1099R Data). From Table BE_IRS1099R.dstrb_cd.

35 Taxable Amount Not Determined Indicator

1 Box – 2b: Enter blank.

36 IRA/SEP/SIMPLE Indicator 1 Enter blank. 37 Total Distribution Indicator 1 Box – 2b: Enter a 1, 1 = G for refunds and

blank for monthly annuitants (refer to IRS Publication 1220 pages 60). From Table BE_IRS1099R.irs_1099r_in.

38 Percentage of Total Distribution 2 Box – 9a: Enter appropriate percentage for death refunds and blanks for annuitants (refer to IRS Publication 1220 pages 60). From Table BE_IRS1099R.dstrb_pct.

39 Blank 111 Enter blanks. 40 Special Data Entries 60 Enter blanks. 41 State Income Tax Withheld 12 Enter blanks. 42 Local Income Tax Withheld 12 Enter blanks. 43 Combined Federal/State Code 2 Enter blanks.



Field # Field Name Size Contents 44 Blank 2 Enter blanks or carriage return/line feed

(CR/LF) characters. Total Record Length 750



Record 4: Payer “C” Field # Field Name Size Contents

1 Record Type 1 Enter C. From Table BE_IRS1099R_tape_ref. 2 Number of Payees 8 Enter the total number of B Records covered by

the preceding A Record. 3 Blank 6 Enter blanks. 4 Control Total 1 18 Enter the total gross benefit amount for all B

Records covered by the preceding A Record. 5 Control Total 2 18 Enter the total taxable benefit amount for all B

Records covered by the preceding A Record. 6 Control Total 3 18 Enter zeroes. From Table

BE_IRS1099R_tape_ref. 7 Control Total 4 18 Enter the total federal tax withholding amount for

all B Records covered by the preceding A Record.

8 Control Total 5 18 Enter the total non-taxable benefit amount for all B Records covered by the preceding A Record.

9 Control Total 6 18 Enter zeroes. From Table BE_IRS1099R_tape_ref.



12 Control Total 9 18 Enter the total future after-tax contribution amounts for all B Records covered by the preceding A Record (or zeroes if a decision is made to not report this data).

13 Control Total A 18 Enter zeroes. From Table BE_IRS1099R_tape_ref.

14 Control Total B 18 Enter zeroes. From Table BE_IRS1099R_tape_ref.

15 Control Total C 18 Enter zeroes. From Table BE_IRS1099R_tape_ref.

16 Blank 517 Enter blanks. From Table BE_IRS1099R_tape_ref.

17 Blank 2 Enter blanks or carriage return/line feed (CR/LF) characters.




Record 5: End of Transmissions “F” Record

Field # Field Name Size Contents 1 Record Type 1 Enter F. From Table BE_IRS1099R_tape_ref. 2 Number of “A” Records 8 From Table BE_IRS1099R_tape_ref. 3 Zero 21 Enter zeroes. From Table BE_IRS1099R_tape_ref. 4 Blank 718 Enter blanks. 5 Blank 2 Enter blanks or carriage return/line feed (CR/LF)

characters.


ANCHOR PI-Admin


Interface: Generate email

Description:

This data file has the email addresses based on Contact type parameter chosen

File Layout:

Email : alphanumeric 40, database;

Data Rules:

The data file is comma delimited.

ANCHOR PI-Admin


Interface: Member Labels

Description:

This data file has the member label data for the specified parameter.

File Layout:

First Name: alphanumeric 20, database;

Middle Initial: alphanumeric 1, database;

Last Name: alphanumeric 30, database;

Suffix: alphanumeric 4, database;

Guardian / c-o Line: alphanumeric 30,database;

Address Line 1: alphanumeric 30, database;



City Name: alphanumeric 30, database;

State Code: alphabetic 2, database;

Zip Code 5: numeric 5, database;


Foreign Province Name: Alphanumeric 20, database;

Country Code: Alphanumeric 20, database;

Foreign Postal Code: Alphanumeric 10, database;

Data Rules:

The data file is comma delimited. The data file is fixed column and variable length. i.e if a column (field) is

empty or spaces there will be only a comma (no space).

ANCHOR PI-Admin


Interface: Retiree Labels

Description:

This data file has the retiree label data for the specified parameter.





File Layout:

Guardian / c-o Line: alphanumeric 30,database;











Data Rules:



ANCHOR PI-Admin


Interface: Organization Labels

Description:

This data file has the organization label data for the specified parameter.

File Layout:

Contact First Name: Alphanumeric 20, database;

Contact Middle Initial: Alphanumeric 1, database;

Contact Last Name: Alphanumeric 30, database;

Contact Suffix: Alphanumeric 4, database;

Contact Type: Alphanumeric 20, database;

Organization Name: Alphanumeric 40, database;

Address Line 1: Alphanumeric 30, database;



City Name: Alphanumeric 28, database;

State Code: Alphanumeric 2, database;

Zip Code 5: Numeric 5, database;

Zip Code 4: Numeric 4, database;




Data Rules:



ANCHOR PI-Admin


Interface: TSB Recipient List

Description:

This data file has the TSB recipient list data for the specified parameter.

File layout:





Guardian / c-o Line: alphanumeric 30, database;











Data Rules:



ANCHOR PI-BAA


Interface BCP Death Audit Information Tape

Data Rules:

Field Position Length Datatype Default

---------------------------------------------------------------------------------------------------

JOB-O 1 4 A NORM *

SSN-O 5 9 N

LNAME-O 14 15 A

FNAME-O 29 12 A

SEX-O 41 1 A

ZIP-O 42 5 N

DOB-MM-O 47 2 N

SLASH1-O 49 1 A

DOB-DD-O 50 2 N

SLASH2-O 52 1 A

DOB-YY-O 53 4 N

ACCT-8-O 57 8 A 1430 **

FILLER-O 65 14 A

* - Default values for all records

** - Account Number assigned to ERSRI by Pension Benefit Information.

Three files are generated

1.DeathAuditTapeBeneficiaries

2.DeathAuditTapeMembers

3.DeathAuditTapeRetirees

ANCHOR PI-BAA


Interface: Disability Extract

Description:

This data file has the disability retiree data.

Data Rules:















Contact First Name: alphanumeric 20, database;

Contact Middle Initial: alphanumeric 1, database;

Contact Last Name: alphanumeric 30, database;

ERSRI Telephone number : Alphanumeric 10, database;



ANCHOR PI-BAA


Interface: Student extract

Description:

Extract all student recipients by plan whose 18th birthday falls during the next month, who are in Estimated or Final or Pending status.

Data Rules:








Address Line 4: City, State Code,Zip Code 5 -Zip Code 4: alphanumeric 30, database;

Fall year: Alphanumeric 4

Spring year: Alphanumeric 4





The data file is tilde delimited. The data file is fixed column and variable length. i.e if a column (field) is


ANCHOR PI-BAA


Interface: Extract Marital Status Letter

Description:

Extract all survivors spouses whose retirement date anniversary is 2 months from the run date and send

each a letter requiring verification of their single status

Data Rules:





SSN: alphanumeric 9 , database;





Due Date : Month ,day,year (format)





Calendar year: Alphanumeric 4,calendar year



ANCHOR PI-BAA


Interface: SRA Extract

Description:

Extract all retirees who have chose the SRA plus option and who would turn 62 next month

Data Rules:




SSN: alphanumeric 9 , database;









Effective date : Alphanumeric 10, database;

New Amt : Alphanumeric 10, database;

Old amount: Alphanumeric 10, database;



ANCHOR User Interface Review PI-Check File


Interface Check File



Contents

PI- Check File ................................................................................................................................................. 3 Description ..................................................................................................................................................... 3 Data Rules ...................................................................................................................................................... 4



PI- Check File

Description,

This is a text file containing formatted check payment data. This file will be used by an off-site check printing facility for the printing of ERSRI issued checks.

The Check File is fixed length and does not contain delimiters. If the reported data is not long enough to fill the number of spaces allowed, preceding zeros should be entered for a numeric field, and spaces should be added to the end of an alphanumeric field.



Data Rules, The following information will be included on the file:

Field Data type Position Format Comments Check Effective Date

Numeric 8 char from position 1 to 8;

mmddccyy

Check Amount Numeric 11 char from position 9 to 19;

ZZZZZZZZ.ZZ

Payment Instruction Number

Numeric 10 char from position 20 to 29.

Check Message Alphanumeric 160 char from position 30 to 189.

Gross Amount-Heading

Alphanumeric 12 char from position 190 to 201.

‘Gross Amount’

Gross Amount Numeric 11 char from position 202 to 212.

ZZZZZZZZ.ZZ

Non-taxable Amount-Heading


‘Non-taxable Amount’

Non-taxable Amount


ZZZZZZZZ.ZZ

Taxable Amount-Heading


‘Taxable Amount’

Taxable Amount Numeric 11 char from position 256 to 266.

ZZZZZZZZ.ZZ

Allocations-Heading


‘Allocations’

Allocations Amount


ZZZZZZZZ.ZZ

Rollover-Heading Alphanumeric 8 char from position 289 to 296.

‘Rollover’

Rollover Amount Numeric 11 char from position 297 to 307.

ZZZZZZZZ.ZZ

Tax withheld-Heading


‘Tax withheld’

Tax withheld Numeric 11 char from position 320 to 330.

ZZZZZZZZ.ZZ

Net Amount-Heading


‘Net Amount’

Net Amount Numeric 11 char from position 341 to 351.

ZZZZZZZZ.ZZ

Payee ID Alphanumeric 9 char from position 352 to 360;

For a person/organization the format will be #########.

Plan Name Alphanumeric 40 char from position 361 to 400;

Payee Name Alphanumeric 51 char from position 401 to 451;

For a person payee: First Name, Middle Initial,



Last Name; For an organization payee: The first 51 characters will be included, as they are stored in the database.

Payee Suffix Alphanumeric 4 char from position 452 to 455.

Populated only for person payee.

Payee care of name


c/o + Name

Payee Address Line1


Payee Address Line2


Payee Address Line3


Payee City Alphanumeric 28 char from position 576 to 603.

Payee State Alphanumeric 2 char from position 604 to 605.

Payee Zip Alphanumeric 10 char from position 606 to 615.

Bank Account Name


Bank Account Number


Bank Routing Number

Alphanumeric 9 char from position 672 to 680

Check ID Numeric 8 char from position 681 to 688

End of Record Character

Alphanumeric 1 char at position 689

‘@’

Check Effective Date: Date the Cash Disbursements check file creation batch job uses to determine if a check is eligible for printing to check print file. Check Amount: Net amount of check to be printed on the check. Payment Instruction Number: Number assigned to a check, when a check record is created in ANCHOR. Check Message: Free format text message to be printed on the check. Gross Amount-Heading: Text “Gross Amount”. Gross Amount: Gross Amount of the check to be printed. Non-taxable Amount-Heading: Text “Non-taxable Amount” Non-taxable Amount: Non-taxable portion of the gross amount. Taxable Amount-Heading: Text “Taxable Amount”. Taxable Amount: Taxable portion of the gross amount. Allocations-Heading: Text “Allocations”. Allocations Amount: Sum of allocation amounts (i.e. QDRO, Employer Holdback). Rollover-Heading: Text “Rollover”. Rollover Amount: Rollover portion of the gross amount. Tax withheld-Heading: Text “Tax withheld”



Tax withheld Amount: Amount of tax withheld on the gross amount. Net Amount-Heading: Text “Net Amount”. Net Amount: The net amount (after deductions). Payee ID: SSN for a person payee; Tax ID for an organization payee. Plan Name: Name of the plan associated with the payee. Payee Name: Name of the payee. Payee Suffix: Suffix part of payee’s name e.g. Jr., Sr., III etc. Payee care of name: Name of payee’s care of person (c/o + name concatenated) Payee Address Line1: First line of payee address. Payee Address Line2: Second line of payee address. Payee Address Line3: Third line of payee address. Payee City: City of payee address. Payee State: State of Payee address. Payee Zip: Zip Code of payee address. Bank Account Name: Bank account name associated with the payee. Bank Account Number: Bank account number associated with the payee. Bank Routing Number: Bank routing number associated with the payee. Check ID: Unique sequential number assigned to each check record. End of Record Character: ‘@’ indicating the end of each check record.

ANCHOR PI-Citizens File


Interface: Citizens Bank

Description:

This file is generated as part of the General Payment batch cycle .This file is passed on the Citizens Bank.

File Layout:

Standard Input Format for Account Reconciliation

Citizens Bank

Account Reconcilement Standard Input Format

Positions Length Description Comment

01-10 10 Account Number Right justified, left zero filled

11-20 10 Serial Number Right justified, left zero filled

21-30 10 Dollar Amount Right justified, left zero filled

31-36 6 Issue Date MMDDYY

37-37 1 Record Type V = Void

38-47 10 Additional Data 1

48-52 5 Additional Data 2

53-80 28 Filler

Record Size is 80

ANCHOR User Interface Review Interface - Contribution Actuarial Tape


Interface Contribution Actuarial Tape



Contents

Interface: Contribution Actuarial Tape ........................................................................................................... 3 Description: ................................................................................................................................................ 3 Data Rules: ................................................................................................................................................. 3



Interface: Contribution Actuarial Tape

Description: This will put the data previously extracted in the BP-Extract Contribution Actuarial Data job from the text file to tape format for the actuarial firm. The data will be sorted in the following order: plan, SSN. The extract file will be a tilda-delimited file (variable length, fixed column);

Data Rules: The format of the tape is as follows: Plan Code: Alphabetic 4 Character, From DB; SSN: Numeric 9 digit, From DB; Member's First Name: AlphaNumeric 20, From DB; Member's Last Name: AlphaNumeric 30, From DB; Sex: Alphabetic 4, From DB; Date of Birth: Numeric 8 digit, mmddyyyy, From DB; Member's current Status: Alphabetic 4, From DB; Member's Prior Fiscal year status: Alphabetic 4, From DB; Total Contributing Service Credit: Numeric 11 digit, 999.99999999, From DB; Total Non-Contributing Service Credit: Numeric 11 digit, 999.99999999, From DB; Pre-Tax LTD contributions: Numeric 8 digit, 999999.99, From DB; Post-Tax LTD contributions: Numeric 8 digit, 999999.99, From DB; Fiscal YTD wages : Numeric 8 digit, 999999.99, From DB; Prior Fiscal YTD wages: Numeric 8 digit, 999999.99, From DB; STPL Pensionable wages for the Fiscal Year: Numeric 8 digit, 999999.99, Manually populated (only for State police Plan); Date of Last contribution: Numeric 8 digit, mmddyyyy, From DB; Indicator to show if account is vested: Alphabetic 4, From DB; Current/Last Employer Agency Number: Numeric 4 digit, From DB; Current/Last Benefit Structure: Alphabetic 4, From DB; Current/Last Employer's Employer Group: Alphabetic 4, From DB; Projected annual contractual salary with current/last employer: Numeric 8 digit, 999999.99, From DB; Schedule Type : Numeric 2digit From DB;

ANCHOR User Interface Review

Interface - GL Transaction File


Interface GL Transaction File




Contents

Interface: GL Transaction File ....................................................................................................................... 3

Description: ................................................................................................................................................ 3

Data Rules: ................................................................................................................................................. 4




Interface: GL Transaction File

Description:

This file will list all the formatted GL transactions that were extracted during the batch

program for extracting and formatting GL transactions. This file will be used for

importing formatted ANCHOR GL transactions to Peoplesoft. For each set of

transactions created in ANCHOR there will be at least two records in the PeopleSoft file.




Data Rules:

Field Length Position Format

Effective Date 10 1 to 10 mm/dd/ccyy

Plan 4 11 to 14 e.g.: MERS, ERS, STPL, JDGS

Account 5 15 to 19 e.g.: 11101

Transaction Code 20 20 to 39 e.g.:REFUND

ANCHOR Posting Date 10 40 to 49 mm/dd/ccyy

Empr Code 4 50 to 53 e.g: 1000, 2001 etc

Debit/Credit Indicator 1 54 to 54 „D‟ or „C‟

Amount 12 55 to 66 999999999.99


Effective Date: The date that the transaction is effective in ANCHOR and PeopleSoft.

Plan: The plan for which the transaction occurred.

Account: The account number in the “chart of accounts” that the transaction will be posted against.

Transaction Code: The code that indicates what occurred in the ANCHOR system to cause the transaction.

Refer to the GL transactions document for specific transaction codes.

ANCHOR Posting Date: The date the transaction occurred in ANCHOR.

Empr Code: The employer that the transaction should be posted against.

Debit/Credit Indicator: Indicates whether the transaction will be posted as a debit or a credit.

Amount: The amount the transaction will be posted for.

ANCHOR PI-Load Employer Rates


Interface: Load Employer Rates

Description:

The following file would be picked up by the Rate changes batch job to update the rates of the employers

in ANCHOR

File Layout:

Email : alphanumeric 40, database;

Data Rules:

The data file is tilde delimited file.

File Format:

Agency # :Name of the Agency

Effective date :The date the new rate is effective as of

Cola Selection :The type of COLA associated with the agency

Employee Contribution Rate: in the following format VVV..VVVVVV

Employer Contribution Rate :in the following format VVV..VVVVVV

Federally Funded Rate:in the following format VVV..VVVVVV

Department of Education Rate:in the following format VVV..VVVVVV

ANCHOR User Interface Review Interface - Member Account Annual Statements data file


Interface Member Account Annual Statements data file



Contents

Interface: Member Account Annual Statements data file ............................................................................... 3 Description: ................................................................................................................................................ 3 Data Rules: ................................................................................................................................................. 3



Interface: Member Account Annual Statements data file

Description: This data file has information on a member for their Member Account Annual Statement, which may be sent to external agency for printing. . The extract file will be a tilda-delimited file (variable length, fixed column);

Data Rules: Annual Statement generation date: Numeric 8 digit, mmddccyy, From DB; Member information: Member Name: Alphanumeric 51, From DB; Member SSN: Numeric 9 digit, From DB; Member Address: Line 1: Alphanumeric 30, From DB; Line 2: Alphanumeric 30, From DB; Line 3: Alphanumeric 30, From DB; Line 4: Alphanumeric 30, From DB; City Name: Alphanumeric 28, From DB; State: Alphabetic 4, From DB; Zip code: Numeric 5 digit, from DB; Zip plus4 cd: Numeric 4 digit, from DB; Frgn post cd: Alphabumeric 20, From DB; Frgn prov nm : Alphanumeric 10, From DB; Member Birthdate: Numeric 8 digit, mmddyyyy, From DB; Sex: Alphabetic 4, From DB; Member Account Information: Plan: Alphanumeric 40, From DB; Current Employer Name: Alphanumeric 40, From DB; Current Employer Agency Code: Numeric 4 digit, From DB; Member Account Valid flag: Alphabetic 4, From DB; Break-up of Service Credit (upto 15): Service Credit Description: Alphanumeric 40, From DB; Service Credit qty: Numeric 5 digit, ZZ9.99, From DB; Total Years of SC: Numeric 5 digit, ZZ9.99, From DB; Pre-Tax contribution: Numeric 10 digit, 99999999.99, From DB; Post-Tax Contribution: Numeric 10 digit, 99999999.99, From DB; Total Contribution: Numeric 11 digit, 999999999.99, From DB; Survivor benefit: Numeric 10 digit, 99999999.99, From DB; Interest paid for purchases: Numeric 10 digit, 99999999.99, From DB; OSC purchase information (Up-to ten) Type: Alphanumeric 40, From DB;



Total amount of agreement: Numeric 10 digit, 99999999.99, From DB; Contribution: Numeric 10 digit, 99999999.99, From DB; Interest: Numeric 10 digit, 99999999.99, From DB; Payment Received: Numeric 10 digit, 99999999.99, From DB; Completion Date: Numeric 8 digit, mmddyyyy, From DB; Status: Alphanumeric 40, From DB; Rule: OSC purchase information for the following type of OSC purchase will not be retrieved : Granted Prior Service, Granted Military, Legislator Life Insurance, Rollover Prior Service. Beneficiary information: (up-to five (total)) Name: Alphanumeric 40, From DB; Sex: Alphabetic 4, From DB; Birthdate: Numeric 8 digit, mmddyyyy, From DB; Relationship: Alphanumeric 30, From DB; Beneficiary type: Alphabetic 20, From DB; Beneficiary Category: Alphabetic 20, From DB; OAP: Alphabetic 3, From DB; Percentage: Numeric 5 digit, 999.99, From DB; SSN/TIN: Alphanumeric 20, From DB; Family Member: (up-to five) Name: Alphanumeric 40, From DB; Sex: Alphabetic 4, From DB; Birthdate: Numeric 8 digit, mmddyyyy, From DB; Relationship: Alphanumeric 30, From DB; SSN: Numeric 9, From DB; Benefit Estimate: Final Average Salary: Numeric 10 digit, 99999999.99, From DB; SRA Option : Numeric 10 digit, 99999999.99, From DB; Maximum Option: Numeric 10 digit, 99999999.99, From DB; Option 1: Numeric 10 digit, 99999999.99, From DB; Option 2: Numeric 10 digit, 99999999.99, From DB; Death Benefit: Alphabetic 40, From DB; Schedule Type: Numeric 1,From DB

ANCHOR PI‐Positive Pay extract.doc


Interface: Positive Pay extract

Description:

This data file contains the check information from the General payments..

File Layout:

Check number: Length ( 10)

Check amount : Length (11)

Check effective date: Length (6)

Bank spaces : Length (6)

Bank Account number : Length (10)

Zero filler : Length (1)

Bank spaces: Length (10)

Zero filler : Length (10)

Bank spaces :Length (45)

Data Rules:

1.Creates Separate files for each plan and is ordered by Bank account number.

ANCHOR Retro Pension Check Information


Interface: Retro Pension Check Information

Description: This file displays information regarding the retro payment checks from the General payments run File Layout:

Name (ordered First Middle Last - this should be concatenated) address - 1 address - 2 address - 3 City State Zip - 5 Zip - 4 net check amount

Data Rules:

The data file is comma delimited.

Documents

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