267 Individual Life, Annuity and Disability Application
267 Individual Life, Annuity and Disability Application
Function Group IL
This Draft Standard for Trial Use contains the format and establishes the data contents of the Individual Life, Annuity and Disability Application Transaction Set (267) for use within the context of an Electronic Data Interchange (EDI) environment. The transaction set is used to transmit new business application information among distributors (agents, broker/dealers, etc.), insurance companies and reinsurance companies for the purpose of underwriting an individual life, annuity or disability contract.
Position
Segment
Name
Max Use
010
Transaction Set HeaderMandatory
Max 1
To indicate the start of a transaction set and to assign a control number
020
Beginning SegmentMandatory
Max 1
To indicate the beginning of a transaction set
030
Date or Time or PeriodOptional
Max >1
To specify any or all of a date, a time, or a time period
NM1Loop
Optional
Repeat >1
040
Individual or Organizational NameMandatory
Max 1
To supply the full name of an individual or organizational entity
050
Address InformationOptional
Max 3
To specify the location of the named party
060
Geographic LocationOptional
Max 1
To specify the geographic place of the named party
070
Reference IdentificationOptional
Max 9
To specify identifying information
080
Administrative Communications ContactOptional
Max 3
To identify a person or office to whom administrative communications should be directed
Position
Segment
Name
Max Use
ACTLoop
Mandatory
Repeat >1
005
Account IdentificationMandatory
Max 1
To specify account information
010
Action or Status IndicatorOptional
Max 1
To indicate the action to be taken with the information provided or the status of the entity described
015
Administrative Communications ContactOptional
Max >1
To identify a person or office to whom administrative communications should be directed
020
CurrencyOptional
Max 1
To specify the currency being used in the transaction set
025
Language UseOptional
Max >1
To specify language, type of usage, and proficiency or fluency
030
Date or Time or PeriodOptional
Max >1
To specify any or all of a date, a time, or a time period
035
Baseline Item DataOptional
Max 1
To specify basic item data: item identification, quantity, and price
040
Item IdentificationOptional
Max >1
To specify basic item identification data
045
Geographic LocationOptional
Max >1
To specify the geographic place of the named party
050
Informational ValuesOptional
Max >1
To specify a code and the amount or quantity or percentage associated with it
055
Monetary AmountOptional
Max >1
To indicate the total monetary amount
060
Yes/No QuestionOptional
Max >1
To identify and answer yes and no questions, including the date, time, and comments further qualifying the condition
065
Reference IdentificationOptional
Max >1
To specify identifying information
SILoop
Optional
Repeat >1
070
Service Characteristic IdentificationMandatory
Max 1
To specify service characteristic data
075
Monetary AmountOptional
Max >1
To indicate the total monetary amount
080
Date or Time or PeriodOptional
Max >1
To specify any or all of a date, a time, or a time period
085
Reference IdentificationOptional
Max >1
To specify identifying information
090
Individual or Organizational NameOptional
Max 1
To supply the full name of an individual or organizational entity
095
Geographic LocationOptional
Max 1
To specify the geographic place of the named party
100
Message TextOptional
Max >1
To provide a free-form format that allows the transmission of text information
PIDLoop
Optional
Repeat >1
105
Product/Item DescriptionMandatory
Max 1
To describe a product or process in coded or free-form format
110
Baseline Item DataOptional
Max 1
To specify basic item data: item identification, quantity, and price
115
Status of Product or ActivityOptional
Max 1
To indicate the details and status of a product or product activity
120
Underwriting StatusOptional
Max 1
To identify and describe underwriting status of submitted applications
125
Monetary AmountOptional
Max >1
To indicate the total monetary amount
130
Informational ValuesOptional
Max >1
To specify a code and the amount or quantity or percentage associated with it
135
Payment DetailsOptional
Max >1
To transmit information required to establish payment or remittance activity
140
QuantityOptional
Max >1
To specify quantity information
145
Date or Time or PeriodOptional
Max >1
To specify any or all of a date, a time, or a time period
150
Message TextOptional
Max >1
To provide a free-form format that allows the transmission of text information
INVLoop
Optional
Repeat >1
155
Investment Vehicle SelectionMandatory
Max 1
To specify type of investment vehicle or account and other basic data about the investment
160
Informational ValuesOptional
Max >1
To specify a code and the amount or quantity or percentage associated with it
165
Date or Time or PeriodOptional
Max >1
To specify any or all of a date, a time, or a time period
170
QuantityOptional
Max >1
To specify quantity information
175
Item IdentificationOptional
Max 2
To specify basic item identification data
180
Rate Amounts or PercentsOptional
Max >1
To identify rate amounts or percents for a specific cost or other line item
BENLoop
Optional
Repeat >1
185
Beneficiary or Owner InformationMandatory
Max 1
To supply beneficiary, co-participant, and owner information
190
Individual or Organizational NameOptional
Max 1
To supply the full name of an individual or organizational entity
195
Additional Name InformationOptional
Max 3
To specify additional names or those longer than 35 characters in length
200
Address InformationOptional
Max 3
To specify the location of the named party
205
Geographic LocationOptional
Max 1
To specify the geographic place of the named party
210
Reference IdentificationOptional
Max >1
To specify identifying information
215
Date or Time or PeriodOptional
Max >1
To specify any or all of a date, a time, or a time period
220
InformationOptional
Max >1
To report information
225
QuantityOptional
Max >1
To specify quantity information
230
Language UseOptional
Max 1
To specify language, type of usage, and proficiency or fluency
235
Message TextOptional
Max >1
To provide a free-form format that allows the transmission of text information
ENTLoop
Optional
Repeat >1
240
EntityMandatory
Max 1
To designate the entities which are parties to a transaction and specify a reference meaningful to those entities
245
Reference IdentificationOptional
Max >1
To specify identifying information
250
Item IdentificationOptional
Max 9
To specify basic item identification data
255
Demographic InformationOptional
Max 1
To supply demographic information
260
Additional Demographic InformationOptional
Max 1
To supply additional demographic identification
265
Language UseOptional
Max 1
To specify language, type of usage, and proficiency or fluency
270
Date or Time or PeriodOptional
Max >1
To specify any or all of a date, a time, or a time period
275
Informational ValuesOptional
Max >1
To specify a code and the amount or quantity or percentage associated with it
280
Yes/No QuestionOptional
Max >1
To identify and answer yes and no questions, including the date, time, and comments further qualifying the condition
285
QuantityOptional
Max >1
To specify quantity information
290
Message TextOptional
Max >1
To provide a free-form format that allows the transmission of text information
NM1Loop
Optional
Repeat >1
295
Individual or Organizational NameMandatory
Max 1
To supply the full name of an individual or organizational entity
300
Additional Name InformationOptional
Max 3
To specify additional names or those longer than 35 characters in length
305
Reference IdentificationOptional
Max >1
To specify identifying information
N3Loop
Optional
Repeat >1
310
Address InformationMandatory
Max 1
To specify the location of the named party
315
Geographic LocationOptional
Max 1
To specify the geographic place of the named party
320
Communication Contact InformationOptional
Max 9
To specify a communication contact number
325
Date or Time or PeriodOptional
Max >1
To specify any or all of a date, a time, or a time period
LQLoop
Optional
Repeat >1
330
Industry CodeMandatory
Max 1
Code to transmit standard industry codes
335
Status of Product or ActivityOptional
Max 1
To indicate the details and status of a product or product activity
340
Date or Time or PeriodOptional
Max >1
To specify any or all of a date, a time, or a time period
345
Message TextOptional
Max >1
To provide a free-form format that allows the transmission of text information
NM1Loop
Optional
Repeat >1
350
Individual or Organizational NameMandatory
Max 1
To supply the full name of an individual or organizational entity
355
Address InformationOptional
Max 3
To specify the location of the named party
360
Geographic LocationOptional
Max 1
To specify the geographic place of the named party
365
Reference IdentificationOptional
Max >1
To specify identifying information
370
Communication Contact InformationOptional
Max 3
To specify a communication contact number
375
Language UseOptional
Max 1
To specify language, type of usage, and proficiency or fluency
380
Date or Time or PeriodOptional
Max >1
To specify any or all of a date, a time, or a time period
385
Message TextOptional
Max >1
To provide a free-form format that allows the transmission of text information
BENLoop
Optional
Repeat >1
390
Beneficiary or Owner InformationMandatory
Max 1
To supply beneficiary, co-participant, and owner information
395
Individual or Organizational NameOptional
Max 1
To supply the full name of an individual or organizational entity
400
Additional Name InformationOptional
Max 3
To specify additional names or those longer than 35 characters in length
405
Address InformationOptional
Max 3
To specify the location of the named party
410
Geographic LocationOptional
Max 1
To specify the geographic place of the named party
415
Reference IdentificationOptional
Max >1
To specify identifying information
420
Date or Time or PeriodOptional
Max >1
To specify any or all of a date, a time, or a time period
425
InformationOptional
Max >1
To report information
430
QuantityOptional
Max >1
To specify quantity information
435
Language UseOptional
Max 1
To specify language, type of usage, and proficiency or fluency
440
Message TextOptional
Max >1
To provide a free-form format that allows the transmission of text information
PIDLoop
Optional
Repeat >1
445
Product/Item DescriptionMandatory
Max 1
To describe a product or process in coded or free-form format
450
Baseline Item DataOptional
Max 9
To specify basic item data: item identification, quantity, and price
455
Status of Product or ActivityOptional
Max 1
To indicate the details and status of a product or product activity
460
Monetary AmountOptional
Max >1
To indicate the total monetary amount
465
QuantityOptional
Max >1
To specify quantity information
470
Date or Time or PeriodOptional
Max >1
To specify any or all of a date, a time, or a time period
475
Message TextOptional
Max >1
To provide a free-form format that allows the transmission of text information
PDLLoop
Optional
Repeat >1
480
Payment DetailsMandatory
Max 1
To transmit information required to establish payment or remittance activity
485
Reference IdentificationOptional
Max >1
To specify identifying information
INVLoop
Optional
Repeat >1
490
Investment Vehicle SelectionMandatory
Max 1
To specify type of investment vehicle or account and other basic data about the investment
495
Informational ValuesOptional
Max >1
To specify a code and the amount or quantity or percentage associated with it
500
Date or Time or PeriodOptional
Max >1
To specify any or all of a date, a time, or a time period
505
Rate Amounts or PercentsOptional
Max >1
To identify rate amounts or percents for a specific cost or other line item
BENLoop
Optional
Repeat >1
510
Beneficiary or Owner InformationMandatory
Max 1
To supply beneficiary, co-participant, and owner information
515
Individual or Organizational NameOptional
Max 1
To supply the full name of an individual or organizational entity
520
Additional Name InformationOptional
Max 3
To specify additional names or those longer than 35 characters in length
525
Address InformationOptional
Max 3
To specify the location of the named party
530
Geographic LocationOptional
Max 1
To specify the geographic place of the named party
535
Reference IdentificationOptional
Max >1
To specify identifying information
540
Date or Time or PeriodOptional
Max >1
To specify any or all of a date, a time, or a time period
545
InformationOptional
Max >1
To report information
550
QuantityOptional
Max >1
To specify quantity information
555
Language UseOptional
Max 1
To specify language, type of usage, and proficiency or fluency
560
Message TextOptional
Max >1
To provide a free-form format that allows the transmission of text information
UCLoop
Optional
Repeat >1
565
Underwriting CategoryMandatory
Max 1
To identify the category of underwriting data being transmitted
HLLoop
Optional
Repeat >1
570
Hierarchical LevelMandatory
Max 1
To identify dependencies among and the content of hierarchically related groups of data segments
575
Underwriting QuestionOptional
Max 1
To report information provider underwriting data in a question and answer format
580
Yes/No QuestionOptional
Max >1
To identify and answer yes and no questions, including the date, time, and comments further qualifying the condition
585
Individual or Organizational NameOptional
Max 1
To supply the full name of an individual or organizational entity
590
Address InformationOptional
Max 3
To specify the location of the named party
595
Geographic LocationOptional
Max 1
To specify the geographic place of the named party
600
Communication Contact InformationOptional
Max 9
To specify a communication contact number
605
Date or Time or PeriodOptional
Max >1
To specify any or all of a date, a time, or a time period
610
QuantityOptional
Max >1
To specify quantity information
615
Message TextOptional
Max >1
To provide a free-form format that allows the transmission of text information
620
Informational ValuesOptional
Max >1
To specify a code and the amount or quantity or percentage associated with it
625
Monetary AmountOptional
Max >1
To indicate the total monetary amount
630
InformationOptional
Max >1
To report information
635
Employment ClassOptional
Max 1
To provide class of employment information
640
Employment PositionOptional
Max 1
To describe employment position
645
EmployerOptional
Max 1
To provide employment specifics
650
Percent AmountsOptional
Max >1
To qualify percent amounts and supply percent amounts
655
Source of IncomeOptional
Max >1
To define the source and related information about the income being reported
660
Item IdentificationOptional
Max 2
To specify basic item identification data
665
Reference IdentificationOptional
Max >1
To specify identifying information
670
Asset LiabilityOptional
Max >1
To report financial information
675
Type of ActivityOptional
Max >1
To specify type of activity information
680
Vehicle Use InformationOptional
Max >1
To report usage of a vehicle
685
Vehicle InformationOptional
Max >1
To provide descriptions that identify a specific vehicle
690
Case DescriptionOptional
Max >1
To identify and describe a specific court case
695
Administration of Justice Event DescriptionOptional
Max >1
To describe specific administration of justice events and actions
700
Substance UseOptional
Max >1
To report use of tobacco, alcohol, drugs or other substances
705
Underwriting ConsiderationsOptional
Max >1
To report personal health and medical history data
710
Family HistoryOptional
Max >1
To report information about a person's family health history
715
Status of Product or ActivityOptional
Max 1
To indicate the details and status of a product or product activity
720
Military Personnel InformationOptional
Max 1
To report military service data
PWKLoop
Optional
Repeat >1
725
PaperworkMandatory
Max 1
To identify the type or transmission or both of paperwork or supporting information
730
Individual or Organizational NameOptional
Max 1
To supply the full name of an individual or organizational entity
735
Geographic LocationOptional
Max 1
To specify the geographic place of the named party
740
Reference IdentificationOptional
Max >1
To specify identifying information
745
Date or Time or PeriodOptional
Max >1
To specify any or all of a date, a time, or a time period
750
Status of Product or ActivityOptional
Max 1
To indicate the details and status of a product or product activity
EFILoop
Optional
Repeat >1
755
Electronic Format IdentificationMandatory
Max 1
To provide basic information about the electronic format of the interchange data
760
Binary DataMandatory
Max 1
To transfer binary data in a single data segment and allow identification of the end of the data segment through a count; there is no identification of the internal structure of the binary data in this segment
LXLoop
Optional
Repeat >1
765
Assigned NumberMandatory
Max 1
To reference a line number in a transaction set
PDLLoop
Optional
Repeat >1
770
Payment DetailsMandatory
Max 1
To transmit information required to establish payment or remittance activity
775
Reference IdentificationOptional
Max >1
To specify identifying information
AMTLoop
Optional
Repeat >1
780
Monetary AmountMandatory
Max 1
To indicate the total monetary amount
785
NameOptional
Max 1
To identify a party by type of organization, name, and code
790
Address InformationOptional
Max 2
To specify the location of the named party
795
Geographic LocationOptional
Max 1
To specify the geographic place of the named party
800
Item IdentificationOptional
Max 2
To specify basic item identification data
805
Date or Time or PeriodOptional
Max >1
To specify any or all of a date, a time, or a time period
810
QuantityOptional
Max >1
To specify quantity information
815
Message TextOptional
Max >1
To provide a free-form format that allows the transmission of text information
K2Loop
Optional
Repeat >1
820
Administrative MessageMandatory
Max 1
To transmit information in a free-form format for comment or special instruction
825
Date or Time or PeriodOptional
Max 1
To specify any or all of a date, a time, or a time period
830
Individual or Organizational NameOptional
Max 1
To supply the full name of an individual or organizational entity
835
Transaction Set TrailerMandatory
Max 1
To indicate the end of the transaction set and provide the count of the transmitted segments (including the beginning (ST) and ending (SE) segments)