Inbound Enrollment Spec

Field Name	DataType	Description	Format	Example	Length	Required
broker.first_name	String	Broker First Name			50	N
broker.middle_name	String	Broker Middle Name			50	N
broker.last_name	String	Broker Last Name			50	N
broker.prefix	String	Broker Prefix			4	N
broker.suffix	String	Broker Suffix			4	N
broker.phone_number	String	Broker’s phone number	Valid 10-digit Phone Number (No delimiters)	5109027836	15	N
broker.email	String	Broker’s email address	Valid Email Format (No delimiters)	john@test.com	50	N
broker.npn	String	Broker’s National Producer Number - required for enrollee attribution	Valid 9-digit NPN (No delimiters)	123530000	25	N
plan.year	String	Plan Year	Valid plan year	2025	4	Y
plan.hios_id	String	HIOS id	14 digit HIOS id code including variant	50221NJ0040001-02	15	Y
plan.monthly_premium	String	Plan Monthly Premium	Valid decimal value	999.99	20	Y
payment.routing_number	Digit			021000021		N
payment.account_number	Digit					N
payment.payer_name	String	The name of payer				N
payment.account_type	Enum	The account type of ACH		CHECKING		N
payment.is_new_payment_instrument	Boolean	True if this is new or updated payment instrument				Y
enrollment.renewal_type	Enum (ACTIVE/PASSIVE)	Renewal Type	Valid enum value (See DataType column)	INITIATION		N
enrollment.external_policy_id	String	Unique identifier for the policy (coming from the partner)(important)				N
enrollment.external_subscriber_id	String	Required if PlanChange/Cancel enrollment Same as subscriber’s external_member_id				N
enrollment.cancel_overlapping_eligibility	Boolean	Term or cancel existing eligibility if it overlaps and prefer new one	Valid Boolean String	False		N
enrollment.date_signed	String	Time when broker or consumer submitted their enrollment	ISO Format	2011-11-04 00:05:23.283+00:00		Y
enrollment.qualifying_event	Enum	Enrollment Qualifying Event				N
enrollment.qualifying_event_date	String	Enrollment Qualifying Event Date	YYYY-MM-DD	1996-01-01		N
enrollment.application_id	String	The ID of the application				N
employer.employer_name	String	The name of employer
employer.employer_tin	String	The tax number of employer
enrollee.external_member_id	String	member ID defined by vendor				Y
enrollee.issuer_member_id	String	member ID defined by issuer
enrollee.first_name	String	Enrollee First Name				Y
enrollee.middle_name	String	Enrollee Middle Name				N
enrollee.last_name	String	Enrollee Last Name				Y
enrollee.prefix	String	Enrollee Prefix				N
enrollee.suffix	String	Enrollee Suffix				N
enrollee.phone	String	Enrollee Phone Number	Valid 10-digit Phone Number (No delimiters)	5109027836		N
enrollee.email	String	Enrollee Email	Valid Email Format	john@test.com		N
enrollee.ssn	String	Enrollee Social Security Number	Valid 9-digit SSN (No delimiters)	123456789		N
enrollee.marital_status	Enum	Enrollee Marital Status	Valid enum value (See Marital Status Mapping)	M		N
enrollee.sex	Enum (MALE/FEMALE)	Enrollee Sex	Valid enum value (See DataType column)	FEMALE		Y
enrollee.date_of_birth	String	Enrollee Date of Birth	YYYY-MM-DD	1996-01-01		Y
enrollee.ethnicity	Enum	Enrollee Ethnicity (See Ethnicity Code mapping)	Valid enum value	2135-2		N
enrollee.is_tobacco_user	Boolean	Specifies is enrollee is a tobacco user	Valid Boolen String	TRUE		Y
enrollee.relationship_to_policy_holder	Enum	Enrollee’s relationship to policy holder(See Relationship Code Mapping)	Valid enum value	15		Y
enrollee.is_requesting_coverage	Boolean	Specifies if enrollee is requesting coverage	Valid Boolen String	TRUE		Y
enrollee.coverage_start_date	String	Coverage Start Date for enrollee	YYYY-MM-DD	1996-01-01		Y
enrollee.coverage_end_date	String	Coverage End Date for enrollee	YYYY-MM-DD	1996-01-01		Y
enrollee.language_preference	Enum	Enrollee Language Preference	Valid enum value (See Language Code mapping)	spa		N
enrollee.mailing_address.address_line_1	String	Enrollee Mailing Address Line 1				N
enrollee.mailing_address.address_line_2	String	Enrollee Mailing Address Line 2				N
enrollee.mailing_address.city	String	Enrollee Mailing Address City				N
enrollee.mailing_address.state	String	Enrollee Mailing Address State				N
enrollee.mailing_address.zipcode	String	Enrollee Mailing Address Zipcode				N
enrollee.residential_address.address_line_1	String	Enrollee Residential Address Line 1				Y
enrollee.residential_address.address_line_2	String	Enrollee Residential Address Line 2				N
enrollee.residential_address.city	String	Enrollee Residential Address City				Y
enrollee.residential_address.state	String	Enrollee Residential Address State				Y
enrollee.residential_address.zipcode	String	Enrollee Residential Address Zipcode				Y
enrollee.change_type	Enum	Type of modification made to the enrollee’s policy status		CHANGE, ADDITION, CANCELLATION, TERMINATION, REINSTATEMENT		Y
enrollee.additional_maintenance_reason	String	Additional maintenance reason code for the policy status change.		e.g. LEAVE_PLATFORM		N
enrollee.change_effective_date	String	Date at which change should take effect	YYYY-MM-DD