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 john@test.com 50 N
broker.npn String Broker’s National Producer Number - required for enrollee attribution Valid NPN 123530000 10 N
servicing_agent.first_name String Servicing Agent First Name 50 N
servicing_agent.middle_name String Servicing Agent Middle Name 50 N
servicing_agent.last_name String Servicing Agent Last Name 50 N
servicing_agent.prefix String Servicing Agent Prefix 4 N
servicing_agent.suffix String Servicing Agent Suffix 4 N
servicing_agent.phone_number String Servicing Agent’s phone number Valid 10-digit Phone Number (No delimiters) 5109027836 15 N
servicing_agent.email String Servicing Agent’s email address Valid Email Format john@test.com 50 N
servicing_agent.npn String Servicing Agent’s National Producer Number - required for enrollee attribution Valid NPN 123530000 10 N
plan.year String Plan Year Valid plan year 2025 4 Y
plan.hios_id String HIOS ID 14-digit HIOS ID code plus variant 50221NJ0040001-02 17 Y
plan.monthly_premium String Plan Monthly Premium Valid decimal value 999.99 20 Y
payment.routing_number Digit Routing number 21000021 Y if other payment related fields are provided
payment.account_number Digit Account number Y if other payment related fields are provided
payment.payer_name String The name of payer Y if other payment related fields are provided
payment.account_type Enum The account type of ACH CHECKING Y if other payment related fields are provided
payment.is_new_payment_instrument Boolean True if this is new or updated payment instrument Y if other payment related fields are provided
enrollment.renewal_type Enum Renewal Type Valid enum value (ACTIVE/PASSIVE) N
enrollment.external_policy_id String Unique identifier for the policy (coming from the partner) Y
enrollment.external_subscriber_id String 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 Y if enrollee.change_type is not CANCELLATION or TERMINATION
enrollment.qualifying_event_date String Enrollment Qualifying Event Date YYYY-MM-DD 1996-01-01 Y if qualifying_event provided
enrollment.application_id String The ID of the application N
employer.employer_name String The name of employer N
employer.employer_tin String The tax number of employer N
enrollee.external_member_id String Member ID defined by vendor Y
enrollee.issuer_member_id String Member ID defined by issuer N
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 123456789 N
enrollee.marital_status Enum Enrollee Marital Status Valid enum value (See Marital Status Mapping) M N
enrollee.sex Enum Enrollee Sex Valid enum value (MALE/FEMALE) 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 if enrollee is a tobacco user Valid Boolean 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 Boolean 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 Only include/required when change type is CANCELLATION or TERMINATION
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.change_effective_date String Date at which change should take effect YYYY-MM-DD Y if enrollee.change_type is CHANGE
enrollee.additional_maintenance_reason String Additional maintenance reason code for the policy status change. e.g. LEAVE_PLATFORM Y if enrollee.change_type is CHANGE