Benefits Template

Format Setup:

<TEMPLATE TYPE> DELIMITER_BASED

<OUTPUT CHARACTER SET> ASCII
<NEW RECORD CHARACTER> Carriage Return

Format Data Records:

<LEVEL> DATA_DS

<NEW RECORD> Benefits_HEADER

<DISPLAY 1=1
CONDITION>
<MAXIUMUM LENGTH> <FORMAT> <DATA> <TAG> <COMMENTS>
100 Alpha 'File Effective Date'
1 Alpha '|'
100 Alpha 'Maintenance Type Code'
1 Alpha '|'
100 Alpha 'Employment Status Code'
1 Alpha '|'
100 Alpha 'Benefit Status Code'
1 Alpha '|'
100 Alpha 'Employee Number'
1 Alpha '|'
100 Alpha 'Subscriber/Employee SSN'
1 Alpha '|'
100 Alpha 'Subscriber/Employee Last Name'
1 Alpha '|'
100 Alpha 'Subscriber/Employee First Name'
1 Alpha '|'
100 Alpha 'Subscriber/Employee Middle
Initial'
1 Alpha '|'
100 Alpha 'Subscriber/Employee Address 1'
1 Alpha '|'
100 Alpha 'Subscriber/Employee Address 2'
1 Alpha '|'
100 Alpha 'Subscriber/Employee City'
1 Alpha '|'
100 Alpha 'Subscriber/Employee State'
1 Alpha '|'
100 Alpha 'Subscriber/Employee Postal
Code'
1 Alpha '|'
100 Alpha 'Subscriber/Employee Gender
Code'
1 Alpha '|'
100 Alpha 'Subscriber/Employee Marital
Status'
1 Alpha '|'
100 Alpha 'Subscriber/Employee DOB'
1 Alpha '|'
100 Alpha 'Member SSN'
1 Alpha '|'
100 Alpha 'Member Last Name'
1 Alpha '|'
100 Alpha 'Member First Name'
1 Alpha '|'
100 Alpha 'Member Middle Initial'
1 Alpha '|'
100 Alpha 'Member Address 1'
1 Alpha '|'
100 Alpha 'Member Address 2'
1 Alpha '|'
100 Alpha 'Member City'
1 Alpha '|'
100 Alpha 'Member State'
1 Alpha '|'
100 Alpha 'Member Postal Code'
1 Alpha '|'
100 Alpha 'Member Gender Code'
1 Alpha '|'
100 Alpha 'Member Marital Status'
1 Alpha '|'
100 Alpha 'Member DOB'
1 Alpha '|'
100 Alpha 'Relationship Code'
1 Alpha '|'
100 Alpha 'Insurance Line Code'
1 Alpha '|'
100 Alpha 'Coverage Level Code'
1 Alpha '|'
100 Alpha 'Benefit Begin Date'
1 Alpha '|'
100 Alpha 'Benefit End Date'

<END LEVEL> DATA_DS

<LEVEL> DATA_DS/G_1/G_2/FILE_FRAGMENT/Benefits_Extract_Termination/PersonDetails/PersonDetails/Dependent

<NEW RECORD> Benefits_HEADER

<DISPLAY TerminationDate != NULL AND InsLineCode IN ('Basic Life AD&D','Voluntary Child Life','Voluntary
CONDITION> EE Life', 'Voluntary Spouse Life','Short Term Disability','Long Term Disability')
<MAXIUMUM LENGTH> <FORMAT> <DATA> <TAG> <COMMENTS>
100 Date, YYYYMMDD FileDate
1 Alpha '|'
100 Alpha '024'
1 Alpha '|'
100 Alpha IF Termination_Code =
‘RETIREMENT’ THEN ‘RT’ ELSE ‘TE’
END IF
1 Alpha '|'
100 Alpha BenefitStatus
1 Alpha '|'
100 Alpha PersonNumber
1 Alpha '|'
100 Alpha REPLACE(SSN,'-')
1 Alpha '|'
100 Alpha UPPER(LastName)
1 Alpha '|'
100 Alpha UPPER(FirstName)
1 Alpha '|'
100 Alpha UPPER(MiddleName)
1 Alpha '|'
100 Alpha UPPER(Address1)
1 Alpha '|'
100 Alpha UPPER(Address2)
1 Alpha '|'
100 Alpha UPPER(TownCity)
1 Alpha '|'
100 Alpha UPPER(State)
1 Alpha '|'
100 Alpha PostalCode
1 Alpha '|'
100 Alpha Gender
1 Alpha '|'
100 Alpha MaritalStatus
1 Alpha '|'
100 Date, YYYYMMDD DOB
1 Alpha '|'
100 Alpha REPLACE(DepSSN,'-')
1 Alpha '|'
100 Alpha UPPER(DepLastName)
1 Alpha '|'
100 Alpha UPPER(DepFirstName)
1 Alpha '|'
100 Alpha UPPER(DepMiddleName)
1 Alpha '|'
100 Alpha IF DepLastName IS NULL THEN NULL
ELSE UPPER(DepAddress1) END IF
1 Alpha '|'
100 Alpha IF DepLastName IS NULL THEN NULL
ELSE UPPER(DepAddress2) END IF
1 Alpha '|'
100 Alpha IF DepLastName IS NULL THEN NULL
ELSE UPPER(DepTownCity) END IF
1 Alpha '|'
100 Alpha IF DepLastName IS NULL THEN NULL
ELSE UPPER(DepState) END IF
1 Alpha '|'
100 Alpha IF DepLastName IS NULL THEN NULL
ELSE DepPostalCode END IF
1 Alpha '|'
100 Alpha DepGender
1 Alpha '|'
100 Alpha DepMaritalStatus
1 Alpha '|'
100 Date, YYYYMMDD DepDOB
1 Alpha '|'
100 Alpha IF DepRelCode = 'C' THEN '19'
ELSIF DepRelCode = 'S' THEN '01'
ELSE '18' END IF
1 Alpha '|'
100 Alpha IF InsLineCode IN ('PPO 26042',
'PPO HDHP 73475','PPO HDHP
73476') THEN 'MED'
ELSIF InsLineCode = '26042 -
Access Plus Dental' THEN 'DEN'
ELSIF InsLineCode = 'Vision
Plan' THEN 'VIS'
ELSIF InsLineCode IN ('Basic
Life AD&D','Voluntary Child
Life','Voluntary EE Life',
'Voluntary Spouse Life','Short
Term Disability','Long Term
Disability') THEN 'LIF'
ELSE InsLineCode END IF
1 Alpha '|'
100 Alpha IF CovLevelCode = 'Employee
Only' THEN 'IND'
 ELSIF CovLevelCode = 'Employee
Plus Family' THEN 'FAM'
ELSIF CovLevelCode = 'Employee
Plus Children' THEN 'ESP'
ELSIF CovLevelCode = 'Employee
Plus Spouse' THEN 'ECH'
ELSE CovLevelCode END IF
1 Alpha '|'
100 Date, YYYYMMDD StartDate
1 Alpha '|'
100 Date, YYYYMMDD EndDate

<NEW RECORD> Benefits_HEADER

<DISPLAY (PersonNumber_OLD = NULL AND PersonNumber != PersonNumber_OLD AND TerminationDate = NULL AND
CONDITION> InsLineCode IN ('Basic Life AD&D','Voluntary Child Life','Voluntary EE Life', 'Voluntary Spouse
Life','Short Term Disability','Long Term Disability')) OR (DepID_OLD!=DepID AND InsLineCode!=
InsLineCode_OLD AND TerminationDate = NULL AND InsLineCode IN ('Basic Life AD&D','Voluntary
Child Life','Voluntary EE Life', 'Voluntary Spouse Life','Short Term Disability','Long Term
Disability'))
<MAXIUMUM LENGTH> <FORMAT> <DATA> <TAG> <COMMENTS>
100 Date, YYYYMMDD FileDate
1 Alpha '|'
100 Alpha '021'
1 Alpha '|'
100 Alpha 'AC'
1 Alpha '|'
100 Alpha BenefitStatus
1 Alpha '|'
100 Alpha PersonNumber
1 Alpha '|'
100 Alpha REPLACE(SSN,'-')
1 Alpha '|'
100 Alpha UPPER(LastName)
1 Alpha '|'
100 Alpha UPPER(FirstName)
1 Alpha '|'
100 Alpha UPPER(MiddleName)
1 Alpha '|'
100 Alpha UPPER(Address1)
1 Alpha '|'
100 Alpha UPPER(Address2)
1 Alpha '|'
100 Alpha UPPER(TownCity)
1 Alpha '|'
100 Alpha UPPER(State)
1 Alpha '|'
100 Alpha PostalCode
1 Alpha '|'
100 Alpha Gender
1 Alpha '|'
100 Alpha MaritalStatus
1 Alpha '|'
100 Date, YYYYMMDD DOB
1 Alpha '|'
100 Alpha REPLACE(DepSSN,'-')
1 Alpha '|'
100 Alpha UPPER(DepLastName)
1 Alpha '|'
100 Alpha UPPER(DepFirstName)
1 Alpha '|'
100 Alpha UPPER(DepMiddleName)
1 Alpha '|'
100 Alpha IF DepLastName IS NULL THEN NULL
ELSE UPPER(DepAddress1) END IF
1 Alpha '|'
100 Alpha IF DepLastName IS NULL THEN NULL
ELSE UPPER(DepAddress2) END IF
1 Alpha '|'
100 Alpha IF DepLastName IS NULL THEN NULL
ELSE UPPER(DepTownCity) END IF
1 Alpha '|'
100 Alpha IF DepLastName IS NULL THEN NULL
ELSE UPPER(DepState) END IF
1 Alpha '|'
100 Alpha IF DepLastName IS NULL THEN NULL
ELSE DepPostalCode END IF
1 Alpha '|'
100 Alpha DepGender
1 Alpha '|'
100 Alpha DepMaritalStatus
1 Alpha '|'
100 Date, YYYYMMDD DepDOB
1 Alpha '|'
100 Alpha IF DepRelCode = 'C' THEN '19'
ELSIF DepRelCode = 'S' THEN '01'
ELSE '18' END IF
1 Alpha '|'
100 Alpha IF InsLineCode IN ('PPO 26042',
'PPO HDHP 73475','PPO HDHP
73476') THEN 'MED'
ELSIF InsLineCode = '26042 -
Access Plus Dental' THEN 'DEN'
ELSIF InsLineCode = 'Vision
Plan' THEN 'VIS'
ELSIF InsLineCode IN ('Basic
Life AD&D','Voluntary Child
Life','Voluntary EE Life',
'Voluntary Spouse Life','Short
Term Disability','Long Term
Disability') THEN 'LIF'
ELSE InsLineCode END IF
1 Alpha '|'
100 Alpha IF CovLevelCode = 'Employee
Only' THEN 'IND'
ELSIF CovLevelCode = 'Employee
Plus Family' THEN 'FAM'
ELSIF CovLevelCode = 'Employee
Plus Children' THEN 'ESP'
 ELSIF CovLevelCode = 'Employee
Plus Spouse' THEN 'ECH'
ELSE CovLevelCode END IF
1 Alpha '|'
100 Date, YYYYMMDD StartDate
1 Alpha '|'
100 Date, YYYYMMDD EndDate

<NEW RECORD> Benefits_HEADER

<DISPLAY (PersonNumber_OLD!= NULL AND (Address1 != Address1_OLD OR Address2 != Address2_OLD OR
CONDITION> TownCity != TownCity_OLD OR State!= State_OLD OR PostalCode!= PostalCode_OLD OR DepAddress1!=
DepAddress1_OLD OR DepAddress2!= DepAddress2_OLD OR DepTownCity!= DepTownCity_OLD OR DepState!=
DepState_OLD OR DepPostalCode!= DepPostalCode_OLD)) AND TerminationDate = NULL AND InsLineCode
IN ('Basic Life AD&D','Voluntary Child Life','Voluntary EE Life', 'Voluntary Spouse
Life','Short Term Disability','Long Term Disability')
<MAXIUMUM LENGTH> <FORMAT> <DATA> <TAG> <COMMENTS>
100 Date, YYYYMMDD FileDate
1 Alpha '|'
100 Alpha '001'
1 Alpha '|'
100 Alpha 'AC'
1 Alpha '|'
100 Alpha BenefitStatus
1 Alpha '|'
100 Alpha PersonNumber
1 Alpha '|'
100 Alpha REPLACE(SSN,'-')
1 Alpha '|'
100 Alpha UPPER(LastName)
1 Alpha '|'
100 Alpha UPPER(FirstName)
1 Alpha '|'
100 Alpha UPPER(MiddleName)
1 Alpha '|'
100 Alpha UPPER(Address1)
1 Alpha '|'
100 Alpha UPPER(Address2)
1 Alpha '|'
100 Alpha UPPER(TownCity)
1 Alpha '|'
100 Alpha UPPER(State)
1 Alpha '|'
100 Alpha PostalCode
1 Alpha '|'
100 Alpha Gender
1 Alpha '|'
100 Alpha MaritalStatus
1 Alpha '|'
100 Date, YYYYMMDD DOB
1 Alpha '|'
100 Alpha REPLACE(DepSSN,'-')
1 Alpha '|'
100 Alpha UPPER(DepLastName)
1 Alpha '|'
100 Alpha UPPER(DepFirstName)
1 Alpha '|'
100 Alpha UPPER(DepMiddleName)
1 Alpha '|'
100 Alpha IF DepLastName IS NULL THEN NULL
ELSE UPPER(DepAddress1) END IF
1 Alpha '|'
100 Alpha IF DepLastName IS NULL THEN NULL
ELSE UPPER(DepAddress2) END IF
1 Alpha '|'
100 Alpha IF DepLastName IS NULL THEN NULL
ELSE UPPER(DepTownCity) END IF
1 Alpha '|'
100 Alpha IF DepLastName IS NULL THEN NULL
ELSE UPPER(DepState) END IF
1 Alpha '|'
100 Alpha IF DepLastName IS NULL THEN NULL
ELSE DepPostalCode END IF
1 Alpha '|'
100 Alpha DepGender
1 Alpha '|'
100 Alpha DepMaritalStatus
1 Alpha '|'
100 Date, YYYYMMDD DepDOB
1 Alpha '|'
100 Alpha IF DepRelCode = 'C' THEN '19'
ELSIF DepRelCode = 'S' THEN '01'
ELSE '18' END IF
1 Alpha '|'
100 Alpha IF InsLineCode IN ('PPO 26042',
'PPO HDHP 73475','PPO HDHP
73476') THEN 'MED'
ELSIF InsLineCode = '26042 -
Access Plus Dental' THEN 'DEN'
ELSIF InsLineCode = 'Vision
Plan' THEN 'VIS'
ELSIF InsLineCode IN ('Basic
Life AD&D','Voluntary Child
Life','Voluntary EE Life',
'Voluntary Spouse Life','Short
Term Disability','Long Term
Disability') THEN 'LIF'
ELSE InsLineCode END IF
1 Alpha '|'
100 Alpha IF CovLevelCode = 'Employee
Only' THEN 'IND'
ELSIF CovLevelCode = 'Employee
Plus Family' THEN 'FAM'
ELSIF CovLevelCode = 'Employee
Plus Children' THEN 'ESP'
ELSIF CovLevelCode = 'Employee
Plus Spouse' THEN 'ECH'
ELSE CovLevelCode END IF
1 Alpha '|'
100 Date, YYYYMMDD StartDate
1 Alpha '|'
100 Date, YYYYMMDD EndDate

<END LEVEL> DATA_DS/G_1/G_2/FILE_FRAGMENT/Benefits_Extract_Termination/PersonDetails/PersonDetails/Dependent