EDI 111 Segments and Elements for the Individual Insurance Policy And Client Information Standard


AgencySet IDFGTransaction DescriptionSubcommitteeStandard
ANSI111IFIndividual Insurance Policy And Client Information InsuranceDownload


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Research and Development:
See the list of EDI 111 segments and elements in below data grid. The Jobisez.com site has an online translation tool that converts the EDI 111 (Individual Insurance Policy And Client Information) document into a CSV file. If you are researching the 111s, you can view other trading partner's mapping specifications. You can also gain knowledge by researching all EDI document types. Jobisez LLC can also provide assistance if you need additional help.

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The EDI 111 Segments and Elements

SegmentDescriptionSectReqMax LoopMax UsagePos
BHTBeginning Of Hierarchical TransactionHM011
NM1Individual Or Organizational NameHM99999912
N3Party LocationHO033
N4Geographic LocationHO014
REFReference InformationHO095
PERAdministrative Communications ContactHO036
HLHierarchical LevelDM99999917
REFReference InformationDO09999998
ASIAction Or Status IndicatorDO09999999
LQIndustry Code IdentificationDO099999910
C3Currency IdentifierDO0111
DMGDemographic InformationDO0112
LUILanguage UseDO0113
N4Geographic LocationDO099999914
BLIBasic Baseline Item DataDO0115
LINItem IdentificationDO099999916
UDAUnderwriting ConditionDO099999917
SPAStatus Of Product Or ActivityDO099999918
DTPDate Or Time Or PeriodDO099999919
BLNBalance InformationDO099999920
QTYQuantity InformationDO099999921
AMTMonetary Amount InformationDO099999922
RPARate Amounts Or PercentsDO099999923
PDLPayment DetailsDO999999124
REFReference InformationDO099999925
IIIInformationDO999999126
DTPDate Or Time Or PeriodDO099999927
AM1Informational ValuesDO999999128
IIIInformationDO099999929
SPAStatus Of Product Or ActivityDO099999930
DTPDate Or Time Or PeriodDO099999931
AMTMonetary Amount InformationDO099999932
QTYQuantity InformationDO099999933
RPARate Amounts Or PercentsDO099999934
BLNBalance InformationDO099999935
REFReference InformationDO099999936
NM1Individual Or Organizational NameDO999999137
N2Additional Name InformationDO0338
COMCommunication Contact InformationDO099999939
N3Party LocationDO999999140
N4Geographic LocationDO0141
DTPDate Or Time Or PeriodDO099999942
NX1Property Or Entity IdentificationDO999999143
REFReference InformationDO099999944
BENBeneficiary Or Owner InformationDO0145
IIIInformationDO099999946
AM1Informational ValuesDO099999947
IN1Individual IdentificationDO099999948


SegmentElementDescriptionReqMin LengthMax LengthType
BHT1Hierarchical Structure CodeM44ID
BHT2Transaction Set Purpose CodeM22ID
BHT3Reference IdentificationO150AN
BHT4DateO88DT
BHT5TimeO48TM
BHT6Transaction Type CodeO22ID
NM11Entity Identifier CodeM23ID
NM12Entity Type QualifierM11ID
NM13Name Last Or Organization NameC160AN
NM14Name FirstO135AN
NM15Name MiddleO125AN
NM16Name PrefixO110AN
NM17Name SuffixO110AN
NM18Identification Code QualifierC12ID
NM19Identification CodeC280AN
NM110Entity Relationship CodeC22ID
NM111Entity Identifier CodeO23ID
NM112Name Last Or Organization NameO160AN
N31Address InformationM155AN
N32Address InformationO155AN
N41City NameO230AN
N42State Or Province CodeC22ID
N43Postal CodeO315ID
N44Country CodeC23ID
N45Location QualifierC12ID
N46Location IdentifierO130AN
N47Country Subdivision CodeC13ID
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
PER1Contact Function CodeM22ID
PER2NameO160AN
PER3Communication Number QualifierC22ID
PER4Communication NumberC1256AN
PER5Communication Number QualifierC22ID
PER6Communication NumberC1256AN
PER7Communication Number QualifierC22ID
PER8Communication NumberC1256AN
PER9Contact Inquiry ReferenceO120AN
HL1Hierarchical Id NumberM112AN
HL2Hierarchical Parent Id NumberO112AN
HL3Hierarchical Level CodeM12ID
HL4Hierarchical Child CodeO11ID
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
ASI1Action CodeM12ID
ASI2Maintenance Type CodeM33ID
ASI3Status Reason CodeO33ID
LQ1Code List Qualifier CodeO13ID
LQ2Industry CodeC130AN
C31Currency CodeM33ID
C32Exchange RateO410R
C33Currency CodeO33ID
C34Currency CodeO33ID
DMG1Date Time Period Format QualifierC23ID
DMG2Date Time PeriodC135AN
DMG3Gender CodeO11ID
DMG4Marital Status CodeO11ID
DMG5Race Or Ethnicity CodeC11ID
DMG6Code List Qualifier CodeC13ID
DMG7Industry CodeC130AN
DMG8Citizenship Status CodeO12ID
DMG9Country CodeO23ID
DMG10Basis Of Verification CodeO12ID
DMG11QuantityO115R
DMG12Code List Qualifier CodeC13ID
DMG13Industry CodeC130AN
LUI1Identification Code QualifierC12ID
LUI2Identification CodeC280AN
LUI3DescriptionC180AN
LUI4Use Of Language IndicatorO12ID
LUI5Language Proficiency IndicatorO11ID
N41City NameO230AN
N42State Or Province CodeC22ID
N43Postal CodeO315ID
N44Country CodeC23ID
N45Location QualifierC12ID
N46Location IdentifierO130AN
N47Country Subdivision CodeC13ID
BLI1Product/Service Id QualifierM22ID
BLI2Product/Service IdM148AN
BLI3QuantityC115R
BLI4Unit Or Basis For Measurement CodeO22ID
BLI5Price Identifier CodeC33ID
BLI6Unit PriceC117R
BLI7Unit Or Basis For Measurement CodeO22ID
BLI8Product/Service Id QualifierC22ID
BLI9Product/Service IdC148AN
BLI10Product/Service Id QualifierC22ID
BLI11Product/Service IdC148AN
BLI12Product/Service Id QualifierC22ID
BLI13Product/Service IdC148AN
BLI14Product Option CodeO12ID
BLI15Product Option CodeO12ID
BLI16Product Option CodeO12ID
BLI17Product Option CodeO12ID
BLI18Frequency CodeO11ID
LIN1Assigned IdentificationO120AN
LIN2Product/Service Id QualifierM22ID
LIN3Product/Service IdM148AN
LIN4Product/Service Id QualifierC22ID
LIN5Product/Service IdC148AN
LIN6Product/Service Id QualifierC22ID
LIN7Product/Service IdC148AN
LIN8Product/Service Id QualifierC22ID
LIN9Product/Service IdC148AN
LIN10Product/Service Id QualifierC22ID
LIN11Product/Service IdC148AN
LIN12Product/Service Id QualifierC22ID
LIN13Product/Service IdC148AN
LIN14Product/Service Id QualifierC22ID
LIN15Product/Service IdC148AN
LIN16Product/Service Id QualifierC22ID
LIN17Product/Service IdC148AN
LIN18Product/Service Id QualifierC22ID
LIN19Product/Service IdC148AN
LIN20Product/Service Id QualifierC22ID
LIN21Product/Service IdC148AN
LIN22Product/Service Id QualifierC22ID
LIN23Product/Service IdC148AN
LIN24Product/Service Id QualifierC22ID
LIN25Product/Service IdC148AN
LIN26Product/Service Id QualifierC22ID
LIN27Product/Service IdC148AN
LIN28Product/Service Id QualifierC22ID
LIN29Product/Service IdC148AN
LIN30Product/Service Id QualifierC22ID
LIN31Product/Service IdC148AN
UDA1Offer Basis CodeM23ID
UDA2DescriptionO180AN
UDA3Quantity QualifierC22ID
UDA4QuantityC115R
UDA5Unit Or Basis For Measurement CodeO22ID
UDA6AmountO115N2
UDA7Percentage As DecimalO110R
SPA1Status CodeM22ID
SPA2Date Time Period Format QualifierC23ID
SPA3Date Time PeriodC135AN
SPA4Amount Qualifier CodeC13ID
SPA5Monetary AmountC118R
SPA6Status Reason CodeO33ID
SPA7Status Reason CodeO33ID
SPA8Status Reason CodeO33ID
SPA9Agency Qualifier CodeC22ID
SPA10Product Description CodeC112AN
SPA11Source SubqualifierO115AN
DTP1Date/Time QualifierM33ID
DTP2Date Time Period Format QualifierM23ID
DTP3Date Time PeriodM135AN
BLN1Code List Qualifier CodeM13ID
BLN2Industry CodeM130AN
BLN3Monetary AmountM118R
BLN4DateO88DT
BLN5TimeC48TM
BLN6Time CodeO22ID
QTY1Quantity QualifierM22ID
QTY2QuantityC115R
QTY3Unit Or Basis For Measurement CodeO22ID
QTY4ExponentO115R
QTY5MultiplierO110R
QTY6Unit Or Basis For Measurement CodeO22ID
QTY7ExponentO115R
QTY8MultiplierO110R
QTY9Unit Or Basis For Measurement CodeO22ID
QTY10ExponentO115R
QTY11MultiplierO110R
QTY12Unit Or Basis For Measurement CodeO22ID
QTY13ExponentO115R
QTY14MultiplierO110R
QTY15Unit Or Basis For Measurement CodeO22ID
QTY16ExponentO115R
QTY17MultiplierO110R
QTY18Free-Form InformationC130AN
AMT1Amount Qualifier CodeM13ID
AMT2Monetary AmountM118R
AMT3Credit/Debit Flag CodeO11ID
RPA1Rate Or Value Type CodeM12ID
RPA2Monetary AmountC118R
RPA3RateC19R9
RPA4Unit Or Basis For Measurement CodeO22ID
RPA5ExponentO115R
RPA6MultiplierO110R
RPA7Unit Or Basis For Measurement CodeO22ID
RPA8ExponentO115R
RPA9MultiplierO110R
RPA10Unit Or Basis For Measurement CodeO22ID
RPA11ExponentO115R
RPA12MultiplierO110R
RPA13Unit Or Basis For Measurement CodeO22ID
RPA14ExponentO115R
RPA15MultiplierO110R
RPA16Unit Or Basis For Measurement CodeO22ID
RPA17ExponentO115R
RPA18MultiplierO110R
RPA19Percentage As DecimalC110R
PDL1Payment Method CodeM33ID
PDL2Amount Qualifier CodeC13ID
PDL3Monetary AmountC118R
PDL4Percentage As DecimalC110R
PDL5Credit/Debit Flag CodeO11ID
PDL6Frequency CodeO11ID
PDL7(Dfi) Id Number QualifierC22ID
PDL8(Dfi) Identification NumberC312AN
PDL9Account Number QualifierC13ID
PDL10Account NumberC135AN
PDL11Date Time Period Format QualifierC23ID
PDL12Date Time PeriodC135AN
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
III1Code List Qualifier CodeC13ID
III2Industry CodeC130AN
III3Code CategoryO22ID
III4Free-Form Message TextC1264AN
III5QuantityC115R
III6Unit Or Basis For Measurement CodeO22ID
III7ExponentO115R
III8MultiplierO110R
III9Unit Or Basis For Measurement CodeO22ID
III10ExponentO115R
III11MultiplierO110R
III12Unit Or Basis For Measurement CodeO22ID
III13ExponentO115R
III14MultiplierO110R
III15Unit Or Basis For Measurement CodeO22ID
III16ExponentO115R
III17MultiplierO110R
III18Unit Or Basis For Measurement CodeO22ID
III19ExponentO115R
III20MultiplierO110R
III21Surface/Layer/Position CodeO22ID
III22Surface/Layer/Position CodeO22ID
III23Surface/Layer/Position CodeO22ID
DTP1Date/Time QualifierM33ID
DTP2Date Time Period Format QualifierM23ID
DTP3Date Time PeriodM135AN
AM11Code CategoryM22ID
AM12Product/Service Id QualifierM22ID
AM13Product/Service IdM148AN
AM14Monetary AmountO118R
AM15QuantityO115R
AM16Percentage As DecimalO110R
III1Code List Qualifier CodeC13ID
III2Industry CodeC130AN
III3Code CategoryO22ID
III4Free-Form Message TextC1264AN
III5QuantityC115R
III6Unit Or Basis For Measurement CodeO22ID
III7ExponentO115R
III8MultiplierO110R
III9Unit Or Basis For Measurement CodeO22ID
III10ExponentO115R
III11MultiplierO110R
III12Unit Or Basis For Measurement CodeO22ID
III13ExponentO115R
III14MultiplierO110R
III15Unit Or Basis For Measurement CodeO22ID
III16ExponentO115R
III17MultiplierO110R
III18Unit Or Basis For Measurement CodeO22ID
III19ExponentO115R
III20MultiplierO110R
III21Surface/Layer/Position CodeO22ID
III22Surface/Layer/Position CodeO22ID
III23Surface/Layer/Position CodeO22ID
SPA1Status CodeM22ID
SPA2Date Time Period Format QualifierC23ID
SPA3Date Time PeriodC135AN
SPA4Amount Qualifier CodeC13ID
SPA5Monetary AmountC118R
SPA6Status Reason CodeO33ID
SPA7Status Reason CodeO33ID
SPA8Status Reason CodeO33ID
SPA9Agency Qualifier CodeC22ID
SPA10Product Description CodeC112AN
SPA11Source SubqualifierO115AN
DTP1Date/Time QualifierM33ID
DTP2Date Time Period Format QualifierM23ID
DTP3Date Time PeriodM135AN
AMT1Amount Qualifier CodeM13ID
AMT2Monetary AmountM118R
AMT3Credit/Debit Flag CodeO11ID
QTY1Quantity QualifierM22ID
QTY2QuantityC115R
QTY3Unit Or Basis For Measurement CodeO22ID
QTY4ExponentO115R
QTY5MultiplierO110R
QTY6Unit Or Basis For Measurement CodeO22ID
QTY7ExponentO115R
QTY8MultiplierO110R
QTY9Unit Or Basis For Measurement CodeO22ID
QTY10ExponentO115R
QTY11MultiplierO110R
QTY12Unit Or Basis For Measurement CodeO22ID
QTY13ExponentO115R
QTY14MultiplierO110R
QTY15Unit Or Basis For Measurement CodeO22ID
QTY16ExponentO115R
QTY17MultiplierO110R
QTY18Free-Form InformationC130AN
RPA1Rate Or Value Type CodeM12ID
RPA2Monetary AmountC118R
RPA3RateC19R9
RPA4Unit Or Basis For Measurement CodeO22ID
RPA5ExponentO115R
RPA6MultiplierO110R
RPA7Unit Or Basis For Measurement CodeO22ID
RPA8ExponentO115R
RPA9MultiplierO110R
RPA10Unit Or Basis For Measurement CodeO22ID
RPA11ExponentO115R
RPA12MultiplierO110R
RPA13Unit Or Basis For Measurement CodeO22ID
RPA14ExponentO115R
RPA15MultiplierO110R
RPA16Unit Or Basis For Measurement CodeO22ID
RPA17ExponentO115R
RPA18MultiplierO110R
RPA19Percentage As DecimalC110R
BLN1Code List Qualifier CodeM13ID
BLN2Industry CodeM130AN
BLN3Monetary AmountM118R
BLN4DateO88DT
BLN5TimeC48TM
BLN6Time CodeO22ID
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
NM11Entity Identifier CodeM23ID
NM12Entity Type QualifierM11ID
NM13Name Last Or Organization NameC160AN
NM14Name FirstO135AN
NM15Name MiddleO125AN
NM16Name PrefixO110AN
NM17Name SuffixO110AN
NM18Identification Code QualifierC12ID
NM19Identification CodeC280AN
NM110Entity Relationship CodeC22ID
NM111Entity Identifier CodeO23ID
NM112Name Last Or Organization NameO160AN
N21NameM160AN
N22NameO160AN
COM1Communication Number QualifierM22ID
COM2Communication NumberM1256AN
COM3Communication Number QualifierO22ID
COM4Communication NumberO1256AN
N31Address InformationM155AN
N32Address InformationO155AN
N41City NameO230AN
N42State Or Province CodeC22ID
N43Postal CodeO315ID
N44Country CodeC23ID
N45Location QualifierC12ID
N46Location IdentifierO130AN
N47Country Subdivision CodeC13ID
DTP1Date/Time QualifierM33ID
DTP2Date Time Period Format QualifierM23ID
DTP3Date Time PeriodM135AN
NX11Entity Identifier CodeM23ID
NX12Entity Identifier CodeO23ID
NX13Entity Identifier CodeO23ID
NX14Entity Identifier CodeO23ID
NX15Entity Identifier CodeO23ID
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
BEN1Primary Or Contingent CodeO11ID
BEN2Percentage As DecimalO110R
BEN3Individual Relationship CodeO22ID
BEN4Yes/No Condition Or Response CodeO11ID
BEN5Yes/No Condition Or Response CodeO11ID
BEN6Type Of Account CodeO22ID
III1Code List Qualifier CodeC13ID
III2Industry CodeC130AN
III3Code CategoryO22ID
III4Free-Form Message TextC1264AN
III5QuantityC115R
III6Unit Or Basis For Measurement CodeO22ID
III7ExponentO115R
III8MultiplierO110R
III9Unit Or Basis For Measurement CodeO22ID
III10ExponentO115R
III11MultiplierO110R
III12Unit Or Basis For Measurement CodeO22ID
III13ExponentO115R
III14MultiplierO110R
III15Unit Or Basis For Measurement CodeO22ID
III16ExponentO115R
III17MultiplierO110R
III18Unit Or Basis For Measurement CodeO22ID
III19ExponentO115R
III20MultiplierO110R
III21Surface/Layer/Position CodeO22ID
III22Surface/Layer/Position CodeO22ID
III23Surface/Layer/Position CodeO22ID
AM11Code CategoryM22ID
AM12Product/Service Id QualifierM22ID
AM13Product/Service IdM148AN
AM14Monetary AmountO118R
AM15QuantityO115R
AM16Percentage As DecimalO110R
IN11Entity Type QualifierM11ID
IN12Name Type CodeM22ID
IN13Entity Identifier CodeO23ID
IN14Reference Identification QualifierC23ID
IN15Reference IdentificationC150AN
IN16Individual Relationship CodeO22ID
IN17Level Of Individual, Test, Or Course CodeO22ID



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