Data > Exports > Manage

The purpose of this article is to guide the user in reading and comprehending an 834 benefit file.

The first look at the data held within an 834 file can be very intimidating but once a user learns the segment and headers of a file, reading the file becomes much more digestible. For the purposes of this article, the focus will be on an employee and dependent record, and will disregard the header and trailer record. To understand the basics of an 834 file, please see the article, Data Export Tool: Understanding 834 Files

Each member record is comprised of three loops: loop 2000, loop 2100, and loop 2300. Each loop is comprised of segments, titled after the prefix used, and each segment is broken into positions that are separated by asterisks.

To begin, here is an excerpt from a sample 834 file. Below contains an employee and her dependent:

INS*Y*18*030**A*E**FT~
REF*0F*286243289~
REF*1L*0001~
REF*DX*ZZ02~
DTP*336*D8*20060101~
NM1*IL*1*Brady*Rachel****34*286243289~
N3*7870 S. Kiowa Dr.~
N4*Los Angeles*CA*90012~
DMG*D8*19820301*F~
HD*030**HLT*805015*ESP~
DTP*348*D8*20171101~
HD*030**DEN*806016*ESP~
DTP*348*D8*20171101~
INS*N*01*030**A~
REF*0F*286243289~
REF*1L*0001~
REF*DX*ZZ02~
DTP*336*D8*20100913~
NM1*IL*1*Brady*Mark****34*111223333~
N3*7870 S. Kiowa Dr.~
N4*Los Angeles*CA*90012~
DMG*D8*19800115*M~
HD*030**HLT*805015~
DTP*348*D8*20171101~
HD*030**DEN*806016~
DTP*348*D8*20171101~

To better describe data elements, the above excerpt will be divided by loops below and each segment will be alpha bulleted to easily reference. Each alpha bullet will be described and will be followed by the position definitions. To concentrate this article, segments and positions that are not commonly used, or do not need to be understood by a common administrator, will be skipped.

Loop 2000

Loop 2000 begins with the INS segment and will contain subscriber data. The member data is specific to the subscriber, whether it is an employee or dependent. The segments vary depending on carrier requirements and may contain additional segments that assign employees to divisions and subgroups. If employees are not divided into categories by the carrier, these segments will be omitted.

1. INS*Y*18*030**A*E**FT~

2. REF*0F*286243289~

3. REF*1L*0001~

4. REF*DX*ZZ02~

5. DTP*336*D8*20060101~

1. INS segment - contains subscriber indicators
   • Position one (INS01) - insured indicator; the values will always be "Y" for employees or an "N" for dependents
     
   • Position two (INS02) - relationship code; common values are: "18" for employees, "01" for spouse, "19" for child, "53" for domestic partner
     
   • Position eight (INS08) - employment status code; common values are: "FT" for full time, "PT" for part time, "RT" for retired, and "TE" for terminated
2. REF 0F segment - employee social security number. Whether in an employee record or a dependent record, this segment will always have the employee social security number.
3. REF 1L segment - group or policy number. Position two (REF02) will have the policy number with the carrier; in the above instance, the policy number is "0001"
4. REF DX segment - department number. When a carrier organizes employees into divisions, the file will have an REF*DX segment. These values are mutually defined between the client and carrer. In the above example, this employee is in department "ZZ02"
5. DTP 336 segment - employee hire date. All DTP segments throughout an 834 files are dates. Position one (DTP01) will indicate what date is expected in the segment. In this example, 336 is the qualifier and will let the carrier know they should be expecting the hire date in position three (DTP03)

Loop 2100

Loop 2100 begins with the NM segment. This loop contains member demographic information. This can contain either employee or dependent information, depending on the record type. In every 834 file, each of the below segments must be present for the file to pass compliance. 

1. NM1*IL*1*Brady*Rachel****34*286243289~

2. N3*7870 S. Kiowa Dr.~

3. N4*Los Angeles*CA*90012~

4. DMG*D8*19820301*F~

1. NM segment - contains member information
   • Position three (NM03) - member last name
     
   • Position four (NM04) - member first name
     
   • Position eight (NM08) - the number in position NM08 will always be "34". This indicator lets the carrier know to expect a social security number in the following position
     
   • Position nine (NM09) - member social security number; this number applies to the employee or dependent record. If the dependent social security number is unknown, this position will be blank.
2. N3 segment - contains subscriber's street address
3. N4 segment - contains subscriber's city, state, and zip code
4. DMG segment - contains subscriber demographics
   • Position two (DMG02) - subscriber date of birth
   • Position three (DMG03) - subscriber gender; "F" indicates female, "M" indicates male

Loop 2300

Loop 2300 begins with segment HD. This is the health coverage loop and will house the subscriber's benefit plan and coverage information. These loops will be found in both the employee's record and the dependent's record. The loop will repeat, depending on how many benefits are administered with the carrier. In this example, the carrier administer's the medical and dental benefits. 

1. HD*030**HLT*805015*ESP~

2. DTP*348*D8*20171101~

3. HD*030**DEN*806016*ESP~

4. DTP*348*D8*20170101~

5. DTP*349*D8*20170831~

1. HD segment - subscriber health insurance information
   • Position three (HD03) - this code is used to identify the insurance product. This segment is displaying the subscriber's medical coverage, "HLT" is identifying the product as "health."
     
   • Position four (HD04) - HD04 contains the plan coverage description. In this example, a number is used to reference the elected plan. The formatting of this position is not an industry standard, so the value can vary between carriers.
     
   • Position five (HD05) - Coverage level code. This position contains a three letter code describing the elected plan option. In this example, the member has selected employee plus spouse coverage. HD05 is not required in the dependent record. The most typical tier codes are as follows:
     • EMP - Employee only
     • ECH - Employee + Children
     • ESP - Employee + Spouse
     • FAM - Employee + Family
     • E1D - Employee + 1
     • IND - Employee Only, or Individual
2. DTP 348 segment - since there are multiple DTP segments in different loops, when referring to a DTP segment, it is important to note the three digit indicator (in position HD02). When referencing this particular segment, you would call it the DTP 348 segment. Each DTP segment in this loop will immediately follow the applicable health insurance information. For example, the line k date applies to the medical insurance (as described in line j). The medical coverage is in effect as of 11/01/2017.
   • Position one (DTP01) - In this segment, 348 is the indicator. This number indicates that the segment will be sending the benefit effective date.
     
   • Position three (DTP03) - Subscriber benefit effective date
3. HD segment - subscriber health insurance information. This is the same as line j, but in this line, the file is sending the subscriber's dental information, as indicated in position three of this segment (DEN)
4. DTP 348 segment - This segment is sending the same information as in line k. In this line, the file is sending the effective date for the employee's dental coverage. This example shows the effective date of the benefit is 1/01/2017.
5. DTP 349 segment - Similar to the above examples in like k and m, this segment is sending a date record for the subscriber. This segment is different, as the indicator is 349. The number 349 indicates a coverage expiration date. In this example, the subscriber is terminating their dental coverage as of 8/31/2017.