Screen Label

Required

Min/Max Length

Description

Notes

Prefix

N

1/10

Title of person

Person ID

*

1/30

Unique number assigned to each insured person

Required if Auto Assign ID is not selected.

Last Name

Y

1/35

Legal last name of person

First Name

Y

1/35

Legal first name of person

Middle Name

N

1/35

Legal middle name of person

Suffix

N

1/35

Elements or letters that follow surname

Medicare ID

N

1/30

Number assigned for Medicare enrollment ID

Medicaid ID

N

1/30

Number assigned for Medicaid enrollment ID

Digital Effective Date

N

Digital Termination Date

N

Address (1, 2, or 3)

*

1/30

Person’s address of record

Address 1 is required if state, city, or zip are entered.

City

*

1/30

City in which the person resides

Required if address 1, state, or zip are entered.

Zip Code

N

1/10

Assigned ZIP Code for city

Required if address 1, state, or city are entered.

Phone (Home, Work/Office, Cellular)

N

1/10

Contact phone number for person

Extension

N

1/5

Direct extension for associated phone number

Email Address (Person, Work)

N

1/141

Personal email address or work email address

Subscriber ID

Y

1/30

Unique ID assigned to the subscriber

Effective

Y

Date that enrollment in plan begins

Termination

N

Date that enrollment in plan terminates

Waiting Period

N

Days between eligibility and when plan can be used

Coverage Type

Y

Coverage plan is primary or secondary

Only one primary is allowed active on any single day.