**SUBJECT:** Electronic Enrollment

This letter outlines the major changes we have made to the electronic
enrollment system for the upcoming Open Season. The individual file
layout OPM-Macon uses to send changes to carriers has been updated. The
changes for 2000 are listed in Enclosure one.

Enclosure one also contains information on testing electronic
transmissions and e-mail. This year, OPM-Macon will send you both test
data files and e-mails to help you process enrollment changes. Last
year, we learned that although the electronic enrollment information was
successfully sent, several carriers did not process the information
correctly. We expect you to process enrollment change information
quickly and efficiently. It is very important that you read, understand
and use the information in this letter\'s enclosures.

Enclosure two provides information on how data is transmitted, as well
as the schedule OPM-Macon will use to transmit data this Open Season.

Enclosure three contains the layout for the file header layout. This
file is used to summarize the individual file records that accompany a
carrier\'s weekly transmission. The file header layout is the electronic
version of the Standard Form 2811, the Transmittal and Summary Report to
Carrier. Enclosure three also contains a question and answer section
explaining the file header layout in more detail. Please note that the
file header layout is not changing from last year.

Enclosure four contains the two individual file layouts that OPM-Macon
uses to transmit FEHB members\' enrollment changes. The individual file
layouts have changed for this year; please review them carefully.
Enclosure five contains a notes section and a question and answer
session for the individual file layouts.

All participating carriers must be set up to process electronic
enrollment transactions. If you are an existing carrier, you should have
a connection already established with OPM-Macon. If you are a new
carrier for contract year 2000 or need to establish a new connection,
please contact Chris Selle at OPM-Macon at (912)-744-2115. Please review

Enclosure six, which outlines the technical specifications for
electronic enrollment. If you are a new carrier for contract year 2000,
you must have your system in place by September 6, 1999.

OPM-Macon will begin testing carriers\' systems on September 6, 1999.
When you have made the changes to the individual file layout, you should
be able to process information that is sent to you in the format found
in Enclosure six. Please contact Chris Selle of OPM-Macon sometime
during the week starting September 6, 1999, to begin testing.

When you contact OPM-Macon, they will send you fictitious enrollment
records for your plan\'s enrollment code(s). In order to prepare for the
upcoming Open Season, we expect you to enter these fictitious
enrollments into your enrollment system as a test, and then delete them
once they have been successfully processed. Once you have successfully
tested the new file layout by processing the fictitious enrollments,
please notify your contract specialist at their e-mail address and Mike
Hodges at [mjhodges@opm.gov.]{.underline}

Enclosure seven contains information provided by a carrier that has
completely automated the electronic enrollment process. We hope that
this \"best practice\" will help you automate your electronic
enrollments.

OPM-Macon will begin sending weekly reports the week beginning October
4, 1999. Enclosure eight is a list of which carriers will receive
transmissions on which day of the week. If you are a new carrier, or
would like to request a different day of the week to receive
transmissions, please contact Chris Selle at (912) 744-2115.

Enclosure nine contains a list of Federal agencies participating in
electronic enrollment, and their agency identifiers. The agency
identifier field is explained in Enclosure three.

If you have further questions regarding the FEHB and Employee Express,
please contact Mike Hodges or Dean Schleicher at (202) 606-0745. For
information about establishing communications or testing Employee
Express, please contact Chris Selle at OPM Macon at (912) 744-2115.

Sincerely,

Frank D. Titus

Assistant Director

for Insurance Programs

Enclosures

####### Enclosures

One - Electronic Enrollment Overview (2 pages)

\- New for FEHB 2000

\- Purpose of electronic enrollment

\- Testing and administration

\- E-Mail

Two - Transmitting data (2 pages)

Three - FEHB Carrier File Header Layout (4 pages)

\- Batch/Header Record

\- FEHB Carrier File Header Field Questions and Answers

Four - Individual File Layouts (8 pages)

\- Definitions and Notes

Five - Individual file layouts-Notes, Questions and Answers (6 pages)

\- Notes

\- Frequently asked questions about individual file layouts

Six - Electronic transmission to the carriers \-- Technical
Specifications (one page)

Seven - Best Practice for file automation (one page)

Eight - File transfer days by carrier code (9 pages)

Nine - Federal Agencies participating in electronic enrollment transfers
(one page)

**[Enclosure One]{.underline}**

**[Electronic Enrollment Overview]{.underline}**

OPM is making the following changes so that the attached file layout is
consistent with the new Standard Form (SF) 2809. Please note that in
enclosure four, any changes that are new for year 2000 are boldfaced and
marked with an \*.

# New for FEHB 2000

1.  We expanded the FEHB DAYTIME PHONE number field from 10 digits to 17
    digits.

```{=html}
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```
2.  We added a FEHB OTHER INSURANCE POLICY HOLDER NAME data element.
    This field indicates the policy holder name for any other insurance
    an employee might have.

3.  We added FEHB MEDICARE-A SPOUSE and FEHB MEDICARE-B SPOUSE data
    elements. These fields indicate whether the employee\'s or
    annuitant\'s spouse has Medicare coverage.

```{=html}
<!-- -->
```
4.  We added a Foreign/OverSeas Address Indicator data element. If an
    employee or annuitant has a foreign home address, this field will
    show a \"Y\". If an employee or annuitant does not have a foreign
    home address, this field will show a \"N\" or a blank space.

**[Purpose of electronic enrollment]{.underline}**

OPM created file layouts to send enrollment information electronically
to carriers. Our goal is to ensure that when an enrollee or annuitant
makes an enrollment change, you will receive the same information both
electronically and on paper. When an enrollee or annuitant makes an
enrollment change, the information is sorted and stored at OPM-Macon.
OPM-Macon will send you the enrollment changes that affect your plan.
OPM-Macon does not verify the enrollment information they receive, other
than the validity of the carriers\' FEHB enrollment codes.

##### Testing and administration 

Most carriers have established a modem connection with OPM-Macon.
However, if you are a new carrier for contract year 2000 or wish to
re-establish a connection, you must contact OPM-Macon. Once your
connection is established and you have updated the file layout, you must
contact OPM-Macon and request a test file. You should call OPM-Macon
sometime during the week beginning September 6, 1999, to receive the
test file.

The test file will contain individual file layouts filled with
fictitious information. These files will contain start and change
actions (see enclosure five for further explanation of these actions)
for fictitious enrollees. It is important that you enter this fictitious
information into your system during a trial run. Although the enrollment
information will not be real, by treating it as if it were your plan can
identify any difficulties in processing electronic enrollments. The test
will also include stop actions to remove the fictitious enrollments from
your system at the conclusion of your test.

Last year, many carriers tested successfully but did not attempt to
process enrollments until the Open Season began. Since it took them time
to learn how to process the enrollments, they were not able to process
enrollee and annuitant enrollments in a timely fashion. We urge carriers
not to let this occur. You will be receiving enrollment records 7-10
days after an enrollee makes a change. If you delay processing for
several weeks, the purpose of sending the changes electronically is
defeated. Enclosure seven contains guidelines on how one FEHB carrier
was able to automate the processing of electronic enrollment
transactions into their enrollment system. We are sharing this \"best
practice\" to give you a possible solution when you attempt to automate
your processes.

##### E-mail

Starting this year, when OPM-Macon sends electronic enrollment
transaction to a carrier they will also send you an e-mail. OPM-Macon
will send an e-mail to the designated plan contact, the enrollment
contact, and your OPM contract specialist. Although you should check
your system every week for enrollment changes, these e-mails will serve
as a reminder. See Enclosure eight for when you will receive your
transmissions.

#### [Enclosure Two]{.underline}

#### [Transmitting data]{.underline}

There are three sources of electronic information that we will send to
you:

-   Federal agencies can transmit their FEHB data directly to OPM-Macon,
    who then forwards these changes to you. These records are called
    Agency Generated Records. The abbreviation for Agency Generated
    Records in the file layout is AG.

-   Employee Express is a system that some employees can use when making
    enrollment changes. This system allows the employees to contact
    OPM-Macon directly with their enrollment changes. OPM-Macon then
    transfers the information to carriers. The abbreviation for Employee
    Express in the file layout is EE.

-   Open Season Express is used by annuitants. The National Computer
    Service (NCS) receives annuitant changes, and forwards them to
    OPM-Macon, who then forwards the changes to you. The abbreviation
    for Open Season Express in the file layout is OE.

OPM-Macon compiles all enrollment transactions from these sources, and
then forwards them to carriers. OPM-Macon sends enrollment changes
weekly to both the gaining (FEHB Enrollment Code) and losing (FEHB
Present Enrollment Code) carrier each week.

OPM-Macon will begin transmitting files the week beginning October 4,
1999. If you do not have any changes during a given week from the week
beginning October 4, 1999, through the week ending January 30, 2000,
OPM-Macon will send you a \"null file\". From January 30, 2000 until the
next Open Season, OPM-Macon will only send you a report if there is
enrollment activity to report.

Each data transmission from OPM-Macon will contain a header record and
will be sorted by Report Number, Payroll Office ID, and information
source (i.e., Agency Generated Record, Employee Express, or Open Season
Express).

The naming conventions used for the files are based on the 8 character
creation date, followed by the carrier enrollment code. Please note that
the naming convention itself does not appear in the file layout. Since
all files are created on Sunday, here are some examples of files going
to carrier codes FP and 10: 06252000.FP, 07082000.10.

Examples of file names sent:

Oct. 4 - 8 All carriers receive a file named 10032000.\[carrier code\]

Oct. - Dec. Process continues weekly

Jan. 3 - 7 All carriers receive a file named 01022000.\[carrier code\]

Jan. 10 -14 All carriers receive a file named 01092000.\[carrier code\]

Jan. 24- 28 All carriers receive a file named 01232000.\[carrier code\]

Please note:

During the rest of the year, you will only receive a file when there is
data to transmit.

**[Enclosure Three]{.underline}**

**[FEHB Carrier File Header Layout]{.underline}**

Each transmission you receive will contain a FEHB Carrier File Header
Layout. This is a summary report of all the individual files in a given
transmission. It serves the same function as the Standard Form (SF)
2811, Transmittal and Summary report.

Batch/Header Record (replaces the 2811)

  ----------------------------------------------- ---------- ------------
  FIELD NAME                                      LENGTH     POSITION

  Carrier Name                                    35         1- 35

  Carrier Code                                    2          36- 37

  Total Number of Transactions                    12         38- 49

  Total Number of Starts                          6          50- 55

  Total Number of Changes                         6          56- 61

  Total Number of Stops                           6          62- 67

  Certification Date (MMDDYYYY)                   8          68- 75

  Filler                                          630        76-705

  Report Number                                   15         706-720
  ----------------------------------------------- ---------- ------------

**[FEHB Carrier File Header Field Questions and Answers]{.underline}**

1\. What is a Certification Date?

The Certification Date is the date OPM-Macon creates the carrier file
for transmission. OPM-Macon will prepare Carrier files each Sunday.
OPM-Macon begins transferring files to carriers each Monday, starting at
8:00 a.m.

2\. What is Filler?

Filler is blank spaces in the file. In the Header File, positions 76-705
are filler.

3\. What is the Report Number?

The Report Number is generated by OPM-Macon for both Header and
Individual records. It has 15 positions:

Position: Description: Value:

2.  System AG = Agency Generated Record

> EE = Employee Express

OE =Open Season Express

3-5 Agency Agency identifier

6-9 Fiscal Year Numeric value

10-15 Sequential No. Numeric value

Example: The first report for fiscal year 2000 from the Department of
Transportation (in the Employee Express system) is: EEDOT2000000001.

The Agency Identifier will be generated by Macon and sent to the
carriers for their documentation when a new agency is added. The current
list of agencies can be found in Enclosure nine.

The Sequential No. is incremented each time Macon sends a file to a
carrier. The Sequential No. starts with 000001 the week beginning
October 4^th^ and is incremented each time Macon sends the carrier a
file.

> Sample Report Number for DoD Demo AGDD12000000001
>
> Sample Report Number Employee Express EEDOD2000000001
>
> Sample Report Number for annuitants OEOPM2000000001

Please note: Carrier file headers will always list the three systems
alphabetically, i.e., Agency Generated records will come first, followed
by Employee Express records, then Open Season Express records. Please
see Enclosure nine for a list of federal agencies that use electronic
enrollment and the system (AG, EE, or OE) that they use.

4\. How often will I receive reports?

OPM-Macon transmits data weekly to each carrier. Report number 000001
will be transmitted the week beginning October 4th. OPM-Macon will
continue to send a file each week, through the week ending January 29.
Each carrier, therefore, will receive report numbers 000001 through
000017. All carriers will receive these first 17 files, even though some
files may contain no data.

For the rest of the year (up until the next Open Season), OPM-Macon will
transmit only as needed, and the report numbers will increment each time
a new file is created. Report number 18 might not come for several weeks
after report 17 if no actions occurred for a particular carrier.

5\. Will a carrier receive information if there is no enrollment
activity to report?

Each carrier will receive a report once a week from the week beginning
October 4^th^ through the week ending January 29th. During this time
frame, if a carrier has no enrollment activity, they will receive a
carrier file header that contains null records. After January 29^th^,
carriers will only receive a carrier file header from OPM-Macon if there
is enrollment activity to report.

6\. What do the Null records in the carrier file header look like?

If there is no data from an Agency Generated record (AG), Employee
Express (EE), or Open Season Express (OE), the carrier file header will
be the only record transmitted to the carrier. This is referred to as a
null record. The number of transactions (positions 38-49), starts
(positions 50-55), changes (positions 56-61), and stops (positions
62-67) will all contain zeros, to indicate no records.

Example: Anytown HMO, code XX, did not have any enrollment changes for
the report that was prepared on November 14, 1999, the seventh report
for this carrier. The carrier file header would read:

Anytown HMO, XX, (30 zeros), 11141999, (630 spaces of filler),
AGNUL2000000007

Anytown HMO, XX, (30 zeros), 11141999, (630 spaces of filler),
EENUL2000000007

Anytown HMO, XX, (30 zeros), 11141999, (630 spaces of filler),
OENUL2000000007

Please note: Although the reports in the example above were created on
November 14, 1999, the report number on the far right starts with 2000.
This is because OPM-Macon's numbering system starts week number one with
the beginning of the federal fiscal year. The federal fiscal year begins
October 1, 1999.

7\. What if a carrier receives enrollment changes from one system but
not the other two? Will the carrier file header somehow show this?

Yes. Throughout the year, if a carrier has any enrollment activity to
receive, the carrier file header will show information from all three
systems. Please see the example below.

Example: Anytown HMO, code XX, received enrollment changes from the
Employee Express system (Department of Defense), but no enrollment
changes from Agency Generated records or Open Season Express. The report
was created January 2, 2000, the fourteenth for this carrier. The
carrier file header would read:

Anytown HMO, XX, (30 zeros), 01022000, (630 spaces of filler),
AGNUL2000000014

Anytown HMO, XX, total transactions, total starts, total changes, total
stops, 01022000, (630 spaces of filler), EEDOD2000000014

Anytown HMO, XX, (30 zeros), 01022000, (630 spaces of filler),
OENUL2000000014

##### [Enclosure Four]{.underline}

##### [Individual File Layouts]{.underline}

We will continue to use two different address layouts, one for employees
and one for annuitants. Please note the differences between the two
types of layouts. Address layout 1 is used for employees, and address
layout 2 is used for annuitants.

If your plan has enrollment activity, the transmission that OPM-Macon
sends will contain individual records. Each individual record has an
enrollee or annuitant\'s individual enrollment information, just like
the Standard Form 2809.

**[Definitions and Notes:]{.underline}**

-   All dates are MMDDYYYY in format

-   All fields are left justified, and padded right with spaces unless
    otherwise noted.

-   All character data should be in upper case.

Individual Records (This is the same for Address Layouts 1 and 2)

+---------------+-----------------------------+------+------+--------+
| Field         | Values: Edits: Examples:    | Requ | Le   | Po     |
| Description   | Justification               | ired | ngth | sition |
+---------------+-----------------------------+------+------+--------+
| 1\. Nature of | Values: START/CHANGE/STOP   | Y    | 6    | 1 - 6  |
| Transaction   |                             |      |      |        |
|               | Justification: Left         |      |      |        |
+---------------+-----------------------------+------+------+--------+
| 2\. Employee  | Values: Last First Middle I | Y    | 41   | 7 - 47 |
| Name          |                             |      |      |        |
|               | Edits: No punctuation       |      |      |        |
|               |                             |      |      |        |
|               | Example: JOHNSON DERRICK M  |      |      |        |
|               |                             |      |      |        |
|               | Justification: Left         |      |      |        |
+---------------+-----------------------------+------+------+--------+
| 3\. Social    | Edits: No dashes            | Y    | 9    | 48 -   |
| Security      |                             |      |      | 56     |
| Number        | Example: 123456789          |      |      |        |
+---------------+-----------------------------+------+------+--------+
| 4\. Date of   | Edits: MMDDYYYY             | Y    | 8    | 57 -   |
| Birth         |                             |      |      | 64     |
|               | Example: 01011969           |      |      |        |
+---------------+-----------------------------+------+------+--------+

The following sections describe the 2 different layouts that OPM-Macon
uses for employees and annuitants. OPM-Macon uses Address Layout 1 for
the Employee Express (EE) and Agency Generated Records (AG) systems.
OPM-Macon uses Address Layout 2 for annuitant Open Season Express (OE)
changes.

Address Layout 1 only:

\* Used by Employee Express (EE) and Agency Generated Records (AG)
systems

+--------------+------------------------------+-------+------+--------+
| Field        | Values: Edits: Examples:     | Req   | Le   | Po     |
| Description  | Justification                | uired | ngth | sition |
+--------------+------------------------------+-------+------+--------+
| 5\. Home     | Edits: No punctuation, A -   | Y     | 35   | 65 -   |
| Street 1     | Z, 0 - 9, \#                 |       |      | 99     |
|              |                              |       |      |        |
|              | Example: ROUTE 1 BOX 618B    |       |      |        |
|              |                              |       |      |        |
|              | Justification: Left          |       |      |        |
+--------------+------------------------------+-------+------+--------+
| 6\. Home     | Edits: Same as Home Street 1 | N     | 35   | 1      |
| Street 2     |                              |       |      | 00-134 |
+--------------+------------------------------+-------+------+--------+
| 7\. Home     | Edits: Same as Home Street 1 | N     | 35   | 1      |
| Street 3     |                              |       |      | 35-169 |
+--------------+------------------------------+-------+------+--------+
| 8\. Home     | -Edits: Valid city name      | Y     | 23   | 1      |
| City         |                              |       |      | 70-192 |
|              | Example: MACON               |       |      |        |
|              |                              |       |      |        |
|              | Justification: Left          |       |      |        |
+--------------+------------------------------+-------+------+--------+
| 9\. Home     | Values: Valid State          | Y     | 2    | 1      |
| State        | Abbreviation                 |       |      | 93-194 |
|              |                              |       |      |        |
|              | Example: GA                  |       |      |        |
+--------------+------------------------------+-------+------+--------+
| 10\. Home    | Edits: 5 Required, 4         | Y     | 11   | 1      |
| Zip          | Optional                     |       |      | 95-205 |
|              |                              |       |      |        |
|              | Values: Valid Zip Code or    |       |      |        |
|              | Zip+4 code                   |       |      |        |
|              |                              |       |      |        |
|              | Examples: 31206, 312064204   |       |      |        |
+--------------+------------------------------+-------+------+--------+

Address Layout 2 only:

\* Used by Open Season Express (OE), Annuitants

+----------------+--------------------------+------+-------+----------+
| Field          | Values: Edits: Examples: | Requ | L     | Position |
| Description    | Justification            | ired | ength |          |
+----------------+--------------------------+------+-------+----------+
| 5\. Address    | Edits:                   | Y    | 22    | 65- 86   |
| Line 1         |                          |      |       |          |
|                | Justification: Left      |      |       |          |
+----------------+--------------------------+------+-------+----------+
| 6\. Address    | Edits: Same as Address   | N    | 22    | 87-108   |
| Line 2         | Line 1                   |      |       |          |
+----------------+--------------------------+------+-------+----------+
| 7\. Address    | Edits: Same as Address   | N    | 22    | 109-130  |
| Line 3         | Line 1                   |      |       |          |
+----------------+--------------------------+------+-------+----------+
| 8\. Address    | Edits: Same as Address   | N    | 22    | 131-152  |
| Line 4         | Line 1                   |      |       |          |
+----------------+--------------------------+------+-------+----------+
| 9\. Address    | Edits: Same as Address   | N    | 22    | 153-174  |
| Line 5         | Line 1                   |      |       |          |
+----------------+--------------------------+------+-------+----------+
| 10\. Address   | Edits: Same as Address   | N    | 31    | 175-205  |
| Line 6         | Line 1                   |      |       |          |
+----------------+--------------------------+------+-------+----------+

FEHB Carrier File Layout(Continued.) Fields 11-67 are the same for
Address Layouts 1 and 2

\* denotes a new/changed data element

+---------------+---------------------------+------+-------+----------+
| Field         | Values: Edits: Examples:  | Requ | L     | Position |
| Description   | Justification             | ired | ength |          |
+---------------+---------------------------+------+-------+----------+
| 11\. Sex      | Values: M/F               | Y    | 1     | 206      |
+---------------+---------------------------+------+-------+----------+
| 12\. FEHB     | Values: Y/N               | Y    | 1     | 207      |
| Marriage      |                           |      |       |          |
| Indicator     |                           |      |       |          |
+---------------+---------------------------+------+-------+----------+
| **\*13. FEHB  | Edits: Empty or 17 digits | N    | 17    | 208-224  |
| Daytime       |                           |      |       |          |
| Phone**       | Edits: Employee=s daytime |      |       |          |
|               | phone number              |      |       |          |
|               |                           |      |       |          |
|               | Values: 0 - 9             |      |       |          |
|               |                           |      |       |          |
|               | Example: 9127442286(Pad   |      |       |          |
|               | Right with Spaces)        |      |       |          |
+---------------+---------------------------+------+-------+----------+
| 14\. FEHB     | Values: Valid FEHB        | Y/N  | 3     | 225-227  |
| Enrollment    | enrollment code of the    |      |       |          |
| Code          | carrier the employee or   |      |       |          |
|               | annuitant is enrolling in |      |       |          |
|               | or changing to            |      |       |          |
|               |                           |      |       |          |
|               | Edits: Required for       |      |       |          |
|               | Starts, Changes           |      |       |          |
|               |                           |      |       |          |
|               | Edits: Blank for Stops    |      |       |          |
|               |                           |      |       |          |
|               | Example: 104              |      |       |          |
+---------------+---------------------------+------+-------+----------+
| 15\. FEHB     | Edits: Last First Middle  | Y/N  | 35    | 228-262  |
| Family Member | Initial                   |      |       |          |
| Name 1        |                           |      |       |          |
|               | Edits: NO PUNCTUATION     |      |       |          |
|               |                           |      |       |          |
|               | Edits: Occurrence 1 is    |      |       |          |
|               | required for family       |      |       |          |
|               | coverage                  |      |       |          |
|               |                           |      |       |          |
|               | Example: JOHNSON SUSAN    |      |       |          |
+---------------+---------------------------+------+-------+----------+
| 16\. FEHB     | Values: Valid Zip Code or | N    | 11    | 263-273  |
| Family Zip    | Zip+4 code                |      |       |          |
| Code 1        |                           |      |       |          |
|               | Edits: 5 or 9 digits      |      |       |          |
|               |                           |      |       |          |
|               | Examples: 31206,          |      |       |          |
|               | 312064204                 |      |       |          |
+---------------+---------------------------+------+-------+----------+
| 17\. FEHB     | Edits: MMDDYYYY           | Y/N  | 8     | 274-281  |
| Family DOB 1  |                           |      |       |          |
|               | Edits: Occurrence 1 is    |      |       |          |
|               | required for family       |      |       |          |
|               | coverage                  |      |       |          |
|               |                           |      |       |          |
|               | Example: 01011996         |      |       |          |
+---------------+---------------------------+------+-------+----------+
| 18\. FEHB     | Values: M/F               | Y/N  | 1     | 282      |
| Family Sex    |                           |      |       |          |
| Code 1        | Edits: F = Female, M =    |      |       |          |
|               | Male                      |      |       |          |
|               |                           |      |       |          |
|               | Edits: Occurrence 1 is    |      |       |          |
|               | required for family       |      |       |          |
|               | coverage                  |      |       |          |
+---------------+---------------------------+------+-------+----------+
| 19\. FEHB     | Values: 1,2,3,4           | Y/N  | 1     | 283      |
| Family        |                           |      |       |          |
| Relationship  | Edits: See field          |      |       |          |
| 1             | description               |      |       |          |
|               |                           |      |       |          |
|               | Edits: Occurrence 1 is    |      |       |          |
|               | required for family       |      |       |          |
|               | coverage                  |      |       |          |
+---------------+---------------------------+------+-------+----------+
| 20\. FEHB     | Edits: No dashes          | N    | 9     | 284-292  |
| Family SSN 1  |                           |      |       |          |
|               | Example: 123456789        |      |       |          |
+---------------+---------------------------+------+-------+----------+

+----------------+-----------------------------+---+-------+----------+
| 21\. FEHB      | If family member 2 is used, | Y | 35    | 293-327  |
| Family Member  | Name is required            | / |       |          |
| Name 2         |                             | N |       |          |
|                | See family member 1 edits   |   |       |          |
|                | for remaining family        |   |       |          |
|                | member\'s fields.           |   |       |          |
|                |                             |   |       |          |
|                | Family Members 2 - 5 are    |   |       |          |
|                | optional with family        |   |       |          |
|                | coverage. (Fields 21 - 44)  |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| 22\. FEHB      | If family member 2 is used, | N | 11    | 328-338  |
| Family Zip     | Zip Code is optional but    |   |       |          |
| Code 2         | recommended                 |   |       |          |
|                |                             |   |       |          |
|                | Refer to family member 1    |   |       |          |
|                | for edits                   |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| 23\. FEHB      | If family member 2 is used, | Y | 8     | 339-346  |
| Family DOB 2   | DOB is required             | / |       |          |
|                |                             | N |       |          |
|                | Refer to family member 1    |   |       |          |
|                | for edits                   |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| 24\. FEHB      | If family member 2 is used, | Y | 1     | 347      |
| Family Sex     | Sex Code is required        | / |       |          |
| Code 2         |                             | N |       |          |
|                | Refer to family member 1    |   |       |          |
|                | for edits                   |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| 25\. FEHB      | If family member 2 is used, | Y | 1     | 348      |
| Family         | Relationship is required    | / |       |          |
| Relationship 2 |                             | N |       |          |
|                | Refer to family member 1    |   |       |          |
|                | for edits                   |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| 26\. FEHB      | If family member 2 is used, | N | 9     | 349-357  |
| Family SSN 2   | SSN is optional but         |   |       |          |
|                | recommended                 |   |       |          |
|                |                             |   |       |          |
|                | Refer to family member 1    |   |       |          |
|                | for edits                   |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| 27\. FEHB      | If family member 3 is used, | Y | 35    | 358-392  |
| Family Member  | Name is required            | / |       |          |
| Name 3         |                             | N |       |          |
|                | Refer to family member 1    |   |       |          |
|                | for edits                   |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| 28\. FEHB      | If family member 3 is used, | N | 11    | 393-403  |
| Family Zip     | Zip Code is optional but    |   |       |          |
| Code 3         | recommended                 |   |       |          |
|                |                             |   |       |          |
|                | Refer to family member 1    |   |       |          |
|                | for edits                   |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| 29\. FEHB      | If family member 3 is used, | Y | 8     | 404-411  |
| Family DOB 3   | DOB is required             | / |       |          |
|                |                             | N |       |          |
|                | Refer to family member 1    |   |       |          |
|                | for edits                   |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| 30\. FEHB      | If family member 3 is used, | Y | 1     | 412      |
| Family Sex     | Sex Code is required        | / |       |          |
| Code 3         |                             | N |       |          |
|                | Refer to family member 1    |   |       |          |
|                | for edits                   |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| 31\. FEHB      | If family member 3 is used, | Y | 1     | 413      |
| Family         | Relationship is required    | / |       |          |
| Relationship 3 |                             | N |       |          |
|                | Refer to family member 1    |   |       |          |
|                | for edits                   |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| 32\. FEHB      | If family member 3 is used, | N | 9     | 414-422  |
| Family SSN 3   | SSN is optional but         |   |       |          |
|                | recommended                 |   |       |          |
|                |                             |   |       |          |
|                | Refer to family member 1    |   |       |          |
|                | for edits                   |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| 33\. FEHB      | If family member 4 is used, | Y | 35    | 423-457  |
| Family Member  | Name is required            | / |       |          |
| Name 4         |                             | N |       |          |
|                | Refer to family member 1    |   |       |          |
|                | for edits                   |   |       |          |
+----------------+-----------------------------+---+-------+----------+

+----------------+-----------------------------+---+-------+----------+
| 34\. FEHB      | If family member 4 is used, | N | 11    | 458-468  |
| Family Zip     | Zip Code is optional but    |   |       |          |
| Code 4         | recommended                 |   |       |          |
|                |                             |   |       |          |
|                | Refer to family member 1    |   |       |          |
|                | for edits                   |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| 35\. FEHB      | If family member 4 is used, | Y | 8     | 469-476  |
| Family DOB 4   | DOB is required             | / |       |          |
|                |                             | N |       |          |
|                | Refer to family member 1    |   |       |          |
|                | for edits                   |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| 36\. FEHB      | If family member 4 is used, | Y | 1     | 477      |
| Family Sex     | Sex Code is required        | / |       |          |
| Code 4         |                             | N |       |          |
|                | Refer to family member 1    |   |       |          |
|                | for edits                   |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| 37\. FEHB      | If family member 4 is used, | Y | 1     | 478      |
| Family         | Relationship is required    | / |       |          |
| Relationship 4 |                             | N |       |          |
|                | Refer to family member 1    |   |       |          |
|                | for edits                   |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| 38\. FEHB      | If family member 4 is used, | N | 9     | 479-487  |
| Family SSN 4   | SSN is optional but         |   |       |          |
|                | recommended                 |   |       |          |
|                |                             |   |       |          |
|                | Refer to family member 1    |   |       |          |
|                | for edits                   |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| 39\. FEHB      | If family member 5 is used, | Y | 35    | 488-522  |
| Family Member  | Name is required            | / |       |          |
| Name 5         |                             | N |       |          |
|                | Refer to family member 1    |   |       |          |
|                | for edits                   |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| 40\. FEHB      | If family member 5 is used, | N | 11    | 523-533  |
| Family Zip     | Zip Code is optional but    |   |       |          |
| Code 5         | recommended                 |   |       |          |
|                |                             |   |       |          |
|                | Refer to family member 1    |   |       |          |
|                | for edits                   |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| 41\. FEHB      | If family member 5 is used, | Y | 8     | 534-541  |
| Family DOB 5   | DOB is required             | / |       |          |
|                |                             | N |       |          |
|                | Refer to family member 1    |   |       |          |
|                | for edits                   |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| 42\. FEHB      | If family member 5 is used, | Y | 1     | 542      |
| Family Sex     | Sex Code is required        | / |       |          |
| Code 5         |                             | N |       |          |
|                | Refer to family member 1    |   |       |          |
|                | for edits                   |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| 43\. FEHB      | If family member 5 is used, | Y | 1     | 543      |
| Family         | Relationship is required    | / |       |          |
| Relationship 5 |                             | N |       |          |
|                | Refer to family member 1    |   |       |          |
|                | for edits                   |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| 44\. FEHB      | If family member 5 is used, | N | 9     | 544-552  |
| Family SSN 5   | SSN is optional but         |   |       |          |
|                | recommended                 |   |       |          |
|                |                             |   |       |          |
|                | Refer to family member 1    |   |       |          |
|                | for edits                   |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| 45\. FEHB      | Values: Y/N                 | Y | 1     | 553      |
| Other          |                             |   |       |          |
| Insurance      |                             |   |       |          |
| Indicator      |                             |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| **\*46. FEHB   | Values: Last First Middle   | # | ##    | 554-588  |
| Other          | Initial                     | # |       |          |
| Insurance**    |                             |   | 35    |          |
|                | Edits: NO PUNCTUATION       | Y |       |          |
| **Policy       |                             | / |       |          |
| Holder Name**  | Edits: Indicates Policy     | N |       |          |
|                | Holder for Other insurance  |   |       |          |
|                |                             |   |       |          |
|                | Edits: Required if FEHB     |   |       |          |
|                | Other Insurance Indicator   |   |       |          |
|                | is Y                        |   |       |          |
+----------------+-----------------------------+---+-------+----------+

+----------------+-----------------------------+---+-------+----------+
| 47\. FEHB      | Values: Y/N                 | Y | 1     | 589      |
| Medicare       |                             | / |       |          |
| Indicator      | Edits: Indicates if the     | N |       |          |
|                | employee, spouse, or any    |   |       |          |
|                | other eligible family       |   |       |          |
|                | members have Medicare       |   |       |          |
|                | coverage                    |   |       |          |
|                |                             |   |       |          |
|                | Edits: Required if FEHB     |   |       |          |
|                | Other Insurance Indicator   |   |       |          |
|                | is Y                        |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| 48\. FEHB      | Values: Y/N                 | Y | 1     | 590      |
| Medicare-A     |                             | / |       |          |
| Employee       | Edits: Indicates if the     | N |       |          |
|                | employee has Medicare       |   |       |          |
|                | Part-A                      |   |       |          |
|                |                             |   |       |          |
|                | Edits: Required if FEHB     |   |       |          |
|                | Other Insurance Indicator   |   |       |          |
|                | is Y                        |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| 49\. FEHB      | Values: Y/N                 | Y | 1     | 591      |
| Medicare-B     |                             | / |       |          |
| Employee       | Edits: Indicates if the     | N |       |          |
|                | employee has Medicare       |   |       |          |
|                | Part-B                      |   |       |          |
|                |                             |   |       |          |
|                | Edits: Required if FEHB     |   |       |          |
|                | Other Insurance Indicator   |   |       |          |
|                | is Y                        |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| **\*50. FEHB   | Values: Y/N                 | Y | 1     | 592      |
| Medicare-A     |                             | / |       |          |
| Spouse**       | Edits: Indicates if the     | N |       |          |
|                | employee=s spouse has       |   |       |          |
|                | Medicare Part-A             |   |       |          |
|                |                             |   |       |          |
|                | ###                         |   |       |          |
|                | Edits: Required if FEHB Oth |   |       |          |
|                | er Insurance Indicator is Y |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| **\*51. FEHB   | Values: Y/N                 | Y | 1     | 593      |
| Medicare-B     |                             | / |       |          |
| Spouse**       | Edits: Indicates if the     | N |       |          |
|                | employee=s spouse has       |   |       |          |
|                | Medicare Part-B             |   |       |          |
|                |                             |   |       |          |
|                | Edits: Required if FEHB     |   |       |          |
|                | Other Insurance Indicator   |   |       |          |
|                | is Y                        |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| 52\. FEHB      | Values: Y/N                 | Y | 1     | 594      |
| TRICARE        |                             | / |       |          |
| (formerly      | Edits: Required if FEHB     | N |       |          |
| CHAMPUS)       | Other Insurance Indicator   |   |       |          |
| Indicator      | is Y                        |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| 53\. FEHB      | Values: Name of any group   | Y | 35    | 595-629  |
| Other          | health insurance coverage   | / |       |          |
| Insurance Name | the employee, the           | N |       |          |
|                | employee=s spouse, or any   |   |       |          |
|                | other eligible family       |   |       |          |
|                | members have other than the |   |       |          |
|                | FEHB plan in which the      |   |       |          |
|                | employee is enrolling in or |   |       |          |
|                | changing to.                |   |       |          |
|                |                             |   |       |          |
|                | Edits: Required if FEHB     |   |       |          |
|                | Other Insurance Indicator   |   |       |          |
|                | is Y and all other types of |   |       |          |
|                | insurance are N.            |   |       |          |
|                |                             |   |       |          |
|                | Example: STATE FARM HEALTH  |   |       |          |
+----------------+-----------------------------+---+-------+----------+

+----------------+-----------------------------+---+-------+----------+
| 54\. FEHB      | Values: FEHB enrollment     | Y | 3     | 630-632  |
| Present        | code the employee or        |   |       |          |
| Enrollment     | annuitant is currently      |   |       |          |
| Code           | enrolled in                 |   |       |          |
|                |                             |   |       |          |
|                | Edits: Blank for Starts     |   |       |          |
|                |                             |   |       |          |
|                | Edits: Required valid code  |   |       |          |
|                | for Stops, Changes          |   |       |          |
|                |                             |   |       |          |
|                | Example: 451                |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| 55\. FEHB      | Values: Blank, 1B, 2B, 1C   | Y | 2     | 633-634  |
| Event Code     | etc. depending on the time  |   |       |          |
|                | of year and type of action  |   |       |          |
|                |                             |   |       |          |
|                | Edits: Refer to current     |   |       |          |
|                | FEHB documentation for      |   |       |          |
|                | various Event Codes, and    |   |       |          |
|                | see the Field Descriptions  |   |       |          |
|                | in this document for more   |   |       |          |
|                | details                     |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| 56\. Premium   | Values: The date Payroll or | Y | 8     | 635-642  |
| Effective Date | Annuity Deduction changes   |   |       |          |
|                | take affect.                |   |       |          |
|                |                             |   |       |          |
|                | Edits: MMDDYYYY             |   |       |          |
|                |                             |   |       |          |
|                | Example: 01022000           |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| 57\. Coverage  | Values: The date the        | Y | 8     | 643-650  |
| Effective Date | requested Coverage changes  |   |       |          |
|                | take affect                 |   |       |          |
|                |                             |   |       |          |
|                | Edits: MMDDYYYY             |   |       |          |
|                |                             |   |       |          |
|                | Example: 01022000           |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| 58\. Date of   | Values: The date of this    | Y | 8     | 651-658  |
| Action         | election                    |   |       |          |
|                |                             |   |       |          |
|                | Edits: MMDDYYYY             |   |       |          |
|                |                             |   |       |          |
|                | Example: 12011999           |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| 59\. Time of   | Values: The time of this    | Y | 6     | 659-664  |
| Action         | election                    |   |       |          |
|                |                             |   |       |          |
|                | Edits: HHMMSS, 24 hour time |   |       |          |
|                |                             |   |       |          |
|                | Example: 162206             |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| 60\. CPDF      | Values: Valid Federal CPDF  | Y | 4     | 665-668  |
| Agency Code    | code for the agency the     |   |       |          |
|                | employee is serviced by.    |   |       |          |
|                |                             |   |       |          |
|                | Edits: Annuitants ONLY will |   |       |          |
|                | pass 0000                   |   |       |          |
|                |                             |   |       |          |
|                | Example: OM00 for OPM       |   |       |          |
|                | employees                   |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| 61\. Personnel | Values: Valid Federal       | Y | 8     | 669-676  |
| Office ID      | Personnel Office ID         |   |       |          |
|                |                             |   |       |          |
|                | Edits: Annuitants ONLY will |   |       |          |
|                | pass 24900002               |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| 62\. Payroll   | Values: Valid Federal       | Y | 8     | 677-684  |
| Office Number  | Payroll Office Number       |   |       |          |
|                |                             |   |       |          |
|                | Edits: Annuitants ONLY will |   |       |          |
|                | pass 24900002 for all       |   |       |          |
|                | actions.                    |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| 63\. Annuity   | Values: Valid Annuitant     | Y | 9     | 685-693  |
| Claim Number   | Claim Number                | \ |       |          |
|                |                             | \ |       |          |
|                | Edits: Required for         | N |       |          |
|                | annuitants Only             |   |       |          |
|                |                             |   |       |          |
|                | Edits: All other agencies,  |   |       |          |
|                | blank                       |   |       |          |
+----------------+-----------------------------+---+-------+----------+

+----------------+-----------------------------+---+-------+----------+
| 64\. HB        | Values: SSN of the original | Y | 9     | 694-702  |
| Identification | enrollee in this FEHB plan  | \ |       |          |
| Number         |                             | \ |       |          |
|                | Edits: Required for         | N |       |          |
|                | annuitants Only             |   |       |          |
|                |                             |   |       |          |
|                | Edits: All other agencies,  |   |       |          |
|                | blank                       |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| **\*65.        | Values: Y/N                 | Y | 1     | 703      |
| For            |                             | / |       |          |
| eign/Over-Seas | Edits: Y indicates that the | N |       |          |
| Address        | employee has an foreign     |   |       |          |
| Indicator**    | home address (not an        |   |       |          |
|                | APO/FPO address).           |   |       |          |
|                |                             |   |       |          |
|                | Edits: N indicates that the |   |       |          |
|                | employee has a US address,  |   |       |          |
|                | which includes APO/FPO      |   |       |          |
|                | addresses and US            |   |       |          |
|                | Territories.                |   |       |          |
+----------------+-----------------------------+---+-------+----------+
| 66\. Filler    | Values: Blanks              |   | 2     | 704-705  |
+----------------+-----------------------------+---+-------+----------+
| 67\. Report    | Values: Agencies leave      | N | 15    | 706-720  |
| Number         | blank, further descriptions |   |       |          |
|                | included in the Field       |   |       |          |
|                | Descriptions portion of     |   |       |          |
|                | this document               |   |       |          |
|                |                             |   |       |          |
|                | Edits: Generated by         |   |       |          |
|                | OPM-Macon                   |   |       |          |
+----------------+-----------------------------+---+-------+----------+

##### [Enclosure Five]{.underline}

**[Individual file layouts-Notes, Questions and Answers]{.underline}**

**[Notes]{.underline}**

Field 1. Nature of Transaction

-   STARTS are used when a new enrollee joins the FEHB Program.

-   CHANGES are used when an enrollee moves from one plan to another or
    makes a change within a plan.

-   STOPS are used when an enrollee is no longer part of the FEHB
    Program.

Field 14. When an enrollee changes health plans, the enrollment code of
the plan he or she is joining is shown in the FEHB Enrollment Code
field. This will be blank for Stops and contain a valid enrollment code
for Changes and Starts.

Enrollment codes: Positions 1 and 2 Carrier Code

Position 3 Coverage type

If Position 3 is 1, the enrollment is for High Option, Self Only. If
Position 3 is 2, the enrollment is for High Option, Self & Family. If
Position 3 is 4, the enrollment is for Standard Option, Self Only. If
Position 3 is 5, the enrollment is Standard Option, Self & Family.

For example, if Anytown HMO has an enrollment code of ZZ, then the
enrollment code for an employee in High Option Self & Family is ZZ2.

Fields 15 - 20: If an enrollee has Self and Family coverage, they must
provide certain information for the person in the family member 1
position. The person listed in the family member 1 must provide their
name, date of birth, sex, and family relationship (see below). They are
not required to provide their SSN number or their zip code.

Fields 19, 25, 31, 37, 43: FEHB Family Relationship Codes:

1 = Spouse

2 = Unmarried dependent child under age 22 including an adopted child

3 = Step child, foster child, or recognized child

4 = Unmarried disabled child over age 22 incapable of self-support.

Fields 45 - 53, Other Insurance Field: If the employee, spouse, or other
eligible family member has additional insurance outside of the FEHB
Program, they will list it here.

If the FEHB Other Insurance Indicator is Y, then at least one of the
following fields will contain valid coverage information:

Field 46 FEHB Other Insurance Policy Holder\'s Name

Field 47 FEHB Medicare Indicator

Field 52 FEHB TRICARE (formerly CHAMPUS) Indicator

Field 53 FEHB Other Insurance Name

If the FEHB Medicare Indicator is Y, then at least one of the following
fields will contain a Y:

Field 48 FEHB Medicare-A Employee

Field 49 FEHB Medicare-B Employee

Field 50 FEHB Medicare-A Employee\'s Spouse

Field 51 FEHB Medicare-B Employee\'s Spouse

Field 54: Present Enrollment Code:

When an enrollee changes health plans, the enrollment code the enrollee
is leaving is called the Present Enrollment Code. This field will be
blank for Starts and contain a valid enrollment code for Changes and
Stops.

Field 55: Event Codes correspond to the event that allowed the
enrollee\'s action.

For employees, Code 1B indicates that the effective date of an
enrollment change is the first day of the first full pay period in
January. For annuitants, Code 2B indicates that the effective date of an
enrollment change is January 1^st^. This field is used for Open Season
starts and changes. Other codes may be valid based on existing FEHB
regulations, but most Open Season starts and changes will be shown as
either 1B or 2B.

When a Stop or Change to Self Only occurs, this field will be left
blank.

Field 56: Premium Effective Date: Carriers can ignore this field.

Field 57: Coverage Effective Date:

The date the enrollee\'s change becomes effective. Carriers should use
this date as the first day of an enrollee\'s health insurance coverage.
For most Open Season Starts and Changes, (other than Changes to Self
Only coverage and Stops), the Coverage Effective Date is the first day
of the first full pay period in January.

For changes to Self Only coverage and Stops, regardless of the time of
year, the Coverage Effective Date is different. For Stops, the effective
date is either the last day of the current pay period, or the first day
of the first full pay period in January. For Changes to Self Only, the
effective date is either the first day of the next pay period, or the
first day of the first full pay period in January.

For annuitant Changes to Self Only, and Stops, Open Season Express (OE)
will calculate a date that does not follow the convention mentioned
above. You should accept the Coverage Effective Date that OE provides in
this field.

Field 63: The Annuity Claim Number is used to provide proper tracking of
annuitant FEHB actions. This is used for annuitants only.

Field 64: The HB Identification Number is used to provide proper
tracking of annuitant elections. This field contains the SSN of the
retiree or in the case of a survivor annuitant, the SSN of the deceased
retiree/employee. This number will be the SSN of the person to whom the
policy was originally issued and it will not change. The Social Security
Number field can and does change at the death of the annuitant, but the
HB Identification Number does not.

Example:

Annuitant\'s SSN: 222222222

Spouse\'s SSN: 333333333

An annuitant selects an FEHB plan.

For any electronic transactions, the Social Security Number is 222222222
and HB Identification Number is 222222222.

If the annuitant dies, OPM will notify the carrier and provide them with
the surviving spouse\'s SSN, Name, DOB, and Address.

Any subsequent electronic transactions would include 333333333 in the
Social Security Number field, and 222222222 in the HB Identification
Number.

This field is used for annuitants only.

Field 65: The Foreign/OverSeas Address Indicator indicates that the
employee has a foreign home address.

A \"Y\" indicates that the employee has a foreign home address (not an
APO/FPO address). \"N\" indicates that the employee has a US address,
which includes APO/FPO addresses and US Territories. Carriers will need
to set up special processing procedures to process employees that have a
\"Y\" in this field.

Field 67. The Report Number is generated by OPM-Macon:

Position: Description: Value:

2.  System AG = Agency Generated Record

EE = Employee Express

OE = Open Season Express (Annuitants)

3-5 Agency Agency identifier (Example): EPA

6-9 Fiscal Year Example: 2000

10-15 Sequential No. Example: 000001

Sample Report Number Veteran\'s Affairs: AGVET2000000001

Sample Report Number for Employee Express: EEDOT2000000001

Sample Report Number for annuitants: OEOPM2000000001

The Report Number will be generated for both the Header Record (a
summary record that is similar to the SF 2811), and Individual data
records (individual records similar to SF 2809), and sent to the
carriers by OPM-Macon.

OPM-Macon will generate the Agency Identifier and send to carriers when
a new agency is added to the system.

OPM-Macon will increment the Sequential No. each time they send a file
to a carrier. The Sequential No. starts with 000001 and is incremented
each time a carrier receives a file from Macon.

**[Frequently Asked Questions about Individual file
layouts]{.underline}**

Please note that annuitant requirements differ slightly from those for
current Federal employees. These differences are noted in this document.

Question: The record layout has room for five dependents. Can an
enrollee or annuitant with more than five dependents use the system?

Answer: No. If an enrollee or annuitant has more than five dependents,
they cannot use the electronic enrollment system.

Question: Does OPM-Macon edit the files?

Answer: OPM-Macon does not edit any data.

Question: What should be reported in the FEHB Other Insurance field?

Answer: Data should include the employee\'s or any eligible family
member\'s additional medical insurance. The purpose of these fields is
to report what the family as a whole has. These fields may be blank.

Here\'s an example:

The employee\'s spouse has a health insurance policy through her
employer. His daughter has Blue Cross insurance. The various fields
would look like this:

> FEHB Other Insurance Indicator: Y
>
> FEHB Other Ins. Policy Holder\'s Name: DOE JANE R
>
> FEHB Medicare Indicator: N
>
> FEHB Medicare ‑ A Employee: N
>
> FEHB Medicare ‑ B Employee: N
>
> FEHB Medicare ‑ A Employee\'s Spouse: N
>
> FEHB Medicare ‑ B Employee\'s Spouse: N
>
> FEHB TRICARE (formerly CHAMPUS): N
>
> FEHB Other Insurance Name: Anytown HMO, BLUE CROSS

Question: What is the FEHB Premium Effective Date?

Answer: The Premium Effective Date is determined by the enrollee\'s
agency for calculating payroll deductions.

Question: What is the CPDF agency Code?

Answer: An OPM-Macon generated code that is used across the Federal
Government to identify agencies and sub agencies.

Example: OPM\'s CPDF code is OM00

For annuitants only, the code is 0000

All other agencies will use their agency\'s given CPDF code.

Question: What is the Personnel Office ID?

Answer: Federal agencies have a Personnel Office Identifier that can be
used to locate a specific Personnel Office.

For Annuitants this will be a duplicate of the Payroll Office ID. All
other agencies will use the employee\'s servicing Personnel Office ID.

Question: What is the Payroll Office ID?

Answer: The Payroll Office Identifier is used to identify the office
responsible for the payroll functions for a specific employee.

o For Annuitants Only: The Payroll Office ID is 24900002.

> o For all other agencies, the number will be the employee\'s servicing
> Payroll Office ID.

Question: Does OPM-Macon keep a history of all data transferred to the

Carriers?

Answer: Yes.

**[Enclosure Six]{.underline}**

**[Electronic Transmission to the Carriers-Technical
Specifications]{.underline}**

PC-to-PC Communications

OPM-Macon will dial into the carrier\'s personal computer (386 or
higher, DOS or WINDOWS based) that is equipped with a modem (internal or
external, 19.2 baud rate or higher), phone line, and Norton-Lambert
Closeup v6.0 or Closeup v6.5 communications software (Host package). The
communications software allows for:

-   automated scripting so file transfers can be accomplished at
    scheduled times without human intervention

-   logging to provide connection feedback to determine proper file
    transfers and help in troubleshooting

-   password protection

-   various baud rate transfers.

The cost for the Closeup host license and manual is approximately
\$75.00.

###### Enclosure Seven

###### Best Practice for file automation

A carrier can use a REDEFINES function that allows them to view the same

portion of a data record in more than one way. The carrier determines
which way to view the data record based on the data source. Each data
record has a report number field at the end of the record. The first two
characters of the report number indicate the source: \"AG\" for Agency
Generated record, \"EE\" for Employee Express, or \"OE\" for Open Season
Express. The REDEFINES function allows the carrier to say, in effect,
\"If the source of this record is \"EE\" or \"AG\", use one view to
interpret the address section. If the source is \'OE\', use a second
view.

The first view , \"E\" or \"AG\", tells the program to interpret the
141-character address section as being made up of these fields: Street1,
Street2, Street3, City, State, Zip. The Street fields are each viewed as
35 characters long, while City is 23 characters, the State is 2
characters, and the Zip is 11.

The second view, \"OE\", tells the program to interpret the address
section as being made up of six address lines, each of which is exactly
22 characters long, with 9 characters of unused blank space. The
difficulty with using this view is that it\'s up to the program to
determine what\'s in each of the six lines. For example, how to tell
where the State and Zip are located:

\"TROY NY 09532\" and

\"SACRAMENTO CA 71256\" each has the State and Zip code values in
different positions within the given line.

Once the program decides on which view to use, it processes the address
section according to what\'s defined in that view.

**[Enclosure Eight]{.underline}**

**[File Transfer Days by Carrier Code]{.underline}**

CODE NAME Day of Transfer

\-\-\-- \-\-\-- \-\-\-\-\-\-\-\-\-\-\-\-\-\--

47 APWU Health Plan MONDAY

XW Advantage Care, Inc. TUESDAY

2U Aetna U.S. Healthcare TUESDAY

2X Aetna U.S. Healthcare TUESDAY

3G Aetna U.S. Healthcare TUESDAY

5B Aetna U.S. Healthcare TUESDAY

5U Aetna U.S. Healthcare TUESDAY

6F Aetna U.S. Healthcare TUESDAY

6J Aetna U.S. Healthcare TUESDAY

8A Aetna U.S. Healthcare TUESDAY

8J Aetna U.S. Healthcare TUESDAY

8L Aetna U.S. Healthcare TUESDAY

8V Aetna U.S. Healthcare TUESDAY

8X Aetna U.S. Healthcare TUESDAY

8Z Aetna U.S. Healthcare TUESDAY

BU Aetna U.S. Healthcare TUESDAY

H1 Aetna U.S. Healthcare TUESDAY

JC Aetna U.S. Healthcare TUESDAY

KL Aetna U.S. Healthcare TUESDAY

NE Aetna U.S. Healthcare TUESDAY

NG Aetna U.S. Healthcare TUESDAY

NK Aetna U.S. Healthcare TUESDAY

P3 Aetna U.S. Healthcare TUESDAY

RD Aetna U.S. Healthcare TUESDAY

SU Aetna U.S. Healthcare TUESDAY

TK Aetna U.S. Healthcare TUESDAY

TS Aetna U.S. Healthcare TUESDAY

UJ Aetna U.S. Healthcare TUESDAY

V8 Aetna U.S. Healthcare TUESDAY

WQ Aetna U.S. Healthcare TUESDAY

XC Aetna U.S. Healthcare TUESDAY

Z1 Aetna U.S. Healthcare TUESDAY

YQ Alliance Health Plan WEDNESDAY

2R Altru Health Plan TUESDAY

FK AmeriHealth HMO, Inc. MONDAY

SP AmeriHealth HMO, Inc. MONDAY

AC American HMO TUESDAY

4U American Healthcare Trust, Inc MONDAY

9X Antero HealthPlans TUESDAY

G2 Arnett HMO FRIDAY

42 Association Benefit Plan FRIDAY

8Y Athens Area Health Plan Select TUESDAY

3A AultCare HMO WEDNESDAY

EM Av-Med Health Plan TUESDAY

GP Av-Med Health Plan TUESDAY

H5 Av-Med Health Plan TUESDAY

HW Av-Med Health Plan TUESDAY

JF Av-Med Health Plan TUESDAY

3B BCI HMO, Inc. MONDAY

4K Beacon Health Plans TUESDAY

K5 Blue Care Network East MI TUESDAY

KN Blue Care Network East MI TUESDAY

LN Blue Care Network Mid MI Reg TUESDAY

LX Blue Care Network SE Michigan TUESDAY

G7 Blue Care Network West MI TUESDAY

KF Blue Care Network West MI TUESDAY

KR Blue Care Network West Region TUESDAY

DA Blue Chip, Coord Hlth Partners FRIDAY

MK Blue Choice WEDNESDAY

10 Blue Cross and Blue Shield MONDAY

SJ Blue Shield of CA Access+HMO FRIDAY

9G BlueCHOICE TUESDAY

5K BlueChoice HMO MONDAY

5L BlueChoice HMO MONDAY

S7 BlueChoice HMO MONDAY

N5 BlueLincs HMO MONDAY

2B Bluegrass Family Health WEDNESDAY

SG C.D.P.H.P. WEDNESDAY

MG CHP of Ohio FRIDAY

P4 CIGNA CoMED HealthCare MONDAY

16 CIGNA HC of AZ-Phoenix THURSDAY

9T CIGNA HealthCare of CA THURSDAY

1C CIGNA HealthCare of CO THURSDAY

HU CIGNA HealthCare of NY MONDAY

W2 CIGNA HealthCare of VA TUESDAY

W3 CIGNA HealthCare of VA TUESDAY

M5 CaliforniaCare FRIDAY

EA Capital Health Plan WEDNESDAY

2G CapitalCare TUESDAY

FA Care Choices WEDNESDAY

4C Carelink Health Plans FRIDAY

3Y Certus HealthCare TUESDAY

7C CommunityCare HMO MONDAY

69 Compcare Health Services FRIDAY

6X Compcare Health Services FRIDAY

TE ConnectiCare TUESDAY

Q3 DayMed Hlth Maintenance Plan WEDNESDAY

WD Dean Health Plan THURSDAY

6D Doctors Health Plan, Inc. FRIDAY

9Y Exclusive Healthcare TUESDAY

JV Fallon Community Health Plan WEDNESDAY

WH Family Health Plan MONDAY

5G First Choice Health Plan MONDAY

2F First Option Health Plan of NJ FRIDAY

C8 First Priority Hlth TUESDAY

6U Firstcare THURSDAY

CK Firstcare THURSDAY

40 Foreign Service WEDNESDAY

5C Foundation Health FRIDAY

5D Foundation Health FRIDAY

5E Foundation Health FRIDAY

LD Free State Health Plan MONDAY

31 GEHA Benefit Plan MONDAY

80 GHI Health Plan TUESDAY

8B Generations Family Health Plan MONDAY

E5 George Washington Univ HP MONDAY

RL Grand Valley Health Plan TUESDAY

WJ Group Health Coop WEDNESDAY

54 Group Health Cooperative WEDNESDAY

VR Group Health Cooperative TUESDAY

MM Group Health Plan WEDNESDAY

WT Group Hlth Coop/Eau Claire MONDAY

ZA Guam Memorial Health Plan WEDNESDAY

LY Gulf South Health Plan, Inc. MONDAY

K7 HIP Health Plan of FL MONDAY

P9 HIP Health Plan of NJ TUESDAY

5J HIP Health Plan of Pennsylvania TUESDAY

51 HIP of Greater New York TUESDAY

AH HMO BLUE FRIDAY

5Q HMO Blue TUESDAY

5R HMO Blue TUESDAY

4Y HMO Blue/Rio Grande TUESDAY

4Z HMO Blue/Rio Grande TUESDAY

L2 HMO Colorado/Nevada THURSDAY

VS HMO Colorado/Nevada THURSDAY

L4 HMO Health Ohio FRIDAY

5H HMO New Mexico THURSDAY

2T HMO Texas, L.C. FRIDAY

UK HMO Texas, L.C. FRIDAY

EB HMO-CNY WEDNESDAY

87 HMSA MONDAY

68 Harvard Community Hlth Plan TUESDAY

70 Harvard Pilgrim Hlth Care-NE TUESDAY

52 Health Alliance THURSDAY

7X Health Alliance HMO TUESDAY

FX Health Alliance HMO TUESDAY

28 Health Maintenance Life MONDAY

R5 Health Maintenance Plan(HMP) TUESDAY

LB Health Net MONDAY

DJ Health New England TUESDAY

D7 Health Options MONDAY

FN Health Options MONDAY

FR Health Options MONDAY

DF Health Partners of Alabama THURSDAY

RN Health Partners of the Midwest WEDNESDAY

U4 Health Plan Upper OH Valley WEDNESDAY

NM Health Plan of Nevada FRIDAY

XR Health Power HMO MONDAY

26 HealthAmerica Pennsylvania TUESDAY

4N HealthAmerica Pennsylvania TUESDAY

SW HealthAmerica Pennsylvania TUESDAY

ZN HealthAmerica Pennsylvania TUESDAY

5X HealthAssurance HMO TUESDAY

6L HealthAssurance HMO TUESDAY

Q8 HealthCarePlan MONDAY

8E HealthFirst HMO FRIDAY

RF HealthFirst, Inc. THURSDAY

NQ HealthGuard FRIDAY

53 HealthPartners Classic WEDNESDAY

HQ HealthPartners Health Plan WEDNESDAY

2S HealthPartners Health Plans TUESDAY

TD HealthPartners Health Plans TUESDAY

8F HealthPlus THURSDAY

X5 HealthPlus MI TUESDAY

6W Healthcare Oklahoma TUESDAY

X8 Healthkeepers WEDNESDAY

XL Healthsource HMO of NY FRIDAY

RU Heart of America HMO TUESDAY

3J Heritage National Healthplan WEDNESDAY

4T Heritage National Healthplan WEDNESDAY

4H Hometown Health Plan FRIDAY

18 Humana Care Plan THURSDAY

HR Humana Care Plan THURSDAY

D2 Humana Health Plan THURSDAY

75 Humana Health Plan Inc. THURSDAY

DY Humana Health Plan of AZ THURSDAY

UE Humana Health Plan of Texas THURSDAY

UR Humana Health Plan of Texas THURSDAY

TL Humana Health Plan, Inc. THURSDAY

TW Humana Health Plans of Texas THURSDAY

MS Humana Kansas City, Inc. THURSDAY

7F Humana Medical Plan THURSDAY

EE Humana Medical Plan THURSDAY

JH Humana Medical Plan THURSDAY

P5 Humana Medical Plan THURSDAY

P7 Humana Medical Plan THURSDAY

X1 Humana Wisconsin Hlth Org. THURSDAY

TX Humana of Corpus Christi THURSDAY

C1 Independent Health Assoc THURSDAY

QA Independent Health Assoc THURSDAY

A7 Intergroup of Arizona, Inc. FRIDAY

1J John Deere Family Healthplan WEDNESDAY

63 Kaiser HI FRIDAY

64 Kaiser Permanente FRIDAY

E3 Kaiser Permanente MONDAY

QT Kaiser Permanente MONDAY

57 Kaiser Permanente THURSDAY

8M Kaiser Permanente WEDNESDAY

PW Kaiser Permanente WEDNESDAY

QB Kaiser Permanente WEDNESDAY

59 Kaiser Permanente MONDAY

62 Kaiser Permanente MONDAY

65 Kaiser Permanente MONDAY

DM Kaiser Permanente MONDAY

F8 Kaiser Permanente MONDAY

HA Kaiser Permanente MONDAY

K1 Kaiser Permanente MONDAY

QH Kaiser Permanente MONDAY

S4 Keystone Health Plan Central THURSDAY

ED Keystone Health Plan East MONDAY

EF KeystoneBlue FRIDAY

VT Kitsap Physicians Service THURSDAY

Q1 Lovelace Health Plan FRIDAY

EG M-Care FRIDAY

JP MD-IPA MONDAY

5Y MDNY Healthcare, Inc WEDNESDAY

GA MVP Health Plan WEDNESDAY

M9 MVP Health Plan WEDNESDAY

MX MVP Health Plan WEDNESDAY

VW MVP Health Plan WEDNESDAY

45 Mail Handlers MONDAY

GK Maxicare Indiana FRIDAY

JA Maxicare Louisiana FRIDAY

CM Maxicare Southern California FRIDAY

EV Medical Value Plan THURSDAY

7M Mercy Health Plans/Premier WEDNESDAY

32 NALC MONDAY

UM NYLCare HP of the Gulf Coast WEDNESDAY

ZE NYLCare HP of the Gulf Coast WEDNESDAY

ZF NYLCare HP of the Gulf Coast WEDNESDAY

V2 NYLCare Health Plans SW MONDAY

9M NYLCare Health Plans of Maine WEDNESDAY

8N NYLCare Northwest THURSDAY

JN NYLCare/Mid-Atlantic MONDAY

MN National HMO Health Plan THURSDAY

9F OSF Health Plans THURSDAY

HN Omni Healthcare WEDNESDAY

KA OmniCare MONDAY

9R Optima Health Plan THURSDAY

FQ PCA Family Health Plan of FL MONDAY

PJ PCA Health Plans of Florida MONDAY

5P PCA Health Plans/Puerto Rico MONDAY

SH PHP/Mohawk Valley Region TUESDAY

JK PacifiCare Asia Pacific MONDAY

2N PacifiCare OK MONDAY

7R PacifiCare of Arizona MONDAY

A3 PacifiCare of Arizona MONDAY

CY PacifiCare of California MONDAY

D6 PacifiCare of Colorado MONDAY

K9 PacifiCare of Nevada MONDAY

R8 PacifiCare of Ohio INC MONDAY

SS PacifiCare of Oregon MONDAY

GF PacifiCare of Texas MONDAY

9K PacifiCare of Utah MONDAY

WB PacifiCare of Washington MONDAY

43 Panama Canal Area TUESDAY

U2 Paramount Health Care THURSDAY

7Y Partners Health Plans WEDNESDAY

EQ Partners NHP of NC FRIDAY

MC Partners Nat\'l HPs of IN WEDNESDAY

N9 Penn State Geisinger HlthPlan TUESDAY

4X Personal Care Plan of NC MONDAY

GE PersonalCare\'s HMO TUESDAY

DQ Physicians HP of N. Indiana THURSDAY

U5 Physicians Health Plan TUESDAY

U6 Physicians Health Plan TUESDAY

U7 Physicians Health Plan TUESDAY

U8 Physicians Health Plan TUESDAY

PD Physicians Health Srvs of NY WEDNESDAY

DP Physicians Hlth Services/CT WEDNESDAY

7P Physicians Plus HMO TUESDAY

36 Postmasters TUESDAY

GV Preferred Care FRIDAY

VA Preferred Plus of Kansas THURSDAY

9A Premier HealthCare of Arizona FRIDAY

9B Premier HealthCare of Arizona FRIDAY

QE Prepaid Health Plan TUESDAY

P2 Presbyterian Health Plan TUESDAY

AA PrimeHealth of Alabama Inc TUESDAY

9W PrimeOne FRIDAY

SV Principal Health Care of Iowa FRIDAY

7W Principal Health Care of KC FRIDAY

12 Principal St.Louis FRIDAY

BQ Priority Health TUESDAY

W7 Priority Health Care, Inc. THURSDAY

SD Providence Health Plan TUESDAY

8C Prudential HealthCare HMO MONDAY

8P Prudential HealthCare HMO MONDAY

9P Prudential HealthCare HMO MONDAY

JB Prudential HealthCare HMO MONDAY

VV Prudential HealthCare HMO MONDAY

1K Prudential HealthCare HMO MONDAY

6P Prudential HealthCare HMO MONDAY

RR Prudential HealthCare HMO MONDAY

RS Prudential HealthCare HMO MONDAY

UN Prudential HealthCare HMO MONDAY

UP Prudential HealthCare HMO MONDAY

VX Prudential HealthCare HMO MONDAY

VY Prudential HealthCare HMO MONDAY

VZ Prudential HealthCare HMO MONDAY

EC Prudential HealthCare HMO MONDAY

EH Prudential HealthCare HMO MONDAY

EZ Prudential HealthCare HMO MONDAY

HE Prudential HealthCare HMO MONDAY

Q4 Prudential HealthCare HMO MONDAY

UA Prudential HealthCare HMO MONDAY

UB Prudential HealthCare HMO MONDAY

V6 Prudential HealthCare HMO MONDAY

AY Prudential HealthCare MidWest MONDAY

Q9 Prudential HealthCare MidWest MONDAY

S3 Prudential HealthCare MidWest MONDAY

8Q QCA Health Plan MONDAY

7Q QualChoice of North Carolina TUESDAY

27 QualMed Plans for Health MONDAY

2K QualMed Plans for Health MONDAY

PX QualMed Plans for Health MONDAY

24 QualMed Plans for Health - PA WEDNESDAY

QJ QualMed Plans for Health OH/WV WEDNESDAY

TM QualMed WA Health Plan MONDAY

2D QualMed of Colorado FRIDAY

88 Rocky Mountain HMO WEDNESDAY

38 Rural Carrier Benefit Plan FRIDAY

17 Rush Prudential HMO, Inc. TUESDAY

44 SAMBA WEDNESDAY

UF Scott and White MONDAY

Y7 Secret Service FRIDAY

3Q SecureCare of Iowa WEDNESDAY

K6 SelectCare WEDNESDAY

8D Smartplan THURSDAY

5W SummaCare Health Plan MONDAY

8T Super Blue HMO TUESDAY

5M Super Med HMO FRIDAY

IN The M\*Plan MONDAY

K3 The Wellness Plan THURSDAY

N2 Total Health Care WEDNESDAY

89 Triple-S THURSDAY

XM UHC of North Carolina TUESDAY

76 Union Health Service TUESDAY

VC United Health Care Ohio TUESDAY

3U United Health Care of Ohio TUESDAY

C4 United Health Plan FRIDAY

BL United HealthCare Mid-Atlantic THURSDAY

4M United HealthCare MidWest TUESDAY

VF United HealthCare New England TUESDAY

7U United HealthCare Puerto Rico MONDAY

H8 United HealthCare Select TUESDAY

QK United HealthCare of Florida TUESDAY

DU United HealthCare of Kentucky TUESDAY

NF United HealthCare/Midlands WEDNESDAY

W4 Unity Health Plans TUESDAY

4B VIVA Health Plan FRIDAY

VH Valley Health Plan THURSDAY

7V Vantage Health Plan MONDAY

J6 Vytra Health Plans MONDAY

H3 Welborn HMO MONDAY

6V WellCare of New York THURSDAY

X4 WellCare of New York THURSDAY

3Z WellChoice FRIDAY

2E WellPath Select THURSDAY

5Z Western Health Advantage MONDAY

2Y Yellowstone Community Health WEDNESDAY

# Enclosure Nine

**[Federal Agencies participating in Electronic Enrollment
Transfers]{.underline}**

Agency Generated Records

AGDD1 (Dept. of Defense-electronic feed from Randolf AFB)

AGDD2 (Dept. of Defense-electronic feed from Iowa Foundation for Medical
Care - TriCare Project)

Employee Express

EEDOD (Dept. of Defense)

EEDOI (Dept. of Interior)

EEDOL (Dept. of Labor)

EEDOT (Dept. of Transportation)

EEEDU (Education)

EEEPA (Environmental Protection Agency)

EEGSA (General Services Administration)

EEHHS (Health & Human Services)

EENAS (National Aeronautics and Space Admin.)

EENIH (National Institute of Health)

EEOPM (Office of Personnel Mgt.)

EESSA (Social Security Admin.)

Open Season Express (Annuitants)

OEOPM (Office of Personnel Mgt.)

Note: The System/Agency Identifier used in positions 1-5 of the report
number.