Announcing Public Review Periods for Implementation Guides

  • The Benefit Enrollment and Maintenance Implementation Guide (007030X333)
  • The Payroll Deducted and Other Group Premium Payment for Insurance Products Implementation Guide (007030X334)
  • The Health Insurance Exchange Related Payment Implementation Guide (007030X345)
  • The Health Insurance Exchange: Enrollment Implementation Guide (007030X346)

These four implementation guides are available for public review beginning September 1, 2016. Each review period will close October 31, 2016 at 8:00 PM, Eastern Time. These guides have been developed by X12's Insurance subcommittee based on version 007030 of the X12 Standard. Following these review periods, X12 will conduct corresponding Informational Forums. The Informational Forum is the final opportunity for public discussion of the review comments and resulting revisions.

The following implementations guides are available for public review during this period.

The Benefit Enrollment and Maintenance Implementation Guide (007030X333) which describes the use of the X12 Benefit Enrollment Maintenance (834) transaction set and addresses the enrollment and maintenance of human resources benefit plans including:

  • Tier-based coverage (medical, dental and vision)
  • Tax advantage accounts (flexible spending accounts, healthcare spending accounts, and healthcare reimbursement accounts)
  • Rate-based coverage (life, short term disability and long term disability)

The Payroll Deducted and Other Group Premium Payment for Insurance Products Implementation Guide (007030X334) which describes the use of the X12 Payment Order/Remittance Advice (820) transaction set for the following business usage:

  • Transmit payroll deducted premiums for a wide variety of insurance products, to include life, health, property and casualty, and disability
  • This guide was also designed for health care premium payments between federal and state governments, government agencies, and private industry

The Health Insurance Exchange Related Payment Implementation Guide (007030X345) which describes the use of the X12 Payment Order/Remittance Advice (820) transaction set for:

  • The payment of premium
  • The advance payment of premium tax credits and cost-sharing reduction amount
  • Annual reconciliations

The Health Insurance Exchange: Enrollment Implementation Guide (007030X346) which describes the use of the X12 Health Care Enrollment (834) transaction set for:

  • The transfer of enrollment information between Health Insurance Exchanges and Issuers
  • The reconciliation of enrollment information between Health Insurance Exchanges and Issuers

The draft implementation guides are available in on-line forums at http://forums.x12.org. The draft information is provided for public review and cannot be used for any other purpose without permission from X12. Reviewers may submit comments on the drafts via the on-line forum. Instructions for reviewing the pages and submitting comments are posted on the forums page.

Interested parties may monitor all submitted comments and the associated responses via the on-line forums during the public review period and prior to the Informational Forums. Watch for the announcement of the corresponding Informational Forums.

Questions may be directed to info@x12.org.