Complete EDI X12 Reference Guide for Transaction Sets, Segments, and Elements

X12 Release Version

EDI 834 Benefit Enrollment And Maintenance

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📄 What is this 834 EDI document?

📄 How is this 834 EDI document used?

  • ST (Transaction Set Header) [Min: 0, Max: 1]
  • BGN (Beginning Segment) M
  • REF (Reference Identification) M [Max: 20]
  • DTP (Date or Time or Period) [Min: 0, Max: 1]
  • AMT (Monetary Amount) [Min: 0, Max: 4]
  • QTY (Quantity) [Min: 0, Max: 4]
  • ▶
    N1Loop1 () M [Max: 10]
      • N1 (Name) M
      • N2 (Additional Name Information) [Min: 0, Max: 2]
      • N3 (Address Information) [Min: 0, Max: 2]
      • N4 (Geographic Location) [Min: 0, Max: 1]
      • PER (Administrative Communications Contact) [Min: 0, Max: 3]
      • ▶
        ACTLoop1 () [Min: 0, Max: 2]
          • ACT (Account Identification) M
          • REF (Reference Identification) [Min: 0, Max: 5]
          • N3 (Address Information) [Min: 0, Max: 1]
          • N4 (Geographic Location) [Min: 0, Max: 1]
          • PER (Administrative Communications Contact) [Min: 0, Max: 5]
          • DTP (Date or Time or Period) [Min: 0, Max: 1]
          • AMT (Monetary Amount) [Min: 0, Max: 1]
  • ▶
    INSLoop1 () M [Max: 999]
      • INS (Insured Benefit) M
      • REF (Reference Identification) M [Max: 20]
      • NM1 (Individual or Organizational Name) [Min: 0, Max: 2]
      • DTP (Date or Time or Period) [Min: 0, Max: 20]
      • N3 (Address Information) [Min: 0, Max: 1]
      • N4 (Geographic Location) [Min: 0, Max: 1]
      • DMG (Demographic Information) [Min: 0, Max: 1]
      • PM (Electronic Funds Transfer Information) [Min: 0, Max: 1]
      • EC (Employment Class) [Min: 0, Max: 5]
      • ICM (Individual Income) [Min: 0, Max: 1]
      • AMT (Monetary Amount) [Min: 0, Max: 10]
      • HLH (Health Information) [Min: 0, Max: 1]
      • CD2 (Multi-Valued Characteristics) [Min: 0, Max: 10]
      • ▶
        N1Loop2 () [Min: 0, Max: 2]
          • N1 (Name) M
          • DTP (Date or Time or Period) [Min: 0, Max: 1]
          • N3 (Address Information) [Min: 0, Max: 1]
          • N4 (Geographic Location) [Min: 0, Max: 1]
      • ▶
        DSBLoop1 () [Min: 0, Max: 4]
          • DSB (Disability Information) M
          • DTP (Date or Time or Period) [Min: 0, Max: 10]
          • AD1 (Adjustment Amount) [Min: 0, Max: 10]
      • ▶
        PERLoop1 () [Min: 0, Max: 10]
          • PER (Administrative Communications Contact) M
          • N3 (Address Information) [Min: 0, Max: 1]
          • N4 (Geographic Location) [Min: 0, Max: 1]
      • ▶
        HDLoop1 () [Min: 0, Max: 99]
          • HD (Health Coverage) M
          • DTP (Date or Time or Period) [Min: 0, Max: 10]
          • AMT (Monetary Amount) [Min: 0, Max: 3]
          • REF (Reference Identification) [Min: 0, Max: 5]
          • IDC (Identification Card) [Min: 0, Max: 2]
          • ▶
            LXLoop1 () [Min: 0, Max: 30]
              • LX (Assigned Number) M
              • NM1 (Individual or Organizational Name) [Min: 0, Max: 1]
              • N1 (Name) [Min: 0, Max: 2]
              • N2 (Additional Name Information) [Min: 0, Max: 1]
              • N3 (Address Information) [Min: 0, Max: 2]
              • N4 (Geographic Location) [Min: 0, Max: 2]
              • PER (Administrative Communications Contact) [Min: 0, Max: 2]
              • PRV (Provider Information) [Min: 0, Max: 1]
              • DTP (Date or Time or Period) [Min: 0, Max: 6]
          • ▶
            COBLoop1 () [Min: 0, Max: 5]
              • COB (Coordination of Benefits) M
              • N1 (Name) [Min: 0, Max: 1]
              • N2 (Additional Name Information) [Min: 0, Max: 1]
              • N3 (Address Information) [Min: 0, Max: 2]
              • N4 (Geographic Location) [Min: 0, Max: 1]
              • DTP (Date or Time or Period) [Min: 0, Max: 2]
      • ▶
        LCLoop1 () [Min: 0, Max: 10]
          • LC (Life Coverage) M
          • AMT (Monetary Amount) [Min: 0, Max: 5]
          • DTP (Date or Time or Period) [Min: 0, Max: 2]
          • ▶
            BENLoop1 () [Min: 0, Max: 20]
              • BEN (Beneficiary or Owner Information) M
              • NM1 (Individual or Organizational Name) [Min: 0, Max: 1]
              • N1 (Name) [Min: 0, Max: 1]
              • N2 (Additional Name Information) [Min: 0, Max: 1]
              • N3 (Address Information) [Min: 0, Max: 1]
              • N4 (Geographic Location) [Min: 0, Max: 1]
              • DMG (Demographic Information) [Min: 0, Max: 1]
      • ▶
        FSALoop1 () [Min: 0, Max: 5]
          • FSA (Flexible Spending Account) M
          • AMT (Monetary Amount) [Min: 0, Max: 10]
          • DTP (Date or Time or Period) [Min: 0, Max: 10]
      • ▶
        RPLoop1 () [Min: 0, Max: 99]
          • RP (Retirement Product) M
          • DTP (Date or Time or Period) [Min: 0, Max: 1]
          • REF (Reference Identification) [Min: 0, Max: 10]
          • INV (Investment Vehicle Selection) [Min: 0, Max: 99]
          • ▶
            BENLoop2 () [Min: 0, Max: 5]
              • BEN (Beneficiary or Owner Information) M
              • NM1 (Individual or Organizational Name) [Min: 0, Max: 1]
              • N1 (Name) [Min: 0, Max: 2]
              • N2 (Additional Name Information) [Min: 0, Max: 1]
              • N3 (Address Information) [Min: 0, Max: 2]
              • N4 (Geographic Location) [Min: 0, Max: 2]
              • DMG (Demographic Information) [Min: 0, Max: 1]
          • ▶
            FCLoop1 () [Min: 0, Max: 99]
              • FC (Financial Contribution) M
              • DTP (Date or Time or Period) [Min: 0, Max: 1]
              • INV (Investment Vehicle Selection) [Min: 0, Max: 40]
  • SE (Transaction Set Trailer) [Min: 0, Max: 1]

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