Administrative Bulletin  Required Municipal Initial Enrollment Data

Date:	07/01/2011
Referenced Sources:	Group Insurance Commission

File Format

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Enrollee Information	Dependent Information
Social Security Number	Social Security Number
First Name	Relationship (Dependent, Spouse, Former Spouse)
Middle Initial	First Name
Last Name	Middle Initial
Gender	Last Name
Primary Address 1	Gender
Primary Address 2	Date of Birth
Primary Address 3	Primary Address 1 (if former spouse)
City	Primary Address 2 (if former spouse)
State	Primary Address 3 (if former spouse)
Zip code	City (if former spouse)
Zip plus 4	State (if former spouse)
Foreign City/Country	Zip Code (if former spouse)
Date of Birth	Zip plus 4 (if former spouse and available)
Date of Retirement (only if retired status)	Home phone area code (if former spouse and available)
Date into Service (only if active status)	Home phone number (if former spouse and available)
Status (Active, Retired, Survivor, COBRA)
Home phone area code (if available)
Home phone number (if available)
Business phone area code (if available)
Business phone number (if available)
Business phone extension (if available)
COBRA start date (only if COBRA status)
COBRA end date (only if COBRA status)
Hours worked (only if active status)
Department (only if active status)

Supported File Formats

1. Excel comma separated file
2. XML