Administrative Bulletin  Required Municipal Initial Enrollment Data

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

File Format

Enrollee Information	Dependent Information
Social Security Number	Social Security Number
First Name	First Name
Middle Initial
Last Name	Middle Initial
Sex	Last Name
Date of Birth	Zip plus 4 (if former spouse and available)
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 Extension	State (if former spouse)
Country	Zip Code (if former spouse)
Date of Retirement (only if retired status)	Home phone area code (if former spouse and available)
Hire Date (only if active status)	Home phone number (if former spouse and available)
Number of hours worked (only if active status)
Preferred phone number
Work status (full time or part time, only if active status)
COBRA end date (only if COBRA status)

Supported File Formats

1. Excel - comma separated file
2. Excel - XML