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RDS Program Components

Additional Program Tasks

Quick Access Reports (QAR)

Supplemental Information

Retiree File Layouts

User Roles:

AM

AR

D

V

Program Components:

Retiree Management

The following retiree file layouts are available for reference:

For tips on retiree file layouts, refer to Best Practices for CSV File Layout and Best Practices for Connect:Direct Record Layout.

Retiree File RDS Secure Website CSV File Layout

If subsidy is being requested for the spouse or dependant of a Qualifying Covered Retiree, make sure the information provided in this record is that of the spouse or dependant, not the retiree.

If a beneficiary's SSN has a leading zero and the field is numeric, leading zeroes are truncated. Reformat the SSN field to "text" before creating the CSV file.

Note: An asterisk (*) indicates a required field.

Retiree File RDS Secure Website CSV File Layout
Data Element Max Size Notes
*Application ID 10 RDS Application ID under which you are submitting this beneficiary for subsidy.
This Application ID must match the Application ID EXACTLY as it appears on the RDS Secure Website and must correspond to the coverage periods you are submitting.
*SSN 09

Social Security Number (SSN) of the beneficiary for whom you are seeking subsidy. This field may be left blank if a Medicare beneficiary identifier is provided.

  • 9 numeric characters. Do not include hyphens or other special characters.
  • Cannot contain all zeros.
  • First three digits cannot be '666' or '900' - '999'.
*Medicare beneficiary identifier 12 This field may be left blank if the SSN is provided.

May contain:

Medicare Beneficiary Identifier (MBI) of the beneficiary for whom you are seeking subsidy.

  • 11 alphanumeric characters.
  • Cannot begin with 0.
  • Must not start or end with two alphabetic characters.
  • Must contain no more than 2 consecutive numbers.
  • Must contain no more than 2 consecutive alphabetic characters.
  • Must not contain the alphabetic characters S, L, O, I, B, Z.
  • Must not contain lowercase letters.
  • Do not include hyphens or other special characters.

Medicare Health Insurance Claim Number (HICN) of the beneficiary for whom you are seeking subsidy.

  • Valid HICN consists of a SSN followed by an alpha or alphanumeric Beneficiary Identification Code (BIC)
  • Characters 1-3 cannot be '000', '666', or '990' – '999'.
  • Characters 4-5 cannot be '00'.
  • Bytes 6-9 cannot be '0000'.
  • Character 10 must be a letter.
  • Character 11 is dependent on character 10 (can be space, letter, or number).
  • Must not contain lowercase letters.
  • Do not include hyphens or other special characters.

Railroad Retirement Board (RRB) number of the beneficiary for whom you are seeking subsidy.

  • Up to 12 alphanumeric characters
  • 6 or 9 numeric characters preceded by one or more uppercase alpha characters.
*First Name 30 First Name of the beneficiary for whom you are seeking subsidy.
Middle Initial 01 Optional field. Middle Initial of the beneficiary for whom you are seeking subsidy.
*Last Name 40 Last Name of the beneficiary for whom you are seeking subsidy.
*Date of Birth 08 Date of Birth of the beneficiary for whom you are seeking subsidy. Format: CCYYMMDD
*Gender 01 Gender of the beneficiary for whom you are seeking subsidy.
Value '0' = Gender Unknown
Value '1' = Male
Value '2' = Female
*Coverage Effective Date 08 The date the beneficiary's (retiree, spouse, or dependant) coverage under the Plan Sponsor's Prescription Drug Benefit Option begins. Format: CCYYMMDD
*Coverage Termination Date 08 The date the beneficiary's (retiree, spouse, or dependant) coverage under the Plan Sponsor's Prescription Drug Benefit Option ends. Format: CCYYMMDD
Unique Benefit Option Identifier 20 Unique Benefit Option Identifier (UBOI) corresponding to the benefit under which you are submitting this beneficiary for subsidy.
You MUST reference the UBOI in this field exactly as it was entered on the RDS application, including any leading or trailing zeroes, spaces, punctuation, etc.
Reference the Benefit Option Summary page in the RDS Secure Website if you are unsure what should be entered in this field.
*Relationship to Retiree 02 Relationship to the retiree of the beneficiary for whom you are seeking subsidy.
Value '01' = Self
Value '02' = Spouse
Value '03' = Other
Transaction Type 03 Value 'ADD' = The beneficiary has either never been submitted for the corresponding RDS Application ID, or was submitted but never accepted for a Subsidy Period.
Value 'UPD' = The beneficiary and the corresponding UBOI have been previously accepted for a Subsidy Period for the corresponding RDS application and updated information is being sent.
Value 'DEL' = The beneficiary has been previously approved for subsidy for the corresponding RDS application and Benefit Option. All coverage under this Benefit Option for this Qualifying Covered Retiree (QCR) should be removed.

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Retiree File Connect:Direct Record Layout

Header Record

Retiree File Connect:Direct Record Layout - Header Record
Data Element Field Description Notes
Record Type PIC X(01) Value 'H' = Header Record
Application ID PIC X(10) The number assigned to the application by CMS' RDS Center. Includes leading zeroes as needed to completely fill field.
Creation Date PIC X(08) Date the file was created. Format: CCYYMMDD
Creation Time PIC X(06) Time the file was created. Format: HHMMSS
Filler PIC X(175) Spaces

Retiree File Submissions Record Layout

Note: If subsidy is being requested for the spouse or dependant of a Qualifying Covered Retiree (QCR), make sure the information provided in this record is that of the spouse or dependant, not the retiree.

Note: An asterisk (*) indicates a required field.

Retiree File Submissions Record Layout
Data Element Field Description Notes
Record Type PIC X(01) Value 'D' = Detail Record
*SSN PIC X(09) Social Security Number (SSN) of the beneficiary for whom you are seeking subsidy. This field may contain spaces if a Medicare beneficiary identifier is provided.
  • 9 numeric characters. Do not include hyphens or other special characters.
  • Cannot contain all zeros.
  • First three digits cannot be '666' or '900' - '999'.
*Medicare beneficiary identifier PIC X(12)

This field may contain spaces if the SSN is provided.

May contain:

Medicare Beneficiary Identifier (MBI) of the beneficiary for whom you are seeking subsidy.

  • 11 alphanumeric characters.
  • Cannot begin with 0.
  • Must not start or end with two alphabetic characters.
  • Must contain no more than 2 consecutive numbers.
  • Must contain no more than 2 consecutive alphabetic characters.
  • Must not contain the alphabetic characters S, L, O, I, B, Z.
  • Must not contain lowercase letters.
  • Do not include hyphens or other special characters.

Medicare Health Insurance Claim Number (HICN) of the beneficiary for whom you are seeking subsidy.

  • Valid HICN consists of a SSN followed by an alpha or alphanumeric Beneficiary Identification Code (BIC)
  • Characters 1-3 cannot be '000', '666', or '990' – '999'.
  • Characters 4-5 cannot be '00'.
  • Bytes 6-9 cannot be '0000'.
  • Character 10 must be a letter.
  • Character 11 is dependent on character 10 (can be space, letter, or number).
  • Must not contain lowercase letters.
  • Do not include hyphens or other special characters.

Railroad Retirement Board (RRB) number of the beneficiary for whom you are seeking subsidy.

  • Up to 12 alphanumeric characters
  • 6 or 9 numeric characters preceded by one or more uppercase alpha characters.
*First Name PIC X(30) First Name of the beneficiary for whom you are seeking subsidy.
Middle Initial PIC X(01) Optional field. Middle Initial of the beneficiary for whom you are seeking subsidy.
*Last Name PIC X(40) Last Name of the beneficiary for whom you are seeking subsidy.
*Date of Birth PIC X(08) Date of Birth of the beneficiary for whom you are seeking subsidy. Format: CCYYMMDD
*Gender PIC X(01) Gender of the beneficiary for whom you are seeking subsidy.
Value '0' = Gender Unknown
Value '1' = Male
Value '2' = Female
*Coverage Effective Date PIC X(08) The date the beneficiary's (retiree, spouse, or dependant) coverage under the Plan Sponsor's Prescription Drug Benefit Option begins. Format: CCYYMMDD
*Coverage Termination Date PIC X(08) The date the beneficiary's (retiree, spouse, or dependant) coverage under the Plan Sponsor's Prescription Drug Benefit Option ends. Format: CCYYMMDD
*Unique Benefit Option Identifier PIC X(20) Unique Benefit Option Identifier (UBOI) (for example, Rx Group number) corresponding to the benefit under which you are submitting this beneficiary for subsidy.
You MUST reference the UBOI in this field exactly as it was entered on the RDS application, including any leading or trailing zeroes, spaces, punctuation, etc.
Reference the Benefit Option Summary page in the RDS Secure Website if you are unsure what should be entered in this field.
*Relationship to Retiree PIC X(02) Relationship to the retiree of the beneficiary for whom you are seeking subsidy.
Value '01' = Self
Value '02' = Spouse
Value '03' = Other
Transaction Type PIC X(03) Value 'ADD' = The beneficiary has either never been submitted for the corresponding RDS Application ID, or was submitted but never accepted for a Subsidy Period.
Value 'UPD' = The beneficiary and the corresponding UBOI have been previously accepted for a Subsidy Period for the corresponding RDS application and updated information is being sent.
Value 'DEL' = The beneficiary has been previously accepted for a Subsidy Period for the corresponding RDS application and all coverage under this application should be removed.

Trailer Record

Retiree File Submissions Record Layout - Trailer Record
Data Element Field Description Notes
Record Type PIC X(01) Value 'T' = Trailer Record
Application ID PIC X(10) The number assigned to the application by CMS' RDS Center. Includes leading zeroes as needed to completely fill field.
Creation Date PIC X(08) Date the file was created. Format: CCYYMMDD
Creation Time PIC X(06) Time the file was created. Format: HHMMSS
Number of Detail Records PIC X(07) Right justified and includes leading zeros as needed to completely fill field.
Filler PIC X(168) Spaces

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Best Practices for CSV File Layout

  • Download the Sample Retiree File Spreadsheet or create your own spreadsheet or comma separated value (CSV) file.
  • Populate the retiree information for each beneficiary.
  • Confirm that the file is saved in CSV format.
  • If subsidy is being requested for the spouse or dependant of a Qualifying Covered Retiree (QCR), make sure the information provided in this record is that of the spouse or dependant, not the retiree.
  • CMS’ RDS Center will process multiple records for the same beneficiary within the same retiree file. DEL records will be processed first, followed by ADD and UPD. CMS’ RDS Center will disregard the order that these records appear in the file and will process in the aforementioned order.

For instructions to upload a file to CMS' RDS Center, refer to Submit a Valid Initial Retiree List and Monthly Retiree List.

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Best Practices for Connect:Direct Record Layout

For more information, refer to Connect:Direct Retiree List Copybook.

While submitting retiree files using Connect:Direct, consider the following required format and information:

  • One header record, one or more detail retiree records, and one trailer record.
  • Fixed length file/records.
  • Fixed field lengths.
  • Unless otherwise stated, all fields are defined as alpha numeric (Cobol PIC X) and left justified.
  • If subsidy is being requested for the spouse or dependant of a Qualifying Covered Retiree (QCR), make sure the information provided in this record is that of the spouse or dependant, not the retiree.
  • CMS’ RDS Center will process multiple records for the same beneficiary within the same retiree file. DEL records will be processed first, followed by ADD and UPD. CMS’ RDS Center will disregard the order that these records appear in the file and will process in the aforementioned order.

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