The following retiree file layouts are available for reference:
If subsidy is being requested for the spouse or dependent of a Qualifying Covered Retiree, make sure the information provided in this record is that of the spouse or dependent, 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.
Do not name Retiree Files with the following prefixes, regardless of case: “resp_”, “notify_”, or “covered_”. For example, “Resp_Plan2022.csv” would not be accepted, however “Fullyear_Plan2022.csv” would be accepted.
Note: An asterisk (*) indicates a required field.
Data Element |
Max Size |
Notes |
*Application ID |
10 |
RDS Application ID under which you are submitting this beneficiary for subsidy. |
*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.
|
*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.
Medicare Health Insurance Claim Number (HICN) of the beneficiary for whom you are seeking subsidy.
Railroad Retirement Board (RRB) number of the beneficiary for whom you are seeking subsidy.
|
*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. |
*Coverage Effective Date |
08 |
The date the beneficiary's (retiree, spouse, or dependent) 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 dependent) coverage under the Plan Sponsor's Prescription Drug Benefit Option ends. Format: CCYYMMDD This field accepts 99999999 or may be left blank if the date is unknown. |
*Unique Benefit Option Identifier |
20 |
Unique Benefit Option Identifier (UBOI) (for example, Rx Group number) corresponding to the benefit under which you are submitting this beneficiary for subsidy. |
*Relationship to Retiree |
02 |
Relationship to the retiree of the beneficiary for whom you are seeking subsidy. |
*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. |
For instructions to upload a file to CMS' RDS Center, refer to Submit a Valid Initial Retiree List and Monthly Retiree List.
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 the 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 |
Note: If subsidy is being requested for the spouse or dependent of a Qualifying Covered Retiree (QCR), make sure the information provided in this record is that of the spouse or dependent, not the retiree.
Note: An asterisk (*) indicates a required field.
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.
|
*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.
Medicare Health Insurance Claim Number (HICN) of the beneficiary for whom you are seeking subsidy.
Railroad Retirement Board (RRB) number of the beneficiary for whom you are seeking subsidy.
|
*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. |
*Coverage Effective Date |
PIC X(08) |
The date the beneficiary's (retiree, spouse, or dependent) 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 dependent) coverage under the Plan Sponsor's Prescription Drug Benefit Option ends. Format: CCYYMMDD This field accepts 99999999 if the date is unknown. |
*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. |
*Relationship to Retiree |
PIC X(02) |
Relationship to the retiree of the beneficiary for whom you are seeking subsidy. |
*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. |
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 the 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 the field. |
Filler |
PIC X(168) |
Spaces |
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: