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DocuSign Envelope ID: 29EAB906-1936-4BAB-83BE-97C974F00293 <br />Enrollment File Feed Requirements <br />(rev. lune 2020) � <br />Enrollment File feed layout <br />Usage i Field I Data TvDe Description <br />Identity <br />Re uired Pian_Sponsor Name <br />i String <br />I Name of the Plan nsor <br />Required <br />_ <br />P!an S onsor EIN <br />I string, <br />Plan Sponsor EIN or TIN <br />Enrolee Ide <br />Required Enrollee SSN <br />Social SecurityNumber <br />Situational Employee -11) <br />Situational Enrollee Medical ID <br />String <br />Em io ee Identifier associated with the Enrollee <br />ID <br />nal Enrollee Su lemental -1D <br />Member Identity— <br />Required Member SSN <br />allriAblr <br />Re red Enrollee IndicabDr <br />Stri <br />of the <br />Required Member ReWbriship Code <br />O nal Member Su lemental ID <br />Stri <br />I Strina 114mober <br />Mdicati the relatloIshiP between two individuals or entities <br />Suppiernentai ID <br />Member Eii Ibil' <br />Required I Medical Covera Status Code <br />String <br />Current Benefits Status <br />Required Medical Cavern Effective Date <br />Date <br />Coverage EffecdvWStart Date <br />(jobonal I Medical Covera Termination Date <br />Date <br />Coverage Termination/End Date <br />Stull" COBRA COC Event_Date <br />91118001W- meua rnr F- n..re <br />Date <br />.._._ <br />COBRA continuation of coverage Event date <br />,,.. . __--•- -•- _ - <br />-2- 146 <br />