Stedi X12 HIPAA ICHRA 834 Benefit Enrollment and Maintenance (X220A1) v0.5

ISA*00*          *00*          *ZZ*SENDER         *ZZ*RECEIVER       *240105*1802*^*00501*000001566*1*P*:~
GS*BE*SENDER*RECEIVER*20240105*1802*5757*X*005010X220A1~
ST*834*74592441*005010X220A1~
BGN*00*74592441*20240105*202953*ET***2~
DTP*950*D8*20240101~
N1*P5*John Doe*FI*000000001~
N1*IN*Insure Co*FI*111111111~
N1*BO*Thatch*94*111111111~
INS*Y*18*021*EC*A***AC~
REF*0F*0000068929~
DTP*356*D8*20240101~
NM1*IL*1*Doe*John**34*000000000~
PER*IP**TE*5017622641***EM*john.doe@gmail.com~
N3*106 Test Trail~
N4*Hot Springs*AR*71913~
DMG*D8*19930101*F*M~
NM1*36*1*ACME INC~
PER*EP**TE*5555555555***EM*abc@employer.com~
N3*123 Main Street~
N4*Hot Springs*AR*71913*~
AMT*93*1000~
INS*N*01*021*EC*A~
REF*0F*0000068929~
DTP*EDL*D8*20240101~
NM1*IL*1*Cynthia*Kristina****34*000000001~
N3*106 Test Trail~
N4*Hot Springs*AR*71913~
DMG*D8*19890101*M*~
SE*27*74592441~
GE*1*5757~
IEA*1*000001566~


Dependent_ICHRA_Sample

ISA*00*          *00*          *ZZ*SENDER         *ZZ*RECEIVER       *240104*1802*^*00501*000001566*1*P*:~
GS*BE*SENDER*RECEIVER*20240105*1802*000005757*X*005010X220A1~
ST*834*74592441*005010X220A1~
BGN*00*74592441*20240104*202953*ET***2~
N1*P5*John Doe*FI*000000001~
N1*IN*Insure Co*FI*111111111~
N1*BO*Thatch*94*111111111~
INS*Y*18*021*EC*A***AC~
REF*0F*0000068929~
DTP*356*D8*20240101~
NM1*IL*1*Doe*John**34*000000000~
PER*IP**TE*5017622641***EM*john.doe@gmail.com~
N3*106 Test Trail~
N4*Hot Springs*AR*719137123~
DMG*D8*19930101*F*M~
NM1*36*1*Acme Inc~
PER*EP**TE*5555555555***EM*abc@employer.com~
N3*123 Main Street~
N4*Hot Springs*AR*71913*~
AMT*93*1000~
SE*19*74592441~
GE*1*000005757~
IEA*1*000001566~


X12 834 Stedi X12 HIPAA ICHRA 834 Benefit Enrollment and Maintenance (X220A1) v0.5