Retiree Response File Layouts

^Application ID

10

The RDS Application ID that was submitted in the retiree file correlating to this Retiree Response File.

^SSN

09

Social Security Number (SSN) that was submitted for this beneficiary. This field may be blank if a Medicare beneficiary identifier was provided.

^Medicare beneficiary identifier

12

Medicare beneficiary identifier that was submitted for this beneficiary.

This field may be blank if the SSN was provided.

May contain:

• Medicare Beneficiary Identifier (MBI) that was submitted for this beneficiary.
• Medicare Health Insurance Claim Number (HICN) that was submitted for this beneficiary.
• Railroad Retirement Board (RRB) number that was submitted for this beneficiary.

^First Name

30

First Name that was submitted for this beneficiary.

^Middle Initial

01

Optional field. Middle Initial that was submitted for this beneficiary.

^Last Name

40

Last Name that was submitted for this beneficiary.

^Date of Birth

08

Date of Birth that was submitted for this beneficiary. Format: CCYYMMDD

^Gender

01

Gender that was submitted for this beneficiary.
Value '0' = Gender Unknown
Value '1' = Male
Value '2' = Female

^Coverage Effective Date

08

The date that was submitted for this beneficiary's (retiree, spouse, or dependent) coverage to begin under the Plan Sponsor's prescription drug Benefit Option. Format: CCYYMMDD

^Coverage Termination Date

08

The date that was submitted for this beneficiary's (retiree, spouse, or dependent) coverage to end under the Plan Sponsor's prescription drug Benefit Option. Format: CCYYMMDD

^Unique Benefit Option Identifier

20

Unique Benefit Option Identifier (UBOI) (for example, Rx Group Number) corresponding to the benefit under which was submitted for this beneficiary for subsidy.

^Relationship to Retiree

02

Relationship to retiree that was submitted for this beneficiary.
Value '01' = Self
Value '02' = Spouse
Value '03' = Other

^Transaction Type

03

Transaction type that was submitted for this beneficiary.
Value 'ADD' = Add
Value 'UPD' = Update
Value 'DEL' = Delete

Determination Indicator

01

Value 'Y' = Yes, the retiree qualifies for all or some portion of the Subsidy Period for which you applied.
Value 'N' = No, the retiree does not qualify for subsidy for the entire period for which you applied.

Reason Code

02

The Reason Code provides a reason that this beneficiary was not approved or only partially approved for the subsidy for which you applied. For more information, refer to RDS Reason Codes.

Subsidy Period Effective Date

08

The effective date that the Subsidy Period for which this Qualifying Covered Retiree (QCR) has been approved.
For a description of how these dates are filled in combination with specific scenarios, refer to RDS Reason Codes.
Format: CCYYMMDD

Subsidy Period Termination Date

08

The termination date that the Subsidy Period for which this Qualifying Covered Retiree (QCR) has been approved.
For a description of how these dates are filled in combination with specific scenarios, refer to RDS Reason Codes.
Format: CCYYMMDD

Record Type

PIC X(01)

Value 'H' = Header Record

Application ID

PIC X(10)

The RDS Application ID that was submitted in the retiree file correlating to this Retiree Response File. 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

Record Type

PIC X(01)

Value 'D' = Detail Record

^SSN

PIC X(09)

Social Security Number (SSN) that was submitted for this beneficiary. This field may contain spaces if a Medicare beneficiary identifier was provided.

^Medicare beneficiary identifier

PIC X(12)

Medicare beneficiary identifier that was submitted for this beneficiary.

This field may be blank if the SSN was provided.

May contain:

• Medicare Beneficiary Identifier (MBI) that was submitted for this beneficiary.
• Medicare Health Insurance Claim Number (HICN) that was submitted for this beneficiary.
• Railroad Retirement Board (RRB) number that was submitted for this beneficiary.

^First Name

PIC X(30)

First Name that was submitted for this beneficiary.

Middle Initial

PIC X(01)

Optional field. Middle Initial that was submitted for this beneficiary.

^Last Name

PIC X(40)

Last Name that was submitted for this beneficiary.

^Date of Birth

PIC X(08)

Date of Birth that was submitted for this beneficiary. Format: CCYYMMDD

^Gender

PIC X(01)

Gender that was submitted for this beneficiary.
Value '0' = Gender Unknown
Value '1' = Male
Value '2' = Female

^Coverage Effective Date

PIC X(08)

The date that was submitted for this beneficiary's (retiree, spouse, or dependent) coverage to begin under the Plan Sponsor's Prescription Drug Benefit Option. Format: CCYYMMDD

^Coverage Termination Date

PIC X(08)

The date that was submitted for this beneficiary's (retiree, spouse, or dependent) coverage to end under the Plan Sponsor's Prescription Drug Benefit Option. 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 was submitted for this beneficiary for subsidy.

^Relationship to Retiree

PIC X(02)

Relationship to retiree that was submitted for this beneficiary.
Value '01' = Self
Value '02' = Spouse
Value '03' = Other

^Transaction Type

PIC X(03)

Transaction type that was submitted for this beneficiary.
Value 'ADD' = Add
Value 'UPD' = Update
Value 'DEL' = Delete

Determination Indicator

PIC X(01)

Value 'Y' = Yes, the retiree qualifies for all or some portion of the Subsidy Period for which you applied.
Value 'N ' = No, the retiree does not qualify for all or some portion of subsidy for which you applied.

Reason Code

PIC X(02)

The Reason Code provides a reason that this beneficiary was not approved or only partially approved for the subsidy for which you applied. For more information, refer to RDS Reason Codes.

Subsidy Period Effective Date

PIC X(08)

The effective date that the Subsidy Period for which this Qualifying Covered Retiree (QCR) has been approved.
For a description of how these dates are filled in combination with specific scenarios, refer to RDS Reason Codes.
Format: CCYYMMDD

Subsidy Period Termination Date

PIC X(08)

The termination date that the Subsidy Period for which this Qualifying Covered Retiree (QCR) has been approved.
For a description of how these dates are filled in combination with specific scenarios, refer to RDS Reason Codes.
Format: CCYYMMDD

Filler

PIC X(38)

Spaces

Record Type

PIC X(01)

Value 'T' = Trailer Record

Application ID

PIC X(10)

The RDS Application ID that was submitted in the retiree file correlating to this Retiree Response File. 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)

Includes leading zeroes as needed to completely fill field.

Filler

PIC X(168)

Spaces

01 (*) - RETIREE-LIST-HDR

(blank cell)

05 (*) - RECORD-TYPE

PIC X(01)

88 (*) - HEADER

VALUE 'H'

05 (*) - APPLICATION-ID

PIC X(10) 

05 (*) - TRANSMIT-DATE

PIC X(08)

05 (*) - TRANSMIT-TIME

PIC X(06)

05 (*) - RECORD-COUNT

PIC 9(07)

05 FILLER

PIC X(27)

01 (*) - RETIREE-ENTRY

(blank cell)

02 (*) - RETIREE-RECORD

(blank cell)

05 (*) - RECORD-TYPE

PIC X(01)

88 (*) - DETAIL

VALUE 'D'

05 (*) - BENE-SSN

PIC X(09)

05 (*) - BENE-MEDICARE-BENEFICIARY-IDENTIFIER

PIC X(12)

05 (*) - BENE-FIRST-NAME

PIC X(30)

05 (*) - BENE-INITIAL

PIC X(01)

05 (*) - BENE-LAST-NAME

PIC X(40)

05 (*) - BENE-BIRTH-DATE

PIC X(08)

05 (*) - BENE-SEX-CODE

PIC X(01)

88 (*) - SEX-UNKNOWN

VALUE '0'

88 (*) - MALE

VALUE '1'

88 (*) - FEMALE

VALUE '2'

05 (*) - COVG-EFF-DATE

PIC X(08)

05 (*) - COVG-TERM-DATE

PIC X(08)

05 (*) - RX-GROUP-NUMBER

PIC X(20)

05 (*) - BENE-RELATIONSHIP

PIC X(02)

88 (*) - SELF

VALUE '01'

88 (*) - SPOUSE

VALUE '02'

88 (*) - OTHER

VALUE '03'

05 (*) - RECORD-ACTION

PIC X(03)

88 (*) - ADD

VALUE 'ADD'

88 (*) - UPDATE

VALUE 'UPD'

88 (*) - DELETE

VALUE 'DEL'

02 (*) - RETIREE-RESPONSE.

(blank cell)

05 (*) - RDS-SUBSIDY-SW

PIC X(01)

05 (*) - RDS-DENIAL-CODE

PIC X(02)

05 (*) - RDS-EFF-DATE

PIC X(08)

05 (*) - RDS-TERM-DATE

PIC X(08)

05 FILLER

PIC X(143)

05 (*) - DCN

PIC X(15)

01 (*) - RETIREE-LIST-TRL

(blank cell)

05 (*) - RECORD-TYPE

PIC X(01)

88 (*) - TRAILER

VALUE 'T'

05 (*) - APPLICATION-ID

PIC X(10)

05 (*) - TRANSMIT-DATE

PIC X(08)

05 (*) - TRANSMIT-TIME

PIC X(06)

05 (*) - RECORD-COUNT

PIC 9(07)