Sample Health Care Inbound Message for Fully-Insured Group Customer Setup
Using the below example, you can do the following:
-
Create the parent customer and bill groups for a fully-insured group health insurance business
-
Create policies where the policy category is set to Fully-Insured Group
-
Create various medical and dental plans for active and retired employees in the fully-insured group policies
-
Associate a pricing rule type with the policy plans
| Person Name | Person Type | Account | Policy | Policy Plan | Pricing Rule Type |
|---|---|---|---|---|---|
| Antartica Petroleum Corp | Parent Customer | - | Active Employee Medical Health Insurance Policy | HMO Medical Bronze 60 AE | AGE_BASED |
| HMO Medical Silver 70 AE | AGE_BASED | ||||
| HMO Medical Gold 80 AE | AGE_BASED | ||||
| HMO Medical Platinum 90 AE | AGE_BASED | ||||
| PPO Medical Bronze 60 AE | AGE_BASED | ||||
| PPO Medical Silver 70 AE | AGE_BASED | ||||
| PPO Medical Gold 80 AE | AGE_BASED | ||||
| PPO Medical Platinum 90 AE | AGE_BASED | ||||
| Active Employee Dental Health Insurance Policy | DD BASIC PLAN AE | TIER_BASED | |||
| DD STANDARD PLAN AE | TIER_BASED | ||||
| Retiree Employee Health Insurance Policy | HMO Medical Bronze 60 RE | AGE_BASED | |||
| HMO Medical Silver 70 RE | AGE_BASED | ||||
| PPO Medical Bronze 60 RE | AGE_BASED | ||||
| PPO Medical Silver 70 RE | AGE_BASED | ||||
| DD BASIC RE | TIER_BASED | ||||
| Antartica Petroleum ACTIVE | Bill Group | CMS | - | - | - |
| CMR | |||||
| Antartica Petroleum COBRA | Bill Group | CMS | - | - | - |
| CMR | |||||
| Antartica Petroleum RETIREE | Bill Group | CMS | Employee Medicare Policy | APE Medicare Bronze RE MALE | AGE_BASED |
| CMR | APE Medicare Silver RE MALE | AGE_BASED | |||
| APE Medicare Gold RE MALE | AGE_BASED | ||||
| APE Medicare Bronze RE FEMALE | AGE_BASED | ||||
| APE Medicare Silver RE FEMALE | AGE_BASED | ||||
| APE Medicare Gold RE FEMALE | AGE_BASED |
| Bill Group | Source System | Parameter 1 | Parameter 2 | Parameter 3 | Parameter 4 |
|---|---|---|---|---|---|
| Antartica Petroleum ACTIVE | SMALLPRIME | ACTIVE | SEATTLE | MEDICAL | HMO |
| SMALLPRIME | ACTIVE | SEATTLE | MEDICAL | PPO | |
| SMALLPRIME | ACTIVE | SEATTLE | DENTAL | HMO | |
| SMALLPRIME | ACTIVE | SEATTLE | DENTAL | PPO | |
| SMALLPRIME | ACTIVE | SAN FRANCISCO | MEDICAL | HMO | |
| SMALLPRIME | ACTIVE | SAN FRANCISCO | MEDICAL | PPO | |
| SMALLPRIME | ACTIVE | SAN FRANCISCO | DENTAL | HMO | |
| SMALLPRIME | ACTIVE | SAN FRANCISCO | DENTAL | PPO | |
| SMALLPRIME | ACTIVE | LOS ANGELES | MEDICAL | HMO | |
| SMALLPRIME | ACTIVE | LOS ANGELES | MEDICAL | PPO | |
| SMALLPRIME | ACTIVE | LOS ANGELES | DENTAL | HMO | |
| SMALLPRIME | ACTIVE | LOS ANGELES | DENTAL | PPO | |
| Antartica Petroleum COBRA | SMALLPRIME | COBRA | SEATTLE | MEDICAL | HMO |
| SMALLPRIME | COBRA | SEATTLE | MEDICAL | PPO | |
| SMALLPRIME | COBRA | SEATTLE | DENTAL | HMO | |
| SMALLPRIME | COBRA | SEATTLE | DENTAL | PPO | |
| SMALLPRIME | COBRA | SAN FRANCISCO | MEDICAL | HMO | |
| SMALLPRIME | COBRA | SAN FRANCISCO | MEDICAL | PPO | |
| SMALLPRIME | COBRA | SAN FRANCISCO | DENTAL | HMO | |
| SMALLPRIME | COBRA | SAN FRANCISCO | DENTAL | PPO | |
| SMALLPRIME | COBRA | LOS ANGELES | MEDICAL | HMO | |
| SMALLPRIME | COBRA | LOS ANGELES | MEDICAL | PPO | |
| SMALLPRIME | COBRA | LOS ANGELES | DENTAL | HMO | |
| SMALLPRIME | COBRA | LOS ANGELES | DENTAL | PPO | |
| Antartica Petroleum RETIREE | SMALLPRIME | RETIRED | SEATTLE | MEDICAL | HMO |
| SMALLPRIME | RETIRED | SEATTLE | MEDICAL | PPO | |
| SMALLPRIME | RETIRED | SEATTLE | DENTAL | HMO | |
| SMALLPRIME | RETIRED | SEATTLE | DENTAL | PPO | |
| SMALLPRIME | RETIRED | SAN FRANCISCO | MEDICAL | HMO | |
| SMALLPRIME | RETIRED | SAN FRANCISCO | MEDICAL | PPO | |
| SMALLPRIME | RETIRED | SAN FRANCISCO | DENTAL | HMO | |
| SMALLPRIME | RETIRED | SAN FRANCISCO | DENTAL | PPO | |
| SMALLPRIME | RETIRED | LOS ANGELES | MEDICAL | HMO | |
| SMALLPRIME | RETIRED | LOS ANGELES | MEDICAL | PPO | |
| SMALLPRIME | RETIRED | LOS ANGELES | DENTAL | HMO | |
| SMALLPRIME | RETIRED | LOS ANGELES | DENTAL | PPO |
<schema>
<bo>C1-HCInboundMessage</bo>
<characteristics>
<inboundMessageCharacteristic>
<adhocCharacteristicValue></adhocCharacteristicValue>
<characteristicType>C1-EXTBTCT</characteristicType>
<effectiveDate>2019-01-01</effectiveDate>
<characteristicValue>DATAEXT1</characteristicValue>
<characteristicValueForeignKey1>
</characteristicValueForeignKey1>
<characteristicValueFK2></characteristicValueFK2>
<characteristicValueFK3></characteristicValueFK3>
<characteristicValueFk4></characteristicValueFk4>
<characteristicValueFK5></characteristicValueFK5>
</inboundMessageCharacteristic>
</characteristics>
<customerStructureMessage>
<headerData>
<messageType>
C1-HEALTHCARE-INB-MSG-TYPE
</messageType>
<sourceSystem>SMALLPRIME</sourceSystem>
<externalTransactionId>889977</externalTransactionId>
<externalBatchId>565656</externalBatchId>
<externalSourceId>656565</externalSourceId>
</headerData>
<customerStructureData>
<personData>
<sequence>1</sequence>
<personType>PG</personType>
<personName>
<sequence>1</sequence>
<entityName>Antartica Petroleum Corp</entityName>
<nameType>PRIM</nameType>
</personName>
<identifiers>
<idType>EIN</idType>
<idValue>98-7654329</idValue>
<isPrimary>Y</isPrimary>
</identifiers>
<division>HC</division>
<birthDate>1980-03-24</birthDate>
<sinceDate>2019-01-01</sinceDate>
<accessGroup></accessGroup>
<collectionClass></collectionClass>
<postponeCreditReviewUntil></postponeCreditReviewUntil>
<lastCreditReviewDate></lastCreditReviewDate>
<dragDays></dragDays>
<advanceDepositAmount></advanceDepositAmount>
<advanceDepositGraceDays></advanceDepositGraceDays>
<advanceDepositLevel></advanceDepositLevel>
<address>
<addressEffDate>2019-01-01</addressEffDate>
<addressType>MAIN</addressType>
<mailingName>
Antartica Petroleum Corp
</mailingName>
<address1>Saturn Park</address1>
<address2>Saturn Street</address2>
<address3>River Side</address3>
<address4></address4>
<city>San Franciso</city>
<state>CA</state>
<zip>94122</zip>
<country>USA</country>
<houseType></houseType>
<streetNumber1></streetNumber1>
<streetNumber2></streetNumber2>
<inCityLimit></inCityLimit>
<taxVendorGeographicalCode>
</taxVendorGeographicalCode>
<county></county>
<addressStatus></addressStatus>
</address>
<email>apc@example.com</email>
<overrideMailingName1>
Antartica Petroleum Corporation
</overrideMailingName1>
<overrideMailingName2>
</overrideMailingName2>
<overrideMailingName3>
</overrideMailingName3>
<phones>
<phoneType>BUSN</phoneType>
<phoneValue>415-555-0100</phoneValue>
</phones>
<relatedPersons>
<idType></idType>
<idValue></idValue>
<personRelationshipType>
</personRelationshipType>
<startDate></startDate>
<endDate></endDate>
<financialRelationshipSw>
</financialRelationshipSw>
<parentOrChild></parentOrChild>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
</relatedPersons>
<characteristics>
<characteristicsList>
<characteristicType>PER_CAT</characteristicType>
<characteristicValue>EMPOLYER</characteristicValue>
<effectiveDate>2019-01-01</effectiveDate>
</characteristicsList>
</characteristics>
<billLevelParameters>
<sequence></sequence>
<sourceSystem></sourceSystem>
<billLevelInfo1></billLevelInfo1>
<billLevelInfo2></billLevelInfo2>
<billLevelInfo3></billLevelInfo3>
<billLevelInfo4></billLevelInfo4>
<effectiveDate></effectiveDate>
</billLevelParameters>
<memberData>
<sequence>1<sequence>
<startDate></startDate>
<endDate></endDate>
<repriceAfterDate></repriceAfterDate>
<paidThroughDate></paidThroughDate>
<memberId></memberId>
<memberRelationship></memberRelationship>
<membershipPersonStatus>
</membershipPersonStatus>
<membershipPersonstatusReason>
</membershipPersonstatusReason>
<autoRenew></autoRenew>
<associatedMemberIdentifierType>
</associatedMemberIdentifierType>
<associatedMemberIdentifier>
</associatedMemberIdentifier>
<exchangeFlag></exchangeFlag>
<exchangeId></exchangeId>
<binderLiabilityAmount></binderLiabilityAmount>
<binderPayApplicability></binderPayApplicability>
<binderPayGraceDays></binderPayGraceDays>
<binderPayThreshold></binderPayThreshold>
<holdBilling></holdBilling>
<membershipRenewalDate></membershipRenewalDate>
<contractPeriod></contractPeriod>
<membershipIdentifier>
<membershipIdentifierType>
</membershipIdentifierType>
<membershipIdentifierValue>
</membershipIdentifierValue>
</membershipIdentifier>
<isMemberSw></isMemberSw>
<isFinanciallyResponsibleSw>
</isFinanciallyResponsibleSw>
<membershipType></membershipType>
<externalMedicareBeneficiaryId>
</externalMedicareBeneficiaryId>
<mainSubscriber>
<idType></idType>
<idValue></idValue>
<membershipType></membershipType>
</mainSubscriber>
<policyNumber></policyNumber>
<sourceSystem></sourceSystem>
<planNumber></planNumber>
<healthPlanCode></healthPlanCode>
<characteristics>
<characteristicsList>
<characteristicType>
</characteristicType>
<characteristicValue>
</characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
<membershipRateGuarantee>
<membershipRateGuaranteeList>
<rateGuaranteeStartDate></rateGuaranteeStartDate>
<rateGuaranteeEndDate></rateGuaranteeEndDate>
<rateGuaranteeStatus></rateGuaranteeStatus>
</membershipRateGuaranteeList>
</membershipRateGuarantee>
<membershipPersonCharacteristic>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</membershipPersonCharacteristic>
<benefitData>
<benefitDataList>
<sequence></sequence>
<startDate></startDate>
<endDate></endDate>
<benefitStatus></benefitStatus>
<benefitSourceFlag></benefitSourceFlag>
<benefitTypeFlag></benefitTypeFlag>
<benefitSubTypeFlag></benefitSubTypeFlag>
<planBenefitPackageId></planBenefitPackageId>
<benefitAmount></benefitAmount>
<characteristics>
<characteristicsList>
<characteristicType>
</characteristicType>
<characteristicValue>
</characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
</benefitDataList>
</benefitData>
<billableChargeData>
<sequence></sequence>
<accountIdType></accountIdType>
<accountIdValue></accountIdValue>
<chargeType></chargeType>
<startDate></startDate>
<endDate></endDate>
<priceItemCode></priceItemCode>
<description></description>
<recurringMethod></recurringMethod>
<billPeriod></billPeriod>
<frequency></frequency>
<billAfterDt></billAfterDt>
<billableChargeLines>
<descriptionOnBill></descriptionOnBill>
<currencyCode></currencyCode>
<chargeAmount></chargeAmount>
<showOnBillSw></showOnBillSw>
<appearInSummarySw></appearInSummarySw>
<distributionCode></distributionCode>
</billableChargeLines>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
</billableChargeData>
</memberData>
<accountData>
<accountType></accountType>
<customerClass></customerClass>
<billCycle></billCycle>
<billLeadDays></billLeadDays>
<division></division>
<dragDays></dragDays>
<currency></currency>
<setUpDate></setUpDate>
<acctUsageFlg></acctUsageFlg>
<comments></comments>
<deferAutoPayDt></deferAutoPayDt>
<collectionClass></collectionClass>
<billRouteType></billRouteType>
<billAddressSource></billAddressSource>
<accessGroup></accessGroup>
<skipAutoMaintenanceSw></skipAutoMaintenanceSw>
<identifiers>
<idType></idType>
<idValue></idValue>
<isPrimary></isPrimary>
</identifiers>
<address>
<addressEffDate></addressEffDate>
<addressType></addressType>
<address1></address1>
<address2></address2>
<address3></address3>
<address4></address4>
<city></city>
<state></state>
<zip></zip>
<country></country>
<houseType></houseType>
<streetNumber1></streetNumber1>
<streetNumber2></streetNumber2>
<inCityLimit></inCityLimit>
<taxVendorGeographicalCode>
</taxVendorGeographicalCode>
<county></county>
<addressStatus></addressStatus>
</address>
<autoPayDetails>
<priority></priority>
<startDate></startDate>
<endDate></endDate>
<percentage></percentage>
<autoPayMethod></autoPayMethod>
<autoPayRouteType></autoPayRouteType>
<autoPaySourceCode></autoPaySourceCode>
<accountNumber></accountNumber>
<expiryMonth></expiryMonth>
<expiryYear></expiryYear>
<name></name>
<maxWithdrawalAmount></maxWithdrawalAmount>
<comments></comments>
</autoPayDetails>
<accountPerson>
<idType></idType>
<idValue></idValue>
<accountRelationshipType>
</accountRelationshipType>
<isFinanciallyResponsible>
</isFinanciallyResponsible>
<personAddressOverride>
<address1></address1>
<address2></address2>
<address3></address3>
<address4></address4>
<city></city>
<state></state>
<country></country>
<houseType></houseType>
<streetNumber1></streetNumber1>
<streetNumber2></streetNumber2>
<inCityLimit></inCityLimit>
<taxVendorGeographicalCode>
</taxVendorGeographicalCode>
<county></county>
<zip></zip>
<addressStatus></addressStatus>
</personAddressOverride>
<accountPersonRouting>
<billRouteType></billRouteType>
<shouldReceiveCopyOfBill>
</shouldReceiveCopyOfBill>
<billFormat></billFormat>
<numberOfBillCopies></numberOfBillCopies>
<receivesNotification></receivesNotification>
<billAddressSource></billAddressSource>
</accountPersonRouting>
</accountPerson>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
</accountData>
<policyData>
<policyType>GROUP CUSTOMER</policyType>
<sourceSystem>SMALLPRIME</sourceSystem>
<policyNumber>AP234356</policyNumber>
<description>
Active Employee Medical Health Insurance Policy
</description>
<advancedLevelFundingEligibility>
</advancedLevelFundingEligibility>
<startDate>2019-01-01</startDate>
<endDate>2019-12-31</endDate>
<runOutEndDate></runOutEndDate>
<runOutAdminOption></runOutAdminOption>
<renewalDate></renewalDate>
<advanceDepositApplSW></advanceDepositApplSW>
<advanceDepositAmount></advanceDepositAmount>
<advanceDepositGraceDays>
</advanceDepositGraceDays>
<advanceDepositAccountIdentifierType>
</advanceDepositAccountIdentifierType>
<advanceDepositAccountIdentifierValue>
</advanceDepositAccountIdentifierValue>
<policyPersons>
<idType></idType>
<idValue></idValue>
<policyPerRole></policyPerRole>
<startDate></startDate>
<endDate></endDate>
</policyPersons>
<terminationInformation>
<terminateDate></terminateDate>
<terminationReason></terminationReason>
</terminationInformation>
<reinstateInformation>
<reinstatementDate></reinstatementDate>
<reinstateReason></reinstateReason>
</reinstateInformation>
<characteristics>
<characteristicsList>
<characteristicType>
C1PRBASE
</characteristicType>
<characteristicValue>Y</characteristicValue>
<effectiveDate>2019-01-01</effectiveDate>
</characteristicsList>
<characteristicsList>
<characteristicType>
C1STISSE
</characteristicType>
<characteristicValue>VG</characteristicValue>
<effectiveDate>2019-01-01</effectiveDate>
</characteristicsList>
</characteristics>
<planData>
<planNumber>HMO_MED_BRONZE</planNumber>
<priceItemCode></priceItemCode>
<planName>HMO Medical Bronze 60 AE</planName>
<pricingRuleTypeList>
<pricingRuleType>AGE_BASED</pricingRuleType>
</pricingRuleTypeList>
<startDate>2019-01-01</startDate>
<endDate>2019-12-31</endDate>
<primaryPlanSw>N</primaryPlanSw>
<benefitTypeFlag></benefitTypeFlag>
<characteristics>
<characteristicsList>
<characteristicType>
C1HPLNID
</characteristicType>
<characteristicValue>
010
</characteristicValue>
<effectiveDate>
2019-01-01
</effectiveDate>
</characteristicsList>
</characteristics>
<policyPlanProrationRuleList>
<effectiveDate></effectiveDate>
<prorationEventType></prorationEventType>
<prorationType></prorationType>
<numberOfDays></numberOfDays>
<membershipType></membershipType>
</policyPlanProrationRuleList>
</planData>
<planData>
<planNumber>HMO_MED_SILVER</planNumber>
<priceItemCode></priceItemCode>
<planName>HMO Medical Silver 70 AE</planName>
<pricingRuleTypeList>
<pricingRuleType>AGE_BASED</pricingRuleType>
</pricingRuleTypeList>
<startDate>2019-01-01</startDate>
<endDate>2019-12-31</endDate>
<primaryPlanSw>N</primaryPlanSw>
<characteristics>
<characteristicsList>
<characteristicType>
C1HPLNID
</characteristicType>
<characteristicValue>
020
</characteristicValue>
<effectiveDate>
2019-01-01
</effectiveDate>
</characteristicsList>
</characteristics>
<policyPlanProrationRuleList>
<effectiveDate></effectiveDate>
<prorationEventType></prorationEventType>
<prorationType></prorationType>
<numberOfDays></numberOfDays>
<membershipType></membershipType>
</policyPlanProrationRuleList>
</planData>
<planData>
<planNumber>HMO_MED_GOLD</planNumber>
<priceItemCode></priceItemCode>
<planName>HMO Medical Gold 80 AE</planName>
<pricingRuleTypeList>
<pricingRuleType>AGE_BASED</pricingRuleType>
</pricingRuleTypeList>
<startDate>2019-01-01</startDate>
<endDate>2019-12-31</endDate>
<primaryPlanSw>N</primaryPlanSw>
<characteristics>
<characteristicsList>
<characteristicType>
C1HPLNID
</characteristicType>
<characteristicValue>
030
</characteristicValue>
<effectiveDate>
2019-01-01
</effectiveDate>
</characteristicsList>
</characteristics>
<policyPlanProrationRuleList>
<effectiveDate></effectiveDate>
<prorationEventType></prorationEventType>
<prorationType></prorationType>
<numberOfDays></numberOfDays>
<membershipType></membershipType>
</policyPlanProrationRuleList>
</planData>
<planData>
<planNumber>HMO_MED_PLATINUM</planNumber>
<priceItemCode></priceItemCode>
<planName>HMO Medical Platinum 90 AE</planName>
<pricingRuleTypeList>
<pricingRuleType>AGE_BASED</pricingRuleType>
</pricingRuleTypeList>
<startDate>2019-01-01</startDate>
<endDate>2019-12-31</endDate>
<primaryPlanSw>N</primaryPlanSw>
<characteristics>
<characteristicsList>
<characteristicType>
C1HPLNID
</characteristicType>
<characteristicValue>
040
</characteristicValue>
<effectiveDate>
2019-01-01
</effectiveDate>
</characteristicsList>
</characteristics>
<policyPlanProrationRuleList>
<effectiveDate></effectiveDate>
<prorationEventType></prorationEventType>
<prorationType></prorationType>
<numberOfDays></numberOfDays>
<membershipType></membershipType>
</policyPlanProrationRuleList>
</planData>
<planData>
<planNumber>PPO_MED_BRONZE</planNumber>
<priceItemCode></priceItemCode>
<planName>PPO Medical Bronze 60 AE</planName>
<pricingRuleTypeList>
<pricingRuleType>AGE_BASED</pricingRuleType>
</pricingRuleTypeList>
<startDate>2019-01-01</startDate>
<endDate>2019-12-31</endDate>
<primaryPlanSw>N</primaryPlanSw>
<characteristics>
<characteristicsList>
<characteristicType>
C1HPLNID
</characteristicType>
<characteristicValue>
050
</characteristicValue>
<effectiveDate>2019-01-01</effectiveDate>
</characteristicsList>
</characteristics>
<policyPlanProrationRuleList>
<effectiveDate></effectiveDate>
<prorationEventType></prorationEventType>
<prorationType></prorationType>
<numberOfDays></numberOfDays>
<membershipType></membershipType>
</policyPlanProrationRuleList>
</planData>
<planData>
<planNumber>PPO_MED_SILVER</planNumber>
<priceItemCode></priceItemCode>
<planName>PPO Medical Silver 70 AE</planName>
<pricingRuleTypeList>
<pricingRuleType>AGE_BASED</pricingRuleType>
</pricingRuleTypeList>
<startDate>2019-01-01</startDate>
<endDate>2019-12-31</endDate>
<primaryPlanSw>N</primaryPlanSw>
<characteristics>
<characteristicsList>
<characteristicType>
C1HPLNID
</characteristicType>
<characteristicValue>
060
</characteristicValue>
<effectiveDate>
2019-01-01
</effectiveDate>
</characteristicsList>
</characteristics>
<policyPlanProrationRuleList>
<effectiveDate></effectiveDate>
<prorationEventType></prorationEventType>
<prorationType></prorationType>
<numberOfDays></numberOfDays>
<membershipType></membershipType>
</policyPlanProrationRuleList>
</planData>
<planData>
<planNumber>PPO_MED_GOLD</planNumber>
<priceItemCode></priceItemCode>
<planName>PPO Medical Gold 80 AE</planName>
<pricingRuleTypeList>
<pricingRuleType>AGE_BASED</pricingRuleType>
</pricingRuleTypeList>
<startDate>2019-01-01</startDate>
<endDate>2019-12-31</endDate>
<primaryPlanSw>N</primaryPlanSw>
<characteristics>
<characteristicsList>
<characteristicType>
C1HPLNID</characteristicType>
<characteristicValue>
070</characteristicValue>
<effectiveDate>
2019-01-01</effectiveDate>
</characteristicsList>
</characteristics>
<policyPlanProrationRuleList>
<effectiveDate></effectiveDate>
<prorationEventType></prorationEventType>
<prorationType></prorationType>
<numberOfDays></numberOfDays>
<membershipType></membershipType>
</policyPlanProrationRuleList>
</planData>
<planData>
<planNumber>PPO_MED_PLATINUM</planNumber>
<priceItemCode></priceItemCode>
<planName>PPO Medical Platinum 90 AE</planName>
<pricingRuleTypeList>
<pricingRuleType>AGE_BASED</pricingRuleType>
</pricingRuleTypeList>
<startDate>2019-01-01</startDate>
<endDate>2019-12-31</endDate>
<primaryPlanSw>N</primaryPlanSw>
<characteristics>
<characteristicsList>
<characteristicType>
C1HPLNID
</characteristicType>
<characteristicValue>
080
</characteristicValue>
<effectiveDate>
2019-01-01
</effectiveDate>
</characteristicsList>
</characteristics>
<policyPlanProrationRuleList>
<effectiveDate></effectiveDate>
<prorationEventType></prorationEventType>
<prorationType></prorationType>
<numberOfDays></numberOfDays>
<membershipType></membershipType>
</policyPlanProrationRuleList>
</planData>
</policyData>
<policyData>
<policyType>GROUP CUSTOMER</policyType>
<sourceSystem>SMALLPRIME</sourceSystem>
<policyNumber>AP234345</policyNumber>
<description>
Active Employee Dental Health Insurance Policy
</description>
<startDate>2019-01-01</startDate>
<endDate>2019-12-31</endDate>
<runOutEndDate></runOutEndDate>
<runOutAdminOption></runOutAdminOption>
<renewalDate></renewalDate>
<advanceDepositApplSW></advanceDepositApplSW>
<advanceDepositAmount></advanceDepositAmount>
<advanceDepositGraceDays></advanceDepositGraceDays>
<advanceDepositAccountIdentifierType>
</advanceDepositAccountIdentifierType>
<advanceDepositAccountIdentifierValue>
</advanceDepositAccountIdentifierValue>
<policyPersons>
<idType></idType>
<idValue></idValue>
<policyPerRole></policyPerRole>
<startDate></startDate>
<endDate></endDate>
</policyPersons>
<terminationInformation>
<terminateDate></terminateDate>
<terminationReason></terminationReason>
</terminationInformation>
<reinstateInformation>
<reinstatementDate></reinstatementDate>
<reinstateReason></reinstateReason>
</reinstateInformation>
<characteristics>
<characteristicsList>
<characteristicType>
C1PRBASE
</characteristicType>
<characteristicValue>
Y
</characteristicValue>
<effectiveDate>
2019-01-01
</effectiveDate>
</characteristicsList>
<characteristicsList>
<characteristicType>
C1STISSE
</characteristicType>
<characteristicValue>
VG
</characteristicValue>
<effectiveDate>
2019-01-01
</effectiveDate>
</characteristicsList>
<characteristicsList>
<characteristicType>
C1PRTNRL
</characteristicType>
<characteristicValue>
M
</characteristicValue>
<effectiveDate>
2019-01-01
</effectiveDate>
</characteristicsList>
</characteristics>
<planData>
<planNumber>DD_BASIC</planNumber>
<priceItemCode></priceItemCode>
<planName>DD BASIC PLAN AE</planName>
<pricingRuleTypeList>
<pricingRuleType>TIER_BASED</pricingRuleType>
</pricingRuleTypeList>
<startDate>2019-01-01</startDate>
<endDate>2019-12-31</endDate>
<primaryPlanSw>N</primaryPlanSw>
<characteristics>
<characteristicsList>
<characteristicType>
C1HPLNID
</characteristicType>
<characteristicValue>
090
</characteristicValue>
<effectiveDate>
2019-01-01
</effectiveDate>
</characteristicsList>
</characteristics>
<policyPlanProrationRuleList>
<effectiveDate></effectiveDate>
<prorationEventType></prorationEventType>
<prorationType></prorationType>
<numberOfDays></numberOfDays>
<membershipType></membershipType>
</policyPlanProrationRuleList>
</planData>
<planData>
<planNumber>DD_STD</planNumber>
<priceItemCode></priceItemCode>
<planName>DD STANDARD PLAN AE</planName>
<pricingRuleTypeList>
<pricingRuleType>TIER_BASED</pricingRuleType>
</pricingRuleTypeList>
<startDate>2019-01-01</startDate>
<endDate>2019-12-31</endDate>
<primaryPlanSw>N</primaryPlanSw>
<characteristics>
<characteristicsList>
<characteristicType>
C1HPLNID
</characteristicType>
<characteristicValue>
100
</characteristicValue>
<effectiveDate>
2019-01-01
</effectiveDate>
</characteristicsList>
</characteristics>
<policyPlanProrationRuleList>
<effectiveDate></effectiveDate>
<prorationEventType></prorationEventType>
<prorationType></prorationType>
<numberOfDays></numberOfDays>
<membershipType></membershipType>
</policyPlanProrationRuleList>
</planData>
</policyData>
<policyData>
<policyType>GROUP CUSTOMER</policyType>
<sourceSystem>SMALLPRIME</sourceSystem>
<policyNumber>AP234389</policyNumber>
<description>
Retiree Employee Health Insurance Policy
</description>
<advancedLevelFundingEligibility>
</advancedLevelFundingEligibility>
<startDate>2019-01-01</startDate>
<endDate>2019-12-31</endDate>
<runOutEndDate></runOutEndDate>
<runOutAdminOption></runOutAdminOption>
<renewalDate></renewalDate>
<advanceDepositApplSW></advanceDepositApplSW>
<advanceDepositAmount></advanceDepositAmount>
<advanceDepositGraceDays>
</advanceDepositGraceDays>
<advanceDepositAccountIdentifierType>
</advanceDepositAccountIdentifierType>
<advanceDepositAccountIdentifierValue>
</advanceDepositAccountIdentifierValue>
<policyPersons>
<idType></idType>
<idValue></idValue>
<policyPerRole></policyPerRole>
<startDate></startDate>
<endDate></endDate>
</policyPersons>
<terminationInformation>
<terminateDate></terminateDate>
<terminationReason></terminationReason>
</terminationInformation>
<reinstateInformation>
<reinstatementDate></reinstatementDate>
<reinstateReason></reinstateReason>
</reinstateInformation>
<characteristics>
<characteristicsList>
<characteristicType>
C1PRBASE
</characteristicType>
<characteristicValue>
Y
</characteristicValue>
<effectiveDate>
2019-01-01
</effectiveDate>
</characteristicsList>
<characteristicsList>
<characteristicType>
C1STISSE
</characteristicType>
<characteristicValue>
VG
</characteristicValue>
<effectiveDate>
2019-01-01
</effectiveDate>
</characteristicsList>
</characteristics>
<planData>
<planNumber>HMO_MED_BRONZE_RETIRED</planNumber>
<priceItemCode></priceItemCode>
<planName>HMO Medical Bronze 60 RE</planName>
<pricingRuleTypeList>
<pricingRuleType>AGE_BASED</pricingRuleType>
</pricingRuleTypeList>
<startDate>2019-01-01</startDate>
<endDate>2019-12-31</endDate>
<primaryPlanSw>N</primaryPlanSw>
<characteristics>
<characteristicsList>
<characteristicType>
C1HPLNID
</characteristicType>
<characteristicValue>
120
</characteristicValue>
<effectiveDate>
2019-01-01
</effectiveDate>
</characteristicsList>
</characteristics>
<policyPlanProrationRuleList>
<effectiveDate></effectiveDate>
<prorationEventType></prorationEventType>
<prorationType></prorationType>
<numberOfDays></numberOfDays>
<membershipType></membershipType>
</policyPlanProrationRuleList>
</planData>
<planData>
<planNumber>HMO_MED_SILVER_RETIRED</planNumber>
<priceItemCode></priceItemCode>
<planName>HMO Medical Silver 70 RE</planName>
<pricingRuleTypeList>
<pricingRuleType>AGE_BASED</pricingRuleType>
</pricingRuleTypeList>
<startDate>2019-01-01</startDate>
<endDate>2019-12-31</endDate>
<primaryPlanSw>N</primaryPlanSw>
<characteristics>
<characteristicsList>
<characteristicType>
C1HPLNID
</characteristicType>
<characteristicValue>
140
</characteristicValue>
<effectiveDate>
2019-01-01
</effectiveDate>
</characteristicsList>
</characteristics>
<policyPlanProrationRuleList>
<effectiveDate></effectiveDate>
<prorationEventType></prorationEventType>
<prorationType></prorationType>
<numberOfDays></numberOfDays>
<membershipType></membershipType>
</policyPlanProrationRuleList>
</planData>
<planData>
<planNumber>PPO_MED_BRONZE_RETIRED</planNumber>
<priceItemCode></priceItemCode>
<planName>PPO Medical Bronze 60 RE</planName>
<pricingRuleTypeList>
<pricingRuleType>AGE_BASED</pricingRuleType>
</pricingRuleTypeList>
<startDate>2019-01-01</startDate>
<endDate>2019-12-31</endDate>
<primaryPlanSw>N</primaryPlanSw>
<characteristics>
<characteristicsList>
<characteristicType>
C1HPLNID
</characteristicType>
<characteristicValue>
160
</characteristicValue>
<effectiveDate>
2019-01-01
</effectiveDate>
</characteristicsList>
</characteristics>
<policyPlanProrationRuleList>
<effectiveDate></effectiveDate>
<prorationEventType></prorationEventType>
<prorationType></prorationType>
<numberOfDays></numberOfDays>
<membershipType></membershipType>
</policyPlanProrationRuleList>
</planData>
<planData>
<planNumber>PPO_MED_SILVER_RETIRED</planNumber>
<priceItemCode></priceItemCode>
<planName>PPO Medical Silver 70 RE</planName>
<pricingRuleTypeList>
<pricingRuleType>AGE_BASED</pricingRuleType>
</pricingRuleTypeList>
<startDate>2019-01-01</startDate>
<endDate>2019-12-31</endDate>
<primaryPlanSw>N</primaryPlanSw>
<characteristics>
<characteristicsList>
<characteristicType>
C1HPLNID
</characteristicType>
<characteristicValue>
180
</characteristicValue>
<effectiveDate>
2019-01-01
</effectiveDate>
</characteristicsList>
</characteristics>
<policyPlanProrationRuleList>
<effectiveDate></effectiveDate>
<prorationEventType></prorationEventType>
<prorationType></prorationType>
<numberOfDays></numberOfDays>
<membershipType></membershipType>
</policyPlanProrationRuleList>
</planData>
<planData>
<planNumber>DD_BASIC_RETIRED</planNumber>
<priceItemCode></priceItemCode>
<planName>DD BASIC RE</planName>
<pricingRuleTypeList>
<pricingRuleType>TIER_BASED</pricingRuleType>
</pricingRuleTypeList>
<startDate>2019-01-01</startDate>
<endDate>2019-12-31</endDate>
<primaryPlanSw>N</primaryPlanSw>
<characteristics>
<characteristicsList>
<characteristicType>
C1HPLNID
</characteristicType>
<characteristicValue>
200
</characteristicValue>
<effectiveDate>
2019-01-01
</effectiveDate>
</characteristicsList>
</characteristics>
<policyPlanProrationRuleList>
<effectiveDate></effectiveDate>
<prorationEventType></prorationEventType>
<prorationType></prorationType>
<numberOfDays></numberOfDays>
<membershipType></membershipType>
</policyPlanProrationRuleList>
</planData>
</policyData>
</personData>
<personData>
<sequence>2</sequence>
<personType>BG</personType>
<personName>
<sequence>1</sequence>
<entityName>Antartica Petroleum ACTIVE</entityName>
<nameType>PRIM</nameType>
</personName>
<identifiers>
<idType>EIN</idType>
<idValue>98-7654320</idValue>
<isPrimary>Y</isPrimary>
</identifiers>
<division>HC</division>
<birthDate>1991-05-09</birthDate>
<sinceDate>2019-01-01</sinceDate>
<accessGroup></accessGroup>
<collectionClass></collectionClass>
<postponeCreditReviewUntil></postponeCreditReviewUntil>
<lastCreditReviewDate></lastCreditReviewDate>
<dragDays></dragDays>
<advanceDepositAmount></advanceDepositAmount>
<advanceDepositGraceDays></advanceDepositGraceDays>
<advanceDepositLevel></advanceDepositLevel>
<address>
<addressEffDate>2019-01-01</addressEffDate>
<addressType>MAIN</addressType>
<mailingName>
Antartica Petroleum ACTIVE
</mailingName>
<address1>Mars Park</address1>
<address2>Mars Street</address2>
<address3>Lake Side</address3>
<address4></address4>
<city>Los Angeles</city>
<state>CA</state>
<zip>90020</zip>
<country>USA</country>
<houseType></houseType>
<streetNumber1></streetNumber1>
<streetNumber2></streetNumber2>
<inCityLimit></inCityLimit>
<taxVendorGeographicalCode>
</taxVendorGeographicalCode>
<county></county>
<addressStatus></addressStatus>
</address>
<email>apcac@example.com</email>
<overrideMailingName1></overrideMailingName1>
<overrideMailingName2></overrideMailingName2>
<overrideMailingName3></overrideMailingName3>
<phones>
<phoneType>BUSN</phoneType>
<phoneValue>661-555-0111</phoneValue>
</phones>
<relatedPersons>
<idType>EIN</idType>
<idValue>98-7654329</idValue>
<personRelationshipType>
</personRelationshipType>
<startDate>2019-01-01</startDate>
<endDate>2019-12-31</endDate>
<financialRelationshipSw>
FALSE
</financialRelationshipSw>
<parentOrChild>P</parentOrChild>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
</relatedPersons>
<characteristics>
<characteristicsList>
<characteristicValue>OTHER</characteristicValue>
<characteristicType>PER_CAT</characteristicType>
<effectiveDate>2019-01-01</effectiveDate>
</characteristicsList>
</characteristics>
<billLevelParameters>
<sequence>1</sequence>
<sourceSystem>SMALLPRIME</sourceSystem>
<billLevelInfo1>ACTIVE</billLevelInfo1>
<billLevelInfo2>SEATTLE</billLevelInfo2>
<billLevelInfo3>MEDICAL</billLevelInfo3>
<billLevelInfo4>HMO</billLevelInfo4>
<effectiveDate>2019-01-01</effectiveDate>
</billLevelParameters>
<billLevelParameters>
<sequence>2</sequence>
<sourceSystem>SMALLPRIME</sourceSystem>
<billLevelInfo1>ACTIVE</billLevelInfo1>
<billLevelInfo2>SEATTLE</billLevelInfo2>
<billLevelInfo3>MEDICAL</billLevelInfo3>
<billLevelInfo4>PPO</billLevelInfo4>
<effectiveDate>2019-01-01</effectiveDate>
</billLevelParameters>
<billLevelParameters>
<sequence>3</sequence>
<sourceSystem>SMALLPRIME</sourceSystem>
<billLevelInfo1>ACTIVE</billLevelInfo1>
<billLevelInfo2>SEATTLE</billLevelInfo2>
<billLevelInfo3>DENTAL</billLevelInfo3>
<billLevelInfo4>HMO</billLevelInfo4>
<effectiveDate>2019-01-01</effectiveDate>
</billLevelParameters>
<billLevelParameters>
<sequence>4</sequence>
<sourceSystem>SMALLPRIME</sourceSystem>
<billLevelInfo1>ACTIVE</billLevelInfo1>
<billLevelInfo2>SEATTLE</billLevelInfo2>
<billLevelInfo3>DENTAL</billLevelInfo3>
<billLevelInfo4>PPO</billLevelInfo4>
<effectiveDate>2019-01-01</effectiveDate>
</billLevelParameters>
<billLevelParameters>
<sequence>5</sequence>
<sourceSystem>SMALLPRIME</sourceSystem>
<billLevelInfo1>ACTIVE</billLevelInfo1>
<billLevelInfo2>SAN FRANCISCO</billLevelInfo2>
<billLevelInfo3>MEDICAL</billLevelInfo3>
<billLevelInfo4>HMO</billLevelInfo4>
<effectiveDate>2019-01-01</effectiveDate>
</billLevelParameters>
<billLevelParameters>
<sequence>6</sequence>
<sourceSystem>SMALLPRIME</sourceSystem>
<billLevelInfo1>ACTIVE</billLevelInfo1>
<billLevelInfo2>SAN FRANCISCO</billLevelInfo2>
<billLevelInfo3>MEDICAL</billLevelInfo3>
<billLevelInfo4>PPO</billLevelInfo4>
<effectiveDate>2019-01-01</effectiveDate>
</billLevelParameters>
<billLevelParameters>
<sequence>7</sequence>
<sourceSystem>SMALLPRIME</sourceSystem>
<billLevelInfo1>ACTIVE</billLevelInfo1>
<billLevelInfo2>SAN FRANCISCO</billLevelInfo2>
<billLevelInfo3>DENTAL</billLevelInfo3>
<billLevelInfo4>HMO</billLevelInfo4>
<effectiveDate>2019-01-01</effectiveDate>
</billLevelParameters>
<billLevelParameters>
<sequence>8</sequence>
<sourceSystem>SMALLPRIME</sourceSystem>
<billLevelInfo1>ACTIVE</billLevelInfo1>
<billLevelInfo2>SAN FRANCISCO</billLevelInfo2>
<billLevelInfo3>DENTAL</billLevelInfo3>
<billLevelInfo4>PPO</billLevelInfo4>
<effectiveDate>2019-01-01</effectiveDate>
</billLevelParameters>
<billLevelParameters>
<sequence>9</sequence>
<sourceSystem>SMALLPRIME</sourceSystem>
<billLevelInfo1>ACTIVE</billLevelInfo1>
<billLevelInfo2>LOS ANGELES</billLevelInfo2>
<billLevelInfo3>MEDICAL</billLevelInfo3>
<billLevelInfo4>HMO</billLevelInfo4>
<effectiveDate>2019-01-01</effectiveDate>
</billLevelParameters>
<billLevelParameters>
<sequence>10</sequence>
<sourceSystem>SMALLPRIME</sourceSystem>
<billLevelInfo1>ACTIVE</billLevelInfo1>
<billLevelInfo2>LOS ANGELES</billLevelInfo2>
<billLevelInfo3>MEDICAL</billLevelInfo3>
<billLevelInfo4>PPO</billLevelInfo4>
<effectiveDate>2019-01-01</effectiveDate>
</billLevelParameters>
<billLevelParameters>
<sequence>11</sequence>
<sourceSystem>SMALLPRIME</sourceSystem>
<billLevelInfo1>ACTIVE</billLevelInfo1>
<billLevelInfo2>LOS ANGELES</billLevelInfo2>
<billLevelInfo3>DENTAL</billLevelInfo3>
<billLevelInfo4>HMO</billLevelInfo4>
<effectiveDate>2019-01-01</effectiveDate>
</billLevelParameters>
<billLevelParameters>
<sequence>12</sequence>
<sourceSystem>SMALLPRIME</sourceSystem>
<billLevelInfo1>ACTIVE</billLevelInfo1>
<billLevelInfo2>LOS ANGELES</billLevelInfo2>
<billLevelInfo3>DENTAL</billLevelInfo3>
<billLevelInfo4>PPO</billLevelInfo4>
<effectiveDate>2019-01-01</effectiveDate>
</billLevelParameters>
<memberData>
<sequence>2</sequence>
<startDate></startDate>
<endDate></endDate>
<repriceAfterDate></repriceAfterDate>
<paidThroughDate></paidThroughDate>
<memberId></memberId>
<memberRelationship></memberRelationship>
<membershipPersonStatus></membershipPersonStatus>
<membershipPersonstatusReason>
</membershipPersonstatusReason>
<autoRenew></autoRenew>
<associatedMemberIdentifierType>
</associatedMemberIdentifierType>
<associatedMemberIdentifier>
</associatedMemberIdentifier>
<exchangeFlag></exchangeFlag>
<exchangeId></exchangeId>
<binderLiabilityAmount></binderLiabilityAmount>
<binderPayApplicability></binderPayApplicability>
<binderPayGraceDays></binderPayGraceDays>
<binderPayThreshold></binderPayThreshold>
<holdBilling></holdBilling>
<membershipRenewalDate></membershipRenewalDate>
<contractPeriod></contractPeriod>
<membershipIdentifier>
<membershipIdentifierType>
</membershipIdentifierType>
<membershipIdentifierValue>
</membershipIdentifierValue>
</membershipIdentifier>
<isMemberSw></isMemberSw>
<isFinanciallyResponsibleSw>
</isFinanciallyResponsibleSw>
<membershipType></membershipType>
<externalMedicareBeneficiaryId>
</externalMedicareBeneficiaryId>
<mainSubscriber>
<idType></idType>
<idValue></idValue>
<membershipType></membershipType>
</mainSubscriber>
<policyNumber></policyNumber>
<sourceSystem></sourceSystem>
<planNumber></planNumber>
<healthPlanCode></healthPlanCode>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
<membershipRateGuarantee>
<membershipRateGuaranteeList>
<rateGuaranteeStartDate></rateGuaranteeStartDate>
<rateGuaranteeEndDate></rateGuaranteeEndDate>
<rateGuaranteeStatus></rateGuaranteeStatus>
</membershipRateGuaranteeList>
</membershipRateGuarantee>
<membershipPersonCharacteristic>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</membershipPersonCharacteristic>
<benefitData>
<benefitDataList>
<sequence></sequence>
<startDate></startDate>
<endDate></endDate>
<benefitStatus></benefitStatus>
<benefitSourceFlag></benefitSourceFlag>
<benefitTypeFlag></benefitTypeFlag>
<benefitSubTypeFlag></benefitSubTypeFlag>
<planBenefitPackageId></planBenefitPackageId>
<benefitAmount></benefitAmount>
<characteristics>
<characteristicsList>
<characteristicType>
</characteristicType>
<characteristicValue>
</characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
</benefitDataList>
</benefitData>
<billableChargeData>
<sequence></sequence>
<accountIdType></accountIdType>
<accountIdValue></accountIdValue>
<chargeType></chargeType>
<startDate></startDate>
<endDate></endDate>
<priceItemCode></priceItemCode>
<description></description>
<recurringMethod></recurringMethod>
<billPeriod></billPeriod>
<frequency></frequency>
<billAfterDt></billAfterDt>
<billableChargeLines>
<descriptionOnBill></descriptionOnBill>
<currencyCode></currencyCode>
<chargeAmount></chargeAmount>
<showOnBillSw></showOnBillSw>
<appearInSummarySw></appearInSummarySw>
<distributionCode></distributionCode>
</billableChargeLines>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
</billableChargeData>
</memberData>
<accountData>
<accountType>CMS</accountType>
<customerClass>HC</customerClass>
<billCycle>BK01</billCycle>
<billLeadDays>10</billLeadDays>
<division>HC</division>
<currency>USD</currency>
<setUpDate>2019-01-01</setUpDate>
<acctUsageFlg>USAG</acctUsageFlg>
<comments></comments>
<deferAutoPayDt></deferAutoPayDt>
<collectionClass></collectionClass>
<billRouteType>POSTAL</billRouteType>
<billAddressSource>PER</billAddressSource>
<accessGroup></accessGroup>
<skipAutoMaintenanceSw></skipAutoMaintenanceSw>
<identifiers>
<idType>ACCT_NM</idType>
<idValue>Medical Account</idValue>
<isPrimary>true</isPrimary>
</identifiers>
<address>
<addressEffDate>2019-01-01</addressEffDate>
<addressType></addressType>
<address1></address1>
<address2>Fresno</address2>
<address3></address3>
<address4></address4>
<city></city>
<state></state>
<zip></zip>
<country></country>
<houseType></houseType>
<streetNumber1></streetNumber1>
<streetNumber2></streetNumber2>
<inCityLimit></inCityLimit>
<taxVendorGeographicalCode>
</taxVendorGeographicalCode>
<county></county>
<addressStatus></addressStatus>
</address>
</accountData>
<accountData>
<accountType>CMR</accountType>
<customerClass>HC</customerClass>
<billCycle>BK02</billCycle>
<billLeadDays>10</billLeadDays>
<division>HC</division>
<currency>USD</currency>
<setUpDate>2019-01-01</setUpDate>
<acctUsageFlg>USAG</acctUsageFlg>
<comments></comments>
<deferAutoPayDt></deferAutoPayDt>
<collectionClass></collectionClass>
<billRouteType>POSTAL</billRouteType>
<billAddressSource>ACOV</billAddressSource>
<accessGroup></accessGroup>
<skipAutoMaintenanceSw></skipAutoMaintenanceSw>
<identifiers>
<idType>ACCT_NM</idType>
<idValue>Dental Account</idValue>
<isPrimary>true</isPrimary>
</identifiers>
<address>
<addressEffDate>2019-01-01</addressEffDate>
<addressType>OVRD</addressType>
<address1>Jupiter Park</address1>
<address2>Jupiter Street</address2>
<address3>Near Corporation Bank</address3>
<address4></address4>
<city>Los Angeles</city>
<state>CA</state>
<zip>90020</zip>
<country>USA</country>
<houseType></houseType>
<streetNumber1></streetNumber1>
<streetNumber2></streetNumber2>
<inCityLimit></inCityLimit>
<taxVendorGeographicalCode>
</taxVendorGeographicalCode>
<county></county>
<addressStatus></addressStatus>
</address>
</accountData>
<policyData>
<policyType></policyType>
<sourceSystem></sourceSystem>
<policyNumber></policyNumber>
<description></description>
<advancedLevelFundingEligibility>
</advancedLevelFundingEligibility>
<startDate></startDate>
<endDate></endDate>
<runOutEndDate></runOutEndDate>
<runOutAdminOption></runOutAdminOption>
<renewalDate></renewalDate>
<advanceDepositApplSW></advanceDepositApplSW>
<advanceDepositAmount></advanceDepositAmount>
<advanceDepositGraceDays></advanceDepositGraceDays>
<advanceDepositAccountIdentifierType>
</advanceDepositAccountIdentifierType>
<advanceDepositAccountIdentifierValue>
</advanceDepositAccountIdentifierValue>
<policyPersons>
<idType></idType>
<idValue></idValue>
<policyPerRole></policyPerRole>
<startDate></startDate>
<endDate></endDate>
</policyPersons>
<terminationInformation>
<terminateDate></terminateDate>
<terminationReason></terminationReason>
</terminationInformation>
<reinstateInformation>
<reinstatementDate></reinstatementDate>
<reinstateReason></reinstateReason>
</reinstateInformation>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
<planData>
<planNumber></planNumber>
<priceItemCode></priceItemCode>
<planName></planName>
<pricingRuleTypeList>
<pricingRuleType></pricingRuleType>
</pricingRuleTypeList>
<startDate></startDate>
<endDate></endDate>
<primaryPlanSw></primaryPlanSw>
<benefitTypeFlag></benefitTypeFlag>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
<policyPlanProrationRuleList>
<effectiveDate></effectiveDate>
<prorationEventType></prorationEventType>
<prorationType></prorationType>
<numberOfDays></numberOfDays>
<membershipType></membershipType>
</policyPlanProrationRuleList>
</planData>
</policyData>
</personData>
<personData>
<sequence>3</sequence>
<personType>BG</personType>
<personName>
<sequence>1</sequence>
<entityName>Antartica Petroleum COBRA</entityName>
<nameType>PRIM</nameType>
</personName>
<identifiers>
<idType>EIN</idType>
<idValue>98-7654321</idValue>
<isPrimary>Y</isPrimary>
</identifiers>
<division>HC</division>
<birthDate>1976-01-12</birthDate>
<sinceDate>2019-01-01</sinceDate>
<accessGroup></accessGroup>
<collectionClass></collectionClass>
<postponeCreditReviewUntil></postponeCreditReviewUntil>
<lastCreditReviewDate></lastCreditReviewDate>
<dragDays></dragDays>
<advanceDepositAmount></advanceDepositAmount>
<advanceDepositGraceDays></advanceDepositGraceDays>
<advanceDepositLevel></advanceDepositLevel>
<address>
<addressEffDate>2019-01-01</addressEffDate>
<addressType>MAIN</addressType>
<mailingName>Antartica Petroleum COBRA</mailingName>
<address1>Venus Park</address1>
<address2>Venus Street</address2>
<address3>Lake Side</address3>
<address4></address4>
<city>Los Angeles</city>
<state>CA</state>
<zip>90020</zip>
<country>USA</country>
<houseType></houseType>
<streetNumber1></streetNumber1>
<streetNumber2></streetNumber2>
<inCityLimit></inCityLimit>
<taxVendorGeographicalCode>
</taxVendorGeographicalCode>
<county></county>
<addressStatus></addressStatus>
</address>
<email>apcco@example.com</email>
<overrideMailingName1></overrideMailingName1>
<overrideMailingName2></overrideMailingName2>
<overrideMailingName3></overrideMailingName3>
<phones>
<phoneType>BUSN</phoneType>
<phoneValue>213-555-0175</phoneValue>
</phones>
<relatedPersons>
<idType>EIN</idType>
<idValue>98-7654329</idValue>
<personRelationshipType></personRelationshipType>
<startDate>2019-01-01</startDate>
<endDate>2019-12-31</endDate>
<financialRelationshipSw>
false
</financialRelationshipSw>
<parentOrChild>P</parentOrChild>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
</relatedPersons>
<characteristics>
<characteristicsList>
<characteristicType>PER_CAT</characteristicType>
<characteristicValue>OTHER</characteristicValue>
<effectiveDate>2019-01-01</effectiveDate>
</characteristicsList>
</characteristics>
<billLevelParameters>
<sequence>13</sequence>
<sourceSystem>SMALLPRIME</sourceSystem>
<billLevelInfo1>COBRA</billLevelInfo1>
<billLevelInfo2>SEATTLE</billLevelInfo2>
<billLevelInfo3>MEDICAL</billLevelInfo3>
<billLevelInfo4>HMO</billLevelInfo4>
<effectiveDate>2019-01-01</effectiveDate>
</billLevelParameters>
<billLevelParameters>
<sequence>14</sequence>
<sourceSystem>SMALLPRIME</sourceSystem>
<billLevelInfo1>COBRA</billLevelInfo1>
<billLevelInfo2>SEATTLE</billLevelInfo2>
<billLevelInfo3>MEDICAL</billLevelInfo3>
<billLevelInfo4>PPO</billLevelInfo4>
<effectiveDate>2019-01-01</effectiveDate>
</billLevelParameters>
<billLevelParameters>
<sequence>15</sequence>
<sourceSystem>SMALLPRIME</sourceSystem>
<billLevelInfo1>COBRA</billLevelInfo1>
<billLevelInfo2>SEATTLE</billLevelInfo2>
<billLevelInfo3>DENTAL</billLevelInfo3>
<billLevelInfo4>HMO</billLevelInfo4>
<effectiveDate>2019-01-01</effectiveDate>
</billLevelParameters>
<billLevelParameters>
<sequence>16</sequence>
<sourceSystem>SMALLPRIME</sourceSystem>
<billLevelInfo1>COBRA</billLevelInfo1>
<billLevelInfo2>SEATTLE</billLevelInfo2>
<billLevelInfo3>DENTAL</billLevelInfo3>
<billLevelInfo4>PPO</billLevelInfo4>
<effectiveDate>2019-01-01</effectiveDate>
</billLevelParameters>
<billLevelParameters>
<sequence>17</sequence>
<sourceSystem>SMALLPRIME</sourceSystem>
<billLevelInfo1>COBRA</billLevelInfo1>
<billLevelInfo2>SAN FRANCISCO</billLevelInfo2>
<billLevelInfo3>MEDICAL</billLevelInfo3>
<billLevelInfo4>HMO</billLevelInfo4>
<effectiveDate>2019-01-01</effectiveDate>
</billLevelParameters>
<billLevelParameters>
<sequence>18</sequence>
<sourceSystem>SMALLPRIME</sourceSystem>
<billLevelInfo1>COBRA</billLevelInfo1>
<billLevelInfo2>SAN FRANCISCO</billLevelInfo2>
<billLevelInfo3>MEDICAL</billLevelInfo3>
<billLevelInfo4>PPO</billLevelInfo4>
<effectiveDate>2019-01-01</effectiveDate>
</billLevelParameters>
<billLevelParameters>
<sequence>19</sequence>
<sourceSystem>SMALLPRIME</sourceSystem>
<billLevelInfo1>COBRA</billLevelInfo1>
<billLevelInfo2>SAN FRANCISCO</billLevelInfo2>
<billLevelInfo3>DENTAL</billLevelInfo3>
<billLevelInfo4>HMO</billLevelInfo4>
<effectiveDate>2019-01-01</effectiveDate>
</billLevelParameters>
<billLevelParameters>
<sequence>20</sequence>
<sourceSystem>SMALLPRIME</sourceSystem>
<billLevelInfo1>COBRA</billLevelInfo1>
<billLevelInfo2>SAN FRANCISCO</billLevelInfo2>
<billLevelInfo3>DENTAL</billLevelInfo3>
<billLevelInfo4>PPO</billLevelInfo4>
<effectiveDate>2019-01-01</effectiveDate>
</billLevelParameters>
<billLevelParameters>
<sequence>21</sequence>
<sourceSystem>SMALLPRIME</sourceSystem>
<billLevelInfo1>COBRA</billLevelInfo1>
<billLevelInfo2>LOS ANGELES</billLevelInfo2>
<billLevelInfo3>MEDICAL</billLevelInfo3>
<billLevelInfo4>HMO</billLevelInfo4>
<effectiveDate>2019-01-01</effectiveDate>
</billLevelParameters>
<billLevelParameters>
<sequence>22</sequence>
<sourceSystem>SMALLPRIME</sourceSystem>
<billLevelInfo1>COBRA</billLevelInfo1>
<billLevelInfo2>LOS ANGELES</billLevelInfo2>
<billLevelInfo3>MEDICAL</billLevelInfo3>
<billLevelInfo4>PPO</billLevelInfo4>
<effectiveDate>2019-01-01</effectiveDate>
</billLevelParameters>
<billLevelParameters>
<sequence>23</sequence>
<sourceSystem>SMALLPRIME</sourceSystem>
<billLevelInfo1>COBRA</billLevelInfo1>
<billLevelInfo2>LOS ANGELES</billLevelInfo2>
<billLevelInfo3>DENTAL</billLevelInfo3>
<billLevelInfo4>HMO</billLevelInfo4>
<effectiveDate>2019-01-01</effectiveDate>
</billLevelParameters>
<billLevelParameters>
<sequence>24</sequence>
<sourceSystem>SMALLPRIME</sourceSystem>
<billLevelInfo1>COBRA</billLevelInfo1>
<billLevelInfo2>LOS ANGELES</billLevelInfo2>
<billLevelInfo3>DENTAL</billLevelInfo3>
<billLevelInfo4>PPO</billLevelInfo4>
<effectiveDate>2019-01-01</effectiveDate>
</billLevelParameters>
<memberData>
<sequence>3</sequence>
<startDate></startDate>
<endDate></endDate>
<repriceAfterDate></repriceAfterDate>
<paidThroughDate></paidThroughDate>
<memberId></memberId>
<memberRelationship></memberRelationship>
<membershipPersonStatus>
</membershipPersonStatus>
<membershipPersonstatusReason>
</membershipPersonstatusReason>
<autoRenew></autoRenew>
<associatedMemberIdentifierType>
</associatedMemberIdentifierType>
<associatedMemberIdentifier>
</associatedMemberIdentifier>
<exchangeFlag></exchangeFlag>
<exchangeId></exchangeId>
<binderLiabilityAmount></binderLiabilityAmount>
<binderPayApplicability></binderPayApplicability>
<binderPayGraceDays></binderPayGraceDays>
<binderPayThreshold></binderPayThreshold>
<holdBilling></holdBilling>
<membershipRenewalDate></membershipRenewalDate>
<contractPeriod></contractPeriod>
<membershipIdentifier>
<membershipIdentifierType>
</membershipIdentifierType>
<membershipIdentifierValue>
</membershipIdentifierValue>
</membershipIdentifier>
<isMemberSw></isMemberSw>
<isFinanciallyResponsibleSw>
</isFinanciallyResponsibleSw>
<membershipType></membershipType>
<externalMedicareBeneficiaryId>
</externalMedicareBeneficiaryId>
<mainSubscriber>
<idType></idType>
<idValue></idValue>
<membershipType></membershipType>
</mainSubscriber>
<policyNumber></policyNumber>
<sourceSystem></sourceSystem>
<planNumber></planNumber>
<healthPlanCode></healthPlanCode>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
<membershipRateGuarantee>
<membershipRateGuaranteeList>
<rateGuaranteeStartDate></rateGuaranteeStartDate>
<rateGuaranteeEndDate></rateGuaranteeEndDate>
<rateGuaranteeStatus></rateGuaranteeStatus>
</membershipRateGuaranteeList>
</membershipRateGuarantee>
<membershipPersonCharacteristic>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</membershipPersonCharacteristic>
<benefitData>
<benefitDataList>
<sequence></sequence>
<startDate></startDate>
<endDate></endDate>
<benefitStatus></benefitStatus>
<benefitSourceFlag></benefitSourceFlag>
<benefitTypeFlag></benefitTypeFlag>
<benefitSubTypeFlag></benefitSubTypeFlag>
<planBenefitPackageId></planBenefitPackageId>
<benefitAmount></benefitAmount>
<characteristics>
<characteristicsList>
<characteristicType>
</characteristicType>
<characteristicValue>
</characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
</benefitDataList>
</benefitData>
<billableChargeData>
<sequence></sequence>
<accountIdType></accountIdType>
<accountIdValue></accountIdValue>
<chargeType></chargeType>
<startDate></startDate>
<endDate></endDate>
<priceItemCode></priceItemCode>
<description></description>
<recurringMethod></recurringMethod>
<billPeriod></billPeriod>
<frequency></frequency>
<billAfterDt></billAfterDt>
<billableChargeLines>
<descriptionOnBill></descriptionOnBill>
<currencyCode></currencyCode>
<chargeAmount></chargeAmount>
<showOnBillSw></showOnBillSw>
<appearInSummarySw></appearInSummarySw>
<distributionCode></distributionCode>
</billableChargeLines>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
</billableChargeData>
</memberData>
<accountData>
<accountType>CMS</accountType>
<customerClass>HC</customerClass>
<billCycle>BK01</billCycle>
<billLeadDays>10</billLeadDays>
<division>HC</division>
<dragDays></dragDays>
<currency>USD</currency>
<setUpDate>2019-01-01</setUpDate>
<acctUsageFlg>USAG</acctUsageFlg>
<comments></comments>
<deferAutoPayDt></deferAutoPayDt>
<collectionClass></collectionClass>
<billRouteType>POSTAL</billRouteType>
<billAddressSource>PER</billAddressSource>
<accessGroup></accessGroup>
<skipAutoMaintenanceSw></skipAutoMaintenanceSw>
<identifiers>
<idType>ACCT_NM</idType>
<idValue>Medical Account</idValue>
<isPrimary>true</isPrimary>
</identifiers>
<address>
<addressEffDate>2019-01-01</addressEffDate>
<addressType></addressType>
<address1><</address1>
<address2></address2>
<address3></address3>
<address4></address4>
<city></city>
<state></state>
<zip></zip>
<country></country>
<houseType></houseType>
<streetNumber1></streetNumber1>
<streetNumber2></streetNumber2>
<inCityLimit></inCityLimit>
<taxVendorGeographicalCode>
</taxVendorGeographicalCode>
<county></county>
<addressStatus></addressStatus>
</address>
</accountData>
<accountData>
<accountType>CMR</accountType>
<customerClass>HC</customerClass>
<billCycle>BK02</billCycle>
<billLeadDays>10</billLeadDays>
<division>HC</division>
<dragDays></dragDays>
<currency>USD</currency>
<setUpDate>2019-01-01</setUpDate>
<acctUsageFlg>USAG</acctUsageFlg>
<comments></comments>
<deferAutoPayDt></deferAutoPayDt>
<collectionClass></collectionClass>
<billRouteType>POSTAL</billRouteType>
<billAddressSource>ACOV</billAddressSource>
<accessGroup></accessGroup>
<skipAutoMaintenanceSw></skipAutoMaintenanceSw>
<identifiers>
<idType>ACCT_NM</idType>
<idValue>Dental Account</idValue>
<isPrimary>true</isPrimary>
</identifiers>
<address>
<addressEffDate>2019-01-01</addressEffDate>
<addressType>OVRD</addressType>
<address1>Venus Park</address1>
<address2>Venus Street</address2>
<address3>Lake Side</address3>
<address4></address4>
<city>Los Angeles</city>
<state>CA</state>
<zip>90020</zip>
<country>USA</country>
<houseType></houseType>
<streetNumber1></streetNumber1>
<streetNumber2></streetNumber2>
<inCityLimit></inCityLimit>
<taxVendorGeographicalCode>
</taxVendorGeographicalCode>
<county></county>
<addressStatus></addressStatus>
</address>
</accountData>
<policyData>
<policyType></policyType>
<sourceSystem></sourceSystem>
<policyNumber></policyNumber>
<description></description>
<advancedLevelFundingEligibility>
</advancedLevelFundingEligibility>
<startDate></startDate>
<endDate></endDate>
<runOutEndDate></runOutEndDate>
<runOutAdminOption></runOutAdminOption>
<renewalDate></renewalDate>
<advanceDepositApplSW></advanceDepositApplSW>
<advanceDepositAmount></advanceDepositAmount>
<advanceDepositGraceDays></advanceDepositGraceDays>
<advanceDepositAccountIdentifierType>
</advanceDepositAccountIdentifierType>
<advanceDepositAccountIdentifierValue>
</advanceDepositAccountIdentifierValue>
<policyPersons>
<idType></idType>
<idValue></idValue>
<policyPerRole></policyPerRole>
<startDate></startDate>
<endDate></endDate>
</policyPersons>
<terminationInformation>
<terminateDate></terminateDate>
<terminationReason></terminationReason>
</terminationInformation>
<reinstateInformation>
<reinstatementDate></reinstatementDate>
<reinstateReason></reinstateReason>
</reinstateInformation>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
<planData>
<planNumber></planNumber>
<priceItemCode></priceItemCode>
<planName></planName>
<pricingRuleTypeList>
<pricingRuleType></pricingRuleType>
</pricingRuleTypeList>
<startDate></startDate>
<endDate></endDate>
<primaryPlanSw></primaryPlanSw>
<benefitTypeFlag></benefitTypeFlag>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
<policyPlanProrationRuleList>
<effectiveDate></effectiveDate>
<prorationEventType></prorationEventType>
<prorationType></prorationType>
<numberOfDays></numberOfDays>
<membershipType></membershipType>
</policyPlanProrationRuleList>
</planData>
</policyData>
</personData>
<personData>
<sequence>4</sequence>
<personType>BG</personType>
<personName>
<sequence>1</sequence>
<entityName>
Antartica Petroleum RETIREE
</entityName>
<nameType>PRIM</nameType>
</personName>
<identifiers>
<idType>EIN</idType>
<idValue>98-7654322</idValue>
<isPrimary>Y</isPrimary>
</identifiers>
<division>HC</division>
<birthDate>1985-01-01</birthDate>
<sinceDate>2019-01-01</sinceDate>
<accessGroup></accessGroup>
<collectionClass></collectionClass>
<postponeCreditReviewUntil></postponeCreditReviewUntil>
<lastCreditReviewDate></lastCreditReviewDate>
<dragDays></dragDays>
<advanceDepositAmount></advanceDepositAmount>
<advanceDepositGraceDays></advanceDepositGraceDays>
<advanceDepositLevel></advanceDepositLevel>
<address>
<addressEffDate>2019-01-01</addressEffDate>
<addressType>MAIN</addressType>
<mailingName>Antartica Petroleum RETIREE</mailingName>
<address1>Neptune Park</address1>
<address2>Neptune Street</address2>
<address3>River Side</address3>
<address4></address4>
<city>San Jose</city>
<state>CA</state>
<zip>94088</zip>
<country>USA</country>
<houseType></houseType>
<streetNumber1></streetNumber1>
<streetNumber2></streetNumber2>
<inCityLimit></inCityLimit>
<taxVendorGeographicalCode>
</taxVendorGeographicalCode>
<county></county>
<addressStatus></addressStatus>
</address>
<email>apcre@example.com</email>
<overrideMailingName1>
</overrideMailingName1>
<overrideMailingName2>
</overrideMailingName2>
<overrideMailingName3>
</overrideMailingName3>
<phones>
<phoneType>BUSN</phoneType>
<phoneValue>408-555-0165</phoneValue>
</phones>
<relatedPersons>
<idType>EIN</idType>
<idValue>98-7654329</idValue>
<personRelationshipType></personRelationshipType>
<startDate>2019-01-01</startDate>
<endDate>2019-12-31</endDate>
<financialRelationshipSw>
FALSE
</financialRelationshipSw>
<parentOrChild>P</parentOrChild>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
</relatedPersons>
<characteristics>
<characteristicsList>
<characteristicType>PER_CAT</characteristicType>
<characteristicValue>OTHER</characteristicValue>
<effectiveDate>2019-01-01</effectiveDate>
</characteristicsList>
</characteristics>
<billLevelParameters>
<sequence>25</sequence>
<sourceSystem>SMALLPRIME</sourceSystem>
<billLevelInfo1>RETIRED</billLevelInfo1>
<billLevelInfo2>SEATTLE</billLevelInfo2>
<billLevelInfo3>MEDICAL</billLevelInfo3>
<billLevelInfo4>HMO</billLevelInfo4>
<effectiveDate>2019-01-01</effectiveDate>
</billLevelParameters>
<billLevelParameters>
<sequence>26</sequence>
<sourceSystem>SMALLPRIME</sourceSystem>
<billLevelInfo1>RETIRED</billLevelInfo1>
<billLevelInfo2>SEATTLE</billLevelInfo2>
<billLevelInfo3>MEDICAL</billLevelInfo3>
<billLevelInfo4>PPO</billLevelInfo4>
<effectiveDate>2019-01-01</effectiveDate>
</billLevelParameters>
<billLevelParameters>
<sequence>27</sequence>
<sourceSystem>SMALLPRIME</sourceSystem>
<billLevelInfo1>RETIRED</billLevelInfo1>
<billLevelInfo2>SEATTLE</billLevelInfo2>
<billLevelInfo3>DENTAL</billLevelInfo3>
<billLevelInfo4>HMO</billLevelInfo4>
<effectiveDate>2019-01-01</effectiveDate>
</billLevelParameters>
<billLevelParameters>
<sequence>28</sequence>
<sourceSystem>SMALLPRIME</sourceSystem>
<billLevelInfo1>RETIRED</billLevelInfo1>
<billLevelInfo2>SEATTLE</billLevelInfo2>
<billLevelInfo3>DENTAL</billLevelInfo3>
<billLevelInfo4>PPO</billLevelInfo4>
<effectiveDate>2019-01-01</effectiveDate>
</billLevelParameters>
<billLevelParameters>
<sequence>29</sequence>
<sourceSystem>SMALLPRIME</sourceSystem>
<billLevelInfo1>RETIRED</billLevelInfo1>
<billLevelInfo2>SAN FRANCISCO</billLevelInfo2>
<billLevelInfo3>MEDICAL</billLevelInfo3>
<billLevelInfo4>HMO</billLevelInfo4>
<effectiveDate>2019-01-01</effectiveDate>
</billLevelParameters>
<billLevelParameters>
<sequence>30</sequence>
<sourceSystem>SMALLPRIME</sourceSystem>
<billLevelInfo1>RETIRED</billLevelInfo1>
<billLevelInfo2>SAN FRANCISCO</billLevelInfo2>
<billLevelInfo3>MEDICAL</billLevelInfo3>
<billLevelInfo4>PPO</billLevelInfo4>
<effectiveDate>2019-01-01</effectiveDate>
</billLevelParameters>
<billLevelParameters>
<sequence>31</sequence>
<sourceSystem>SMALLPRIME</sourceSystem>
<billLevelInfo1>RETIRED</billLevelInfo1>
<billLevelInfo2>SAN FRANCISCO</billLevelInfo2>
<billLevelInfo3>DENTAL</billLevelInfo3>
<billLevelInfo4>HMO</billLevelInfo4>
<effectiveDate>2019-01-01</effectiveDate>
</billLevelParameters>
<billLevelParameters>
<sequence>32</sequence>
<sourceSystem>SMALLPRIME</sourceSystem>
<billLevelInfo1>RETIRED</billLevelInfo1>
<billLevelInfo2>SAN FRANCISCO</billLevelInfo2>
<billLevelInfo3>DENTAL</billLevelInfo3>
<billLevelInfo4>PPO</billLevelInfo4>
<effectiveDate>2019-01-01</effectiveDate>
</billLevelParameters>
<billLevelParameters>
<sequence>33</sequence>
<sourceSystem>SMALLPRIME</sourceSystem>
<billLevelInfo1>RETIRED</billLevelInfo1>
<billLevelInfo2>LOS ANGELES</billLevelInfo2>
<billLevelInfo3>MEDICAL</billLevelInfo3>
<billLevelInfo4>HMO</billLevelInfo4>
<effectiveDate>2019-01-01</effectiveDate>
</billLevelParameters>
<billLevelParameters>
<sequence>34</sequence>
<sourceSystem>SMALLPRIME</sourceSystem>
<billLevelInfo1>RETIRED</billLevelInfo1>
<billLevelInfo2>LOS ANGELES</billLevelInfo2>
<billLevelInfo3>MEDICAL</billLevelInfo3>
<billLevelInfo4>PPO</billLevelInfo4>
<effectiveDate>2019-01-01</effectiveDate>
</billLevelParameters>
<billLevelParameters>
<sequence>35</sequence>
<sourceSystem>SMALLPRIME</sourceSystem>
<billLevelInfo1>RETIRED</billLevelInfo1>
<billLevelInfo2>LOS ANGELES</billLevelInfo2>
<billLevelInfo3>DENTAL</billLevelInfo3>
<billLevelInfo4>HMO</billLevelInfo4>
<effectiveDate>2019-01-01</effectiveDate>
</billLevelParameters>
<billLevelParameters>
<sequence>36</sequence>
<sourceSystem>SMALLPRIME</sourceSystem>
<billLevelInfo1>RETIRED</billLevelInfo1>
<billLevelInfo2>LOS ANGELES</billLevelInfo2>
<billLevelInfo3>DENTAL</billLevelInfo3>
<billLevelInfo4>PPO</billLevelInfo4>
<effectiveDate>2019-01-01</effectiveDate>
</billLevelParameters>
<memberData>
<sequence>4</sequence>
<startDate></startDate>
<endDate></endDate>
<paidThroughDate></paidThroughDate>
<repriceAfterDate></repriceAfterDate>
<memberId></memberId>
<memberRelationship></memberRelationship>
<membershipPersonStatus>
</membershipPersonStatus>
<membershipPersonstatusReason>
</membershipPersonstatusReason>
<autoRenew></autoRenew>
<associatedMemberIdentifierType>
</associatedMemberIdentifierType>
<associatedMemberIdentifier>
</associatedMemberIdentifier>
<exchangeFlag></exchangeFlag>
<exchangeId></exchangeId>
<binderLiabilityAmount></binderLiabilityAmount>
<binderPayApplicability></binderPayApplicability>
<binderPayGraceDays></binderPayGraceDays>
<binderPayThreshold></binderPayThreshold>
<holdBilling></holdBilling>
<membershipRenewalDate></membershipRenewalDate>
<contractPeriod></contractPeriod>
<membershipIdentifier>
<membershipIdentifierType>
</membershipIdentifierType>
<membershipIdentifierValue>
</membershipIdentifierValue>
</membershipIdentifier>
<isMemberSw></isMemberSw>
<isFinanciallyResponsibleSw>
</isFinanciallyResponsibleSw>
<membershipType></membershipType>
<externalMedicareBeneficiaryId>
</externalMedicareBeneficiaryId>
<mainSubscriber>
<idType></idType>
<idValue></idValue>
<membershipType></membershipType>
</mainSubscriber>
<policyNumber></policyNumber>
<sourceSystem></sourceSystem>
<planNumber></planNumber>
<healthPlanCode></healthPlanCode>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
<membershipRateGuarantee>
<membershipRateGuaranteeList>
<rateGuaranteeStartDate></rateGuaranteeStartDate>
<rateGuaranteeEndDate></rateGuaranteeEndDate>
<rateGuaranteeStatus></rateGuaranteeStatus>
</membershipRateGuaranteeList>
</membershipRateGuarantee>
<membershipPersonCharacteristic>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</membershipPersonCharacteristic>
<benefitData>
<benefitDataList>
<sequence></sequence>
<startDate></startDate>
<endDate></endDate>
<benefitStatus></benefitStatus>
<benefitSourceFlag></benefitSourceFlag>
<benefitTypeFlag></benefitTypeFlag>
<benefitSubTypeFlag></benefitSubTypeFlag>
<planBenefitPackageId></planBenefitPackageId>
<benefitAmount></benefitAmount>
<characteristics>
<characteristicsList>
<characteristicType>
</characteristicType>
<characteristicValue>
</characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
</benefitDataList>
</benefitData>
<billableChargeData>
<sequence></sequence>
<accountIdType></accountIdType>
<accountIdValue></accountIdValue>
<chargeType></chargeType>
<startDate></startDate>
<endDate></endDate>
<priceItemCode></priceItemCode>
<description></description>
<recurringMethod></recurringMethod>
<billPeriod></billPeriod>
<frequency></frequency>
<billAfterDt></billAfterDt>
<billableChargeLines>
<descriptionOnBill></descriptionOnBill>
<currencyCode></currencyCode>
<chargeAmount></chargeAmount>
<showOnBillSw></showOnBillSw>
<appearInSummarySw></appearInSummarySw>
<distributionCode></distributionCode>
</billableChargeLines>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
</billableChargeData>
</memberData>
<accountData>
<accountType>CMS</accountType>
<customerClass>HC</customerClass>
<billCycle>BK01</billCycle>
<billLeadDays>10</billLeadDays>
<division>HC</division>
<dragDays></dragDays>
<currency>USD</currency>
<setUpDate>2019-01-01</setUpDate>
<acctUsageFlg>USAG</acctUsageFlg>
<comments></comments>
<deferAutoPayDt></deferAutoPayDt>
<collectionClass></collectionClass>
<billRouteType>POSTAL</billRouteType>
<billAddressSource>PER</billAddressSource>
<accessGroup></accessGroup>
<skipAutoMaintenanceSw></skipAutoMaintenanceSw>
<identifiers>
<idType>ACCT_NM</idType>
<idValue>Medical Account</idValue>
<isPrimary>true</isPrimary>
</identifiers>
<address>
<addressEffDate>2019-01-01</addressEffDate>
<addressType></addressType>
<address1></address1>
<address2></address2>
<address3></address3>
<address4></address4>
<city></city>
<state></state>
<zip></zip>
<country></country>
<houseType></houseType>
<streetNumber1></streetNumber1>
<streetNumber2></streetNumber2>
<inCityLimit></inCityLimit>
<taxVendorGeographicalCode>
</taxVendorGeographicalCode>
<county></county>
<addressStatus></addressStatus>
</address>
</accountData>
<accountData>
<accountType>CMR</accountType>
<customerClass>HC</customerClass>
<billCycle>BK02</billCycle>
<billLeadDays>10</billLeadDays>
<division>HC</division>
<dragDays></dragDays>
<currency>USD</currency>
<setUpDate>2019-01-01</setUpDate>
<acctUsageFlg>USAG</acctUsageFlg>
<comments></comments>
<deferAutoPayDt></deferAutoPayDt>
<collectionClass></collectionClass>
<billRouteType>POSTAL</billRouteType>
<billAddressSource>ACOV</billAddressSource>
<accessGroup></accessGroup>
<skipAutoMaintenanceSw></skipAutoMaintenanceSw>
<identifiers>
<idType>ACCT_NM</idType>
<idValue>Dental Account</idValue>
<isPrimary>true</isPrimary>
</identifiers>
<address>
<addressEffDate>2019-01-01</addressEffDate>
<addressType>OVRD</addressType>
<address1>Saturn Park</address1>
<address2>Saturn Street</address2>
<address3>River Side</address3>
<address4></address4>
<city>San Franciso</city>
<state>CA</state>
<zip>94122</zip>
<country>USA</country>
<houseType></houseType>
<streetNumber1></streetNumber1>
<streetNumber2></streetNumber2>
<inCityLimit></inCityLimit>
<taxVendorGeographicalCode>
</taxVendorGeographicalCode>
<county></county>
<addressStatus></addressStatus>
</address>
</accountData>
<policyData>
<policyType>GROUP CUSTOMER</policyType>
<sourceSystem>SMALLPRIME</sourceSystem>
<policyNumber>AP234367</policyNumber>
<description>
Employee Medicare Policy
</description>
<advancedLevelFundingEligibility>
</advancedLevelFundingEligibility>
<startDate>2019-01-01</startDate>
<endDate>2019-12-31</endDate>
<runOutEndDate></runOutEndDate>
<runOutAdminOption></runOutAdminOption>
<renewalDate></renewalDate>
<advanceDepositApplSW></advanceDepositApplSW>
<advanceDepositAmount></advanceDepositAmount>
<advanceDepositGraceDays></advanceDepositGraceDays>
<advanceDepositAccountIdentifierType>
</advanceDepositAccountIdentifierType>
<advanceDepositAccountIdentifierValue>
</advanceDepositAccountIdentifierValue>
<policyPersons>
<idType></idType>
<idValue></idValue>
<policyPerRole></policyPerRole>
<startDate></startDate>
<endDate></endDate>
</policyPersons>
<terminationInformation>
<terminateDate></terminateDate>
<terminationReason></terminationReason>
</terminationInformation>
<reinstateInformation>
<reinstatementDate></reinstatementDate>
<reinstateReason></reinstateReason>
</reinstateInformation>
<characteristics>
<characteristicsList>
<characteristicType>C1PRBASE</characteristicType>
<characteristicValue>Y</characteristicValue>
<effectiveDate>2019-01-01</effectiveDate>
</characteristicsList>
<characteristicsList>
<characteristicType>C1STISSE</characteristicType>
<characteristicValue>VG</characteristicValue>
<effectiveDate>2019-01-01</effectiveDate>
</characteristicsList>
</characteristics>
<planData>
<planNumber>APE_MEDI_BRONZE_M</planNumber>
<priceItemCode></priceItemCode>
<planName>APE Medicare Bronze RE MALE</planName>
<pricingRuleTypeList>
<pricingRuleType>AGE_BASED</pricingRuleType>
</pricingRuleTypeList>
<startDate>2019-01-01</startDate>
<endDate>2019-12-31</endDate>
<primaryPlanSw>N</primaryPlanSw>
<characteristics>
<characteristicsList>
<characteristicType>
C1HPLNID
</characteristicType>
<characteristicValue>
300
</characteristicValue>
<effectiveDate>
2019-01-01
</effectiveDate>
</characteristicsList>
</characteristics>
</planData>
<planData>
<planNumber>APE_MEDI_SILVER_M</planNumber>
<priceItemCode></priceItemCode>
<planName>APE Medicare Silver RE MALE</planName>
<pricingRuleTypeList>
<pricingRuleType>AGE_BASED</pricingRuleType>
</pricingRuleTypeList>
<startDate>2019-01-01</startDate>
<endDate>2019-12-31</endDate>
<primaryPlanSw>N</primaryPlanSw>
<characteristics>
<characteristicsList>
<characteristicType>
C1HPLNID
</characteristicType>
<characteristicValue>
310
</characteristicValue>
<effectiveDate>
2019-01-01
</effectiveDate>
</characteristicsList>
</characteristics>
</planData>
<planData>
<planNumber>APE_MEDI_GOLD_M</planNumber>
<priceItemCode></priceItemCode>
<planName>APE Medicare Gold RE MALE</planName>
<pricingRuleTypeList>
<pricingRuleType>AGE_BASED</pricingRuleType>
</pricingRuleTypeList>
<startDate>2019-01-01</startDate>
<endDate>2019-12-31</endDate>
<primaryPlanSw>N</primaryPlanSw>
<characteristics>
<characteristicsList>
<characteristicType>
C1HPLNID
</characteristicType>
<characteristicValue>
320
</characteristicValue>
<effectiveDate>
2019-01-01
</effectiveDate>
</characteristicsList>
</characteristics>
</planData>
<planData>
<planNumber>APE_MEDI_BRONZE_F</planNumber>
<priceItemCode></priceItemCode>
<planName>APE Medicare Bronze RE FEMALE</planName>
<pricingRuleTypeList>
<pricingRuleType>AGE_BASED</pricingRuleType>
</pricingRuleTypeList>
<startDate>2019-01-01</startDate>
<endDate>2019-12-31</endDate>
<primaryPlanSw>N</primaryPlanSw>
<characteristics>
<characteristicsList>
<characteristicType>
C1HPLNID
</characteristicType>
<characteristicValue>
330
</characteristicValue>
<effectiveDate>
2019-01-01
</effectiveDate>
</characteristicsList>
</characteristics>
</planData>
<planData>
<planNumber>APE_MEDI_SILVER_F</planNumber>
<priceItemCode></priceItemCode>
<planName>APE Medicare Silver RE FEMALE</planName>
<pricingRuleTypeList>
<pricingRuleType>AGE_BASED</pricingRuleType>
</pricingRuleTypeList>
<startDate>2019-01-01</startDate>
<endDate>2019-12-31</endDate>
<primaryPlanSw>N</primaryPlanSw>
<characteristics>
<characteristicsList>
<characteristicType>
C1HPLNID
</characteristicType>
<characteristicValue>
340
</characteristicValue>
<effectiveDate>
2019-01-01
</effectiveDate>
</characteristicsList>
</characteristics>
</planData>
<planData>
<planNumber>APE_MEDI_GOLD_F</planNumber>
<priceItemCode></priceItemCode>
<planName>APE Medicare Gold RE FEMALE</planName>
<pricingRuleTypeList>
<pricingRuleType>AGE_BASED</pricingRuleType>
</pricingRuleTypeList>
<startDate>2019-01-01</startDate>
<endDate>2019-12-31</endDate>
<primaryPlanSw>N</primaryPlanSw>
<characteristics>
<characteristicsList>
<characteristicType>
C1HPLNID</characteristicType>
<characteristicValue>
350
</characteristicValue>
<effectiveDate>
2019-01-01
</effectiveDate>
</characteristicsList>
</characteristics>
</planData>
</policyData>
</personData>
<pricingRuleData>
<sequence></sequence>
<entityIdentifiers>
<entityIdentifiersList>
<entityIdentifierType>
</entityIdentifierType>
<entityIdentifierValue>
</entityIdentifierValue>
</entityIdentifiersList>
</entityIdentifiers>
<status></status>
<startDate></startDate>
<endDate></endDate>
<pricingRuleType></pricingRuleType>
<priceItemCd></priceItemCd>
<rateOption></rateOption>
<pricingType></pricingType>
<modifierApplicability></modifierApplicability>
<modifierMethod></modifierMethod>
<baseRate>
<sequence></sequence>
<baseFee></baseFee>
<lowerAgeLimit></lowerAgeLimit>
<upperAgeLimit></upperAgeLimit>
<pricingParameter>
<sequence></sequence>
<parameterCode></parameterCode>
<parameterValue></parameterValue>
</pricingParameter>
<modifierInformation>
<sequence></sequence>
<parameterCode></parameterCode>
<parameterValue></parameterValue>
<rate></rate>
</modifierInformation>
</baseRate>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
</pricingRuleData>
<statementConstructsData>
<personStatementConstructs>
<personIdentifier></personIdentifier>
<personIdentifierType></personIdentifierType>
<statementConstructIdentifier>
</statementConstructIdentifier>
<statementAddressSource></statementAddressSource>
<statementCycle></statementCycle>
<statementRouteType></statementRouteType>
<effectiveStatus></effectiveStatus>
<addressId></addressId>
<numberOfCopies></numberOfCopies>
<statementFormat></statementFormat>
<description></description>
<statementConstructDetails>
<serviceAgreement></serviceAgreement>
<accountNumber></accountNumber>
<accountNumberTypeCd></accountNumberTypeCd>
<division></division>
<statementPrintDescription>
</statementPrintDescription>
<printOrder></printOrder>
<startDate></startDate>
<endDate></endDate>
</statementConstructDetails>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</personStatementConstructs>
</statementConstructsData>
</customerStructureData>
</customerStructureMessage>
</schema>Note: We have given the above sample to illustrate how the tags should
be nested while sending an inbound message from the external system.
However, you should not seamlessly use this sample in your environment
because the required pre-requisite data may not be available in your
environment. In such case, the system will give erroneous results.