X12 Reference

267 Individual Life, Annuity and Disability Application

This transaction set is used to submit applications for individual life insurance, annuity products, and disability coverage. Insurance applicants, brokers, or employers typically send it to insurance carriers or underwriting platforms to initiate new business. The 267 communicates applicant information, requested coverage details, beneficiary designations, and underwriting data necessary for policy evaluation. Key segments include the BGN (Beginning Segment), which establishes the application context; the ACT (Account Identification) segment, which identifies the specific insurance account or product line; and the ENT (Entity) segment, which structures hierarchical applicant or family member information including demographics and underwriting responses such as health history and yes/no questions.

Consider a scenario where an independent insurance broker, ProInsure Solutions, submits a life insurance application on behalf of a client to Liberty Life Insurance Company. The 267 transaction would contain the applicant’s personal details through the NM1 name and N3/N4 address segments, the requested coverage amount and product type through ACT and AMT (Monetary Amount) segments, beneficiary information through the BEN loop with associated name and address data, and underwriting questionnaire responses through the YNQ (Yes/No Question) and UC (Underwriting Category) loops. The transaction also carries any supporting documents referenced via the PWK (Paperwork) segment. Liberty Life receives this complete application package electronically, enabling rapid intake and underwriting review without manual data entry.

Individual Life, Annuity and Disability Application (AD267) contains 2 tables (Heading, Detail), 20 loops, and 203 segments. You can view complete details on all of these items free - just sign up or login.

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