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X12 267 — Individual Life, Annuity and Disability Application

The 267 transmits an individual life / annuity / disability application from a producer or portal to the carrier for underwriting.

Purpose

The 267 documents the formal application of an applicant: identity, health, occupation, history, requested plan, insured amount, beneficiaries, initial payment. It triggers the carrier underwriting cycle.

It is exchanged downstream of the 100 (plan description) and triggers a 273 (status) response. Acknowledged by 997. Highly structured to enable jet underwriting when the profile allows.

Envelope structure

The 267 travels within the three X12 envelope levels (ISA/IEA, GS/GE with functional group IL, and ST/SE). Didactic example in release 004010:

x12 example-267.x12
ISA*00*          *00*          *ZZ*BROKERFIRM    *ZZ*LIFECARRIER   *260515*1400*U*00401*000000267*0*P*>~
GS*IL*BROKERFIRM*LIFECARRIER*20260515*1400*1*X*004010~
ST*267*0001~
BGN*00*APP-2026-7799*20260515~
NM1*IL*1*SMITH*JOHN*A***34*SSN-LAST4-5678~
DMG*D8*19850315*M~
N3*555 APPLICANT WAY~
N4*HOUSTON*TX*77001~
REF*ZZ*PRODUCT-CODE-TLIFE-20Y~
AMT*FA*250000.00~
NM1*BENE*1*SMITH*JANE*M~
PCT*RA*100~
NM1*PR*1*MILLER*ALICE*B***34*NPN-12345678~
SE*12*0001~
GE*1*1~
IEA*1*000000267~

Common segments

  • HeaderST, BGN.
  • ApplicantNM1*IL, DMG, N3/N4.
  • RequestREF*ZZ (product code), AMT*FA (face amount), DTM*090 (requested effective).
  • BeneficiariesNM1*BENE, PCT*RA.
  • ProducerNM1*PR (NPN).
  • Health / historyHD loop or MSG (per carrier TR3).
  • SummarySE.

Common pitfalls

  • HIPAA authorization: collecting health history assumes a HIPAA-compliant authorization; without a stored signature, underwriting is invalid.
  • Replacement: if the 267 replaces an existing policy, NAIC requires a separate Replacement Form; the 267 alone is not sufficient.
  • Senior protection: for an applicant 65+, state-specific rules apply (suitability, 30-day minimum free-look); the 267 must flag it.

Documentation

The code 267 and the name Individual Life, Annuity and Disability Application are public and listed on x12.org/products/transaction-sets. The complete structure of loops, qualifiers and code lists is distributed by DISA via the proprietary Implementation Guides (TR3). ediverse.io covers only public concepts, the envelope and didactic examples.