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:
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
- Header —
ST,BGN. - Applicant —
NM1*IL,DMG,N3/N4. - Request —
REF*ZZ(product code),AMT*FA(face amount),DTM*090(requested effective). - Beneficiaries —
NM1*BENE,PCT*RA. - Producer —
NM1*PR(NPN). - Health / history —
HDloop orMSG(per carrier TR3). - Summary —
SE.
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.
Related transactions
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.