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This file has three pages. 'Info' for the basics, 'Example' to see what the data needs to look like, and
'File Template' that can be used to match your data against. Only upload 'File Template'.
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Roster Formatting Requirements
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- Dependents of a Subscriber should always be listed in the rows below them.
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Member Contact Requirements
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- Member's email addresses are required.
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- Every member must have unique contact information (i.e., no duplicate phone or email addresses).
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- Dependent contact information is not required but highly recommended.
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File Requirements
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- .CSV or .XLSX with only one sheet (delete others before upload).
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FieldDescriptionExample
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firstnameFirst nameJan
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lastnameLast nameSample
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emailPersonal emailmember@example.com
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ssnSocial security number000-00-0000
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line1First line of address112 Lake Way
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line2Second line of address (optional)Apt # 402
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cityCityAnchorage
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stateStateAK
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zip5 digit zipcode99213
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birthdayDate of birth1999-12-31
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sexLegal sex (M/F)F
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phonePhone number19074550234
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relationshipRelationship to subscriber (subscriber/child/spouse)subscriber
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hiredateFirst day of work (optional)2024-10-21
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planPlan to enroll member in 501
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pcpPrimary Care Provider for member (optional)Dr. Key
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cobrastartdateCOBRA start date for member (optional)2025-01-02
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locationEmployee location (optional)Milwaukee Site
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alternateidAlternate ID, like employee HRIS id (optional)1082279397
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