THIS LETTER NEEDS TO BE PRINTED ON COMPANY LETTERHEAD
Please complete one letter for each carrier and include your Carrier Representative’s name, telephone number, and email address.
Delete this text BEFORE printing
(Company name), (Carrier) group# ( ), is requesting to submit employee Benefit Enrollment Maintenance data via the ANSI 834 EDI format, version 004010A1.
Employee Navigator, 7979 Old Georgetown Rd # 300, Bethesda, Maryland 20814 will implement and maintain the 834 EDI submission process to (Carrier).
Federal Regulation reference: Our electronic data transmission technology is compliant with 45 C.F.R. 162.1502 and the definition of "standard transaction" applicable since October 16, 2003. You are a covered entity under 45 C.F.R. 925, and therefore required by law to accept our data.
If you believe we are in error, or if you have obtained a regulatory exemption from the Secretary of HHS, please provide us with appropriate citations or a copy of your exemption letter.
All questions and requests for information should be directed to (insert broker or Employee Navigator Contact). Your assistance in a timely implementation is appreciated.