Policyholders

File Name: v2_policyholders.csv

This file contains detailed information about the policyholders (insured individuals) covered under a plan or policy. It includes data required to manage beneficiaries effectively, such as identification details, coverage limits, and participation rules.

Structure

The required fields are marked in bold.

#	Field Name	Type	Description
1	insurer_slug	String[64]	Slug of the Payer provided by Osigu.
2	policy_number	String[32]	Policy/plan number must match a record in the `v2_policies.csv` file.
3	group_code	String[32]	Group code must match a record in the `v2_groups.csv` file.
4	policyholder_certificate	String[64]	Certificate ID of the policyholder. A default value such as "CERT01" can be used if unavailable.
5	insured_id	String[64]	Unique identifier of the insured individual within the payer's system.
6	status	Enum ( ENABLED \| SUSPENDED \| DISABLED )	Status of the insured within the policy.
7	maximum_lifetime_benefit	Decimal(15,5)	Lifetime maximum benefit specific to the policyholder. Replaces any group-level value. Must be 0 if `max_annual_benefit` is greater than 0.
8	maximum_annual_benefit	Decimal(15,5)	Annual maximum benefit for the policyholder. Replaces any group-level value. Must be 0 if `max_lifetime_benefit` is greater than 0.
9	policyholder_name	String[256]	Full name of the insured individual.
10	nationality_country_code	String[2] ISO 3166-1 alpha-2	Country code for the nationality of the insured.
11	identity_document_type	Enum ( NATIONAL_IDENTITY_CARD \| PASSPORT \| DRIVER_LICENSE \| SOCIAL_SECURITY_NUMBER )	Type of identity document. Optional but required if used in lookup mechanisms.
12	identity_document_id	String[64]	Identity document number. Optional but required if used in lookup mechanisms.
13	sex	Enum ( MALE \| FEMALE \| NOT_KNOWN )	Gender of the insured individual.
14	date_of_birth	Timestamp (string) using the ISO 8601	Date of birth of the insured.
15	address	String[256]	Address of the insured individual.
16	email_address	String[256]	Email address of the insured.
17	phone_number	String[32]	Phone number of the insured individual.
18	effective_date	Timestamp (string) using the ISO 8601	Date when coverage begins.
19	policyholder_owner	Boolean (string)	Indicates if the insured is the policyholder (certificate owner).
20	kinship	Enum ( WIFE \| HUSBAND \| SON \| DAUGHTER )	Relationship between the insured and the policyholder.
21	pre_existing_exclusion_period	Integer	Remaining period (in days) for pre-existing condition exclusions.
22	currency_code	String[3] using the ISO 4217	Currency code used for expressing monetary values.
23	reimbursement_base_amount	Decimal(15,5)	Reimbursement base amount (specific to Mexico). Should be 0 for other countries.
24	maximum_out_of_pocket	Decimal(15,5)	Maximum out-of-pocket amount before the insured stops paying participation fees (Stop Loss).
25	maximum_out_of_pocket_reached	Boolean (string)	Indicates if the maximum out-of-pocket amount has been reached.
26	outpatient_care_availability	Enum ( LIMITED \| UNLIMITED \| NOT_AVAILABLE \| NOT_KNOWN )	Availability of outpatient care events.
27	outpatient_care_limit	Integer	Total limit of outpatient care events allowed during the policy period.
28	outpatient_care_available	Integer	Number of outpatient care events still available.
29	net_premium_amount	Decimal(15,5)	Net premium amount for the insured. It must be 0 if not applicable.

Notes

Ensure all fields comply with the described formats and constraints.
Mandatory fields marked in bold must always have valid values.
Utilize the correct ISO 4217 currency codes to express monetary amounts accurately.