Insurance Plans Eligibility Details

Output representation of the insurance plan eligibility check.

JSON Example 

1{
2  "memberId": "0BMxx000000000001",
3  "contextId": "42ce00ea6a44dcc0d308ba1ea7c4c9bb455bd14bb0405ff03dca1b5371c42cda",
4  "isSuccess": true,
5  "planEligibilityDetails": {
6    "plans": [
7      {
8        "planId": "8ckxx000000000001",
9        "planName": "Group Medical Plan",
10        "productCategory": "Medical",
11        "isOptional": false,
12        "attributes": [
13          {
14            "entries": [
15              {
16                "key": "AGE_BAND",
17                "value": "18-25"
18              }
19            ]
20          }
21        ],
22        "coverages": [
23          {
24            "planId": "8ckxx000000000002",
25            "planName": "Dental Coverage",
26            "productCategory": "Dental",
27            "isOptional": true,
28            "attributes": [],
29            "uiTreatments": [
30              {
31                "uiTreatmentType": "disable",
32                "uiTreatmentTarget": "attribute_picklist_value",
33                "details": {
34                  "planId": "8ckxx000000000002",
35                  "attributeCode": "COVERAGE_TIER",
36                  "attributeValue": "Family"
37                }
38              },
39              {
40                "details": {
41                  "attributeId": "0tjxx000000000DAAQ",
42                  "attributeCode": "inCoverageCoinsurance",
43                  "attributeValue": "0",
44                  "stiId": "ref_4316263b_b30e_45fd_ad18_d2830d96f597",
45                  "attributePicklistValue": "CoinsuranceZero",
46                  "attributePicklistValueId": "0v6xx000000000SAAQ"
47                },
48                "uiTreatmentTarget": "attribute_picklist_value",
49                "uiTreatmentType": "hide"
50              },
51              {
52                "details": {
53                  "attributeId": "0tjxx000000000DAAQ",
54                  "attributeCode": "inCoverageCoinsurance",
55                  "attributeValue": "10",
56                  "stiId": "ref_4316263b_b30e_45fd_ad18_d2830d96f597",
57                  "attributePicklistValue": "CoinsuranceTen",
58                  "attributePicklistValueId": "0v6xx000000000TAAQ"
59                },
60                "uiTreatmentTarget": "attribute_picklist_value",
61                "uiTreatmentType": "hide"
62              }
63            ]
64          }
65        ],
66        "uiTreatments": [
67          {
68            "details": {
69              "attributeId": "0tjxx000000000cAAA",
70              "attributeCode": "onmedFees",
71              "stiId": "ref_875915aa_61c4_4916_ae58_9fa7e0dec529",
72              "attributeName": "Out-Network ICU Fees"
73            },
74            "uiTreatmentTarget": "attribute",
75            "uiTreatmentType": "hide"
76          }
77        ]
78      }
79    ],
80    "messages": [
81      {
82        "message": "Plan eligibility evaluated successfully.",
83        "messageType": "INFO"
84      }
85    ]
86  }
87}
Property NameTypeDescriptionFilter Group and VersionAvailable Version
contextIdStringID of the context that’s used for the eligibility check.Small, 66.066.0
errorsInsurance Error[]List of errors that occurred during the eligibility check.Small, 66.066.0
isSuccessBooleanIndicates whether the API operation is successful (true) or not (false).Small, 66.066.0
memberIdStringID of the group census member.Small, 66.066.0
planEligibility​DetailsEligible Plan DetailsDetails of the eligible plans.Small, 66.066.0