Ideon API
API Endpoint
Getting Started
Signing Up
Visit our Developer Portal to create an account.
Once you have created an account, you can create one Application for your Production environment and another for a Sandbox (select the appropriate Plan when you create the Application).
Authentication
To authenticate, pass the API Key you created in the Developer Portal as
a Vericred-Api-Key
header.
curl -H 'Vericred-Api-Key: YOUR_KEY' "https://api.ideonapi.com/networks?search_term=Anthem"
Versioning
Ideon’s API is versioned by endpoint. The current default version for all endpoints is v6
.
Some endpoints feature additional functionality with versions v7
or v8
, which can be accessed using the Accept-Version
header.
For each endpoint, we will indicate in the documentation which version(s) are available.
The API specifications for the latest available version will always be shown. Specifications for prior versions are available via request through Ideon support.
curl -H 'Vericred-Api-Key: YOUR_KEY' -H 'Accept-Version: v7' "https://api.ideonapi.com/networks?search_term=Anthem"
Pagination
Endpoints that accept page
and per_page
parameters are paginated. They expose
four additional fields that contain data about your position in the response,
namely Total
, Per-Page
, Link
, and Page
as described in RFC-5988.
For example, to display 5 results per page and view the second page of a
GET
to /networks
, your final request would be GET /networks?....page=2&per_page=5
.
Errors
Ideon uses HTTP codes to indicate the success or failure of an API request. Codes in the 2xx range indicate success. Codes in the 4xx range indicate an error given the request and/or credentials provided. Codes in the 5xx range indicate an error with Ideon’s servers.
HTTP Code | Description |
---|---|
200 | The request was successful. |
201 | The request was successful and a resource was created. |
204 | The request was successful and no content is returned. |
401 | The API request requires user authentication. Refer to our Authentication section above. |
403 | The API key doesn’t have permissions to perform the request. |
404 | The resource was not found. |
405 | The HTTP Method is not allowed. Are you doing a GET when it’s a POST? |
422 | There is something invalid or missing in the request body. |
429 | Too many requests hit the API too quickly. |
500 | The Ideon server encountered an unexpected condition which prevented it from fulfilling the request. |
503 | The Ideon server timed out when processing the request. |
Sideloading
When we return multiple levels of an object graph (e.g. Provider
s and their
State
s we typically the associated data. In this example, we would
provide an Array of State
s and a state_id
for each provider. This is
done primarily to reduce the payload size since many of the Provider
s
will share a State
Simplified Example
{
providers: [{ id: 1, state_id: 1}, { id: 2, state_id: 1 }],
states: [{ id: 1, code: 'NY' }]
}
If you need the second level of the object graph, you can just match the corresponding id.
Selecting specific data
All endpoints allow you to specify which fields you would like to return. This allows you to limit the response to contain only the data you need.
For example, let’s take a request that returns the following JSON by default
{
provider: {
id: 1,
name: 'John',
phone: '1234567890',
field_we_dont_care_about: 'value_we_dont_care_about'
},
states: [{
id: 1,
name: 'New York',
code: 'NY',
field_we_dont_care_about: 'value_we_dont_care_about'
}]
}
To limit our results to only return the fields we care about, we specify the
select
in the query string for a GET
or the body for a POST
.
In this case, we want to select name
and phone
from the provider
key,
so we would add the parameters select=provider.name,provider.phone
.
We also want the name
and code
from the states
key, so we would
add the parameters select=states.name,states.code
. The id field of
each document is always returned whether or not it is requested.
Our final request would be GET /providers/1234567898?select=provider.name,provider.phone,states.name,states.code
The response would be
{
provider: {
id: 1234567898,
name: 'John',
phone: '1234567890'
},
states: [{
id: 1,
name: 'New York',
code: 'NY'
}]
}
Plan and Rate Data
Ideon’s Plan and Rate Data let you search and quote Major Medical and Ancillary Insurance Plans in a given area for a particular family in the Individual Market or a group of families in the Small Group Market. Ideon provides the relevant data via this API and via our Bulk Format (documented below)
Plans
A Plan defines a set of Benefits available to its purchaser. For example, a Major Medical Plan would specify cost-share Benefits for services like a Primary Care Provider visit, a Specialist visit or an Emergency Room visit. A Dental Plan might specify Benefits for Periodontics and Fluroride Treatments. The Benefits for each Product type (Major Medical, Dental, and Vision) are documented below.
Benefits Format
Benefits for Plans can be quite complex. With the goals of capturing and standardizing the complexity while retaining a human-readable format, we have developed a Bakus-Naur Form(BNF) context-free grammar, with which we present Benefits.
Benefit cost-share strings are formatted to capture:
-
Network tiers
-
Compound or conditional cost-share
-
Limits on the cost-share
-
Benefit-specific maximum out-of-pocket costs
Example #1 As an example, we would represent this Summary of Benefits & Coverage as:
-
Hospital stay facility fees:
- Network Provider:
$400 copay/admit plus 20% coinsurance
- Out-of-Network Provider:
$1,500 copay/admit plus 50% coinsurance
- Ideon’s format for this benefit:
In-Network: $400 before deductible then 20% after deductible / Out-of-Network: $1,500 before deductible then 50% after deductible
- Network Provider:
-
Rehabilitation services:
- Network Provider:
20% coinsurance
- Out-of-Network Provider:
50% coinsurance
- Limitations & Exceptions:
35 visit maximum per benefit period combined with Chiropractic care.
- Ideon’s format for this benefit:
In-Network: 20% after deductible / Out-of-Network: 50% after deductible | limit: 35 visit(s) per Benefit Period
- Network Provider:
Example #2 In this other Summary of Benefits & Coverage, the specialty_drugs cost-share has a maximum out-of-pocket for in-network pharmacies.
- Specialty drugs:
- Network Provider:
40% coinsurance up to a $500 maximum for up to a 30 day supply
- Out-of-Network Provider
Not covered
- Ideon’s format for this benefit:
In-Network: 40% after deductible, up to $500 per script / Out-of-Network: 100%
- Network Provider:
BNF
Here’s a description of the benefits summary string, represented as a context-free grammar:
root ::= (tier_prefix tier space slash space)* (tier_prefix tier) (space pipe space limit_condition_prefix limit)?
tier_prefix ::= tier_name colon space
tier_name ::= ("In-Network-Tier-" integer) | "Out-of-Network" | "In-Network"
integer ::= /[0-9]/+ (comma_int | under_int)*
comma_int ::= ("," /[0-9]/3*3) !"_"
under_int ::= ("_" /[0-9]/3*3) !","
tier ::= allowance_tier_coverage | tier_coverage | not_applicable | unlimited | included | unknown | not_covered
allowance_tier_coverage ::= allowance_coverage (space conjunction space allowance_coverage)* tier_limitation?
allowance_coverage ::= (pre_coverage_limitation space)? percentage_amount (space post_coverage_limitation)? (comma? space coverage_condition)? (space after_allowance)
pre_coverage_limitation ::= first space digits space time_unit plural
digits ::= /[0-9]/+ ("_" /[0-9]/+)*
time_unit ::= /hour/ | /minute/ | /year/ | /month/ | /day/ | /week/ | /visit/ | /lifetime/ | /benefit period/ | /pregnancy/
percentage_amount ::= single_percentage
single_percentage ::= number "%"
number ::= float | integer
float ::= digits "." digits
post_coverage_limitation ::= ((("then" space currency) | "per condition") space)? ("per" | "for") space (treatment_unit | ((integer space)? time_unit)) plural?
currency ::= currency_range | single_currency
currency_range ::= single_currency "-" single_currency
single_currency ::= currency_number
treatment_unit ::= /person/ | /group/ | /condition/ | /script/ | /visit/ | /exam/ | /item/ | /treatment/ | /admission/ | /episode/ | /procedure/
coverage_condition ::= ("before deductible" | "after deductible" | "penalty" | allowance | "deductible applies") (space unit_amount)? (space allowance)?
allowance ::= upto_allowance | after_allowance
upto_allowance ::= "up to" space (currency space)? "allowance"
after_allowance ::= "after" space (currency space)? "allowance"
unit_amount ::= digits space (treatment_unit | (time_unit plural)) plural?
conjunction ::= "then" | "and" | "or" | "plus"
tier_limitation ::= comma space "up to" space (currency | (integer space time_unit plural?)) (space post_coverage_limitation)?
tier_coverage ::= coverage (space conjunction space coverage)* tier_limitation*
coverage ::= disallow_zero_percentage_on_after_deductible (pre_coverage_limitation space)? (currency_amount | percentage_amount | unit_amount) (space post_coverage_limitation)? (comma? space coverage_condition)?
disallow_zero_percentage_on_after_deductible ::= !/0% after deductible/
currency_amount ::= currency_range | single_currency
not_applicable ::= "Not Applicable" | "N/A" | "NA"
limit_condition_prefix ::= limit_condition colon space
limit_condition ::= "limit" | "condition"
limit ::= (coverage (semicolon space see_carrier_documentation)?) | see_carrier_documentation | waived_if_admitted | shared_across_tiers | time_unit_per_duration
waived_if_admitted ::= ("copay" space)? "waived if admitted"
time_unit_per_duration ::= integer time_unit plural space "per" time_unit plural?
see_carrier_documentation ::= "see carrier documentation for more information"
currency_number ::= /[$]{1}[0-9]{1,3}(?:,[0-9]{3})*(?:\.[0-9]{2})?/
included ::= /[iI]ncluded in [mM]edical/
shared_across_tiers ::= "shared across all tiers"
not_covered ::= /[nN]ot [cC]overed/
unlimited ::= /[uU]nlimited/
unknown ::= "unknown"
first ::= "first"
space ::= /[ \t]/
plural ::= "(s)"
semicolon ::= ";"
pipe ::= "|"
slash ::= "/"
comma ::= ","
colon ::= ":"
Major Medical
Ideon’s data covers all Major Medical Plans available in the Individual and Small Groups (2-50 or 2-100) Markets in the US. These Plans are governed by CMS and are ACA-compliant. We do not include certain Plans that fall outside of the ACA, for example, Faith-Based Plans or Short-Term Medical Plans
We support the following Benefits Fields for Major Medical Plans. These represent the vast majority of fields available on a Summary of Benefits and Coverage
The following are the appropriate Benefit Fields for Major Medical:
-
ambulance
-
child_eye_exam
-
child_eyewear
-
chiropractic_services
-
diagnostic_test
-
durable_medical_equipment
-
emergency_room
-
family_drug_deductible
-
family_drug_moop
-
family_medical_deductible
-
family_medical_moop
-
generic_drugs
-
habilitation_services
-
home_health_care
-
hospice_service
-
imaging_center
-
imaging_physician
-
individual_drug_deductible
-
individual_drug_moop
-
individual_medical_deductible
-
individual_medical_moop
-
inpatient_birth
-
inpatient_birth_physician
-
inpatient_facility
-
inpatient_mental_health
-
inpatient_physician
-
inpatient_substance
-
lab_test
-
non_preferred_brand_drugs
-
nonpreferred_generic_drug_share
-
nonpreferred_specialty_drug_share
-
outpatient_ambulatory_care_center
-
outpatient_facility
-
outpatient_mental_health
-
outpatient_physician
-
outpatient_substance
-
plan_coinsurance
-
postnatal_care
-
preferred_brand_drugs
-
prenatal_care
-
preventative_care
-
primary_care_physician
-
rehabilitation_services
-
skilled_nursing
-
specialist
-
specialty_drugs
-
telemedicine
-
urgent_care
Medicare Advantage
Medicare Advantage endpoints support MA (Medicare Advantage plans without prescription drug benefits), MAPD (Medicare Advantage plans with prescription drug benefits), and PDP (prescription drug benefits only) plans.
Medical and hospital benefits - we support over 4000 individual plans through our API nationwide. At this time, we do not support EGHP (employer group health plans).
Prescription drug benefits - drug benefits are categorized into initial coverage phase, coverage gap phase, and catastrophic phase. Each phase is broken down by drug tiers, pharmacy tiers, and length of supply.
Click here to learn more about quoting Medicare Advantage plans.
Dental
Dental benefits are less standardized than Major Medical. Because of this, we have captured benefits in two ways. As a high-level plan summary, the coverage tier fields - preventive, basic, and major - show the amount the plan pays for a benefit.
Additionally, we include the most commonly specified services and procedures and their associated cost to the customer, limitations, and which coverage tier they are included in. If a plan only specifies cost-share for preventive, basic, major, etc, we determine the appropriate category and value for each of the benefits that we support.
To view the technical documentation, click here.
The following are the supported Benefit Fields for Dental:
-
adult_individual_deductible
-
adult_individual_annual_max
-
child_individual_annual_max
-
child_individual_deductible
-
child_individual_moop
-
family_deductible
-
coverage_tiers
- preventive
- basic
- major
-
benefits
- bridges
- crowns
- denture_relines_rebases
- denture_repair_and_adjustments
- dentures
- emergency_treatment
- endodontics
- fluoride_treatment
- implants
- inlays
- onlays
- oral_exam
- oral_surgery
- orthodontics_adult
- orthodontics_child
- periodontal_maintenance
- periodontics
- prophylaxis_cleaning
- radiograph_bitewings
- radiograph_other
- restoration_fillings
- sealant
- simple_extraction
- space_maintainers
-
copay_schedule
-
out_of_network_reimbursement_type
-
usual_customary_reasonable_percentile
Vision
Vision benefits are similar in structure to Dental. We display high-level plan summary data such as copays and service frequencies as well as detailed benefit information. Again, where benefits are broken out by category, we display the appropriate value for each service or procedure.
To view the technical documentation, click here.
The following are the supported Benefit Fields for Dental:
-
exam_copay
-
materials_copay
-
service_frequency
- exams
- lenses
- frames
- contacts
-
benefits
- eye_exam
- retinal_imaging
- frame
- eyeglass_lenses_single_vision
- eyeglass_lenses_bifocal
- eyeglass_lenses_trifocal
- eyeglass_lenses_lenticular
- uv_coating
- tint
- standard_antireflective_coating
- premium_antireflective_coating
- standard_polycarbonate_lenses_child
- standard_polycarbonate_lenses_adult
- standard_progressive_lenses
- premium_progressive_lenses
- standard_scratch_resistance
- polarized_lenses
- photochromatic_lenses
- standard_contact_lens_fit_and_follow_up
- premium_contact_lens_fit_and_follow_up
- contact_lenses_conventional
- contact_lenses_disposable
- contact_lenses_medically_necessary
- laser_vision_correction
- additional_pairs_of_eyeglasses
Life
Group Life insurance is supported. The following are the supported Benefit Fields for Life plans:
-
Benefits
- Employee
- Minimum
- Maximum
- Increment
- Spouse
- Minimum
- Maximum
- Increment
- Child
- Minimum
- Maximum
- Increment
- Employee
-
Guaranteed Issue Bands
- Minimum Age
- Maximum Age
- Employee
- Spouse
- Child
-
Benefit Reduction Schedules
- Age
- Reduction Amount
-
Convertible After Termination
-
Disabled Premium Waiver
-
Premium Increase
-
Accidental Death & Dismemberment Included
-
Accidental Death & Dismemberment Covered Members
- Employee
- Spouse
- Child
Disability
Group Disability insurance is supported. The following are the supported Benefit Fields for Disability plans:
-
Benefit
- Amount
- Maximum Amount
- Maximum Duration
-
Disabled Premium Waiver
-
Own Occupation Disability Definition
-
Waiting Period Accident
-
Waiting Period Illness
Accident
Group Accident insurance is supported. Accident plans are structured to include high-level plan data as well as a standardized set of the most common benefits.
To view the technical documentation, click here.
The following are the supported Benefit Fields for Accident plans:
-
Portability
-
24 Hour
-
Rate Guarantee
-
Accidental Death & Dismemberment Included
-
Accidental Death Benefit
- Employee
- Spouse
- Child
-
Common Carrier Death Benefit
- Employee
- Spouse
- Child
-
Benefits
- Ambulance
- Burns
- Diagnostic Exam
- Dislocations
- Emergency Room Treatment
- Eye Injury
- Fractures
- Hospital Admission
- Hospital Admission ICU
- Hospital Confinement
- Hospital Confinement ICU
- Outpatient Therapy
- Treatment Follow Up
- Treatment Doctor’s Office Initial
- Treatment Urgent Care Initial
- Wellness
Critical Illness
Group Critical Illness insurance is supported. Critical Illness plans are structured to include high-level plan data as well as a standardized set of the most common covered conditions.
To view the technical documentation, click here.
The following are the supported Benefit Fields for Critical Illness plans:
-
Portability
-
Premium Increase
-
Exclusion Period
-
Look Back Period
-
Treatment Free Period
-
Second Occurrence Suspension Period
-
Rate Guarantee
-
Insured Benefits
- Employee
- Minimum
- Maximum
- Increment
- Spouse
- Minimum
- Maximum
- Increment
- Child
- Minimum
- Maximum
- Increment
- Employee
-
Guaranteed Issue Bands
- Minimum Group Size
- Maximum Group Size
- Employee
- Spouse
- Child
-
Benefit Reduction Schedules
- Age
- Reduction Amount
-
Benefits (Covered Conditions)
- Invasive Cancer
- Non Invasive Cancer
- Heart Attack
- Stroke
- Kidney Failure
- Organ Failure
- Major Organ Transplant
- Coronary Artery Disease
- Coronary Artery Bypass Surgery
- Coma
- Loss of Sight
- Loss of Hearing
- Paralysis
- ALS (Lou Gehrig’s Disease)
- Alzheimer’s Disease
- Addison’s Disease
Hospital Indemnity
Group Hospital Indemnity insurance is supported. To view the technical documentation, click here.
The following are the supported Benefit Fields for Hospital Indemnity plans:
-
Portability
-
Premium Increase
-
Exclusion Period
-
Look Back Period
-
Treatment Free Period
-
Rate Guarantee
-
ICU Admission Paid in Addition to Hospital
-
ICU Confinement Paid in Addition to Hospital
-
Benefits
- Hospital Admission
- Hospital Admission ICU
- Hospital Confinement
- Hospital Confinement ICU
- Wellness
Rates
Rates are returned from the API as a part of Quoting. We calculate Rates in one of two ways.
Sheet Rates
When a Carrier supplies us with Sheet Rates, we display exactly the value provided to us. For example, in the Major Medical market, most Carriers provide a single rate for each combination of Applicant age and tobacco status in a given Rating Area. For example, in Austin, TX, a 21-year-old non-tobacco-user may be $312.41 per month while a 22-year-old tobacco-user may be $401.75 per month. Certain Vision and Dental Carriers supply Sheet Rates as well, though it is less common.
Rate Factors
Certain Major Medical Carriers and most Vision and Dental Carriers supply Rate Factors. The attributes on which the factors are based are the same as Sheet Rates for the Major Medical market (due to restrictions on what factors may be used in ACA Plans, which limit the possible factors to age and tobacco status).
In Dental and Vision, the types of Rate Factors are more varied. For example, SIC Code and Group size in the Group market and Gender in the Individual Market are commonly used Rate Factors
Other common Rate Factors for Dental and Vision products are Geographic and “Trend” (enrollment date) Factors. In Major Medical, these types of variance are handled by CMS-defined Rating Areas.
In order to calculate a Rate using Rate Factors, the following methodology is applied:
B = Base Rate
f = Rate Factor Function 1
f' = Rate Factor Function 2
B * f(x) * f'(y) [* f''(z)] ... = n
Rating Areas
For Major Medical products, CMS defines Rating Areas. Under the ACA, all Rate Factors in a Rating Area must be identical for a given time period. E.g. in Arizona, the rate for a 21-year-old non-tobacco user must be identical in all counties contained in Rating Area 1 (Mohave, Coconino, Apache, and Navajo), but may be different than the rate for a 21-year-old non-tobacco user in all counties Rating Area 2 (Yavapai county only) for a given year in the Individual Market and a given quartern in the Small Group market.
Rating Areas are defined either by County, Zip Code or both, depending on the State. Because of this variance, all API endpoints that require a Location require both zip_code
and fips_code
(a county code). Bulk Data for Rating Areas and Service Areas also specifies locations using both zip_code
and fips_code
.
Rating Areas do not apply to products other than Major Medical
Service Areas
CMS mandates that Major Medical Rates be defined by Rating Areas, which themselves define a geography in which Plans are offered. Carriers often choose not to offer a Plan in and entire Rating Area due to network coverage or other factors. Instead, the Carrier would define a Service Area that specifies where a given Plan is offered.
Each Plan is available in a single Service Area and each Service Area is defined by either County, Zip Code, or both, depending on the Carrier. Because of this variance, all API endpoints that require a Location require both zip_code
and fips_code
(a county code). Bulk Data for Rating Areas and Service Areas also specifies locations using both zip_code
and fips_code
.
In Dental and Vision plans, we use a Service Area to define availability as well, although it typically mirrors a Geographic Rate Factor.
Quoting
One of the primary use-cases for the Ideon API is to run Quotes to determine the Rate for a given family (in the Individual Market) or group (in the Small Group Market). We support quoting across Major Medical, Vision, and Dental. In both cases, the process of generating a Quote is broken out into several steps:
-
Find all available Plans in the relevent Service Areas for the family or group.
-
Using Business Rules for each Plan, determine if the family or group is eligible for that Plan.
-
Using Business Rules for each Plan, determine which members of the family or which members of each family in the group should be considered for Rating.
-
Using the Sheet Rates or Rate Factors for each Plan, determine the Rate the family, or for each family in the group.
-
If running a Composite quote, determine the portion of the total Rate that each family will pay.
Individual Quotes
An Individual Quote is one for Plans that are available to a particular family, outside the context of their Employer. In the Major Medical market, many of these Plans are available on Healthcare.gov or the State-Based Exchange for non-Healthcare.gov states. The API supports both on-market and off-market Plans.
For details on Major Medical Quoting API calls see below
Specifying the Location
In order to determine which plans are available and the rate for each Plan, you must specify a location. When creating a Quote for the Individual Market, that information is contained in the POST
body of the request:
POST /plans/medical/search
{
...
"zip_code": "11201",
"fips_code": "36047"
...
}
Specifying Applicants
Applicants are the members of the family being quoted and are specified in the POST
body of the request.
POST /plans/medical/search
{
...
"applicants": [
{
"age": 34,
"smoker": true,
"child": false
},
{
"age": 32,
"smoker": false,
"child": false
},
{
"age": 4,
"smoker": false,
"child": true
}
]
...
}
Specifying Enrollment Date
The enrollment_date
determines which Plans and Rates are returned. Specifying an enrollment_date
in the past allows you to calculate historical data as far back as 2014.
Plan Benefits
Plan Benefits are returned in the response for Individual Quotes
POST /plans/medical/search
{
...
}
Response:
{
"plans": [
{
...
"individual_medical_deductible": "$5,000",
"family_medical_deductible": "$10,000"
...
}
]
}
Premiums
The value for the family being quoted is returned in the premium
field. If no Applicants are provided, the premium
field will be 0
Major Medical Quotes
In order to Quote Major Medical Plans, send a POST
to /plans/medical/search
. In addition, the age
, smoker
and child
attributes of each Applicant must be present.
Subsidies
On-market (Healthcare.gov and State-Based Exchange) Major Medical Plans are eligible for government subsidies. The subsidy calculation is based on the percentage of the family’s income that the IRS has designated as “affordable” for that family and the Second Lowest-Cost Silver Plan available to that family.
In order to calculate subsidies for a family the following parameters must be supplied:
POST /plans/medical/search
{
...
"household_size": 4,
"household_income": 40000
...
}
The amount that the family will pay after subsidy is returned in the premium_subsidized
field for each plan.
Subsidy Calculation
Here is how subsidies are calculated. This is fully handled by the Ideon API, but the steps are enumerated below for clarity.
-
Determine the percentage of the Federal Poverty Level for the family based on the household size and income.
-
Reference the CMS table to determine the appropriate percentage of income for the family to spend on healthcare.
-
Multiply that value by the family’s income. This is the total amount that the family can spend on healthcare for the year, after the subsidy.
-
Find the cost of the Second Least-Expensive Silver Plan available to the family, accounting for the percentage of premium that goes to Essential Health Benefits
-
Calculate the difference in price between the amount the family should spend on healthcare and the Second Least-Expensive Silver Plan’s premium. This is the subsidy.
-
Apply the subsidy to all on-market Plans available to the family. The subsidized premium can never be below $0 (for example, a low-cost Bronze Plan may be less expensive than the subsidy)
Cost Sharing Reduction Plans
Cost Sharing Reduction (CSR) Plans are available to lower income families and offer enhanced benefits for certain Silver Plans at the same cost as the non-CSR Plans available to higher-income families.
If a family is eligible for CSR Plans, the Ideon API will return the relevant Plan in place of the non-CSR version.
In order to include CSR Plans where applicable, the following parameters must be supplied:
POST /plans/medical/search
{
...
"household_size": 4,
"household_income": 40000
...
}
The Children’s Health Insurance Program (CHIP)
The Children’s Health Insurance Program (CHIP) provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid.
If a family is eligible for CHIP, the Ideon API will include the subsidy in the returned premiums. In order to include CHIP subsidies in premium calculations, the following parameters must be supplied:
POST /plans/medical/search
{
...
"applicants": [
{
"age": 34,
"smoker": true,
"child": false
},
{
"age": 32,
"smoker": false,
"child": false
},
{
"age": 4,
"smoker": false,
"child": true
},
{
"age": 4,
"smoker": false,
"child": true
}
],
"household_size": 4,
"household_income": 40000
...
}
CHIP eligibility is displayed within the meta-tag in the response as eligible_for_chip_medicaid
:
{
"meta": {
"total": 150,
"eligible_for_chip_medicaid": true,
"premium_tax_credit": 500.20
},
"coverages": [],
"plans": [...]
}
If you do not want CHIP subsidies to be included in the premiums, simply do not include the household_income
parameter in the request.
Dental Quotes
Quoting Dental Plans for a family requires slightly different parameters for Applicants, due to the method with which Plans are rated. The folloiwng example contains the require parameters:
POST /plans/dental/search
{
...
"applicants": [
{
"age": 34,
"gender": "M",
"child": false
},
{
"age": 32,
"gender": "F",
"child": false
},
{
"age": 4,
"gender": "M",
"child": true
}
]
...
}
Note that in contrast to Major Medical Quotes, Dental Quotes require gender
, but do not require smoker
.
Also note that Subsidies and Cost Sharing Reduction are not relevant for Dental Quotes.
Vision Quotes
Quoting Vision Plans for a family requires slightly different parameters for Applicants, due to the method with which Plans are rated. The folloiwng example contains the require parameters:
POST /plans/vision/search
{
...
"applicants": [
{
"age": 34,
"gender": "M",
"child": false
},
{
"age": 32,
"gender": "F",
"child": false
},
{
"age": 4,
"gender": "M",
"child": true
}
]
...
}
Note that in contrast to Major Medical Quotes, Vision Quotes require gender
, but do not require smoker
.
Also note that Subsidies and Cost Sharing Reduction are not relevant for Vision Quotes.
Medicare Advantage quotes
Given an enrollment date and location, you can search all plans available at this location using /plans/medadv/search; you can also search a specific plan using its plan ID with /plans/medadv/{plan_id} if the plan ID is already known. The following example contains the required parameters:
{
"zip_code": "02880",
"fips_code": "44009",
"enrollment_date": "2019-01-01"
}
To view the technical documentation, click here.
Quotes for Groups
A Group Quote finds Plans and Rates for a group of employees for a small business. Different Plans are available to small groups than are available in Individual Quoting. In addition, Business Rules that apply across multiple families or based upon employer attributes such as SIC code factor into rates and availability.
In addition, due to performance requirements and for enhanced auditing, Group Quotes are persisted across requests. This means that a given Quote can be retrieved after it has been created.
At a very high level, here are the steps to getting set up to quote Groups using the Group Rating API:
- Create the Group - a representation of the Employer and its office locations
- Add the Census - add the members or employees, and their dependents. These are the members that will be quoted.
- Create a Quote - let Ideon know what product line and effective date you want to quote the Group for.
- View Group Rates - normalized for all product lines, Ideon returns the available rates for all quoted plans in one paginated endpoint.
- View Member Rates - look into the details for a particular group rate to see what each Member in the Group costs.
- Loading Plan Data - The plan benefit schema varies by product line. We recommend using the Bulk Plans endpoint to cache plan benefit information in your system in order to provide a seamless experience for your users.
Create the Group
Creating a group is the first step in the Group Rating API. The endpoint requires that certain information such as sic_code
, and chamber_association
be provided and returns a the attributes and id
for the newly created Group
When creating a Group
, you must specify one or more Location
s. Of those Location
s specified, one must be primary
. That Location
is used to calculate Plan eligibility using the relevant Service Areas. Some Carriers use secondary Location
s to determine eligibility as well, which is why those must be specified as well.
POST /groups
{
"group": {
...
},
"locations": [
{
...
"zip_code": "11201",
"fips_code": "36047",
"primary": true
...
}
]
}
Add the Census
A Census is the collection of Member
s contained in the Group
. The attributes of each Member
and his or her Dependent
s determine the Rate for the Group
as a whole. Certain attributes of the Member
are important for calculating Rates and applying Business Rules. For example, the Member
's home address and in which office he or she works are relevant for certain Business Rules.
Dependent Relationships
The Dependent
s for a given Member
also factor into the Rates and application of Business Rules. For example, certain Plans cover only Dependent
s of particular types and/or only Dependent
s of a particular type who live in the same household as the primary Member
. Additionally, Dependent
s with a type of child
, adopted_child
, sibling
, foster_child
, or step_child
will be checked against the maximum dependent age for plans; other Dependent
types will not.
Valid Dependent Relationships:
-
adopted_child
-
child
-
court_appointed_guardian
-
dependent_of_dependent
-
disabled_child
-
ex_spouse
-
foster_child
-
grand_child
-
guardian
-
life_partner
-
other
-
sibling
-
sponsored_dependent
-
spouse
-
step_child
-
ward
While all of the above dependent relationships are valid, some will filter out all or most plans for a quote since they are not allowed based on the business rules for the underlying insurance plans. Therefore, we recommend sticking to the following set:
-
adopted_child
-
child
-
court_appointed_guardian
-
disabled_child
-
foster_child
-
life_partner
-
spouse
-
step_child
-
ward
POST
/groups/{id}/members
{
"members": [
...
{
"cobra": false,
"date_of_birth": "1980-01-01",
"first_name": "John",
"last_name": "Doe",
"fips_code": "36047"
"gender": "M",
"last_used_tobacco": "2017-01-01",
"location_id": :location_id
"retiree": false,
"zip_code": "11201",
"dependents": [
...
{
"relationship": "child",
"first_name": "John",
"last_name": "Doe",
"same_household": true
}
...
]
}
...
]
}
Create a Quote
At this stage, you’ve accomplished the following:
- Create a Group
- Add Members to the Group
Now you’re ready to Create a Quote for the Group! The Group Rating API has support for:
-
Medical (ACA)
-
Medical (Level Funded)
-
Dental
-
Vision
-
Life
-
Long Term Disability
-
Short Term Disability
-
Accident
-
Critical Illness
-
Hospital Indemnity
Quoting different product lines is as simple as providing the appropriate product_line
value in the request body. See the endpoint detail page for more details: Create a Quote.
The Group Rating API returns rates back in a standard format across all of the product lines listed above. However, the plan benefit schema varies by product line. We recommend using the Bulk Plans endpoint to cache plan benefit information in your system in order to provide a seamless experience for your users.
Ideon works with our Carrier partners to acquire and apply Business Rules that can affect either Plan availability or the way in which Member
s and Dependent
s are rated. For example, one Carrier’s Business Rules might specify that Member
s and Dependent
s who have used tobacco in the past 4 months are considered “tobacco-users”, while another’s may specify that period to be 1 year. These rules are applied transparently during the Quoting process and do not require any additional action or input on your part.
When there is a business rule that prevents one or more plan from being quoted, Ideon returned the information in the Limiting Factors endpoint for your system to easily deliver that information to users.
Retrieve Quote Attributes
Once you have created a Quote, you can retrieve the quote and its attributes.
The Quoting API is asynchronous for Level Funded Quotes. You can use the status
field to poll until it is complete. Results are typically returned promptly. Speeds vary based on group size and plan availability.
GET /quotes/{id}
Response
{
"quote": {
"carrier_ids": [
"12345"
],
"commission_amount": 125,
"contribution_percentage": 90,
"created_at": "2018-10-23T12:00:00.000Z",
"effective_date": "2018-12-01",
"id": "5db8ce543d",
"include_member_limited_plans": true,
"market": "small_group",
"npn": "123456789",
"participation_percentage": 75,
"product_line": "medical",
"rating_method": "age_banded",
"status": "complete",
"voluntary": true
}
}
Retrieve Aggregate Rates
Once a Quote has been run, you can retrieve its aggregate Rates. Rates are broken down by Member
and Dependent
, so that you can show the final cost in different scenarios where an employer might cover a different percentage of Member
and Dependent
costs.
GET /quotes/{id}/rates
Response
{
"rates": [
...
{
"id": "123abc",
"claims_surplus_fraction": "1/3",
"plan_id": "12345NY6789012",
"stop_loss_amount": "25000.00",
"total_premium": "2800.00",
"member_premium": "1000.00",
"dependent_premium": "1800.00",
"premiums": {
"age_banded": {
"total_member": "1000.00",
"total_dependent": "1800.00",
"total": "2800.00"
},
"2_tier_composite": {
"employee_only": "200.00",
"employee_plus_family": "400.00",
"total": "2800.00"
},
"3_tier_composite": {
"employee_only": "200.00",
"employee_plus_one": "250.00",
"employee_plus_family": "330.00",
"total": "2800.00"
},
"4_tier_composite": {
"employee_only": "200.00",
"employee_plus_child": "220.00",
"employee_plus_spouse": "250.00",
"employee_plus_family": "330.00",
"claims_fund": "1800.00",
"fixed_costs": "1000.00",
"total": "2800.00"
},
"disability": {
"elimination_period": "8/8",
"premium_bands": [
{
"employee": "0.95",
"maximum_age": 20,
"minimum_age": 0
}
],
"term": "long_term"
},
"life": {
"child_rate": "0.10",
"premium_bands": [
{
"employee": "0.05",
"employee_tobacco": "0.05",
"maximum_age": 20,
"minimum_age": 0,
"spouse": "0.05"
}
]
},
"accidental_death_dismemberment": {
"child": "0.03",
"employee": "0.03",
"spouse": "0.03"
}
}
}
...
]
}
Level Funded rates are illustrative and will contain a claims_surplus_fraction
, indicating the amount of surplus claims fund the employer could get back, a stop_loss_amount
, and total monthly cost breakdown, where available, for 4_tier_composite
rates. The total monthly cost breakdown includes a claims_fund
amount, the amount of monthly premium that goes towards the claims fund, and fixed_costs
, the amount of monthly premium that goes towards administrative fees, stop loss premiums, and other fixed costs.
Life plans display the monthly rate per $1,000 of benefit coverage selected by the member. If applicable, the accompanying accidental_death_dismemberment
rates will be displayed also on a per $1,000 basis. If the plan requires that Accidental Death & Dismemberment coverage be attached to the plan, the final rate will be the sum of the two for each member.
Short Term Disability plans display the monthly rate per $10 of benefit coverage selected by the member. Long Term Disability plans display the monthly rate per $100 of benefit coverage selected by the member.
Retrieve Member-Level Rates
In order to retrieve the exact Rate for each Member
and their Dependents
for given Plan, you can load Member-Level Rates
.
GET /rates/{id}/member_rates
Response
{
"member_rates": [
...
{
"id": "123abc",
"member_id": "234def",
"member_external_id": "externally-supplied-id",
"member_premium": 500.0,
"dependent_premium": 600.0,
"total_premium": 1100.0
}
...
]
}
Note that all MemberRate
s are for one particular Plan - the one referenced by the parent Rate.
Composite Rate Methodology
Composite Rates are commonly used in Major Medical, Dental, and Vision Plans to simplify operations by charging each family the weighted average of the Group
's total premium. The most common methodology is as follows:
-
Calculate the Rates for the entire
Group
using Sheet Rates or Rate Factors as appropriate -
Categorize each Family within the Group. The categorization differs depending on whether the Composite Rate is 2, 3, or 4-tier
-
Multiply the number of Families in each category by the constant for that category. These constants are provided to Ideon by the Carrier. This determines the total number of “Rating Units”
-
Divide the total premium calculated in Step 1 by the total number of Rating Units to get the price per Rating Unit
-
The Rate each Family pays is the constant for that Family’s category multiplied by the price per Rating Unit.
You can request that a Quote be calculated using Composite Rates when creating it:
POST /quotes
{
...
"rating_method": "4_tier_composite"
...
}
If no Composite Rates methodology is available, the Ideon API will return standard age-banded Rates.
Network and Provider Data
A Provider
is an individual or organization in the medical profession. For example, an individual doctor is a Provider
as are certain clinics and hospitals.
Provider
s are related to Network
s. A Network
is a collection of Provider
s that are under a particular contract with a given Carrier
. A given Carrier
will often have multiple Network
s. For example, there may be a large national Network
as well as several smaller regional Network
s.
Each Plan
has a Network
. A consumer who visits a Provider
typically incurs fewer costs when visiting a Provider
in the Network
covered by his or her Plan
. The premium
for a Plan
is often proportional to the size of its Network
Finding Providers
In order to determine if a particular Plan
covers a given Provider
, you must first identify the Provider
. To do so, use the Provider Search API endpoint and specify some search criteria:
POST /providers/search
{
"search_term": "foo",
"zip_code": "11201"
}
The API will return an ordered list of Provider
s who match the query along with their names, addresses, and other demographic data. The id
field returned refers to the Provider
's NPI number. This is the key that is used to identify the Provider
across different API endpoints.
Finding Networks
A Network
is a collection of Provider
s that are under a particular contract with a given Carrier
. A given Carrier
will often have multiple Network
s. For example, there may be a large national Network
as well as several smaller regional Network
s.
The API supports searching for Networks
by Carrier, market and state. For more details view the endpoint documentation
Matching Providers to Networks
In order to determine if a Provider
is covered by a user’s Plan
, you will need to map the Provider
to a Network
. There are several methods to do this using the API
Using Plan Search
You can specify one or more npi
values in the Plan Search. To do so, include a list of providers
in the request
POST /plans/medical/search
{
...
"providers": [
{ "npi": "1234567890" },
{ "npi": "2345678901" }
]
...
}
In Version 7 (Header: “Accept-Version”: “v7”), the response will include the providers along with the particular addresses where they are in-network for each plan.
{
"plans": [
...
{
...
"id": "12345NY1234567",
"providers": [
{
"npi": 1234567890,
"in_network": true,
"addresses": [
{
"city": "New York",
"id": "589c907f-28c2-3d14-8916-1144a5191ba2",
"latitude": 45.55,
"longitude": 14.55,
"phone_numbers": [
"2122223333",
"9172223334"
],
"state": "NY",
"street_line_1": "123 Fake Street",
"street_line_2": "Apt 10",
"zip_code": "11215"
}
]
}
]
...
}
}
In previous versions, the response will return a list of in_network_ids
and out_of_network_ids
for each Plan
.
{
"plans": [
...
{
...
"id": "12345NY1234567",
"in_network_ids": [1234567890],
"out_of_network_ids": [1234567890]
...
},
{
...
"id": "12345NY2345678",
"in_network_ids": [1234567890, 1234567890],
"out_of_network_ids": []
...
}
...
]
}
Simply reference the Provider
in question by its id
for each Plan
to see if that Provider
is in-network for the Plan
.
Matching by Plan ID
Given a Provider
's id
, you can retrieve all of his or her hios_ids
For more details see the endpoint documentation
GET /providers/1234567890
{
"provider": {
...
"hios_ids": [
...
"12345NY1234567"
...
]
...
}
}
The returned hios_ids
can be used to cross-reference a Plan
Matching by Network
Once you have an ID returned from the Network
search endpoint, you can cross-reference it with the network_ids
returned from both the Provider
search and Provider
details endpoints.
This is useful for large group data or when you are not dealing with Plan
s directly, but rather at the Network
level.
Group Member Management ¶
Group Member Management ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Body
{
"group": {
"chamber_association": true,
"company_name": "Foo Bar, Inc.",
"contact_email": "[email protected]",
"contact_name": "John Doe",
"contact_phone": "212-555-1234",
"external_id": "abc123",
"sic_code": "0700"
},
"locations": [
{
"external_id": "def123",
"fips_code": "36081",
"name": "Headquarters",
"number_of_employees": 32,
"primary": true,
"zip_code": "11423"
}
]
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"group": {
"type": "object",
"properties": {
"chamber_association": {
"type": "boolean"
},
"company_name": {
"type": "string"
},
"contact_email": {
"type": "string"
},
"contact_name": {
"type": "string"
},
"contact_phone": {
"type": "string"
},
"external_id": {
"type": "string"
},
"sic_code": {
"type": "string"
}
},
"description": "Group Attributes"
},
"locations": {
"type": "array",
"description": "List of Locations"
}
}
}
Headers
Content-Type: application/json
Body
{
"group": {
"chamber_association": true,
"company_name": "Foo Bar, Inc.",
"contact_email": "[email protected]",
"contact_name": "John Doe",
"contact_phone": "212-555-1234",
"external_id": "abc123",
"id": "b215b6bcdb",
"sic_code": "0700"
},
"locations": [
{
"external_id": "def123",
"fips_code": "36081",
"id": "8be378c035",
"name": "Headquarters",
"number_of_employees": 32,
"primary": true,
"zip_code": "11423"
}
]
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"group": {
"type": "object",
"properties": {
"chamber_association": {
"type": "boolean"
},
"company_name": {
"type": "string"
},
"contact_email": {
"type": "string"
},
"contact_name": {
"type": "string"
},
"contact_phone": {
"type": "string"
},
"external_id": {
"type": "string"
},
"id": {
"type": "string"
},
"sic_code": {
"type": "string"
}
},
"description": "Group Attributes"
},
"locations": {
"type": "array",
"description": "List of Locations"
}
}
}
Create a GroupPOST/groups
Version History
v6
: The documentation for this endpoint references this latest available version.
Endpoint Description
Use this endpoint to create a new Group
. See the Overview Section for more information.
Request Parameters
Group (required)
The group
key is a required object that contains information related to the group that will be quoted.
Field | Type | Notes |
---|---|---|
chamber_association (required) |
boolean |
|
company_name (required) |
string |
|
contact_email (optional) |
string |
|
contact_name (optional) |
string |
|
contact_phone (optional) |
string |
The format is 123-123-1234 . |
external_id (required) |
string |
A field you can use to identify the group with. This can be an empty string. |
sic_code (required) |
string |
Locations (required)
The locations
key is a requied list of objects, each detailing a location in which the group has an office. There should only be one primary location. The primary location is used to determine the plan availability for that group during the quoting process.
Field | Type | Notes |
---|---|---|
external_id (optional) |
string |
A field you can use to identify the location with. This can be an empty string. |
fips_code (required) |
string |
|
name (required) |
string |
|
number_of_employees (required) |
integer |
|
primary (required) |
boolean |
|
zip_code (required) |
string |
Group Member Management ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Headers
Content-Type: application/json
Body
{
"group": {
"chamber_association": true,
"company_name": "Foo Bar, Inc.",
"contact_email": "[email protected]",
"contact_name": "John Doe",
"contact_phone": "212-555-1234",
"external_id": "abc123",
"id": "b215b6bcdb",
"sic_code": "0700"
},
"locations": [
{
"external_id": "def123",
"fips_code": "36081",
"id": "8be378c035",
"name": "Headquarters",
"number_of_employees": 32,
"primary": true,
"zip_code": "11423"
}
]
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"group": {
"type": "object",
"properties": {
"chamber_association": {
"type": "boolean"
},
"company_name": {
"type": "string"
},
"contact_email": {
"type": "string"
},
"contact_name": {
"type": "string"
},
"contact_phone": {
"type": "string"
},
"external_id": {
"type": "string"
},
"id": {
"type": "string"
},
"sic_code": {
"type": "string"
}
},
"description": "Group Attributes"
},
"locations": {
"type": "array",
"description": "List of Locations"
}
}
}
Display a GroupGET/groups/{id}
Version History
v6
: The documentation for this endpoint references this latest available version.
Endpoint Description
Retrieve the details associated with a Group
.
URI Parameters
- id
string
(required) Example: b215b6bcdbID of the Group
Group Member Management ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Body
{
"members": [
{
"annual_salary": 55000,
"cobra": true,
"date_of_birth": "1980-10-31",
"dependents": [
{
"date_of_birth": "2005-10-21",
"first_name": "John",
"gender": "F",
"last_name": "Doe",
"last_used_tobacco": "2017-12-10",
"relationship": "child",
"same_household": true
}
],
"external_id": "def123",
"fips_code": "36081",
"first_name": "John",
"gender": "F",
"hours_per_week": 40,
"household_income": 55000,
"household_size": 1,
"last_name": "Doe",
"last_used_tobacco": "2017-10-30",
"location_id": "8be378c035",
"retiree": false,
"safe_harbor_income": 55000,
"zip_code": "11423"
}
]
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"members": {
"type": "array",
"description": "List of Members"
}
}
}
Headers
Content-Type: application/json
Body
{
"members": [
{
"annual_salary": 55000,
"cobra": true,
"date_of_birth": "1980-10-31",
"dependents": [
{
"date_of_birth": "2005-10-21",
"first_name": "John",
"gender": "F",
"id": "eec232e7d9-523dc2c2e",
"last_name": "Doe",
"last_used_tobacco": "2017-12-10",
"relationship": "child",
"same_household": true
}
],
"external_id": "def123",
"fips_code": "36081",
"first_name": "John",
"gender": "F",
"hours_per_week": 40,
"household_income": 55000,
"household_size": 1,
"id": "eec232e7d9",
"last_name": "Doe",
"last_used_tobacco": "2017-10-30",
"location_id": "8be378c035",
"retiree": false,
"safe_harbor_income": 55000,
"zip_code": "11423"
}
]
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"members": {
"type": "array",
"description": "List of Members"
}
}
}
Create MembersPOST/groups/{id}/members
Version History
v6
: The documentation for this endpoint references this latest available version.
Endpoint Description
Add Members
and their Dependents
to a Group
. In contrast to Create or Replace Members where subsequent calls replace the previous members, this endpoint is additive. It is recommended to cap the maximum count of members in a single call at 500 for improved performance.
Request Parameters
Members (required)
The members
key is a required list containing the Members
for the Group
and their Dependents
.
Field | Type | Notes |
---|---|---|
cobra (required) |
boolean |
|
date_of_birth (required) |
string |
The format is YYYY-MM-DD . Members cannot be less than 0 years old at the time of quoting. |
first_name (optional) |
string |
Required for quoting Angle Health Level Funded plans. Not used for quoting any other lines of coverage or markets. |
last_name (optional) |
string |
Required for quoting Angle Health Level Funded plans. Not used for quoting any other lines of coverage or markets. |
dependents (required) |
list |
If the member does not have dependents, please pass an empty list. |
external_id (required) |
string |
A field you can use to identify the member with. This field has to be unique by member. |
fips_code (required) |
string |
|
gender (required) |
string |
The options are: M or F . |
last_used_tobacco (required) |
string |
The format is YYYY-MM-DD . For those that have never smoked, please pass null . |
location_id (required) |
string |
The location where the member works. The identifier comes from the response when creating a Group . |
retiree (required) |
boolean |
|
zip_code (required) |
string |
|
household_income (optional) |
integer |
The annual income brought in for the household. Required for ICHRA Affordability Calculations. |
household_size (optional) |
integer |
The count of people in the household. Required for ICHRA Affordability Calculations. |
safe_harbor_income (optional) |
integer |
The annual income utilizing ICHRA’s safe harbor provisions. Required for ICHRA Affordability Calculations. |
annual_salary (optional) | integer |
The annual salary for the employee. Required for quoting certain carrier’s disability plans. Currently required for Beam disability. |
hours_per_week (optional) | integer |
The weekly hours worked for the employee. Required for quoting certain carrier’s disability plans. Currently required for Beam disability. |
Dependents
The dependents
key is a required list containing each Dependent
the Member
has. If the Member
has no dependents, an empty list should be passed.
Field | Type | Notes |
---|---|---|
date_of_birth (required) |
string |
The format is YYYY-MM-DD . Dependents cannot be less than 0 years old at the time of quoting. |
first_name (optional) |
string |
Required for quoting Angle Health Level Funded plans. Not used for quoting any other lines of coverage or markets. |
last_name (optional) |
string |
Required for quoting Angle Health Level Funded plans. Not used for quoting any other lines of coverage or markets. |
gender (required) |
string |
The options are M or F . |
last_used_tobacco (required) |
string |
The format is YYYY-MM-DD . For those that have never smoked, please pass null . |
relationship (required) |
string |
Please see the Overview Section for a list of allowed relationships. |
same_household (required) |
boolean |
Does the dependent live in the same household as the member? |
URI Parameters
- id
string
(required) Example: b215b6bcdbID of the Group
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Body
{
"members": [
{
"annual_salary": 55000,
"cobra": true,
"date_of_birth": "1980-10-31",
"dependents": [
{
"date_of_birth": "2005-10-21",
"first_name": "John",
"gender": "F",
"last_name": "Doe",
"last_used_tobacco": "2017-12-10",
"relationship": "child",
"same_household": true
}
],
"external_id": "def123",
"fips_code": "36081",
"first_name": "John",
"gender": "F",
"hours_per_week": 40,
"household_income": 55000,
"household_size": 1,
"last_name": "Doe",
"last_used_tobacco": "2017-10-30",
"location_id": "8be378c035",
"retiree": false,
"safe_harbor_income": 55000,
"zip_code": "11423"
}
]
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"members": {
"type": "array",
"description": "List of Members"
}
}
}
Headers
Content-Type: application/json
Body
{
"members": [
{
"annual_salary": 55000,
"cobra": true,
"date_of_birth": "1980-10-31",
"dependents": [
{
"date_of_birth": "2005-10-21",
"first_name": "John",
"gender": "F",
"id": "eec232e7d9-523dc2c2e",
"last_name": "Doe",
"last_used_tobacco": "2017-12-10",
"relationship": "child",
"same_household": true
}
],
"external_id": "def123",
"fips_code": "36081",
"first_name": "John",
"gender": "F",
"hours_per_week": 40,
"household_income": 55000,
"household_size": 1,
"id": "eec232e7d9",
"last_name": "Doe",
"last_used_tobacco": "2017-10-30",
"location_id": "8be378c035",
"retiree": false,
"safe_harbor_income": 55000,
"zip_code": "11423"
}
]
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"members": {
"type": "array",
"description": "List of Members"
}
}
}
Create or Replace MembersPUT/groups/{id}/members
Version History
v6
: The documentation for this endpoint references this latest available version.
Endpoint Description
Add Members
and their Dependents
to a Group
. If called on the same group twice, it will fully replace the members for that group.
Request Parameters
Members (required)
The members
key is a required list containing the Members
for the Group
and their Dependents
.
Field | Type | Notes |
---|---|---|
cobra (required) |
boolean |
|
date_of_birth (required) |
string |
The format is YYYY-MM-DD . Members cannot be less than 0 years old at the time of quoting. |
first_name (optional) |
string |
Required for quoting Angle Health Level Funded plans. Not used for quoting any other lines of coverage or markets. |
last_name (optional) |
string |
Required for quoting Angle Health Level Funded plans. Not used for quoting any other lines of coverage or markets. |
dependents (required) |
list |
If the member does not have dependents, please pass an empty list. |
external_id (required) |
string |
A field you can use to identify the member with. This field has to be unique by member. |
fips_code (required) |
string |
|
gender (required) |
string |
The options are: M or F . |
last_used_tobacco (required) |
string |
The format is YYYY-MM-DD . For those that have never smoked, please pass null . |
location_id (required) |
string |
The location where the member works. The identifier comes from the response when creating a Group . |
retiree (required) |
boolean |
|
zip_code (required) |
string |
|
household_income (optional) |
integer |
The annual income brought in for the household. Required for ICHRA Affordability Calculations. |
household_size (optional) |
integer |
The count of people in the household. Required for ICHRA Affordability Calculations. |
safe_harbor_income (optional) |
integer |
The annual income utilizing ICHRA’s safe harbor provisions. Required for ICHRA Affordability Calculations. |
annual_salary (optional) | integer |
The annual salary for the employee. Required for quoting certain carrier’s disability plans. Currently required for Beam disability. |
hours_per_week (optional) | integer |
The weekly hours worked for the employee. Required for quoting certain carrier’s disability plans. Currently required for Beam disability. |
Dependents
The dependents
key is a required list containing each Dependent
the Member
has. If the Member
has no dependents, an empty list should be passed.
Field | Type | Notes |
---|---|---|
date_of_birth (required) |
string |
The format is YYYY-MM-DD . Dependents cannot be less than 0 years old at the time of quoting. |
first_name (optional) |
string |
Required for quoting Angle Health Level Funded plans. Not used for quoting any other lines of coverage or markets. |
last_name (optional) |
string |
Required for quoting Angle Health Level Funded plans. Not used for quoting any other lines of coverage or markets. |
gender (required) |
string |
The options are M or F . |
last_used_tobacco (required) |
string |
The format is YYYY-MM-DD . For those that have never smoked, please pass null . |
relationship (required) |
string |
Please see the Overview Section for a list of allowed relationships. |
same_household (required) |
boolean |
Does the dependent live in the same household as the member? |
URI Parameters
- id
string
(required) Example: b215b6bcdbID of the Group
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Headers
Content-Type: application/json
Body
{
"members": [
{
"annual_salary": 55000,
"cobra": true,
"date_of_birth": "1980-10-31",
"dependents": [
{
"date_of_birth": "2005-10-21",
"first_name": "John",
"gender": "F",
"id": "eec232e7d9-523dc2c2e",
"last_name": "Doe",
"last_used_tobacco": "2017-12-10",
"relationship": "child",
"same_household": true
}
],
"external_id": "def123",
"fips_code": "36081",
"first_name": "John",
"gender": "F",
"hours_per_week": 40,
"household_income": 55000,
"household_size": 1,
"id": "eec232e7d9",
"last_name": "Doe",
"last_used_tobacco": "2017-10-30",
"location_id": "8be378c035",
"retiree": false,
"safe_harbor_income": 55000,
"zip_code": "11423"
}
]
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"members": {
"type": "array",
"description": "List of Members"
}
}
}
Display MembersGET/groups/{id}/members
Version History
v6
: The documentation for this endpoint references this latest available version.
Endpoint Description
Retrieve the Members
for a Group
.
URI Parameters
- id
string
(required) Example: b215b6bcdbID of the Group
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Headers
Content-Type: application/json
Remove MembersDELETE/groups/{id}/members
Version History
v6
: The documentation for this endpoint references this latest available version.
Endpoint Description
Delete all Members
for a Group
.
URI Parameters
- id
string
(required) Example: b215b6bcdbID of the Group
Group Supplemental Data ¶
Group Supplemental Data ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Body
{
"medical": {
"current_coverage_type": "ACA",
"current_coverages": [
{
"benefits": {
"diagnostic_test": {
"in_network": {
"amount": "25",
"cost_share_type": "copay"
}
},
"embedded": false,
"emergency_room": {
"in_network": {
"amount": "25",
"cost_share_type": "copay"
}
},
"generic_drugs": {
"in_network": {
"amount": "25",
"cost_share_type": "copay"
}
},
"hsa_eligible": false,
"individual_medical_deductible": {
"in_network": "$3,000"
},
"individual_medical_moop": {
"in_network": "$3,000"
},
"inpatient_physician": {
"in_network": {
"amount": "25",
"cost_share_type": "copay"
}
},
"non_preferred_brand_drugs": {
"in_network": {
"amount": "25",
"cost_share_type": "copay"
}
},
"plan_coinsurance": {
"in_network": {
"amount": "25",
"cost_share_type": "copay"
}
},
"preferred_brand_drugs": {
"in_network": {
"amount": "25",
"cost_share_type": "copay"
}
},
"primary_care_physician": {
"in_network": {
"amount": "25",
"cost_share_type": "copay"
}
},
"specialist": {
"in_network": {
"amount": "25",
"cost_share_type": "copay"
}
},
"specialty_drugs": {
"in_network": {
"amount": "25",
"cost_share_type": "copay"
}
},
"urgent_care": {
"in_network": {
"amount": "25",
"cost_share_type": "copay"
}
}
},
"effective_date": "2022-01-01",
"enrollments": {
"family": 1,
"single": 1,
"single_and_children": 1,
"single_and_spouse": 1,
"single_plus_one": 1
},
"plan_hios_id": "12345CA0000001",
"rates": {
"current": {
"premiums": {
"family": 100,
"single": 100,
"single_and_children": 100,
"single_and_spouse": 100,
"single_plus_one": 100
}
},
"rating_method": "4_tier_composite",
"renewal": {
"premiums": {
"family": 100,
"single": 100,
"single_and_children": 100,
"single_and_spouse": 100,
"single_plus_one": 100
}
}
}
}
]
}
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"medical": {
"type": "object",
"properties": {
"current_coverage_type": {
"type": "string",
"description": "Current Medcial Coverage Type"
},
"current_coverages": {
"type": "array",
"description": "Current Medical Coverages"
}
},
"description": "Medical Coverage"
}
}
}
Headers
Content-Type: application/json
Body
{
"medical": {
"current_coverage_type": "ACA",
"current_coverages": [
{
"benefits": {
"diagnostic_test": {
"in_network": {
"amount": "25",
"cost_share_type": "copay"
}
},
"embedded": false,
"emergency_room": {
"in_network": {
"amount": "25",
"cost_share_type": "copay"
}
},
"generic_drugs": {
"in_network": {
"amount": "25",
"cost_share_type": "copay"
}
},
"hsa_eligible": false,
"individual_medical_deductible": {
"in_network": "$3,000"
},
"individual_medical_moop": {
"in_network": "$3,000"
},
"inpatient_physician": {
"in_network": {
"amount": "25",
"cost_share_type": "copay"
}
},
"non_preferred_brand_drugs": {
"in_network": {
"amount": "25",
"cost_share_type": "copay"
}
},
"plan_coinsurance": {
"in_network": {
"amount": "25",
"cost_share_type": "copay"
}
},
"preferred_brand_drugs": {
"in_network": {
"amount": "25",
"cost_share_type": "copay"
}
},
"primary_care_physician": {
"in_network": {
"amount": "25",
"cost_share_type": "copay"
}
},
"specialist": {
"in_network": {
"amount": "25",
"cost_share_type": "copay"
}
},
"specialty_drugs": {
"in_network": {
"amount": "25",
"cost_share_type": "copay"
}
},
"urgent_care": {
"in_network": {
"amount": "25",
"cost_share_type": "copay"
}
}
},
"effective_date": "2022-01-01",
"enrollments": {
"family": 1,
"single": 1,
"single_and_children": 1,
"single_and_spouse": 1,
"single_plus_one": 1
},
"plan_hios_id": "12345CA0000001",
"rates": {
"current": {
"premiums": {
"family": 100,
"single": 100,
"single_and_children": 100,
"single_and_spouse": 100,
"single_plus_one": 100
}
},
"rating_method": "4_tier_composite",
"renewal": {
"premiums": {
"family": 100,
"single": 100,
"single_and_children": 100,
"single_and_spouse": 100,
"single_plus_one": 100
}
}
}
}
]
}
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"medical": {
"type": "object",
"properties": {
"current_coverage_type": {
"type": "string",
"description": "Current Medcial Coverage Type"
},
"current_coverages": {
"type": "array",
"description": "Current Medical Coverages"
}
},
"description": "Medical Coverage"
}
}
}
Create Supplemental DataPOST/groups/{id}/supplemental_data
Version History
v6
: The documentation for this endpoint references this latest available version.
Endpoint Description
Add Supplemental Data
for a Group
. This data is exclusively used for quoting specific carriers whose rating algorithms support some or all of the data in the request schema. Currently, only Angle Health Level Funded quoting leverages this data.
Request Parameters
Current Coverage Type (required)
The current_coverage_type
key is a required string enum that details the type of medical coverage the group has. Valid values are ACA
, Level Funded
, FI Large Group
, and ASO
.
Current Coverages (required)
The current_coverages
key is a required list containing the Group
's current coverages and their respective benefit, rate, and enrollment information. Each of the current_coverages
requires a plan_hios_id
and the effective_date
of the plan.
Benefits (required)
The benefits
key is a required object containing the benefits associated with the Current Coverage
for the Group
. All parameters within the benefits
object are optional. The embedded
and hsa_eligible
keys are booleans to indicate whether the deductible is embedded and if it is hsa eligible, respectively.
The keys for individual_medical_deductible
and individual_medical_moop
contain an in_network
parameter used to describe the individual deductible and maximum out of pocket. The in_network
key is a string that accepts dollar amounts formatted as $X,XXX.
The remaining keys are used to describe benefits and contain an in_network
parameter with amount
and cost_share_type
keys. The cost_share_type
keys are string enums that accept coinsurance
and copay
. The amount
keys are strings that accept integer values, which correspond to a percentage for coinsurance
and dollars for copay
.
Rates (required)
The rates
key is a required object containing the premium information for the Current Coverage
of the Group
. Within the rates
object, rating_method
, current
, and renewal
are required parameters. The rating_method
key is a string enum that accepts 4_tier_composite
, 3_tier_composite
, and 2_tier_composite
.
The premiums
for the current
and renewal
rates for a Group
must match the rating_method
selected. For 4_tier_composite
rates: single
, single_and_spouse
, single_and_child
, and family
keys must be included in the premiums
. For 3_tier_composite
rates: single
, single_plus_one
, and family
keys must be included in the premiums
. For 2_tier_composite
rates: single
, and family
keys must be included in the premiums
.
Enrollments (required)
The enrollments
key is a required object containing the counts of members by tiers enrolled in the Current Coverage
. The tiers used for the enrollment count should match the tiers used in the rates
object and rating_method
specified.
URI Parameters
- id
string
(required) Example: b215b6bcdbID of the Group
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Headers
Content-Type: application/json
Body
{
"medical": {
"current_coverage_type": "ACA",
"current_coverages": [
{
"benefits": {
"diagnostic_test": {
"in_network": {
"amount": "25",
"cost_share_type": "copay"
}
},
"embedded": false,
"emergency_room": {
"in_network": {
"amount": "25",
"cost_share_type": "copay"
}
},
"generic_drugs": {
"in_network": {
"amount": "25",
"cost_share_type": "copay"
}
},
"hsa_eligible": false,
"individual_medical_deductible": {
"in_network": "$3,000"
},
"individual_medical_moop": {
"in_network": "$3,000"
},
"inpatient_physician": {
"in_network": {
"amount": "25",
"cost_share_type": "copay"
}
},
"non_preferred_brand_drugs": {
"in_network": {
"amount": "25",
"cost_share_type": "copay"
}
},
"plan_coinsurance": {
"in_network": {
"amount": "25",
"cost_share_type": "copay"
}
},
"preferred_brand_drugs": {
"in_network": {
"amount": "25",
"cost_share_type": "copay"
}
},
"primary_care_physician": {
"in_network": {
"amount": "25",
"cost_share_type": "copay"
}
},
"specialist": {
"in_network": {
"amount": "25",
"cost_share_type": "copay"
}
},
"specialty_drugs": {
"in_network": {
"amount": "25",
"cost_share_type": "copay"
}
},
"urgent_care": {
"in_network": {
"amount": "25",
"cost_share_type": "copay"
}
}
},
"effective_date": "2022-01-01",
"enrollments": {
"family": 1,
"single": 1,
"single_and_children": 1,
"single_and_spouse": 1,
"single_plus_one": 1
},
"plan_hios_id": "12345CA0000001",
"rates": {
"current": {
"premiums": {
"family": 100,
"single": 100,
"single_and_children": 100,
"single_and_spouse": 100,
"single_plus_one": 100
}
},
"rating_method": "4_tier_composite",
"renewal": {
"premiums": {
"family": 100,
"single": 100,
"single_and_children": 100,
"single_and_spouse": 100,
"single_plus_one": 100
}
}
}
}
]
}
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"medical": {
"type": "object",
"properties": {
"current_coverage_type": {
"type": "string",
"description": "Current Medcial Coverage Type"
},
"current_coverages": {
"type": "array",
"description": "Current Medical Coverages"
}
},
"description": "Medical Coverage"
}
}
}
Display Supplemental DataGET/groups/{id}/supplemental_data
Version History
v6
: The documentation for this endpoint references this latest available version.
Endpoint Description
Retrieve the Supplemental Data
for a Group
.
URI Parameters
- id
string
(required) Example: b215b6bcdbID of the Group
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Headers
Content-Type: application/json
Remove Supplemental DataDELETE/groups/{id}/supplemental_data
Version History
v6
: The documentation for this endpoint references this latest available version.
Endpoint Description
Delete all Supplemental Data
for a Group
.
URI Parameters
- id
string
(required) Example: b215b6bcdbID of the Group
Group Quoting ¶
Group Quoting ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Body
{
"quote": {
"carrier_ids": [
"bae1d0e1-80dc-48f4-918d-6c492340cc1"
],
"commission_amount": 125,
"contribution_percentage": 90,
"effective_date": "2018-12-01",
"include_member_limited_plans": true,
"issuer_qualifications_met": [
"12345"
],
"market": "small_group",
"npn": "123456789",
"participation_percentage": 75,
"product_line": "medical",
"rating_method": "age_banded",
"voluntary": true
}
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"quote": {
"type": "object",
"properties": {
"carrier_ids": {
"type": "array"
},
"commission_amount": {
"type": "number"
},
"contribution_percentage": {
"type": "number"
},
"effective_date": {
"type": "string"
},
"include_member_limited_plans": {
"type": "boolean"
},
"issuer_qualifications_met": {
"type": "array"
},
"market": {
"type": "string"
},
"npn": {
"type": "string"
},
"participation_percentage": {
"type": "number"
},
"product_line": {
"type": "string"
},
"rating_method": {
"type": "string"
},
"voluntary": {
"type": "boolean"
}
},
"description": "Quote Attributes"
}
}
}
Headers
Content-Type: application/json
Body
{
"quote": {
"carrier_ids": [
"bae1d0e1-80dc-48f4-918d-6c492340cc1"
],
"commission_amount": 125,
"contribution_percentage": 90,
"created_at": "2018-10-23T12:00:00.000Z",
"effective_date": "2018-12-01",
"id": "5db8ce543d",
"include_member_limited_plans": true,
"issuer_qualifications_met": [
"12345"
],
"market": "small_group",
"npn": "123456789",
"participation_percentage": 75,
"product_line": "medical",
"rating_method": "age_banded",
"status": "complete",
"voluntary": true
}
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"quote": {
"type": "object",
"properties": {
"carrier_ids": {
"type": "array"
},
"commission_amount": {
"type": "number"
},
"contribution_percentage": {
"type": "number"
},
"created_at": {
"type": "string"
},
"effective_date": {
"type": "string"
},
"id": {
"type": "string"
},
"include_member_limited_plans": {
"type": "boolean"
},
"issuer_qualifications_met": {
"type": "array"
},
"market": {
"type": "string"
},
"npn": {
"type": "string"
},
"participation_percentage": {
"type": "number"
},
"product_line": {
"type": "string"
},
"rating_method": {
"type": "string"
},
"status": {
"type": "string"
},
"voluntary": {
"type": "boolean"
}
},
"description": "Quote Attributes"
}
}
}
Create a QuotePOST/groups/{id}/quotes
Version History
v8
: Quotes for all product lines and markets are generated asynchronously. The documentation for this endpoint references this latest available version.
v6
: Previous supported version. Only quotes for Level Funded products are generated asychronously using carrier apis. Group quote requests for all other product lines are serviced by Ideon’s rating engine and will not use carrier APIs. These quotes will fully process prior to returning a status of complete in the response of this endpoint.
Endpoint Description
Generate a Quote
for a Group
. See the Group Quoting Overview Section for a high level overview.
Request Parameters
Quote (required)
The quote
key is required and it contains the data below for the quote that is being generated.
Field | Type | Notes |
---|---|---|
contribution_percentage (required) |
integer |
The amount the employer will contribute to the plan premium. |
commission_amount (optional) |
integer |
The amount of commission added to the quote. This only applies to quotes for certain level funded carriers. |
effective_date (required) |
string |
The format is YYYY-MM-DD . |
include_member_limited_plans (optional) |
boolean |
Include plans that are only available to some members. The default is false and this only applies to CalChoice in CA for ACA quotes. |
npn (required) |
string |
The National Producer Number |
participation_percentage (required) |
integer |
The estimated participation of the group. It is recommended to include the census for the full group regardless of participation percentage. |
product_line (required) |
string |
The product line you wish to quote for. The options are medical , dental , vision , life , disability , accident , critical_illness , and hospital_indemnity . |
market (optional) |
string |
The market you wish to quote for. The options are small_group or level_funded . Level Funded quotes display illustrative rates. |
rating_method (required) |
string |
The options are age_banded , 4_tier_composite , 3_tier_composite , 2_tier_composite , and adult_child_tier_composite . We will always return all available rating methods for a plan. The rating_method selected will be used for the total premium calculation. |
voluntary (required) |
boolean |
|
carrier_ids (optional) |
list |
A list of issuer or carrier identifiers in string format. The carriers quoted will be limited to those specified. |
Response Parameters
Status
The Quoting API is asynchronous. The status
field, also returned in the Show Quote and Display Rates endpoints, can be used to poll until it is complete.
Results are typically returned promptly. Speeds vary based on group size and plan availability.
Additionally, some rates are sourced in real-time from carrier APIs; plans quoted this way have the quoted_via_carrier_api
flag set to true.
Status Value | Notes |
---|---|
pending |
The Quote is in process. |
partially_complete |
The Quote is partially complete. |
complete |
The Quote is complete. |
URI Parameters
- id
string
(required) Example: b215b6bcdbID of the Group
Group Quoting ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Headers
Content-Type: application/json
Body
{
"quote": {
"carrier_ids": [
"bae1d0e1-80dc-48f4-918d-6c492340cc1"
],
"commission_amount": 125,
"contribution_percentage": 90,
"created_at": "2018-10-23T12:00:00.000Z",
"effective_date": "2018-12-01",
"id": "5db8ce543d",
"include_member_limited_plans": true,
"issuer_qualifications_met": [
"12345"
],
"market": "small_group",
"npn": "123456789",
"participation_percentage": 75,
"product_line": "medical",
"rating_method": "age_banded",
"status": "complete",
"voluntary": true
}
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"quote": {
"type": "object",
"properties": {
"carrier_ids": {
"type": "array"
},
"commission_amount": {
"type": "number"
},
"contribution_percentage": {
"type": "number"
},
"created_at": {
"type": "string"
},
"effective_date": {
"type": "string"
},
"id": {
"type": "string"
},
"include_member_limited_plans": {
"type": "boolean"
},
"issuer_qualifications_met": {
"type": "array"
},
"market": {
"type": "string"
},
"npn": {
"type": "string"
},
"participation_percentage": {
"type": "number"
},
"product_line": {
"type": "string"
},
"rating_method": {
"type": "string"
},
"status": {
"type": "string"
},
"voluntary": {
"type": "boolean"
}
},
"description": "Quote Attributes"
}
}
}
Show a QuoteGET/quotes/{id}
Version History
v6
: The documentation for this endpoint references this latest available version.
Endpoint Description
Show a Quote
. See the Group Quoting Overview Section for more information.
The Quoting API is asynchronous. The status
field can be used to poll until it is complete.
Response Parameters
Status
Status Value | Notes |
---|---|
pending |
The Quote is in process. |
partially_complete |
The Quote is partially complete. |
complete |
The Quote is complete. |
URI Parameters
- id
string
(required) Example: 5db8ce543dID of the Quote
Group Quoting ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Headers
Content-Type: application/json
Body
{
"limiting_factors": {
"group": [
{
"carrier_names": [
"UnitedHealthcare"
],
"code": "sic_code",
"code_description": "The SIC Code is not in the list of allowable SIC Codes.",
"plan_ids": [
"67138CA0610018"
]
}
],
"member": [
{
"carrier_names": [
"UnitedHealthcare"
],
"code": "dependent_location",
"code_description": "Members have dependents with a same_household value that is not allowed for at least one plan.",
"member_ids": [
"eec232e7d9"
],
"plan_ids": [
"67138CA0610018"
]
}
]
},
"meta": {
"total": 1
}
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"limiting_factors": {
"type": "object",
"properties": {
"group": {
"type": "array",
"description": "Group limiting factors"
},
"member": {
"type": "array",
"description": "Member limiting factors"
}
},
"description": "List of LimitingFactors"
},
"meta": {
"type": "object",
"properties": {
"total": {
"type": "number",
"description": "Number of entities returned"
}
},
"description": "Meta-data"
}
}
}
Show Limiting FactorsGET/quotes/{id}/limiting_factors
Version History
v8
: Limiting factors related to Carrier API errors are added, including carrier_api_error
, carrier_api_timeout
, and invalid_npn
. The documentation for this endpoint references this latest available version.
v6
: Previous supported version.
Endpoint Description
Limiting Factors detail the reasons a Quote did not return certain plans.
A Quote’s Limiting Factors contains two sections: "group"
and "member"
. The only difference between the "group"
section object and the "member"
section object is the presence of member_ids
for "member"
, so that your system can know which members caused the limitation.
Response Parameters
Limiting Factors
Field | Type | Notes |
---|---|---|
code | string |
An enumeration that indicates the Limiting Factor type. Please see the full list of codes below. |
code_description | string |
A description of the Limiting Factor code. |
member_ids | list |
A list of Member identifiers that fit this limiting factor code. This key will only return for member Limiting Factors. |
carrier_names | list |
A list of carrier names that had plans removed from the quote due to the Limiting Factor. |
plan_ids | list |
A list of Plan identifiers that were removed from the quote due to the Limiting Factor. |
Limiting Factor Codes
Code | Limiting Factor Section | Notes |
---|---|---|
carrier_api_error | group |
The quote request to the Carrier’s API returned a {HTTP Code} error. When this code is returned, the carrier_api_error_messages list will be included, containing carrier error strings. |
carrier_api_timeout | group |
The quote request to the Carrier’s API timed out. |
contribution_percentage_minimum | group |
The contribution percentage is too low for at least one plan. |
effective_date_maximum | group |
The effective date is beyond to the latest allowed effective date. |
effective_date_minimum | group |
The effective date is prior to the earliest allowed effective date. |
enrollee_size_minimum | group |
The number of enrolling members is below the minimum allowed for at least one plan. This number is calculated by multiplying the number of members in the group and the participation percentage. |
group_size_maximum | group |
The number of members is above the maximum allowed members for at least one plan. |
group_size_minimum | group |
The number of members is below the minimum allowed members for at least one plan. |
in_state_percentage_minimum | group |
The percentage of members residing in the rated state is below the minimum allowed for at least one plan. |
invalid_npn | group |
The NPN provided is considered ineligible for quoting by the carrier. |
participation_percentage_minimum | group |
The participation percentage is too low for at least one plan. |
sic_code | group |
The SIC Code is not quotable for at least one plan. |
voluntary_status | group |
The voluntary status in the Quote request was inconsistent with at least one plan. |
dependent_age_maximum | member |
Members have dependents that are above the maximum allowed age for at least one plan. |
dependent_age_minimum | member |
Members have dependents that are below the minimum allowed age for at least one plan. |
dependent_location | member |
Members have dependents with a same_household value that is not allowed for at least one plan. |
dependent_relationship | member |
Members have dependents with a relationship that is outside of the allowed relationships for at least one plan. |
member_age_maximum | member |
Members are above the maximum allowed age for at least one plan. |
member_age_minimum | member |
Members are below the minimum allowed age for at least one plan. |
member_location | member |
Members live outside of the allowed area for at least one plan. |
member_name | member |
Members are missing first_name and/or last_name, which is required for quoting at least one plan. |
member_salary | member |
Members are missing annual_salary and/or hours_per_week, which is required for quoting at least one plan. |
URI Parameters
- id
string
(required) Example: 5db8ce543dID of the Quote
Group Quoting ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Headers
Content-Type: application/json
Body
{
"meta": {
"status": "complete",
"total": 1,
"total_members": 5
},
"rates": [
{
"aggregate_stop_loss_amount": "110",
"carrier_quote_id": "bb1f3523f0",
"claims_surplus_fraction": "1/3",
"dependent_premium": "2500.00",
"id": "bb1f3523f0",
"identifiers": [
{
"type": "contract_id",
"value": "abc123"
}
],
"member_limited": false,
"member_premium": "7500.00",
"members_quoted": 5,
"plan_id": "12345CA1234567",
"premiums": {
"2_tier_composite": {
"employee_only": "200.00",
"employee_plus_family": "400.00",
"total": "10000.00"
},
"3_tier_composite": {
"employee_only": "200.00",
"employee_plus_family": "300.00",
"employee_plus_one": "250.00",
"total": "10000.00"
},
"4_tier_composite": {
"claims_fund": "8000.00",
"employee_only": "200.00",
"employee_plus_children": "220.00",
"employee_plus_family": "300.00",
"employee_plus_spouse": "230.00",
"fixed_costs": "2000.00",
"total": "10000.00"
},
"accidental_death_dismemberment": {
"child": "0.12345",
"employee": "0.12345",
"spouse": "0.12345"
},
"adult_child_tier_composite": {
"adult": "200.00",
"child": "400.00",
"total": "10000.00"
},
"age_banded": {
"total": "10000.00",
"total_dependent": "2500.00",
"total_member": "7500.00"
},
"critical_illness": {
"premium_bands": [
{
"benefit_amount": "1000.00",
"maximum_age": 20,
"minimum_age": 0,
"non_tobacco": {
"employee_only": "0.50000",
"employee_plus_children": "1.00000",
"employee_plus_family": "2.00000",
"employee_plus_spouse": "1.50000"
},
"tobacco": {
"employee_only": "0.50000",
"employee_plus_children": "1.00000",
"employee_plus_family": "2.00000",
"employee_plus_spouse": "1.50000"
}
}
],
"rated_for_specific_benefit_amount": true
},
"disability": {
"elimination_period": "8/8",
"premium_bands": [
{
"employee": "0.05000",
"maximum_age": 20,
"minimum_age": 0
}
],
"term": "short_term"
},
"hospital_indemnity": {
"premium_bands": [
{
"employee_only": "10.00000",
"employee_plus_children": "15.00000",
"employee_plus_family": "20.00000",
"employee_plus_spouse": "20.00000",
"maximum_age": 20,
"minimum_age": 0
}
]
},
"life": {
"child_rate": "0.12345",
"premium_bands": [
{
"employee": "0.05000",
"employee_tobacco": "0.05000",
"maximum_age": 20,
"minimum_age": 0,
"spouse": "0.05000"
}
]
}
},
"source": "carrier",
"stop_loss_amount": "25000.00",
"total_premium": "10000.00"
}
]
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"meta": {
"type": "object",
"properties": {
"status": {
"type": "string",
"description": "Status of Quote"
},
"total": {
"type": "number",
"description": "Number of entities returned"
},
"total_members": {
"type": "number",
"description": "Total amount of members in the quote group"
}
},
"description": "Meta-data"
},
"rates": {
"type": "array",
"description": "List of Rates"
}
}
}
Display RatesGET/quotes/{id}/rates{?page,per_page}
Version History
v8
: The carrier_quote_id
field is added to the response for each rates object. The documentation for this endpoint references this latest available version.
v6
: Previous supported version.
Endpoint Description
Retrieve the rates for a Quote
. For detailed information on how to read the rates for each product line, please read Retrieving Aggregate Rates.
Response Parameters
Source
The source
key shows the source from which we received the rates. The possible values are detailed below.
Source Value | Notes |
---|---|
carrier |
The rates were received from a carrier. |
state |
The rates originate from state filings. |
cms |
The rates originate from Centers for Medicare & Medicaid Services (CMS) filings. |
null |
Only Quote s generated before the release of this key (2019-09-10) will contain null source values. |
Premiums
The premiums
key contains the available rating methods we have for the each plan. The rating methods are detailed below.
Premiums Key | Notes |
---|---|
age_banded | The keys include total_member , total_dependent , and total . The values are the sums. |
4_tier_composite | The keys include employee_only , employee_plus_spouse , employee_plus_children , employee_plus_family , and total . The values are the per-member rate for each tier. Level Funded quotes will include a breakdown of monthly cost by fixed_costs and claims_fund . |
3_tier_composite | The keys include employee_only , employee_plus_one , employee_plus_family , and total . The values are the per-member rate for each tier. |
2_tier_composite | The keys include employee_only , employee_plus_family , and total . The values are the per-member rate for each tier. |
adult_child_tier_composite | The keys include adult , child , and total . The values are the per-member rate for each tier. |
life | Life premiums are shown as age bands for member rates per $1,000 for members in the premium_bands key, as well as for children, if applicable, in the child_rate key. Note that the total rate may be the sum of the life and accidental_death_dismemberment rate if AD&D is included in the plan. |
accidental_death_dismemberment | Accidental Death and Dismemberment (“AD&D”) premiums are shown for employee , spouse , and child separately per $1,000. |
disability | Short Term Disability plans display the monthly rate per $10 of benefit coverage selected by the member. Long Term Disability plans display the monthly rate per $100 of benefit coverage selected by the member. |
critical_illness | Critical Illness rates are structured as age bands for tobacco and non_tobacco composite rates. The premiums are the monthly rate per a given benefit_amount . The rated_for_specific_benefit_amounts key indicates whether or not the rate per benefit_amount can be interpolated to all electable benefit amounts for the plan. |
hospital_indemnity | Hospital Indemnity premiums are shown as age bands for composite rates in the premium_bands key. |
Identifiers
The identifiers
key contains various identifiers that can be used to identify the plan with the Carrier during enrollment.
Identifier Type | Description |
---|---|
contract_code | An issuer identifier for the plan. |
contract_id | An issuer identifier for the plan. |
hios_id | The CMS HIOS Identifier for the plan. |
issuer_internal_id | An issuer identifier for the plan. |
package_code | An issuer identifier for the package for which this plan can be offered with. |
Level Funded Rates
Level Funded rates can be illustrative or underwritten, dependent on the carrier quoted. Similarly, dependent on the carrier, rates can contain a claims_surplus_fraction
, indicating the amount of surplus claims fund the employer could get back, a stop_loss_amount
, and total monthly cost breakdown, where available, for 4_tier_composite
rates.
The total monthly cost breakdown can include a claims_fund
amount, the amount of monthly premium that goes towards the claims fund, and fixed_costs
, the amount of monthly premium that goes towards administrative fees, stop loss premiums, and other fixed costs.
For more specific information on level funded quoting, please reach out to your account executive or [email protected].
Life and AD&D Rates
Life plans display the monthly rate per $1,000 of benefit coverage selected by the member. If applicable, the accompanying accidental_death_dismemberment
rates will be displayed also on a per $1,000 basis. If the plan requires that Accidental Death & Dismemberment coverage be attached to the plan, the final rate will be the sum of the two for each member.
Disability Rates
Short Term Disability plans display the monthly rate per $10 of benefit coverage selected by the member. Long Term Disability plans display the monthly rate per $100 of benefit coverage selected by the member.
URI Parameters
- id
string
(required) Example: 5db8ce543dID of the quote
- page
number
(optional) Example: 1Page of paginated response
- per_page
number
(optional) Example: 1Responses per page
Group Quoting ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Headers
Content-Type: application/json
Body
{
"member_rates": [
{
"dependent_premium": "125.00",
"id": "eec232e7d9",
"member_external_id": "abc234",
"member_id": "eec232e7d9",
"member_premium": "100.00",
"premiums": {
"2_tier_composite": {
"category": "employee_only",
"total": "230.00"
},
"3_tier_composite": {
"category": "employee_only",
"total": "230.00"
},
"4_tier_composite": {
"category": "employee_only",
"total": "230.00"
},
"adult_child_tier_composite": {
"adult": "200.00",
"child": "400.00",
"total": "10000.00"
},
"age_banded": {
"dependent": "125.00",
"dependent_premiums": [
{
"id": "eec232e7d9-2a1e1fa",
"premium": "400.00"
}
],
"member": "100.00",
"total": "225.00"
}
},
"total_premium": "225.00"
}
],
"meta": {
"total": 1
}
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"member_rates": {
"type": "array",
"description": "List of MemberRates"
},
"meta": {
"type": "object",
"properties": {
"total": {
"type": "number",
"description": "Number of entities returned"
}
},
"description": "Meta-data"
}
}
}
Display Member RatesGET/rates/{id}/member_rates{?page,per_page}
Version History
v6
: The documentation for this endpoint references this latest available version.
Endpoint Description
Retrieve the member-level rates for a particular Rate
returned for a Quote
.
The premiums
key contains the available rating methods we have for the Rate
, along with the member-specific rates for each method. For composite methods, the category the member falls into is shown.
For age_banded
premiums, the dependent
key returns the sum of premiums for all of the member’s dependents. The dependent_premiums
key contains the age-banded rate for each dependent.
URI Parameters
- id
string
(required) Example: bb1f3523f0ID of the Rate
- page
number
(optional) Example: 1Page of paginated response
- per_page
number
(optional) Example: 1Responses per page
NPN Validation ¶
NPN Validation ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Body
{
"carrier": "UnitedHealthcare",
"npn": "12345678",
"state": "TX"
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"carrier": {
"type": "string",
"description": "Carrier validated"
},
"npn": {
"type": "string",
"description": "NPN of the carrrier"
},
"state": {
"type": "string",
"description": "State the carrier and npn is valid"
}
}
}
Headers
Content-Type: application/json
Body
{
"carrier": "UnitedHealthcare",
"carrier_api_response_code": 1,
"carrier_api_response_error": "Hello, world!",
"npn": "12345678",
"state": "TX",
"valid_npn": true
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"carrier": {
"type": "string",
"description": "Carrier validated"
},
"carrier_api_response_code": {
"type": "number",
"description": "Carrier API response code"
},
"carrier_api_response_error": {
"type": "string",
"description": "Carrier API response error"
},
"npn": {
"type": "string",
"description": "NPN of the carrrier"
},
"state": {
"type": "string",
"description": "State the carrier and npn is valid"
},
"valid_npn": {
"type": [
"boolean",
"null"
],
"description": "Indicates whether the NPN is valid"
}
}
}
Validate NPNPOST/npn_validation
Version History
v8
: The documentation for this endpoint references this latest available version. v6
is not available for this endpoint.
Endpoint Description
Use this endpoint to validate an NPN against a carrier’s list of appointed brokers. A null value in the valid_npn
field in the response indicates that the NPN was unable to be validated.
Request Parameters
Field | Type | Notes |
---|---|---|
npn (required) |
string |
The NPN to be validated. |
state (optional) |
string |
The two-letter state code to validate the NPN in. This is required when validating NPNs with UnitedHealthcare . |
carrier (required) |
string |
The carrier for which the NPN will be validated against. Currently, the only option is UnitedHealthcare . |
Group ICHRA Affordability ¶
Group ICHRA Affordability ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Body
{
"ichra_affordability_calculation": {
"effective_date": "2020-01-01",
"plan_year": 2020,
"rating_area_location": "work"
}
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"ichra_affordability_calculation": {
"type": "object",
"properties": {
"effective_date": {
"type": "string"
},
"plan_year": {
"type": "number"
},
"rating_area_location": {
"type": "string"
}
},
"description": "Ichra Affordability Calculation Attributes"
}
}
}
Headers
Content-Type: application/json
Body
{
"ichra_affordability_calculation": {
"effective_date": "2020-01-01",
"error_message": "Unable to calculate",
"fpl_minimum_employer_contribution": "200.00",
"id": "24ddb277-31d4-4437-853f-5e163c0766d9",
"minimum_employer_contribution": "200.00",
"plan_year": 2020,
"rating_area_location": "work",
"status": "complete"
}
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"ichra_affordability_calculation": {
"type": "object",
"properties": {
"effective_date": {
"type": "string"
},
"error_message": {
"type": "string"
},
"fpl_minimum_employer_contribution": {
"type": "string",
"description": "The minimum employer contribution based on the Federal Poverty Level"
},
"id": {
"type": "string"
},
"minimum_employer_contribution": {
"type": "string",
"description": "The minimum employer contribution"
},
"plan_year": {
"type": "number"
},
"rating_area_location": {
"type": "string"
},
"status": {
"type": "string"
}
},
"description": "Ichra Affordability Calculation attributes"
}
}
}
Create ICHRA AffordabilityPOST/groups/{id}/ichra_affordability_calculations
Version History
v6
: The documentation for this endpoint references this latest available version.
Endpoint Description
Use this endpoint to calculate the minimum a Group
would have to pay to meet affordability guidelines when offering ICHRA to their employees.
To create a Group
please use the Group Quoting API. You will need to do the following:
-
Create a Group
-
Add Members to the Group you created, and make sure to include
household_income
,safe_harbor_income
, andhousehold_size
-
Use the Group ID in this endpoint
Request Parameters
Field | Type | Notes |
---|---|---|
effective_date (required) |
string |
The date when the insurance would become in effect. |
plan_year (optional) |
string |
The plan year to use for the ICHRA calculation. Must be either the year of the effective_date or the prior year. If not provided, we will use the prior year if the current date is before November 1st. |
rating_area_location (required) |
string |
The location for which the affordability calculations will be done. This can be either the member’s work or home location. The options are: home or work . |
Response Parameters
Status
The ICHRA Affordability calculation is asynchronous. You can use the status
field to poll until it is complete. Results are typically returned promptly. Speeds vary based on group size and plan availability.
Status Value | Notes |
---|---|
pending |
The ICHRA Affordability Calculation is in process. |
complete |
The ICHRA Affordability Calculation is complete. |
Calculation Results
Status Value | Notes |
---|---|
minimum_employer_contribution |
This value represents the minimum the employer would have to contribute to the ICHRA program to meet affordability guidelines. The value is the maximum affordability calculation across all members in the group using the location set in the rating_area_location request field. |
fpl_minimum_employer_contribution |
The key difference between this value and minimum_employer_contribution is that we use the Federal Poverty Limit as the household income for each member. |
URI Parameters
- id
string
(required) Example: b215b6bcdbID of the Group
Group ICHRA Affordability ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Headers
Content-Type: application/json
Body
{
"effective_date": "2020-01-01",
"error_message": "Unable to calculate",
"fpl_minimum_employer_contribution": "200.00",
"id": "24ddb277-31d4-4437-853f-5e163c0766d9",
"minimum_employer_contribution": "200.00",
"plan_year": 2020,
"rating_area_location": "work",
"status": "complete"
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"effective_date": {
"type": "string"
},
"error_message": {
"type": "string"
},
"fpl_minimum_employer_contribution": {
"type": "string",
"description": "The minimum employer contribution based on the Federal Poverty Level"
},
"id": {
"type": "string"
},
"minimum_employer_contribution": {
"type": "string",
"description": "The minimum employer contribution"
},
"plan_year": {
"type": "number"
},
"rating_area_location": {
"type": "string"
},
"status": {
"type": "string"
}
}
}
Show ICHRA AffordabilityGET/ichra_affordability_calculations/{id}
Version History
v6
: The documentation for this endpoint references this latest available version.
Endpoint Description
Retrieve the details for an ICHRA Affordability Calculation.
URI Parameters
- id
string
(required) Example: 4ce77785-24ef-413e-bf1e-08ad5e69ca83ID of the ICHRA Affordability Calculation
Group ICHRA Affordability ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Headers
Content-Type: application/json
Body
{
"members": [
{
"fpl_minimum_employer_contribution": 200,
"id": "24ddb277-31d4-4437-853f-5e163c0766d9",
"member_external_id": "24ddb277-31d4-4437-853f-5e163c0766d9",
"minimum_employer_contribution": 200,
"plans": [
{
"id": "96667ME0240018",
"name": "Select Care Silver, Age 29 Rider",
"premium": 200,
"year": 2020
}
],
"premium_tax_credit": 200
}
],
"meta": {
"total": 1
}
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"members": {
"type": "array",
"description": "List of ICHRA member employer contributions"
},
"meta": {
"type": "object",
"properties": {
"total": {
"type": "number",
"description": "Number of entities returned"
}
},
"description": "Metadata"
}
}
}
Show ICHRA Affordability MembersGET/ichra_affordability_calculations/{id}/members
Version History
v6
: The documentation for this endpoint references this latest available version.
Endpoint Description
Retrieve the member-level details for an ICHRA Affordability Calculation.
Response Parameters
Members
The members
key contains the ICHRA Affordability results for each member in the group.
Status Value | Notes |
---|---|
minimum_employer_contribution |
This value represents the minimum the employer would have to contribute to the ICHRA program to meet affordability guidelines for this member. |
fpl_minimum_employer_contribution |
The key difference between this value and minimum_employer_contribution is that we use the Federal Poverty Limit as the household income for each member. |
plans |
Data for two plans is returned: the lowest and second lowest cost silver plans for that member given the parameters included in the calculation. |
URI Parameters
- id
string
(required) Example: 4ce77785-24ef-413e-bf1e-08ad5e69ca83ID of the ICHRA Affordability Calculation
Bulk Plans ¶
Bulk Plans ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Body
{
"market": "small_group",
"page": 1,
"per_page": 20,
"product_line": "medical",
"state": "NY",
"year": "2017"
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"market": {
"type": "string",
"description": "The market for which the plans are offered, options are: individual or small group."
},
"page": {
"type": "number",
"description": "Selected page of paginated response."
},
"per_page": {
"type": "number",
"description": "Results per page of response."
},
"product_line": {
"type": "string",
"description": "The line of coverage, options are: medical, dental, or vision."
},
"state": {
"type": "string",
"description": "The two-letter state code where the plans are offered."
},
"year": {
"type": "string",
"description": "The year when the plans are offered."
}
}
}
Headers
Content-Type: application/json
Body
{
"meta": {
"total": 1
},
"plans": [
{
"abortion_rider": false,
"actuarial_value": 80,
"adult_dental": true,
"age29_rider": false,
"ambulance": "In-Network: 25% after deductible / Out-of-Network: 25% after deductible",
"benefits_summary_url": "https://d2ed110nmrd591.cloudfront.net/blobs/i6XqimNu7KpSbJjKU5HeTSp1.pdf",
"carrier": {
"id": "bae1d0e1-80dc-48f4-918d-6c492340cc1c",
"issuer_id": "A0027",
"logo_url": "https://d1hm12jr612u3r.cloudfront.net/images/carriers/174/1438891372/thumb.png?1438891372",
"name": "Guardian"
},
"carrier_disclaimers": "See Summary of Benefits and Coverage (SBC) for more details.",
"carrier_name": "Aetna",
"child_dental": "In-Network: $0 / Out-of-Network: 100%",
"child_eye_exam": "In-Network: $0 / Out-of-Network: 100%",
"child_eyewear": "In-Network: $0 / Out-of-Network: 100%",
"chiropractic_services": false,
"diagnostic_test": "In-Network: 25% after deductible / Out-of-Network: 100%",
"display_name": "Aetna PPO 20/5000",
"dp_rider": true,
"drug_formulary_url": "https://www.emblemhealth.com/content/dam/emblemhealth/pdfs/resources/formularies/2020_Small-Group_Formulary.pdf",
"durable_medical_equipment": "In-Network: 25% after deductible / Out-of-Network: 100%",
"effective_date": "2020-01-01",
"embedded_deductible": "non_embedded",
"emergency_room": "Deductible, then $150",
"essential_health_benefits_percentage": 1,
"estimated_actuarial_value": 80,
"expiration_date": "2020-12-31",
"family_drug_deductible": "Included in Medical",
"family_drug_moop": "Included in Medical",
"family_medical_deductible": "$4,000",
"family_medical_moop": "$11,000",
"fp_rider": true,
"gated": false,
"generic_drugs": "$10",
"habilitation_services": "In-Network: $0 / Out-of-Network: 100%",
"hios_issuer_id": "88582",
"home_health_care": "In-Network: $0 / Out-of-Network: 100%",
"hospice_service": "In-Network: $0 / Out-of-Network: 100%",
"hsa_eligible": false,
"id": "88582NY0230001",
"identifiers": [
{
"type": "contract_id",
"value": "abc123"
}
],
"imaging_center": "In-Network: 25% after deductible / Out-of-Network: 100%",
"imaging_physician": "In-Network: 25% after deductible / Out-of-Network: 100%",
"individual_drug_deductible": "Included in Medical",
"individual_drug_moop": "Included in Medical",
"individual_medical_deductible": "$2,000",
"individual_medical_moop": "$5,500",
"infertility_treatment_rider": false,
"inpatient_birth": "In-Network: $0 / Out-of-Network: 100%",
"inpatient_birth_physician": "In-Network: 30% after deductible / Out-of-Network: 50% after deductible",
"inpatient_facility": "Deductible, then $1,500 per admission\"",
"inpatient_mental_health": "In-Network: $0 / Out-of-Network: 100%",
"inpatient_physician": "Included in inpatient facility",
"inpatient_substance": "In-Network: $0 / Out-of-Network: 100%",
"lab_test": "In-Network: 25% after deductible / Out-of-Network: 100%",
"level": "silver",
"logo_url": "https://d1hm12jr612u3r.cloudfront.net/images/carriers/174/1438891372/thumb.png?1438891372",
"mail_order_rx": 1.5,
"name": "Select Care Silver, Age 29 Rider",
"network_ids": [
1,
3
],
"network_size": 5000,
"networks": [
{
"id": 1,
"name": "Open Choice",
"provider_directory_url": "https://www.example.com/find-a-doctor"
}
],
"non_preferred_brand_drugs": "$70",
"nonpreferred_generic_drug_share": "$70",
"nonpreferred_specialty_drug_share": "$70",
"off_market": false,
"on_market": true,
"out_of_network_coverage": false,
"outpatient_ambulatory_care_center": "In-Network: 25% after deductible / Out-of-Network: 100%",
"outpatient_facility": "In-Network: 30% after deductible / Out-of-Network: 50% after deductible",
"outpatient_mental_health": "In-Network: 30% after deductible / Out-of-Network: 50% after deductible",
"outpatient_physician": "In-Network: 30% after deductible / Out-of-Network: 50% after deductible",
"outpatient_substance": "In-Network: $0 / Out-of-Network: 100%",
"plan_ancestors": [
{
"id": "88582NY0230001",
"year": 2019
}
],
"plan_calendar": "calendar_year",
"plan_coinsurance": "In-Network: 30% after deductible / Out-of-Network: 50% after deductible",
"plan_documents": [
{
"type": "summary_of_benefits_and_coverage",
"url": "https://www.example.com/summary_of_benefits_and_coverage.pdf"
}
],
"plan_market": "shop",
"plan_type": "HMO",
"postnatal_care": "In-Network: $0 / Out-of-Network: 100%",
"preferred_brand_drugs": "$35",
"prenatal_care": "In-Network: $0 / Out-of-Network: 100%",
"preventative_care": "In-Network: $0 / Out-of-Network: 100%",
"primary_care_physician": "Deductible, then $30",
"quoted_via_carrier_api": false,
"ratings": [
{
"type": "cms_quality_ratings_overall",
"value": "3"
}
],
"rehabilitation_services": "In-Network: $0 / Out-of-Network: 100%",
"sbc_name": "Aetna PPO 20/5000",
"service_area_id": "11234-2016-WI01",
"skilled_nursing": "In-Network: $0 / Out-of-Network: 100%",
"skilled_nursing_facility_365": "unlimited",
"source": "carrier",
"specialist": "Deductible, then $50",
"specialty_drugs": "$70",
"standardized_plan": false,
"telemedicine": false,
"type": "ACAPlan2018",
"updated_at": "2016-01-01",
"urgent_care": "In-Network: $0 / Out-of-Network: 100%"
}
]
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"meta": {
"type": "object",
"properties": {
"total": {
"type": "number",
"description": "Number of entities returned"
}
},
"description": "Meta-data"
},
"plans": {
"type": "array",
"description": "Plan search results"
}
}
}
Plans in BulkPOST/plans/bulk
Version History
v8
: In the response schema, benefits for Medical, Dental, and Vision Plans are represented as objects with tier and limit keys. Dental and Vision also include additional plan benefit and metadata information in this version.
For details on the schema and v8
updates for each line of coverage, reference the list below. The documentation for this endpoint references this latest available version.
v6
: Previous supported version. The response schemas for Medical, Dental, and Vision plans return benefits as strings.
Endpoint Description
Use this endpoint to get plan information in bulk by state, market, year, and product line.
This endpoint returns plans for the following product lines. Below are links to the different response schemas:
Request Parameters
Field | Type | Notes |
---|---|---|
market (required) |
string |
The options are individual , small_group or level_funded . |
state (required) |
string |
The two-letter state code where the plans are offered. |
product_line (required) |
string |
The options are medical , medicare_advantage , dental , vision , life , disability , accident , critical_illness or hospital_indemnity . |
year (required) |
string |
Major Medical Plans ¶
Major Medical Plans ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Headers
Content-Type: application/json
Body
{
"plan": {
"abortion_rider": false,
"actuarial_value": 80,
"adult_dental": true,
"age29_rider": false,
"ambulance": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"benefits_summary_url": "https://d2ed110nmrd591.cloudfront.net/blobs/i6XqimNu7KpSbJjKU5HeTSp1.pdf",
"carrier": {
"id": "bae1d0e1-80dc-48f4-918d-6c492340cc1c",
"issuer_id": "A0027",
"logo_url": "https://d1hm12jr612u3r.cloudfront.net/images/carriers/174/1438891372/thumb.png?1438891372",
"name": "Guardian"
},
"carrier_disclaimers": "See Summary of Benefits and Coverage (SBC) for more details.",
"carrier_name": "Aetna",
"child_dental": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"child_eye_exam": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"child_eyewear": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"chiropractic_services": false,
"diagnostic_test": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"display_name": "Aetna PPO 20/5000",
"dp_rider": true,
"drug_formulary_url": "https://www.emblemhealth.com/content/dam/emblemhealth/pdfs/resources/formularies/2020_Small-Group_Formulary.pdf",
"durable_medical_equipment": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"effective_date": "2020-01-01",
"embedded_deductible": "non_embedded",
"emergency_room": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"essential_health_benefits_percentage": 1,
"estimated_actuarial_value": 80,
"expiration_date": "2020-12-31",
"family_drug_deductible": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"family_drug_moop": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"family_medical_deductible": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"family_medical_moop": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"fp_rider": true,
"gated": false,
"generic_drugs": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"habilitation_services": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"hios_issuer_id": "88582",
"home_health_care": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"hospice_service": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"hsa_eligible": false,
"id": "88582NY0230001",
"identifiers": [
{
"type": "contract_id",
"value": "abc123"
}
],
"imaging": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"imaging_center": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"imaging_physician": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"individual_drug_deductible": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"individual_drug_moop": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"individual_medical_deductible": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"individual_medical_moop": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"infertility_treatment_rider": false,
"inpatient_birth": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"inpatient_birth_physician": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"inpatient_facility": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"inpatient_mental_health": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"inpatient_physician": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"inpatient_substance": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"lab_test": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"level": "silver",
"logo_url": "https://d1hm12jr612u3r.cloudfront.net/images/carriers/174/1438891372/thumb.png?1438891372",
"mail_order_rx": 1.5,
"name": "Select Care Silver, Age 29 Rider",
"network_ids": [
1,
3
],
"network_size": 5000,
"networks": [
{
"id": 1,
"name": "Open Choice",
"provider_directory_url": "https://www.example.com/find-a-doctor"
}
],
"non_preferred_brand_drugs": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"nonpreferred_generic_drug_share": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"nonpreferred_specialty_drug_share": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"off_market": false,
"on_market": true,
"out_of_network_coverage": false,
"outpatient_ambulatory_care_center": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"outpatient_facility": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"outpatient_mental_health": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"outpatient_physician": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"outpatient_substance": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"plan_ancestors": [
{
"id": "88582NY0230001",
"year": 2019
}
],
"plan_calendar": "calendar_year",
"plan_coinsurance": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"plan_documents": [
{
"type": "summary_of_benefits_and_coverage",
"url": "https://www.example.com/summary_of_benefits_and_coverage.pdf"
}
],
"plan_market": "shop",
"plan_type": "HMO",
"postnatal_care": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"preferred_brand_drugs": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"prenatal_care": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"prenatal_postnatal_care": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"preventative_care": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"primary_care_physician": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"quoted_via_carrier_api": false,
"ratings": [
{
"type": "cms_quality_ratings_overall",
"value": "3"
}
],
"rehabilitation_services": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"sbc_name": "Aetna PPO 20/5000",
"service_area_id": "11234-2016-WI01",
"skilled_nursing": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"skilled_nursing_facility_365": "unlimited",
"source": "carrier",
"specialist": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"specialty_drugs": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"standardized_plan": false,
"telemedicine": false,
"type": "ACAPlan2018",
"updated_at": "2016-01-01",
"urgent_care": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
}
}
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"plan": {
"type": "object",
"properties": {
"abortion_rider": {
"type": "boolean",
"description": "True if plan covers abortion when there is no public funding available"
},
"actuarial_value": {
"type": "number",
"description": "Percentage of total average costs for covered benefits that a plan will cover."
},
"adult_dental": {
"type": "boolean",
"description": "Does the plan provide dental coverage for adults?"
},
"age29_rider": {
"type": "boolean",
"description": "True if the plan allows dependents up to age 29"
},
"ambulance": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Ambulance benefit"
},
"benefits_summary_url": {
"type": "string",
"description": "Link to the summary of benefits and coverage (SBC) document."
},
"carrier": {
"type": "object",
"properties": {
"id": {
"type": "string",
"description": "Carrier unique identifier"
},
"issuer_id": {
"type": "string",
"description": "Issuer Identifier"
},
"logo_url": {
"type": "string",
"description": "Link to a copy of the insurance carrier's logo"
},
"name": {
"type": "string",
"description": "Name of the insurance carrier"
}
},
"description": "Carrier Subsidiary associated to this Plan"
},
"carrier_disclaimers": {
"type": "string",
"description": "Most recent Disclaimer issued for this Plan"
},
"carrier_name": {
"type": "string",
"description": "Name of the insurance carrier"
},
"child_dental": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Child Dental benefit"
},
"child_eye_exam": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Child Eye Exam benefit"
},
"child_eyewear": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Child Eyewear benefit"
},
"chiropractic_services": {
"type": "boolean",
"description": "Does the plan provide a degree of coverage for chiropractic services?"
},
"diagnostic_test": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Diagnostic Test benefit"
},
"display_name": {
"type": "string",
"description": "Alternate name for the Plan"
},
"dp_rider": {
"type": "boolean",
"description": "True if plan does not cover domestic partners"
},
"drug_formulary_url": {
"type": "string",
"description": "Link to the summary of drug benefits for the plan"
},
"durable_medical_equipment": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Durable Medical Equipment benefit"
},
"effective_date": {
"type": "string",
"description": "Effective date of plan offering."
},
"embedded_deductible": {
"type": "string",
"description": "Is the individual deductible for each covered person, embedded in the family deductible"
},
"emergency_room": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Emergency Room benefit"
},
"essential_health_benefits_percentage": {
"type": "number",
"description": "Percentage of essential plan benefits"
},
"estimated_actuarial_value": {
"type": "number",
"description": "An estimation of the percentage of total average costs for covered benefits that a plan will cover."
},
"expiration_date": {
"type": "string",
"description": "Expiration date of plan offering."
},
"family_drug_deductible": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Family Drug Deductible benefit"
},
"family_drug_moop": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Family Drug Moop benefit"
},
"family_medical_deductible": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Family Medical Deductible benefit"
},
"family_medical_moop": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Family Medical Moop benefit"
},
"fp_rider": {
"type": "boolean",
"description": "True if plan does not cover family planning"
},
"gated": {
"type": "boolean",
"description": "Does the plan's network require a physician referral?"
},
"generic_drugs": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Generic Drugs benefit"
},
"habilitation_services": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Habilitation Services benefit"
},
"hios_issuer_id": {
"type": "string"
},
"home_health_care": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Home Health Care benefit"
},
"hospice_service": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Hospice Service benefit"
},
"hsa_eligible": {
"type": "boolean",
"description": "Is the plan HSA eligible?"
},
"id": {
"type": "string",
"description": "Government-issued HIOS plan ID"
},
"identifiers": {
"type": "array",
"description": "List of identifiers of this Plan"
},
"imaging": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
]
},
"imaging_center": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Imaging Center benefit"
},
"imaging_physician": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Imaging Physician benefit"
},
"individual_drug_deductible": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Individual Drug Moop benefit"
},
"individual_drug_moop": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Individual Drug Moop benefit"
},
"individual_medical_deductible": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Individual Medical Deductible benefit"
},
"individual_medical_moop": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Individual Medical Moop benefit"
},
"infertility_treatment_rider": {
"type": "boolean",
"description": "True if plan covers infertility treatment"
},
"inpatient_birth": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Inpatient Birth benefit"
},
"inpatient_birth_physician": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Inpatient Birth Physician benefit"
},
"inpatient_facility": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Inpatient Facility benefit"
},
"inpatient_mental_health": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Inpatient Mental Health benefit"
},
"inpatient_physician": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Inpatient Physician benefit"
},
"inpatient_substance": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Inpatient Substance benefit"
},
"lab_test": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Lab Test benefit"
},
"level": {
"type": "string",
"description": "Plan metal grouping (e.g. platinum, gold, silver, etc)"
},
"logo_url": {
"type": "string",
"description": "Link to a copy of the insurance carrier's logo"
},
"mail_order_rx": {
"type": "number",
"description": "Multiple of the standard Rx cost share for orders filled via mail order"
},
"name": {
"type": "string",
"description": "Marketing name of the plan"
},
"network_ids": {
"type": "array",
"description": "List of Vericred-generated network_ids"
},
"network_size": {
"type": "number",
"description": "Total number of Providers in network"
},
"networks": {
"type": "array",
"description": "List of networks associated with the plan"
},
"non_preferred_brand_drugs": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Non Preferred Brand_drugs benefit"
},
"nonpreferred_generic_drug_share": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Non Preferred Generic_drug_share benefit"
},
"nonpreferred_specialty_drug_share": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Non Preferred Specialty Drug Share benefit"
},
"off_market": {
"type": "boolean",
"description": "Is the plan off-market?"
},
"on_market": {
"type": "boolean",
"description": "Is the plan on-market?"
},
"out_of_network_coverage": {
"type": "boolean",
"description": "Does this plan provide any out of network coverage?"
},
"outpatient_ambulatory_care_center": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Outpatient Ambulatory Care Center benefit"
},
"outpatient_facility": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Outpatient Hospital benefit"
},
"outpatient_mental_health": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Outpatient Mental Health benefit"
},
"outpatient_physician": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "outpatient Physician benefit"
},
"outpatient_substance": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Outpatient Substance benefit"
},
"plan_ancestors": {
"type": "array",
"description": "A list of plan identifiers and years indicating the previous plans that the plan replaces"
},
"plan_calendar": {
"type": "string",
"description": "Are deductibles and MOOPs reset on Dec-31 (\"calendar year\"), 365 day(s) after enrollment date (\"plan year\"), or are both options available (\"both\")?"
},
"plan_coinsurance": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Plan Coinsurance benefit"
},
"plan_documents": {
"type": "array",
"description": "A list of plan documents including the document type and it's URL"
},
"plan_market": {
"type": "string",
"description": "Market in which the plan is offered (on_marketplace, shop, etc)"
},
"plan_type": {
"type": "string",
"description": "Category of the plan (e.g. EPO, HMO, PPO, POS, Indemnity, PACE, Medicare-Medicaid, HMO w/POS, Cost, FFS, MSA)"
},
"postnatal_care": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Postnatal Care benefit"
},
"preferred_brand_drugs": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Preferred Brand Drugs benefit"
},
"prenatal_care": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Prenatal Care benefit"
},
"prenatal_postnatal_care": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
]
},
"preventative_care": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Preventative Care benefit"
},
"primary_care_physician": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Primary Care Physician benefit"
},
"quoted_via_carrier_api": {
"type": "boolean",
"description": "The quotes for this plan will be provided by the carrier api"
},
"ratings": {
"type": "array",
"description": "Source of the CMS Quality Ratings"
},
"rehabilitation_services": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Rehabilitation Services benefit"
},
"sbc_name": {
"type": "string",
"description": "Name of the SBC"
},
"service_area_id": {
"type": "string",
"description": "Foreign key for service area"
},
"skilled_nursing": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Skilled Nursing benefit"
},
"skilled_nursing_facility_365": {
"type": "string",
"description": "Does the plan cover full-time, year-round, nursing facilities?"
},
"source": {
"type": "string",
"description": "Source of the plan benefit data"
},
"specialist": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Specialist benefit"
},
"specialty_drugs": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Specialty Drugs benefit"
},
"standardized_plan": {
"type": "boolean",
"description": "Indicates whether this plan is designated as a standardized plan option and should be displayed with the \"Easy pricing\" tag, per CMS regulations"
},
"telemedicine": {
"type": "boolean",
"description": "Indicates whether there is coverage for the remote delivery of medical benefits"
},
"type": {
"type": "string",
"description": "The type of the Plan"
},
"updated_at": {
"type": "string",
"description": "Time when plan was last updated"
},
"urgent_care": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Urgent Care benefit"
}
},
"description": "Medical Plan response"
}
}
}
Show PlanGET/plans/medical/{id}{?year}
Version History
v8
: In the response schema, benefits are represented as objects with tier and limit keys. The documentation for this endpoint references this latest available version.
v6
: Previous supported version. The response schema returns benefits as strings.
Endpoint Description
Show the details of a specific Plan. This includes all benefits for the Plan.
For more details on displaying Plans and their related data, see the Individual Quoting or Group Quoting sections.
Response Parameters
Identifiers
The identifiers
key contains various identifiers that can be used to identify the plan with the Carrier during enrollment.
Identifier Type | Description |
---|---|
contract_code | An issuer identifier for the plan. |
contract_id | An issuer identifier for the plan. |
hios_id | The CMS HIOS Identifier for the plan. |
issuer_internal_id | An issuer identifier for the plan. |
package_code | An issuer identifier for the package for which this plan can be offered with. |
Ratings
Starting in 2022, Ideon will be populating the CMS Star Ratings for Individual & Family plans that are sold on the federal exchange. These ratings will be present in the new ratings
list key. The following are the potential values for the type
field:
Type | Description |
---|---|
cms_quality_ratings_overall | The CMS overall plan rating |
cms_quality_ratings_medical_care | The CMS plan rating for Medical Care |
cms_quality_ratings_member_experience | The CMS plan rating for Member Experience |
cms_quality_ratings_plan_administration | The CMS plan rating for Plan Administration |
Plan Documents
A list of Carrier document links is provided for each plan. The following are the potential values for the type
field:
Type | Description |
---|---|
summary_of_benefits_and_coverage | The standard Summary of Benefits and Coverage |
summary_of_benefits | The carrier-specific Benefits Summary |
URI Parameters
- id
string
(required) Example: 88582NY0230001ID of the Plan
- year
number
(optional) Example: 2024Plan year (defaults to current year)
Major Medical Plans ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Body
{
"applicants": [
{
"age": 21,
"child": false,
"smoker": false
}
],
"drug_packages": [
{
"id": "01002-1200-11",
"med_id": 1
}
],
"enrollment_date": "2020-01-01",
"fips_code": "36081",
"household_income": 55000,
"household_size": 1,
"ids": [
1
],
"issuer_qualifications_met": [
"12345"
],
"market": "individual",
"page": 1,
"per_page": 20,
"providers": [
{
"address_id": "589c907f-28c2-3d14-8916-1144a5191ba2",
"npi": 1234567890
}
],
"sort": "premium:asc",
"zip_code": "11423"
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"applicants": {
"type": "array",
"description": "Applicants for desired plans."
},
"drug_packages": {
"type": "array",
"description": "National Drug Code Package Id"
},
"enrollment_date": {
"type": "string",
"description": "Date of enrollment"
},
"fips_code": {
"type": "string",
"description": "County code to determine eligibility"
},
"household_income": {
"type": "number",
"description": "Total household income."
},
"household_size": {
"type": "number",
"description": "Number of people living in household."
},
"ids": {
"type": "array",
"description": "List of plan IDs to filter by"
},
"issuer_qualifications_met": {
"type": "array",
"description": "A list of HIOS Issuer IDs with specific plan eligibility qualifications"
},
"market": {
"type": "string",
"description": "Type of plan to search for."
},
"page": {
"type": "number",
"description": "Selected page of paginated response."
},
"per_page": {
"type": "number",
"description": "Results per page of response."
},
"providers": {
"type": "array",
"description": "List of providers to search for."
},
"sort": {
"type": "string",
"description": "Sort responses by plan field."
},
"zip_code": {
"type": "string",
"description": "5-digit zip code - this helps determine pricing."
}
}
}
Headers
Content-Type: application/json
Body
{
"coverages": [
{
"drug_package_id": "01002-1200-11",
"plan_id": "88582NY0230001",
"prior_authorization": true,
"quantity_limit": true,
"step_therapy": true,
"tier": "generic"
}
],
"meta": {
"total": 1
},
"plans": [
{
"abortion_rider": false,
"actuarial_value": 80,
"adult_dental": true,
"age29_rider": false,
"ambulance": "In-Network: 25% after deductible / Out-of-Network: 25% after deductible",
"benefits_summary_url": "https://d2ed110nmrd591.cloudfront.net/blobs/i6XqimNu7KpSbJjKU5HeTSp1.pdf",
"carrier": {
"id": "bae1d0e1-80dc-48f4-918d-6c492340cc1c",
"issuer_id": "A0027",
"logo_url": "https://d1hm12jr612u3r.cloudfront.net/images/carriers/174/1438891372/thumb.png?1438891372",
"name": "Guardian"
},
"carrier_disclaimers": "See Summary of Benefits and Coverage (SBC) for more details.",
"carrier_name": "Aetna",
"child_dental": "In-Network: $0 / Out-of-Network: 100%",
"child_eye_exam": "In-Network: $0 / Out-of-Network: 100%",
"child_eyewear": "In-Network: $0 / Out-of-Network: 100%",
"chiropractic_services": false,
"diagnostic_test": "In-Network: 25% after deductible / Out-of-Network: 100%",
"display_name": "Aetna PPO 20/5000",
"dp_rider": true,
"drug_formulary_url": "https://www.emblemhealth.com/content/dam/emblemhealth/pdfs/resources/formularies/2020_Small-Group_Formulary.pdf",
"durable_medical_equipment": "In-Network: 25% after deductible / Out-of-Network: 100%",
"effective_date": "2020-01-01",
"embedded_deductible": "non_embedded",
"emergency_room": "Deductible, then $150",
"essential_health_benefits_percentage": 1,
"estimated_actuarial_value": 80,
"expiration_date": "2020-12-31",
"family_drug_deductible": "Included in Medical",
"family_drug_moop": "Included in Medical",
"family_medical_deductible": "$4,000",
"family_medical_moop": "$11,000",
"fp_rider": true,
"gated": false,
"generic_drugs": "$10",
"habilitation_services": "In-Network: $0 / Out-of-Network: 100%",
"hios_issuer_id": "88582",
"home_health_care": "In-Network: $0 / Out-of-Network: 100%",
"hospice_service": "In-Network: $0 / Out-of-Network: 100%",
"hsa_eligible": false,
"id": "88582NY0230001",
"identifiers": [
{
"type": "contract_id",
"value": "abc123"
}
],
"imaging_center": "In-Network: 25% after deductible / Out-of-Network: 100%",
"imaging_physician": "In-Network: 25% after deductible / Out-of-Network: 100%",
"individual_drug_deductible": "Included in Medical",
"individual_drug_moop": "Included in Medical",
"individual_medical_deductible": "$2,000",
"individual_medical_moop": "$5,500",
"infertility_treatment_rider": false,
"inpatient_birth": "In-Network: $0 / Out-of-Network: 100%",
"inpatient_birth_physician": "In-Network: 30% after deductible / Out-of-Network: 50% after deductible",
"inpatient_facility": "Deductible, then $1,500 per admission\"",
"inpatient_mental_health": "In-Network: $0 / Out-of-Network: 100%",
"inpatient_physician": "Included in inpatient facility",
"inpatient_substance": "In-Network: $0 / Out-of-Network: 100%",
"lab_test": "In-Network: 25% after deductible / Out-of-Network: 100%",
"level": "silver",
"logo_url": "https://d1hm12jr612u3r.cloudfront.net/images/carriers/174/1438891372/thumb.png?1438891372",
"mail_order_rx": 1.5,
"name": "Select Care Silver, Age 29 Rider",
"network_ids": [
1,
3
],
"network_size": 5000,
"networks": [
{
"id": 1,
"name": "Open Choice",
"provider_directory_url": "https://www.example.com/find-a-doctor"
}
],
"non_preferred_brand_drugs": "$70",
"nonpreferred_generic_drug_share": "$70",
"nonpreferred_specialty_drug_share": "$70",
"off_market": false,
"on_market": true,
"out_of_network_coverage": false,
"outpatient_ambulatory_care_center": "In-Network: 25% after deductible / Out-of-Network: 100%",
"outpatient_facility": "In-Network: 30% after deductible / Out-of-Network: 50% after deductible",
"outpatient_mental_health": "In-Network: 30% after deductible / Out-of-Network: 50% after deductible",
"outpatient_physician": "In-Network: 30% after deductible / Out-of-Network: 50% after deductible",
"outpatient_substance": "In-Network: $0 / Out-of-Network: 100%",
"plan_ancestors": [
{
"id": "88582NY0230001",
"year": 2019
}
],
"plan_calendar": "calendar_year",
"plan_coinsurance": "In-Network: 30% after deductible / Out-of-Network: 50% after deductible",
"plan_documents": [
{
"type": "summary_of_benefits_and_coverage",
"url": "https://www.example.com/summary_of_benefits_and_coverage.pdf"
}
],
"plan_market": "shop",
"plan_type": "HMO",
"postnatal_care": "In-Network: $0 / Out-of-Network: 100%",
"preferred_brand_drugs": "$35",
"premium": 533.24,
"premium_source": "carrier",
"premium_subsidized": 321.5,
"prenatal_care": "In-Network: $0 / Out-of-Network: 100%",
"preventative_care": "In-Network: $0 / Out-of-Network: 100%",
"primary_care_physician": "Deductible, then $30",
"providers": [
{
"addresses": [
{
"accepting_new_patients": true,
"city": "New York",
"external_id": "50c2d41e021f0eb5baaa6f134f15bd29",
"id": "589c907f-28c2-3d14-8916-1144a5191ba2",
"latitude": 45.55,
"longitude": 14.55,
"pcp": true,
"pcp_id": "123456",
"phone_numbers": [
"2122223333",
"9172223334"
],
"state": "NY",
"street_line_1": "123 Fake Street",
"street_line_2": "Apt 10",
"zip_code": "11215"
}
],
"in_network": true,
"npi": 1234567890
}
],
"quoted_via_carrier_api": false,
"ratings": [
{
"type": "cms_quality_ratings_overall",
"value": "3"
}
],
"rehabilitation_services": "In-Network: $0 / Out-of-Network: 100%",
"sbc_name": "Aetna PPO 20/5000",
"service_area_id": "11234-2016-WI01",
"skilled_nursing": "In-Network: $0 / Out-of-Network: 100%",
"skilled_nursing_facility_365": "unlimited",
"source": "carrier",
"specialist": "Deductible, then $50",
"specialty_drugs": "$70",
"standardized_plan": false,
"telemedicine": false,
"type": "ACAPlan2018",
"updated_at": "2016-01-01",
"urgent_care": "In-Network: $0 / Out-of-Network: 100%"
}
]
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"coverages": {
"type": "array",
"description": "Coverages associated with the plan."
},
"meta": {
"type": "object",
"properties": {
"total": {
"type": "number",
"description": "Number of entities returned"
}
},
"description": "Meta-data"
},
"plans": {
"type": "array",
"description": "Plan search results"
}
}
}
Search PlansPOST/plans/medical/search{?page,per_page}
Version History
v8
: In the response schema, benefits are represented as objects with tier and limit keys. Updates from v7
are included. The documentation for this endpoint references this latest available version.
v7
: Support added for the optional provider address_id
in the providers
list of the request schema for further filtering of in-network logic.
Additionally, the in_network_ids
and out_of_network_ids
fields were deprecated from the response and replaced with the providers
list. The response schema returns benefits as strings.
v6
: Previous supported version.
Endpoint Description
Determine the available Plans and their Premiums for a particular Family in a given location. This endpoint can also be used to search available group Plans in a specific zip code and county.
For details on searching for Plans and their related data, see the Individual Quoting section.
Additionally, this endpoint supports checks for in-network providers and drug coverages. See the “Providers” and “Drug Coverages” sections below for more information.
Request Parameters
Field | Type | Notes |
---|---|---|
zip_code (required) |
string |
|
fips_code (required) |
string |
|
market (required) |
string |
The options are: individual or small_group . |
enrollment_date (optional) |
string |
The format is 2019-01-01 . If this is not provided, we default it to today’s date. |
applicants (optional) |
list |
Use this field to see premiums for individual quotes. See below for parameters. |
drug_packages (optional) |
list |
Use this field to see drug coverage information by plan. Supply either the NDC Package Code or the Med ID of the Drug . More information can be found in the “Drug Coverages” section below. |
household_income (optional) |
int |
The total household income of the applicant for individual quotes. |
household_size (optional) |
int |
The number of applicants and dependents applying for individual quotes. |
ids (optional) |
list |
Use this field to hard filter results to certain HIOS IDs. |
providers (optional) |
list |
Use this field to see if providers are in- or out-of-network for each plan by providing their NPIs. More information can be found in the “Providers” section below. |
issuer_qualifications_met (optional) |
list |
A list of HIOS Issuer IDs of which the end-user has answered qualification questions for. |
Issuer Qualifications
Some issuers require end users to answer questions before their plans can be made available to them.
Ideon supports this by asking you to confirm that the end user has answered the requisite questions by passing the HIOS Issuer ID of the issuer in the optional issuer_qualifications_met
request key.
Plans for the requested issuer(s) that are available in the geographic area will have a -94
suffix in their id
.
For information on the issuers with qualifications that are supported, please reach out to [email protected].
Applicants (optional)
Field | Type | Notes |
---|---|---|
age (required) |
int |
|
child (required) |
boolean |
|
smoker (required) |
boolean |
Additional Sorting
Plans can be sorted by the premium
, carrier_name
, level
, and plan_type
fields, by either ascending (as asc
) or descending (as dsc
) sort under the sort
field.
Response Parameters
The Meta Response
The response will include a meta
key, which will always contain the following keys:
Field | Type | Notes |
---|---|---|
total | int |
The total number of records across all pages. |
eligible_for_chip_medicaid | boolean |
An indication as to whether the child dependents are eligible for CHIP medicaid. Important Note: If true , dependent children will not be included in the premium or premium_subsidized quote values. |
premium_tax_credit | float |
The amount of premium that will be subsidized. |
Identifiers
In the response, the identifiers
key contains various identifiers that can be used to identify the plan with the Carrier during enrollment.
Identifier Type | Description |
---|---|
contract_code | An issuer identifier for the plan. |
contract_id | An issuer identifier for the plan. |
hios_id | The CMS HIOS Identifier for the plan. |
issuer_internal_id | An issuer identifier for the plan. |
package_code | An issuer identifier for the package for which this plan can be offered with. |
Ratings
Starting in 2022, Ideon will be populating the CMS Star Ratings for Individual & Family plans that are sold on the federal exchange. These ratings will be present in the new ratings
list key. The following are the potential values for the type
field:
Type | Description |
---|---|
cms_quality_ratings_overall | The CMS overall plan rating |
cms_quality_ratings_medical_care | The CMS plan rating for Medical Care |
cms_quality_ratings_member_experience | The CMS plan rating for Member Experience |
cms_quality_ratings_plan_administration | The CMS plan rating for Plan Administration |
Plan Documents
A list of Carrier document links is provided for each plan. The following are the potential values for the type
field:
Type | Description |
---|---|
summary_of_benefits_and_coverage | The standard Summary of Benefits and Coverage |
summary_of_benefits | The carrier-specific Benefits Summary |
Providers
This endpoint enables you to see if one or more providers are in-network for each plan returned in the search. To do this, you can provide one of more providers in the following manner within in the request:
"providers": [
{"npi": "THE_PROVIDER_NPI", "address_id": "THE_ADDRESS_ID"},
{"npi": "ANOTHER_PROVIDER_NPI"}
]
You can optionally include an address_id
retrieved from our Provider Search. Including an address_id
will further filter the in-network logic to only those Providers that are in-network at that particular address.
Not including the address_id will return in-network logic based on whether the Provider accepts that network at any address.
Drug Coverages
This endpoint enables you to check coverage information for particular drugs for each plan returned in the search. To do this, you can provide one of more drugs, either by referencing the NDC Package Code or Med ID, in the following manner within in the request:
"drug_packages": [
{"id": "THE_NDC_PACKAGE_CODE"},
{"med_id": "A_MED_ID"}
]
In the response, you will see a coverages
key within the parent body of the response. Each coverage will contain an indication as to tier which the drug is labeled, whether prior authorization is required, whether there is a quantity limit, and whether step therapy is included. The tier
can have the following values:
Tier | Description |
---|---|
preferred_generic* | Unbranded drugs, with the same active ingredients as their brand-name equivalents. The preferred tier typically comes with lower cost shares than generic tier drugs. |
generic | Unbranded drugs, with the same active ingredients as their brand-name equivalents, and generally available at a lower cost than brand-name equivalents. |
preferred_brand | Brand-name drugs included within a preferred tier on the health plan’s formulary. Generally more expensive than generics, and less expensive than non-preferred drugs. |
non_preferred_brand | Brand-name drugs included within a non-preferred tier on the health plan’s formulary. These generally have a higher cost shares. |
specialty | Used to treat complex conditions like cancer. May require special handling or monitoring. May be generic or brand-name. Generally the most expensive drugs covered by a plan. |
not_covered | Specifically excluded from the health plan. |
not_listed | Neither included nor excluded from the health plan. Most plans provide some default level of coverage for unlisted drugs. |
URI Parameters
- page
number
(optional) Example: 1Page of paginated response
- per_page
number
(optional) Example: 1Responses per page
Major Medical Plans ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Body
{
"end_date": "2019-12-31",
"market": "small_group",
"quarter": "1",
"start_date": "2019-01-01",
"state_code": "CA",
"year": "2020"
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"end_date": {
"type": "string",
"description": "The date from which to end looking for changes."
},
"market": {
"type": "string",
"description": "The market for which the plans are available."
},
"quarter": {
"type": "string",
"description": "The quarter when the plans are available."
},
"start_date": {
"type": "string",
"description": "The date from which to start looking for changes."
},
"state_code": {
"type": "string",
"description": "The state where the plans are available."
},
"year": {
"type": "string",
"description": "The year when the plans are available."
}
}
}
Headers
Content-Type: application/json
Body
{
"meta": {
"total": 1
},
"plans": [
{
"changes": [
{
"timestamp": "2019-10-01T18:53:12.684Z",
"type": "add"
}
],
"id": "11111NY1111111"
}
]
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"meta": {
"type": "object",
"properties": {
"total": {
"type": "number",
"description": "Number of entities returned"
}
},
"description": "Meta-data"
},
"plans": {
"type": "array",
"description": "List of Plan Changes"
}
}
}
Plan ChangesPOST/plans/medical/changes{?page,per_page}
Version History
v6
: The documentation for this endpoint references this latest available version.
Endpoint Description
Search for plans that have either been added, updated, or dropped within a date range.
Request Parameters
Field | Type | Notes |
---|---|---|
start_date (required) |
date |
The date from which to end looking for changes. The format is YYYY-MM-DD . |
end_date (required) |
date |
The market for which the plans are available. The format is YYYY-MM-DD . |
state_code (required) |
string |
The state where the plans are available. |
market (required) |
string |
The market for which the plans are available. The options are individual or small_group . |
year (required) |
string |
The year when the plans are available. |
quarter (optional) |
string |
The quarter when the plans are available. This field is required if the market is small_group . The options are 1 , 2 , 3 , or 4 . |
Response Parameters
Types
Type Value | Notes |
---|---|
add |
The plan was added. |
update |
The plan information was updated. |
drop |
The plan was dropped from the system. |
URI Parameters
- page
number
(optional) Example: 1Page of paginated response
- per_page
number
(optional) Example: 1Responses per page
Medicare Advantage Plans ¶
Medicare Advantage Plans ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Headers
Content-Type: application/json
Body
{
"medicare_advantage_plan": {
"audience": "individual",
"benefits": {
"acupuncture": "In-Network: $300 / Out-of-Network: $300 after deductible",
"ambulance": "In-Network: $300 / Out-of-Network: $300 after deductible",
"catastrophic_brand_name": "In-Network: 20% / Out-of-Network: 40% after deductible",
"catastrophic_excluded": "In-Network: 20% / Out-of-Network: 40% after deductible",
"catastrophic_generic": "In-Network: 20% / Out-of-Network: 40% after deductible",
"chemotherapy_drug": "In-Network: 20% / Out-of-Network: 40% after deductible",
"deductible_annual_drug": "In-Network: $0 / Out-of-Network: unknown",
"deductible_annual_medical": "In-Network: $0 / Out-of-Network: unknown",
"dental_cleaning": "In-Network: $0 / Out-of-Network: Not Applicable",
"dental_diagnostic_services": "In-Network: 50% / Out-of-Network: 40% after deductible",
"dental_endodontics": "In-Network: 50% / Out-of-Network: 40% after deductible",
"dental_exam": "In-Network: $0 / Out-of-Network: Not Applicable",
"dental_extraction": "In-Network: $0 / Out-of-Network: Not Applicable",
"dental_fluoride_treatment": "In-Network: 100% / Out-of-Network: 100%",
"dental_medicare_covered_benefits": "In-Network: $40 / Out-of-Network: 40% after deductible",
"dental_non_routine_services": "In-Network: 100% / Out-of-Network: 100%",
"dental_periodontics": "In-Network: 100% / Out-of-Network: 100%",
"dental_prosthodontics_and_other": "In-Network: 100% / Out-of-Network: 100%",
"dental_restorative_services": "In-Network: 100% / Out-of-Network: 100%",
"dental_x_rays": "In-Network: $0 / Out-of-Network: Not Applicable",
"diabetes_management_monitoring_supplies": "In-Network: 0%-20% / Out-of-Network: 0%-20% after deductible",
"diagnostic_lab_service": "In-Network: $40 / Out-of-Network: 40% after deductible",
"diagnostic_outpatient_x_rays": "In-Network: $40 / Out-of-Network: 40% after deductible",
"diagnostic_radiology": "In-Network: 20% / Out-of-Network: 40% after deductible",
"diagnostic_test_and_procedures": "In-Network: 20% / Out-of-Network: 40% after deductible",
"diagnostic_therapeutic_radiology": "In-Network: 20% / Out-of-Network: 40% after deductible",
"doctor_visit_primary": "In-Network: 20% / Out-of-Network: 40% after deductible",
"doctor_visit_specialist": "In-Network: 20% / Out-of-Network: 40% after deductible",
"durable_medical_equipment": "In-Network: 20% / Out-of-Network: 40% after deductible",
"emergency_care": "In-Network: 20% / Out-of-Network: 40% after deductible",
"gap_brand_name": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_generic": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_generic_preferred_mail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_generic_preferred_mail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_generic_preferred_retail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_generic_preferred_retail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_generic_standard_mail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_generic_standard_mail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_generic_standard_retail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_generic_standard_retail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_non_preferred_preferred_mail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_non_preferred_preferred_mail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_non_preferred_preferred_retail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_non_preferred_preferred_retail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_non_preferred_standard_mail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_non_preferred_standard_mail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_non_preferred_standard_retail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_non_preferred_standard_retail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_preferred_brand_preferred_mail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_preferred_brand_preferred_mail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_preferred_brand_preferred_retail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_preferred_brand_preferred_retail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_preferred_brand_standard_mail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_preferred_brand_standard_mail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_preferred_brand_standard_retail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_preferred_brand_standard_retail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_preferred_generic_preferred_mail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_preferred_generic_preferred_mail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_preferred_generic_preferred_retail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_preferred_generic_preferred_retail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_preferred_generic_standard_mail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_preferred_generic_standard_mail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_preferred_generic_standard_retail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_preferred_generic_standard_retail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_specialty_preferred_mail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_specialty_preferred_mail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_specialty_preferred_retail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_specialty_preferred_retail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_specialty_standard_mail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_specialty_standard_mail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_specialty_standard_retail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_specialty_standard_retail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"hearing_aids": "In-Network: 20% / Out-of-Network: 40% after deductible",
"hearing_aids_fitting_and_evaluation": "In-Network: 20% / Out-of-Network: 40% after deductible",
"hearing_exam": "In-Network: 20% / Out-of-Network: 40% after deductible",
"hearing_medicare_covered_benefits": "In-Network: 20% / Out-of-Network: 40% after deductible",
"home_health_care": "In-Network: 20% / Out-of-Network: 40% after deductible",
"home_safety_devices_and_modifications": "In-Network: 20% / Out-of-Network: 40% after deductible",
"hospice": "In-Network: 20% / Out-of-Network: 40% after deductible",
"in_home_support_services": "In-Network: 20% / Out-of-Network: 40% after deductible",
"initial_generic_preferred_mail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_generic_preferred_mail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_generic_preferred_retail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_generic_preferred_retail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_generic_standard_mail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_generic_standard_mail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_generic_standard_retail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_generic_standard_retail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_non_preferred_preferred_mail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_non_preferred_preferred_mail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_non_preferred_preferred_retail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_non_preferred_preferred_retail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_non_preferred_standard_mail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_non_preferred_standard_mail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_non_preferred_standard_retail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_non_preferred_standard_retail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_preferred_brand_preferred_mail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_preferred_brand_preferred_mail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_preferred_brand_preferred_retail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_preferred_brand_preferred_retail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_preferred_brand_standard_mail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_preferred_brand_standard_mail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_preferred_brand_standard_retail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_preferred_brand_standard_retail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_preferred_generic_preferred_mail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_preferred_generic_preferred_mail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_preferred_generic_preferred_retail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_preferred_generic_preferred_retail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_preferred_generic_standard_mail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_preferred_generic_standard_mail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_preferred_generic_standard_retail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_preferred_generic_standard_retail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_specialty_preferred_mail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_specialty_preferred_mail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_specialty_preferred_retail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_specialty_preferred_retail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_specialty_standard_mail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_specialty_standard_mail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_specialty_standard_retail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_specialty_standard_retail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"inpatient_hospital": "In-Network: 20% / Out-of-Network: 40% after deductible",
"meals": "In-Network: 20% / Out-of-Network: 40% after deductible",
"medical_chiropractic_services": "In-Network: 20% / Out-of-Network: 40% after deductible",
"medical_moop": "In-Network: $6,700 / Out-of-Network: $9,500",
"mental_health_inpatient_visit": "In-Network: 20% / Out-of-Network: 40% after deductible",
"mental_health_outpatient_group_therapy": "In-Network: 20% / Out-of-Network: 40% after deductible",
"mental_health_outpatient_individual_therapy": "In-Network: 20% / Out-of-Network: 40% after deductible",
"other_part_b_drug": "In-Network: 20% / Out-of-Network: 40% after deductible",
"outpatient_hospital": "In-Network: 20% / Out-of-Network: 40% after deductible",
"over_the_counter": "In-Network: 20% / Out-of-Network: 40% after deductible",
"personal_emergency_response_system": "In-Network: 20% / Out-of-Network: 40% after deductible",
"physical_therapy": "In-Network: 20% / Out-of-Network: 40% after deductible",
"podiatry_medicare_covered_benefits": "In-Network: 20% / Out-of-Network: 40% after deductible",
"podiatry_routine_footcare": "In-Network: 20% / Out-of-Network: 40% after deductible",
"preventive_care": "In-Network: 20% / Out-of-Network: 40% after deductible",
"prosthetics": "In-Network: 20% / Out-of-Network: 40% after deductible",
"rehabilitation_occupational_therapy": "In-Network: 20% / Out-of-Network: 40% after deductible",
"remote_access_technology": "In-Network: 20% / Out-of-Network: 40% after deductible",
"renal_dialysis": "In-Network: 20% / Out-of-Network: 40% after deductible",
"routine_transportation": "In-Network: 20% / Out-of-Network: 40% after deductible",
"skilled_nursing_facility": "In-Network: 20% / Out-of-Network: 40% after deductible",
"telehealth": "In-Network: 20% / Out-of-Network: 40% after deductible",
"urgent_care": "In-Network: 20% / Out-of-Network: 40% after deductible",
"vision_contact_lenses": "In-Network: 20% / Out-of-Network: 40% after deductible",
"vision_exam": "In-Network: 20% / Out-of-Network: 40% after deductible",
"vision_eyeglass_frames_and_lenses": "In-Network: 20% / Out-of-Network: 40% after deductible",
"vision_medicare_covered_benefits": "In-Network: 20% / Out-of-Network: 40% after deductible",
"vision_upgrades": "In-Network: 20% / Out-of-Network: 40% after deductible",
"wellness_program": "In-Network: 20% / Out-of-Network: 40% after deductible",
"worldwide_emergency": "In-Network: 20% / Out-of-Network: 40% after deductible"
},
"benefits_summary_url": "http://www.emblemhealth.com/~/media/Files/PDF/HIXHub/BenefitSummary_SelectCareSilver.pdf",
"carrier": {
"id": "bae1d0e1-80dc-48f4-918d-6c492340cc1c",
"issuer_id": "A0027",
"logo_url": "https://d1hm12jr612u3r.cloudfront.net/images/carriers/174/1438891372/thumb.png?1438891372",
"name": "Guardian"
},
"carrier_name": "EmblemHealth",
"customer_service_phone_member": "(800)282-5366",
"customer_service_phone_non_member": "(855)338-7027",
"id": "uaLcmyru",
"identifiers": [
{
"type": "contract_id",
"value": "abc123"
}
],
"logo_url": "https://d1hm12jr612u3r.cloudfront.net/images/carriers/174/1438891372/thumb.png?1438891372",
"name": "Aetna Medicare Choice Plan (PPO)",
"network_size": 5000,
"networks": [
{
"id": 1,
"name": "Open Choice",
"provider_directory_url": "https://www.example.com/find-a-doctor"
}
],
"part_b_premium_reduction": 30.33,
"plan_documents": [
{
"type": "summary_of_benefits_and_coverage",
"url": "https://www.example.com/summary_of_benefits_and_coverage.pdf"
}
],
"plan_type": "HMO",
"premium_drug": 533.24,
"premium_health": 533.24,
"source": "carrier",
"stand_alone_part_d": false,
"star_rating_drug_plan": 4,
"star_rating_health_plan": 4,
"star_rating_overall": 4,
"supplemental_options": [
{
"benefits": [
"Preventive Dental",
"Comprehensive Dental"
],
"deductible": 50,
"id": 1,
"moop": 1000,
"name": "Aetna Medicare Advantage PPO Dental Plan",
"premium": 23
}
],
"year": "2019"
}
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"medicare_advantage_plan": {
"type": "object",
"properties": {
"audience": {
"type": "string",
"description": "The medicare advantage plan audience"
},
"benefits": {
"type": "object",
"properties": {
"acupuncture": {
"type": "string",
"description": "Acupuncture benefit string"
},
"ambulance": {
"type": "string",
"description": "Ambulance benefit string"
},
"catastrophic_brand_name": {
"type": "string",
"description": "Catastrophic Brand Name benefit string"
},
"catastrophic_excluded": {
"type": "string",
"description": "Catastrophic Excluded benefit string"
},
"catastrophic_generic": {
"type": "string",
"description": "Catastrophic Generic benefit string"
},
"chemotherapy_drug": {
"type": "string",
"description": "Chemotherapy Drug benefit string"
},
"deductible_annual_drug": {
"type": "string",
"description": "Deductible Annual Drug benefit string"
},
"deductible_annual_medical": {
"type": "string",
"description": "Deductible Annual Medical benefit string"
},
"dental_cleaning": {
"type": "string",
"description": "Dental Cleaning benefit string"
},
"dental_diagnostic_services": {
"type": "string",
"description": "Dental Diagnostics Services benefit string"
},
"dental_endodontics": {
"type": "string",
"description": "Dental Endodontics benefit string"
},
"dental_exam": {
"type": "string",
"description": "Dental Exam benefit string"
},
"dental_extraction": {
"type": "string",
"description": "Dental Extraction benefit string"
},
"dental_fluoride_treatment": {
"type": "string",
"description": "Dental Extraction benefit string"
},
"dental_medicare_covered_benefits": {
"type": "string",
"description": "Dental Medicare Covered Benefits benefit string"
},
"dental_non_routine_services": {
"type": "string",
"description": "Dental Non-Routine Services benefit string"
},
"dental_periodontics": {
"type": "string",
"description": "Dental Peridontics benefit string"
},
"dental_prosthodontics_and_other": {
"type": "string",
"description": "Dental Prosthodontics And Other benefit string"
},
"dental_restorative_services": {
"type": "string",
"description": "Dental Prosthodontics And Other benefit string"
},
"dental_x_rays": {
"type": "string",
"description": "Dental X-rays benefit string"
},
"diabetes_management_monitoring_supplies": {
"type": "string",
"description": "Diabetes Management Monitoring Supplies benefit string"
},
"diagnostic_lab_service": {
"type": "string",
"description": "Diagnostic Lab Service benefit string"
},
"diagnostic_outpatient_x_rays": {
"type": "string",
"description": "Diagnostic Outpatient X-rays benefit string"
},
"diagnostic_radiology": {
"type": "string",
"description": "Diagnostic Radiology benefit string"
},
"diagnostic_test_and_procedures": {
"type": "string",
"description": "Diagnostic Test and Procedures benefit string"
},
"diagnostic_therapeutic_radiology": {
"type": "string",
"description": "Diagnostic Therapeutic Radiology benefit string"
},
"doctor_visit_primary": {
"type": "string",
"description": "Doctor Visit Primary benefit string"
},
"doctor_visit_specialist": {
"type": "string",
"description": "Doctor Visit Specialist benefit string"
},
"durable_medical_equipment": {
"type": "string",
"description": "Durable Medical Equipment benefit string"
},
"emergency_care": {
"type": "string",
"description": "Emergency Care benefit string"
},
"gap_brand_name": {
"type": "string",
"description": "Gap Brand Name benefit string"
},
"gap_generic": {
"type": "string",
"description": "Gap Generic benefit string"
},
"gap_generic_preferred_mail_1_month": {
"type": "string",
"description": "Gap Generic Preferred Mail 1 Month benefit string"
},
"gap_generic_preferred_mail_3_month": {
"type": "string",
"description": "Gap Generic Preferred Mail 3 Month benefit string"
},
"gap_generic_preferred_retail_1_month": {
"type": "string",
"description": "Gap Generic Preferred Retail 1 Month benefit string"
},
"gap_generic_preferred_retail_3_month": {
"type": "string",
"description": "Gap Generic Preferred Retail 3 Month benefit string"
},
"gap_generic_standard_mail_1_month": {
"type": "string",
"description": "Gap Generic Standard Mail 1 Month benefit string"
},
"gap_generic_standard_mail_3_month": {
"type": "string",
"description": "Gap Generic Standard Mail 3 Month benefit string"
},
"gap_generic_standard_retail_1_month": {
"type": "string",
"description": "Gap Generic Standard Retail 1 Month benefit string"
},
"gap_generic_standard_retail_3_month": {
"type": "string",
"description": "Gap Generic Standard Retail 3 Month benefit string"
},
"gap_non_preferred_preferred_mail_1_month": {
"type": "string",
"description": "Gap Non-Preferred Preferred Mail 1 Month benefit string"
},
"gap_non_preferred_preferred_mail_3_month": {
"type": "string",
"description": "Gap Non-Preferred Preferred Mail 3 Month benefit string"
},
"gap_non_preferred_preferred_retail_1_month": {
"type": "string",
"description": "Gap Non-Preferred Preferred Retail 1 Month benefit string"
},
"gap_non_preferred_preferred_retail_3_month": {
"type": "string",
"description": "Gap Non-Preferred Preferred Retail 3 Month benefit string"
},
"gap_non_preferred_standard_mail_1_month": {
"type": "string",
"description": "Gap Non-Preferred Preferred Mail 1 Month benefit string"
},
"gap_non_preferred_standard_mail_3_month": {
"type": "string",
"description": "Gap Non-Preferred Standard Mail 3 Month benefit string"
},
"gap_non_preferred_standard_retail_1_month": {
"type": "string",
"description": "Gap Non-Preferred Standard Retail 1 Month benefit string"
},
"gap_non_preferred_standard_retail_3_month": {
"type": "string",
"description": "Gap Non-Preferred Standard Retail 3 Month benefit string"
},
"gap_preferred_brand_preferred_mail_1_month": {
"type": "string",
"description": "Gap Preferred Brand Preferred Mail 1 Month benefit string"
},
"gap_preferred_brand_preferred_mail_3_month": {
"type": "string",
"description": "Gap Preferred Brand Preferred Mail 3 Month benefit string"
},
"gap_preferred_brand_preferred_retail_1_month": {
"type": "string",
"description": "Gap Preferred Brand Preferred Retail 1 Month benefit string"
},
"gap_preferred_brand_preferred_retail_3_month": {
"type": "string",
"description": "Gap Preferred Brand Preferred Retail 3 Month benefit string"
},
"gap_preferred_brand_standard_mail_1_month": {
"type": "string",
"description": "Gap Preferred Brand Standard Mail 1 Month benefit string"
},
"gap_preferred_brand_standard_mail_3_month": {
"type": "string",
"description": "Gap Preferred Brand Standard Mail 3 Month benefit string"
},
"gap_preferred_brand_standard_retail_1_month": {
"type": "string",
"description": "Gap Preferred Brand Standard Retail 1 Month benefit string"
},
"gap_preferred_brand_standard_retail_3_month": {
"type": "string",
"description": "Gap Preferred Brand Standard Retail 3 Month benefit string"
},
"gap_preferred_generic_preferred_mail_1_month": {
"type": "string",
"description": "Gap Preferred Generic Preferred Mail 1 Month benefit string"
},
"gap_preferred_generic_preferred_mail_3_month": {
"type": "string",
"description": "Gap Preferred Generic Preferred Mail 3 Month benefit string"
},
"gap_preferred_generic_preferred_retail_1_month": {
"type": "string",
"description": "Gap Preferred Generic Preferred Retail 1 Month benefit string"
},
"gap_preferred_generic_preferred_retail_3_month": {
"type": "string",
"description": "Gap Preferred Generic Preferred Retail 3 Month benefit string"
},
"gap_preferred_generic_standard_mail_1_month": {
"type": "string",
"description": "Gap Preferred Generic Standard Mail 1 Month benefit string"
},
"gap_preferred_generic_standard_mail_3_month": {
"type": "string",
"description": "Gap Preferred Generic Standard Mail 3 Month benefit string"
},
"gap_preferred_generic_standard_retail_1_month": {
"type": "string",
"description": "Gap Preferred Generic Standard Retail 1 Month benefit string"
},
"gap_preferred_generic_standard_retail_3_month": {
"type": "string",
"description": "Gap Preferred Generic Standard Retail 3 Month benefit string"
},
"gap_specialty_preferred_mail_1_month": {
"type": "string",
"description": "Gap Specialty Preferred Mail 1 Month benefit string"
},
"gap_specialty_preferred_mail_3_month": {
"type": "string",
"description": "Gap Specialty Preferred Mail 3 Month benefit string"
},
"gap_specialty_preferred_retail_1_month": {
"type": "string",
"description": "Gap Specialty Preferred Retail 1 Month benefit string"
},
"gap_specialty_preferred_retail_3_month": {
"type": "string",
"description": "Gap Specialty Preferred Retail 3 Month benefit string"
},
"gap_specialty_standard_mail_1_month": {
"type": "string",
"description": "Gap Specialty Standard Mail 1 Month benefit string"
},
"gap_specialty_standard_mail_3_month": {
"type": "string",
"description": "Gap Specialty Standard Mail 3 Month benefit string"
},
"gap_specialty_standard_retail_1_month": {
"type": "string",
"description": "Gap Specialty Standard Retail 1 Month benefit string"
},
"gap_specialty_standard_retail_3_month": {
"type": "string",
"description": "Gap Specialty Standard Retail 3 Month benefit string"
},
"hearing_aids": {
"type": "string",
"description": "Hearing Aids benefit string"
},
"hearing_aids_fitting_and_evaluation": {
"type": "string",
"description": "Hearing Aids Fitting and Evaluation benefit string"
},
"hearing_exam": {
"type": "string",
"description": "Hearing Exam benefit string"
},
"hearing_medicare_covered_benefits": {
"type": "string",
"description": "Hearing Medicare Covered Benefits benefit string"
},
"home_health_care": {
"type": "string",
"description": "Home Health Care benefit string"
},
"home_safety_devices_and_modifications": {
"type": "string",
"description": "Home Safety Devices and Modifications benefit string"
},
"hospice": {
"type": "string",
"description": "Hospice benefit string"
},
"in_home_support_services": {
"type": "string",
"description": "In-Home Support Services benefit string"
},
"initial_generic_preferred_mail_1_month": {
"type": "string",
"description": "Initial Generic Preferred Mail 1 Month benefit string"
},
"initial_generic_preferred_mail_3_month": {
"type": "string",
"description": "Initial Generic Preferred Mail 3 Month benefit string"
},
"initial_generic_preferred_retail_1_month": {
"type": "string",
"description": "Initial Generic Preferred Retail 1 Month benefit string"
},
"initial_generic_preferred_retail_3_month": {
"type": "string",
"description": "Initial Generic Preferred Retail 3 Month benefit string"
},
"initial_generic_standard_mail_1_month": {
"type": "string",
"description": "Initial Generic Standard Mail 1 Month benefit string"
},
"initial_generic_standard_mail_3_month": {
"type": "string",
"description": "Initial Generic Standard Mail 3 Month benefit string"
},
"initial_generic_standard_retail_1_month": {
"type": "string",
"description": "Initial Generic Standard Retail 1 Month benefit string"
},
"initial_generic_standard_retail_3_month": {
"type": "string",
"description": "Initial Generic Standard Retail 3 Month benefit string"
},
"initial_non_preferred_preferred_mail_1_month": {
"type": "string",
"description": "Initial Non-Preferred Preferred Mail 1 Month benefit string"
},
"initial_non_preferred_preferred_mail_3_month": {
"type": "string",
"description": "Initial Non-Preferred Preferred Mail 3 Month benefit string"
},
"initial_non_preferred_preferred_retail_1_month": {
"type": "string",
"description": "Initial Non-Preferred Preferred Retail 1 Month benefit string"
},
"initial_non_preferred_preferred_retail_3_month": {
"type": "string",
"description": "Initial Non-Preferred Preferred Retail 3 Month benefit string"
},
"initial_non_preferred_standard_mail_1_month": {
"type": "string",
"description": "Initial Non-Preferred Preferred Mail 1 Month benefit string"
},
"initial_non_preferred_standard_mail_3_month": {
"type": "string",
"description": "Initial Non-Preferred Standard Mail 3 Month benefit string"
},
"initial_non_preferred_standard_retail_1_month": {
"type": "string",
"description": "Initial Non-Preferred Standard Retail 1 Month benefit string"
},
"initial_non_preferred_standard_retail_3_month": {
"type": "string",
"description": "Initial Non-Preferred Standard Retail 3 Month benefit string"
},
"initial_preferred_brand_preferred_mail_1_month": {
"type": "string",
"description": "Initial Preferred Brand Preferred Mail 1 Month benefit string"
},
"initial_preferred_brand_preferred_mail_3_month": {
"type": "string",
"description": "Initial Preferred Brand Preferred Mail 3 Month benefit string"
},
"initial_preferred_brand_preferred_retail_1_month": {
"type": "string",
"description": "Initial Preferred Brand Preferred Retail 1 Month benefit string"
},
"initial_preferred_brand_preferred_retail_3_month": {
"type": "string",
"description": "Initial Preferred Brand Preferred Retail 3 Month benefit string"
},
"initial_preferred_brand_standard_mail_1_month": {
"type": "string",
"description": "Initial Preferred Brand Standard Mail 1 Month benefit string"
},
"initial_preferred_brand_standard_mail_3_month": {
"type": "string",
"description": "Initial Preferred Brand Standard Mail 3 Month benefit string"
},
"initial_preferred_brand_standard_retail_1_month": {
"type": "string",
"description": "Initial Preferred Brand Standard Retail 1 Month benefit string"
},
"initial_preferred_brand_standard_retail_3_month": {
"type": "string",
"description": "Initial Preferred Brand Standard Retail 3 Month benefit string"
},
"initial_preferred_generic_preferred_mail_1_month": {
"type": "string",
"description": "Initial Preferred Generic Preferred Mail 1 Month benefit string"
},
"initial_preferred_generic_preferred_mail_3_month": {
"type": "string",
"description": "Initial Preferred Generic Preferred Mail 3 Month benefit string"
},
"initial_preferred_generic_preferred_retail_1_month": {
"type": "string",
"description": "Initial Preferred Generic Preferred Retail 1 Month benefit string"
},
"initial_preferred_generic_preferred_retail_3_month": {
"type": "string",
"description": "Initial Preferred Generic Preferred Retail 3 Month benefit string"
},
"initial_preferred_generic_standard_mail_1_month": {
"type": "string",
"description": "Initial Preferred Generic Standard Mail 1 Month benefit string"
},
"initial_preferred_generic_standard_mail_3_month": {
"type": "string",
"description": "Initial Preferred Generic Standard Mail 3 Month benefit string"
},
"initial_preferred_generic_standard_retail_1_month": {
"type": "string",
"description": "Initial Preferred Generic Standard Retail 1 Month benefit string"
},
"initial_preferred_generic_standard_retail_3_month": {
"type": "string",
"description": "Initial Preferred Generic Standard Retail 3 Month benefit string"
},
"initial_specialty_preferred_mail_1_month": {
"type": "string",
"description": "Initial Specialty Preferred Mail 1 Month benefit string"
},
"initial_specialty_preferred_mail_3_month": {
"type": "string",
"description": "Initial Specialty Preferred Mail 3 Month benefit string"
},
"initial_specialty_preferred_retail_1_month": {
"type": "string",
"description": "Initial Specialty Preferred Retail 1 Month benefit string"
},
"initial_specialty_preferred_retail_3_month": {
"type": "string",
"description": "Initial Specialty Preferred Retail 3 Month benefit string"
},
"initial_specialty_standard_mail_1_month": {
"type": "string",
"description": "Initial Specialty Standard Mail 1 Month benefit string"
},
"initial_specialty_standard_mail_3_month": {
"type": "string",
"description": "Initial Specialty Standard Mail 3 Month benefit string"
},
"initial_specialty_standard_retail_1_month": {
"type": "string",
"description": "Initial Specialty Standard Retail 1 Month benefit string"
},
"initial_specialty_standard_retail_3_month": {
"type": "string",
"description": "Initial Specialty Standard Retail 3 Month benefit string"
},
"inpatient_hospital": {
"type": "string",
"description": "Inpatient Hospital benefit string"
},
"meals": {
"type": "string",
"description": "Meals benefit string"
},
"medical_chiropractic_services": {
"type": "string",
"description": "Medical Chiropractic Services benefit string"
},
"medical_moop": {
"type": "string",
"description": "Medical Medicare Advantage Maxiumum Out-Of-Pocket benefit string"
},
"mental_health_inpatient_visit": {
"type": "string",
"description": "Medical Medicare Advantage Maxiumum Out-Of-Pocket benefit string"
},
"mental_health_outpatient_group_therapy": {
"type": "string",
"description": "Medical Health Outpatient Group Therapy benefit string"
},
"mental_health_outpatient_individual_therapy": {
"type": "string",
"description": "Medical Health Outpatient Individual Therapy benefit string"
},
"other_part_b_drug": {
"type": "string",
"description": "Other Part B Drug benefit string"
},
"outpatient_hospital": {
"type": "string",
"description": "Outpatient Hospital benefit string"
},
"over_the_counter": {
"type": "string",
"description": "Over the Counter benefit string"
},
"personal_emergency_response_system": {
"type": "string",
"description": "Personal Emergency Response System benefit string"
},
"physical_therapy": {
"type": "string",
"description": "Physical Therapy benefit string"
},
"podiatry_medicare_covered_benefits": {
"type": "string",
"description": "Podiatry Medicare Covered Benefits benefit string"
},
"podiatry_routine_footcare": {
"type": "string",
"description": "Podiatry Routine Footcare benefit string"
},
"preventive_care": {
"type": "string",
"description": "Preventive Care benefit string"
},
"prosthetics": {
"type": "string",
"description": "Prosthetics benefit string"
},
"rehabilitation_occupational_therapy": {
"type": "string",
"description": "Rehabilitation Occupational Therapy benefit string"
},
"remote_access_technology": {
"type": "string",
"description": "Remote Access Technology benefit string"
},
"renal_dialysis": {
"type": "string",
"description": "Rehabilitation Occupational Therapy benefit string"
},
"routine_transportation": {
"type": "string",
"description": "Rehabilitation Occupational Therapy benefit string"
},
"skilled_nursing_facility": {
"type": "string",
"description": "Skilled Nursing Facility benefit string"
},
"telehealth": {
"type": "string",
"description": "Telehealth benefit string"
},
"urgent_care": {
"type": "string",
"description": "Urgent Care benefit string"
},
"vision_contact_lenses": {
"type": "string",
"description": "Vision Contact Lenses benefit string"
},
"vision_exam": {
"type": "string",
"description": "Vision Exam benefit string"
},
"vision_eyeglass_frames_and_lenses": {
"type": "string",
"description": "Vision Eyeglasses Frames and Lenses benefit string"
},
"vision_medicare_covered_benefits": {
"type": "string",
"description": "Vision Medicare Covered Benefits benefit string"
},
"vision_upgrades": {
"type": "string",
"description": "Vision Upgrades benefit string"
},
"wellness_program": {
"type": "string",
"description": "Wellness Program benefit string"
},
"worldwide_emergency": {
"type": "string",
"description": "Worldwide Emergency benefit string"
}
},
"description": "Medicare Advantage Plan Benefits"
},
"benefits_summary_url": {
"type": "string",
"description": "Link to the summary of benefits and coverage (SBC) document."
},
"carrier": {
"type": "object",
"properties": {
"id": {
"type": "string",
"description": "Carrier unique identifier"
},
"issuer_id": {
"type": "string",
"description": "Issuer Identifier"
},
"logo_url": {
"type": "string",
"description": "Link to a copy of the insurance carrier's logo"
},
"name": {
"type": "string",
"description": "Name of the insurance carrier"
}
},
"description": "Carrier Subsidiary associated to this Plan"
},
"carrier_name": {
"type": "string",
"description": "Name of the insurance carrier"
},
"customer_service_phone_member": {
"type": "string",
"description": "Customer Service member phone number"
},
"customer_service_phone_non_member": {
"type": "string",
"description": "Customer_service for non-member phone number"
},
"id": {
"type": "string",
"description": "The medicare advantage plan identifier"
},
"identifiers": {
"type": "array",
"description": "List of identifiers of this Plan"
},
"logo_url": {
"type": "string",
"description": "Link to a copy of the insurance carrier's logo"
},
"name": {
"type": "string",
"description": "The medicare advantage plan name"
},
"network_size": {
"type": "number",
"description": "Total number of Providers in network"
},
"networks": {
"type": "array",
"description": "List of networks associated with the plan"
},
"part_b_premium_reduction": {
"type": "number",
"description": "Part B premium reduction amount"
},
"plan_documents": {
"type": "array",
"description": "A list of plan documents including the document type and it's URL"
},
"plan_type": {
"type": "string",
"description": "Category of the plan (e.g. EPO, HMO, PPO, POS, Indemnity, PACE, Medicare-Medicaid, HMO w/POS, Cost, FFS, MSA)"
},
"premium_drug": {
"type": "number",
"description": "Cumulative premium amount"
},
"premium_health": {
"type": "number",
"description": "Cumulative premium amount"
},
"source": {
"type": "string",
"description": "Source of the plan benefit data"
},
"stand_alone_part_d": {
"type": "boolean",
"description": "Stand alone flag for medical advantage plan"
},
"star_rating_drug_plan": {
"type": "number",
"description": "Star rating for the drug medicare advantage plan"
},
"star_rating_health_plan": {
"type": "number",
"description": "Star rating for the medical medicare advantage plan"
},
"star_rating_overall": {
"type": "number",
"description": "Overall star rating for the plan"
},
"supplemental_options": {
"type": "array",
"description": "List of supplemental options of this Plan"
},
"year": {
"type": "string",
"description": "The year of medicare advantage plan"
}
},
"description": "Medicare Advantage Plan response"
}
}
}
Show PlanGET/plans/medadv/{id}{?year}
Version History
v6
: The documentation for this endpoint references this latest available version.
Endpoint Description
This endpoint displays the details of a specific Medicare Advantage Plan.
Response Parameters
Prescription Drug Benefits
The initial coverage phase and gap phase are each broken down by 5 drug tiers (generic, non-preferred, preferred-brand, preferred-generic, and specialty), 4 pharmacy tiers (preferred mail, preferred retail, standard mail, and standard retail), and 2 lengths of supply (1-month and 3-month.)
If there is no additional coverage during coverage gap phase, then cost sharing in this phase may be presented in just 2 fields - gap_brand_name and gap_generic, instead of broken-down benefits as described above. For a description of each drug benefit field, please see the schema on the right side.
Identifiers
The identifiers
key contains various identifiers that can be used to identify the plan with the Carrier during enrollment.
Identifier Type | Description |
---|---|
contract_code | An issuer identifier for the plan. |
contract_id | An issuer identifier for the plan. |
medicare_plan_id | The CMS Medicare Contract Code ID for the plan. |
URI Parameters
- id
string
(required) Example: H4045-001-0ID of the Plan
- year
number
(optional) Example: 2024Plan year (defaults to current year)
Medicare Advantage Plans ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Body
{
"drug_packages": [
{
"id": "01002-1200-11",
"med_id": 1
}
],
"enrollment_date": "2024-03-08",
"fips_code": "36081",
"ids": [
"S2893-003-0",
"H9585-001-0"
],
"page": 1,
"per_page": 20,
"providers": [
{
"address_id": "589c907f-28c2-3d14-8916-1144a5191ba2",
"npi": 1234567890
}
],
"zip_code": "11423"
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"drug_packages": {
"type": "array",
"description": "National Drug Code Package Id"
},
"enrollment_date": {
"type": "string",
"description": "Date of enrollment"
},
"fips_code": {
"type": "string",
"description": "County code for the geographic area of the search"
},
"ids": {
"type": "array",
"description": "List of Medicare Advantage plan contract identifiers"
},
"page": {
"type": "number",
"description": "Selected page of paginated response."
},
"per_page": {
"type": "number",
"description": "Results per page of response."
},
"providers": {
"type": "array",
"description": "List of providers to search for."
},
"zip_code": {
"type": "string",
"description": "Zip code for the geographic area of the search"
}
}
}
Headers
Content-Type: application/json
Body
{
"coverages": [
{
"drug_package_id": "01002-1200-11",
"plan_id": "88582NY0230001",
"prior_authorization": true,
"quantity_limit": true,
"step_therapy": true,
"tier": "generic"
}
],
"meta": {
"total": 1
},
"plans": [
{
"audience": "individual",
"benefits": {
"acupuncture": "In-Network: $300 / Out-of-Network: $300 after deductible",
"ambulance": "In-Network: $300 / Out-of-Network: $300 after deductible",
"catastrophic_brand_name": "In-Network: 20% / Out-of-Network: 40% after deductible",
"catastrophic_excluded": "In-Network: 20% / Out-of-Network: 40% after deductible",
"catastrophic_generic": "In-Network: 20% / Out-of-Network: 40% after deductible",
"chemotherapy_drug": "In-Network: 20% / Out-of-Network: 40% after deductible",
"deductible_annual_drug": "In-Network: $0 / Out-of-Network: unknown",
"deductible_annual_medical": "In-Network: $0 / Out-of-Network: unknown",
"dental_cleaning": "In-Network: $0 / Out-of-Network: Not Applicable",
"dental_diagnostic_services": "In-Network: 50% / Out-of-Network: 40% after deductible",
"dental_endodontics": "In-Network: 50% / Out-of-Network: 40% after deductible",
"dental_exam": "In-Network: $0 / Out-of-Network: Not Applicable",
"dental_extraction": "In-Network: $0 / Out-of-Network: Not Applicable",
"dental_fluoride_treatment": "In-Network: 100% / Out-of-Network: 100%",
"dental_medicare_covered_benefits": "In-Network: $40 / Out-of-Network: 40% after deductible",
"dental_non_routine_services": "In-Network: 100% / Out-of-Network: 100%",
"dental_periodontics": "In-Network: 100% / Out-of-Network: 100%",
"dental_prosthodontics_and_other": "In-Network: 100% / Out-of-Network: 100%",
"dental_restorative_services": "In-Network: 100% / Out-of-Network: 100%",
"dental_x_rays": "In-Network: $0 / Out-of-Network: Not Applicable",
"diabetes_management_monitoring_supplies": "In-Network: 0%-20% / Out-of-Network: 0%-20% after deductible",
"diagnostic_lab_service": "In-Network: $40 / Out-of-Network: 40% after deductible",
"diagnostic_outpatient_x_rays": "In-Network: $40 / Out-of-Network: 40% after deductible",
"diagnostic_radiology": "In-Network: 20% / Out-of-Network: 40% after deductible",
"diagnostic_test_and_procedures": "In-Network: 20% / Out-of-Network: 40% after deductible",
"diagnostic_therapeutic_radiology": "In-Network: 20% / Out-of-Network: 40% after deductible",
"doctor_visit_primary": "In-Network: 20% / Out-of-Network: 40% after deductible",
"doctor_visit_specialist": "In-Network: 20% / Out-of-Network: 40% after deductible",
"durable_medical_equipment": "In-Network: 20% / Out-of-Network: 40% after deductible",
"emergency_care": "In-Network: 20% / Out-of-Network: 40% after deductible",
"gap_brand_name": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_generic": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_generic_preferred_mail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_generic_preferred_mail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_generic_preferred_retail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_generic_preferred_retail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_generic_standard_mail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_generic_standard_mail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_generic_standard_retail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_generic_standard_retail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_non_preferred_preferred_mail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_non_preferred_preferred_mail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_non_preferred_preferred_retail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_non_preferred_preferred_retail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_non_preferred_standard_mail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_non_preferred_standard_mail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_non_preferred_standard_retail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_non_preferred_standard_retail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_preferred_brand_preferred_mail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_preferred_brand_preferred_mail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_preferred_brand_preferred_retail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_preferred_brand_preferred_retail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_preferred_brand_standard_mail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_preferred_brand_standard_mail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_preferred_brand_standard_retail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_preferred_brand_standard_retail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_preferred_generic_preferred_mail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_preferred_generic_preferred_mail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_preferred_generic_preferred_retail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_preferred_generic_preferred_retail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_preferred_generic_standard_mail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_preferred_generic_standard_mail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_preferred_generic_standard_retail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_preferred_generic_standard_retail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_specialty_preferred_mail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_specialty_preferred_mail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_specialty_preferred_retail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_specialty_preferred_retail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_specialty_standard_mail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_specialty_standard_mail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_specialty_standard_retail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"gap_specialty_standard_retail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"hearing_aids": "In-Network: 20% / Out-of-Network: 40% after deductible",
"hearing_aids_fitting_and_evaluation": "In-Network: 20% / Out-of-Network: 40% after deductible",
"hearing_exam": "In-Network: 20% / Out-of-Network: 40% after deductible",
"hearing_medicare_covered_benefits": "In-Network: 20% / Out-of-Network: 40% after deductible",
"home_health_care": "In-Network: 20% / Out-of-Network: 40% after deductible",
"home_safety_devices_and_modifications": "In-Network: 20% / Out-of-Network: 40% after deductible",
"hospice": "In-Network: 20% / Out-of-Network: 40% after deductible",
"in_home_support_services": "In-Network: 20% / Out-of-Network: 40% after deductible",
"initial_generic_preferred_mail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_generic_preferred_mail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_generic_preferred_retail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_generic_preferred_retail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_generic_standard_mail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_generic_standard_mail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_generic_standard_retail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_generic_standard_retail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_non_preferred_preferred_mail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_non_preferred_preferred_mail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_non_preferred_preferred_retail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_non_preferred_preferred_retail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_non_preferred_standard_mail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_non_preferred_standard_mail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_non_preferred_standard_retail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_non_preferred_standard_retail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_preferred_brand_preferred_mail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_preferred_brand_preferred_mail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_preferred_brand_preferred_retail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_preferred_brand_preferred_retail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_preferred_brand_standard_mail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_preferred_brand_standard_mail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_preferred_brand_standard_retail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_preferred_brand_standard_retail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_preferred_generic_preferred_mail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_preferred_generic_preferred_mail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_preferred_generic_preferred_retail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_preferred_generic_preferred_retail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_preferred_generic_standard_mail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_preferred_generic_standard_mail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_preferred_generic_standard_retail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_preferred_generic_standard_retail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_specialty_preferred_mail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_specialty_preferred_mail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_specialty_preferred_retail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_specialty_preferred_retail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_specialty_standard_mail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_specialty_standard_mail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_specialty_standard_retail_1_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"initial_specialty_standard_retail_3_month": "In-Network: $40 / Out-of-Network: 40% after deductible",
"inpatient_hospital": "In-Network: 20% / Out-of-Network: 40% after deductible",
"meals": "In-Network: 20% / Out-of-Network: 40% after deductible",
"medical_chiropractic_services": "In-Network: 20% / Out-of-Network: 40% after deductible",
"medical_moop": "In-Network: $6,700 / Out-of-Network: $9,500",
"mental_health_inpatient_visit": "In-Network: 20% / Out-of-Network: 40% after deductible",
"mental_health_outpatient_group_therapy": "In-Network: 20% / Out-of-Network: 40% after deductible",
"mental_health_outpatient_individual_therapy": "In-Network: 20% / Out-of-Network: 40% after deductible",
"other_part_b_drug": "In-Network: 20% / Out-of-Network: 40% after deductible",
"outpatient_hospital": "In-Network: 20% / Out-of-Network: 40% after deductible",
"over_the_counter": "In-Network: 20% / Out-of-Network: 40% after deductible",
"personal_emergency_response_system": "In-Network: 20% / Out-of-Network: 40% after deductible",
"physical_therapy": "In-Network: 20% / Out-of-Network: 40% after deductible",
"podiatry_medicare_covered_benefits": "In-Network: 20% / Out-of-Network: 40% after deductible",
"podiatry_routine_footcare": "In-Network: 20% / Out-of-Network: 40% after deductible",
"preventive_care": "In-Network: 20% / Out-of-Network: 40% after deductible",
"prosthetics": "In-Network: 20% / Out-of-Network: 40% after deductible",
"rehabilitation_occupational_therapy": "In-Network: 20% / Out-of-Network: 40% after deductible",
"remote_access_technology": "In-Network: 20% / Out-of-Network: 40% after deductible",
"renal_dialysis": "In-Network: 20% / Out-of-Network: 40% after deductible",
"routine_transportation": "In-Network: 20% / Out-of-Network: 40% after deductible",
"skilled_nursing_facility": "In-Network: 20% / Out-of-Network: 40% after deductible",
"telehealth": "In-Network: 20% / Out-of-Network: 40% after deductible",
"urgent_care": "In-Network: 20% / Out-of-Network: 40% after deductible",
"vision_contact_lenses": "In-Network: 20% / Out-of-Network: 40% after deductible",
"vision_exam": "In-Network: 20% / Out-of-Network: 40% after deductible",
"vision_eyeglass_frames_and_lenses": "In-Network: 20% / Out-of-Network: 40% after deductible",
"vision_medicare_covered_benefits": "In-Network: 20% / Out-of-Network: 40% after deductible",
"vision_upgrades": "In-Network: 20% / Out-of-Network: 40% after deductible",
"wellness_program": "In-Network: 20% / Out-of-Network: 40% after deductible",
"worldwide_emergency": "In-Network: 20% / Out-of-Network: 40% after deductible"
},
"benefits_summary_url": "http://www.emblemhealth.com/~/media/Files/PDF/HIXHub/BenefitSummary_SelectCareSilver.pdf",
"carrier": {
"id": "bae1d0e1-80dc-48f4-918d-6c492340cc1c",
"issuer_id": "A0027",
"logo_url": "https://d1hm12jr612u3r.cloudfront.net/images/carriers/174/1438891372/thumb.png?1438891372",
"name": "Guardian"
},
"carrier_name": "EmblemHealth",
"customer_service_phone_member": "(800)282-5366",
"customer_service_phone_non_member": "(855)338-7027",
"id": "uaLcmyru",
"identifiers": [
{
"type": "contract_id",
"value": "abc123"
}
],
"logo_url": "https://d1hm12jr612u3r.cloudfront.net/images/carriers/174/1438891372/thumb.png?1438891372",
"name": "Aetna Medicare Choice Plan (PPO)",
"network_size": 5000,
"networks": [
{
"id": 1,
"name": "Open Choice",
"provider_directory_url": "https://www.example.com/find-a-doctor"
}
],
"part_b_premium_reduction": 30.33,
"plan_documents": [
{
"type": "summary_of_benefits_and_coverage",
"url": "https://www.example.com/summary_of_benefits_and_coverage.pdf"
}
],
"plan_type": "HMO",
"premium_drug": 533.24,
"premium_health": 533.24,
"providers": [
{
"addresses": [
{
"accepting_new_patients": true,
"city": "New York",
"external_id": "50c2d41e021f0eb5baaa6f134f15bd29",
"id": "589c907f-28c2-3d14-8916-1144a5191ba2",
"latitude": 45.55,
"longitude": 14.55,
"pcp": true,
"pcp_id": "123456",
"phone_numbers": [
"2122223333",
"9172223334"
],
"state": "NY",
"street_line_1": "123 Fake Street",
"street_line_2": "Apt 10",
"zip_code": "11215"
}
],
"in_network": true,
"npi": 1234567890
}
],
"source": "carrier",
"stand_alone_part_d": false,
"star_rating_drug_plan": 4,
"star_rating_health_plan": 4,
"star_rating_overall": 4,
"supplemental_options": [
{
"benefits": [
"Preventive Dental",
"Comprehensive Dental"
],
"deductible": 50,
"id": 1,
"moop": 1000,
"name": "Aetna Medicare Advantage PPO Dental Plan",
"premium": 23
}
],
"year": "2019"
}
]
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"coverages": {
"type": "array",
"description": "Coverages associated with the plan."
},
"meta": {
"type": "object",
"properties": {
"total": {
"type": "number",
"description": "Number of entities returned"
}
},
"description": "Meta-data"
},
"plans": {
"type": "array",
"description": "Medicare Advantage plan search results"
}
}
}
Search PlansPOST/plans/medadv/search
Version History
v7
: Support added for the optional provider address_id
in the providers
list of the request schema for further filtering of in-network logic.
Additionally, the in_network_ids
and out_of_network_ids
fields were deprecated from the response and replaced with the providers
list. The response schema returns benefits as strings.
v6
: Previous supported version.
Endpoint Description
Quoting medicare advantage plans for an individual only requires location (zip and fips codes) and enrollment date.
This endpoint also supports checks for in-network providers and drug coverages. See the “Providers” and “Drug Coverages” sections below for more information.
Response Parameters
Identifiers
The identifiers
key contains various identifiers that can be used to identify the plan with the Carrier during enrollment.
Identifier Type | Description |
---|---|
contract_code | An issuer identifier for the plan. |
contract_id | An issuer identifier for the plan. |
medicare_plan_id | The CMS Medicare Contract Code ID for the plan. |
Providers
This endpoint enables you to see if one or more providers are in-network for each plan returned in the search. To do this, you can provide one of more providers in the following manner within in the request:
"providers": [
{"npi": "THE_PROVIDER_NPI", "address_id": "THE_ADDRESS_ID"},
{"npi": "ANOTHER_PROVIDER_NPI"}
]
You can optionally include an address_id
retrieved from our Provider Search. Including an address_id
will further filter the in-network logic to only those Providers that are in-network at that particular address.
Not including the address_id will return in-network logic based on whether the Provider accepts that network at any address.
Drug Coverages
This endpoint enables you to check coverage information for particular drugs for each plan returned in the search. To do this, you can provide one of more drugs, either by referencing the NDC Package Code or Med ID, in the following manner within in the request:
"drug_packages": [
{"id": "THE_NDC_PACKAGE_CODE"},
{"med_id": "A_MED_ID"}
]
In the response, you will see a coverages
key within the parent body of the response. Each coverage will contain an indication as to tier which the drug is labeled, whether prior authorization is required, whether there is a quantity limit, and whether step therapy is included. The tier
can have the following values:
Tier | Description |
---|---|
preferred_generic* | Unbranded drugs, with the same active ingredients as their brand-name equivalents. The preferred tier typically comes with lower cost shares than generic tier drugs. |
generic | Unbranded drugs, with the same active ingredients as their brand-name equivalents, and generally available at a lower cost than brand-name equivalents. |
preferred_brand | Brand-name drugs included within a preferred tier on the health plan’s formulary. Generally more expensive than generics, and less expensive than non-preferred drugs. |
non_preferred_brand | Brand-name drugs included within a non-preferred tier on the health plan’s formulary. These generally have a higher cost shares. |
specialty | Used to treat complex conditions like cancer. May require special handling or monitoring. May be generic or brand-name. Generally the most expensive drugs covered by a plan. |
not_covered | Specifically excluded from the health plan. |
not_listed | Neither included nor excluded from the health plan. Most plans provide some default level of coverage for unlisted drugs. |
Dental Plans ¶
Dental Plans ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Headers
Content-Type: application/json
Body
{
"dental_plan": {
"adult_individual_annual_max": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"adult_individual_deductible": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"audience": "small_group",
"benefits": {
"bridges": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"crowns": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"denture_relines_rebases": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"denture_repair_and_adjustments": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"dentures": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"emergency_treatment": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"endodontics": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"fluoride_treatment": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"implants": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"inlays": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"onlays": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"oral_exam": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"oral_surgery": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"orthodontics_adult": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"orthodontics_child": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"periodontal_maintenance": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"periodontics": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"prophylaxis_cleaning": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"radiograph_bitewings": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"radiograph_other": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"restoration_fillings": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"sealant": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"simple_extraction": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"space_maintainers": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
}
},
"benefits_summary_url": "http://www.example.com/benefits_summary.pdf",
"carrier": {
"id": "bae1d0e1-80dc-48f4-918d-6c492340cc1c",
"issuer_id": "A0027",
"logo_url": "https://d1hm12jr612u3r.cloudfront.net/images/carriers/174/1438891372/thumb.png?1438891372",
"name": "Guardian"
},
"carrier_disclaimers": "See Summary of Benefits and Coverage (SBC) for more details.",
"child_individual_annual_max": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"child_individual_deductible": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"child_individual_moop": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"copay_schedule": true,
"coverage_tiers": {
"basic": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"major": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"preventive": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
}
},
"family_deductible": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"id": "uaLcmyru",
"identifiers": [
{
"type": "issuer_internal_id",
"value": "Identifier 1"
}
],
"issuer_name": "Guardian",
"logo_url": "http://www.example.com/logo.jpg",
"name": "Select Care Silver, Age 29 Rider",
"network_size": 5000,
"networks": [
{
"id": 1,
"name": "Open Choice",
"provider_directory_url": "https://www.example.com/find-a-doctor"
}
],
"out_of_network_reimbursement_type": "UCR",
"plan_documents": [
{
"type": "summary_of_benefits_and_coverage",
"url": "https://www.example.com/summary_of_benefits_and_coverage.pdf"
}
],
"plan_type": "HMO",
"quoted_via_carrier_api": false,
"source": "carrier",
"stand_alone": false,
"usual_customary_reasonable_percentile": 80
}
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"dental_plan": {
"type": "object",
"properties": {
"adult_individual_annual_max": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Individual Annual Max benefit hash"
},
"adult_individual_deductible": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Individual Deductible benefit hash"
},
"audience": {
"type": "string",
"description": "The dental plan audience"
},
"benefits": {
"type": "object",
"properties": {
"bridges": {
"type": "object",
"properties": {
"coverage_tier": {
"type": [
"string",
"null"
],
"description": "Benefit coverage tier"
},
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"coverage_tier",
"in_network",
"limit",
"out_of_network"
],
"description": "Bridges benefit hash"
},
"crowns": {
"type": "object",
"properties": {
"coverage_tier": {
"type": [
"string",
"null"
],
"description": "Benefit coverage tier"
},
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"coverage_tier",
"in_network",
"limit",
"out_of_network"
],
"description": "Crowns benefit hash"
},
"denture_relines_rebases": {
"type": "object",
"properties": {
"coverage_tier": {
"type": [
"string",
"null"
],
"description": "Benefit coverage tier"
},
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"coverage_tier",
"in_network",
"limit",
"out_of_network"
],
"description": "Denture Relines/Rebases benefit hash"
},
"denture_repair_and_adjustments": {
"type": "object",
"properties": {
"coverage_tier": {
"type": [
"string",
"null"
],
"description": "Benefit coverage tier"
},
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"coverage_tier",
"in_network",
"limit",
"out_of_network"
],
"description": "Denture Repair and Adjustments benefit hash"
},
"dentures": {
"type": "object",
"properties": {
"coverage_tier": {
"type": [
"string",
"null"
],
"description": "Benefit coverage tier"
},
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"coverage_tier",
"in_network",
"limit",
"out_of_network"
],
"description": "Dentures benefit hash"
},
"emergency_treatment": {
"type": "object",
"properties": {
"coverage_tier": {
"type": [
"string",
"null"
],
"description": "Benefit coverage tier"
},
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"coverage_tier",
"in_network",
"limit",
"out_of_network"
],
"description": "Emergency Treatment benefit hash"
},
"endodontics": {
"type": "object",
"properties": {
"coverage_tier": {
"type": [
"string",
"null"
],
"description": "Benefit coverage tier"
},
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"coverage_tier",
"in_network",
"limit",
"out_of_network"
],
"description": "Endodontics benefit hash"
},
"fluoride_treatment": {
"type": "object",
"properties": {
"coverage_tier": {
"type": [
"string",
"null"
],
"description": "Benefit coverage tier"
},
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"coverage_tier",
"in_network",
"limit",
"out_of_network"
],
"description": "Fluoride Treatment benefit hash"
},
"implants": {
"type": "object",
"properties": {
"coverage_tier": {
"type": [
"string",
"null"
],
"description": "Benefit coverage tier"
},
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"coverage_tier",
"in_network",
"limit",
"out_of_network"
],
"description": "Implants benefit hash"
},
"inlays": {
"type": "object",
"properties": {
"coverage_tier": {
"type": [
"string",
"null"
],
"description": "Benefit coverage tier"
},
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"coverage_tier",
"in_network",
"limit",
"out_of_network"
],
"description": "Inlays benefit hash"
},
"onlays": {
"type": "object",
"properties": {
"coverage_tier": {
"type": [
"string",
"null"
],
"description": "Benefit coverage tier"
},
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"coverage_tier",
"in_network",
"limit",
"out_of_network"
],
"description": "Onlays benefit hash"
},
"oral_exam": {
"type": "object",
"properties": {
"coverage_tier": {
"type": [
"string",
"null"
],
"description": "Benefit coverage tier"
},
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"coverage_tier",
"in_network",
"limit",
"out_of_network"
],
"description": "Oral Exam benefit hash"
},
"oral_surgery": {
"type": "object",
"properties": {
"coverage_tier": {
"type": [
"string",
"null"
],
"description": "Benefit coverage tier"
},
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"coverage_tier",
"in_network",
"limit",
"out_of_network"
],
"description": "Oral Surgery benefit hash"
},
"orthodontics_adult": {
"type": "object",
"properties": {
"coverage_tier": {
"type": [
"string",
"null"
],
"description": "Benefit coverage tier"
},
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"coverage_tier",
"in_network",
"limit",
"out_of_network"
],
"description": "Orthodontics - Adult benefit hash"
},
"orthodontics_child": {
"type": "object",
"properties": {
"coverage_tier": {
"type": [
"string",
"null"
],
"description": "Benefit coverage tier"
},
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"coverage_tier",
"in_network",
"limit",
"out_of_network"
],
"description": "Orthodontics - Child benefit hash"
},
"periodontal_maintenance": {
"type": "object",
"properties": {
"coverage_tier": {
"type": [
"string",
"null"
],
"description": "Benefit coverage tier"
},
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"coverage_tier",
"in_network",
"limit",
"out_of_network"
],
"description": "Periodontal Maintenance benefit hash"
},
"periodontics": {
"type": "object",
"properties": {
"coverage_tier": {
"type": [
"string",
"null"
],
"description": "Benefit coverage tier"
},
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"coverage_tier",
"in_network",
"limit",
"out_of_network"
],
"description": "Periodontics benefit hash"
},
"prophylaxis_cleaning": {
"type": "object",
"properties": {
"coverage_tier": {
"type": [
"string",
"null"
],
"description": "Benefit coverage tier"
},
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"coverage_tier",
"in_network",
"limit",
"out_of_network"
],
"description": "Prophylaxis Cleaning benefit hash"
},
"radiograph_bitewings": {
"type": "object",
"properties": {
"coverage_tier": {
"type": [
"string",
"null"
],
"description": "Benefit coverage tier"
},
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"coverage_tier",
"in_network",
"limit",
"out_of_network"
],
"description": "Radiograph - Bitewings benefit hash"
},
"radiograph_other": {
"type": "object",
"properties": {
"coverage_tier": {
"type": [
"string",
"null"
],
"description": "Benefit coverage tier"
},
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"coverage_tier",
"in_network",
"limit",
"out_of_network"
],
"description": "Radiograph - Other benefit hash"
},
"restoration_fillings": {
"type": "object",
"properties": {
"coverage_tier": {
"type": [
"string",
"null"
],
"description": "Benefit coverage tier"
},
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"coverage_tier",
"in_network",
"limit",
"out_of_network"
],
"description": "Restoration - Fillings benefit hash"
},
"sealant": {
"type": "object",
"properties": {
"coverage_tier": {
"type": [
"string",
"null"
],
"description": "Benefit coverage tier"
},
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"coverage_tier",
"in_network",
"limit",
"out_of_network"
],
"description": "Sealant benefit hash"
},
"simple_extraction": {
"type": "object",
"properties": {
"coverage_tier": {
"type": [
"string",
"null"
],
"description": "Benefit coverage tier"
},
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"coverage_tier",
"in_network",
"limit",
"out_of_network"
],
"description": "Simple Extraction benefit hash"
},
"space_maintainers": {
"type": "object",
"properties": {
"coverage_tier": {
"type": [
"string",
"null"
],
"description": "Benefit coverage tier"
},
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"coverage_tier",
"in_network",
"limit",
"out_of_network"
],
"description": "Space Maintainers benefit hash"
}
},
"description": "Dental Plan Benefits"
},
"benefits_summary_url": {
"type": "string",
"description": "Link to the summary of benefits and coverage (SBC) document."
},
"carrier": {
"type": "object",
"properties": {
"id": {
"type": "string",
"description": "Carrier unique identifier"
},
"issuer_id": {
"type": "string",
"description": "Issuer Identifier"
},
"logo_url": {
"type": "string",
"description": "Link to a copy of the insurance carrier's logo"
},
"name": {
"type": "string",
"description": "Name of the insurance carrier"
}
},
"description": "Carrier Subsidiary associated to this Plan"
},
"carrier_disclaimers": {
"type": "string",
"description": "Most recent Disclaimer issued for this Plan"
},
"child_individual_annual_max": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Child Individual Annual Max benefit hash"
},
"child_individual_deductible": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Child Individual Deductible benefit hash"
},
"child_individual_moop": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Child Individual Max out-of-pocket benefit hash"
},
"copay_schedule": {
"type": "boolean",
"description": "Copay schedule benefit hash"
},
"coverage_tiers": {
"type": "object",
"properties": {
"basic": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Basic coverage tier hash"
},
"major": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Major coverage tier hash"
},
"preventive": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Preventive coverage tier hash"
}
},
"description": "Coverage Tiers"
},
"family_deductible": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Family Deductible benefit hash"
},
"id": {
"type": "string",
"description": "The dental plan identifier"
},
"identifiers": {
"type": "array",
"description": "List of identifiers of this Plan"
},
"issuer_name": {
"type": "string",
"description": "Name of the insurance carrier"
},
"logo_url": {
"type": "string",
"description": "Link to a copy of the insurance carrier's logo"
},
"name": {
"type": "string",
"description": "Marketing name of the plan"
},
"network_size": {
"type": "number",
"description": "Total number of Providers in network"
},
"networks": {
"type": "array",
"description": "List of networks associated with the plan"
},
"out_of_network_reimbursement_type": {
"type": "string",
"description": "Out of network reimbursement type benefit hash"
},
"plan_documents": {
"type": "array",
"description": "A list of plan documents including the document type and it's URL"
},
"plan_type": {
"type": "string",
"description": "Category of the plan (e.g. EPO, HMO, PPO, POS, Indemnity, PACE, Medicare-Medicaid, HMO w/POS, Cost, FFS, MSA)"
},
"quoted_via_carrier_api": {
"type": "boolean",
"description": "The quotes for this plan will be provided by the carrier api"
},
"source": {
"type": "string",
"description": "Source of the plan benefit data"
},
"stand_alone": {
"type": "boolean",
"description": "Stand alone flag for dental plan"
},
"usual_customary_reasonable_percentile": {
"type": "number",
"description": "Usual customary reasonable percentile benefit hash"
}
},
"description": "Dental Plan response"
}
}
}
Show PlanGET/plans/dental/{id}{?year}
Version History
v8
: In the response schema, benefits are represented as objects with tier and limit keys.
Additionally, fields for UCR Percentile, Coverage Tiers, Copay Schedules, and OON Reimbursement Type were added. The documentation for this endpoint references this latest available version.
v6
: Previous supported version. The response schema returns benefits as strings.
Endpoint Description
Show the details of a specific Plan. This includes all benefits for the Plan.
Response Parameters
Identifiers
The identifiers
key contains various identifiers that can be used to identify the plan with the Carrier during enrollment.
Identifier Type | Description |
---|---|
contract_code | An issuer identifier for the plan. |
contract_id | An issuer identifier for the plan. |
issuer_internal_id | An issuer identifier for the plan. |
package_code | An issuer identifier for the package for which this plan can be offered with. |
Version 8 Added Fields
Key | Description |
---|---|
out_of_network_reimbursement_type |
The method used for calculating reimbursements for out of network visits. |
usual_customary_reasonable_percentile |
The percentile used for UCR-calculated out of network reimbursement. |
copay_schedule |
Specifies whether or not a plan is on a copay schedule. |
coverage_tiers |
Specifies the cost share for preventive, basic, and major services, represented as the percentage the plan pays. |
Version 8 Benefits Schema
v8
supports the same benefits and grammar rules for in_network
, out_of_network
, and limit
, but structures data as an object instead of a string. The coverage_tier
key specifies which coverage tier category the benefit is included in for the plan - preventive
, basic
, major
, or orthodontics
.
"benefits": {
"oral_exam": {
"in_network": "IN_NETWORK_COST_SHARE",
"out_of_network": "OUT_OF_NETWORK_COST_SHARE",
"limit": "BENEFIT_LIMIT",
"coverage_tier": "BENEFIT_COVERAGE_TIER"
}
}
URI Parameters
- id
string
(required) Example: dta2DWxvID of the Plan
- year
number
(optional) Example: 2024Plan year (defaults to current year)
Dental Plans ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Body
{
"applicants": [
{
"age": 21,
"child": false,
"gender": "F"
}
],
"enrollment_date": "2024-03-08",
"fips_code": "36081",
"market": "individual",
"page": 1,
"per_page": 20,
"providers": [
{
"address_id": "589c907f-28c2-3d14-8916-1144a5191ba2",
"npi": 1234567890
}
],
"zip_code": "11423"
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"applicants": {
"type": "array",
"description": "Applicants for desired plans."
},
"enrollment_date": {
"type": "string",
"description": "Date of enrollment"
},
"fips_code": {
"type": "string",
"description": "County code to determine eligibility"
},
"market": {
"type": "string",
"description": "The audience of plan to search for. Possible values are individual, shop, small_group, medicare_advantage, large_group, level_funded"
},
"page": {
"type": "number",
"description": "Selected page of paginated response."
},
"per_page": {
"type": "number",
"description": "Results per page of response."
},
"providers": {
"type": "array",
"description": "List of Provider National Practitioner Index numbers"
},
"zip_code": {
"type": "string",
"description": "5-digit zip code - this helps determine pricing."
}
},
"required": [
"market"
]
}
Headers
Content-Type: application/json
Body
{
"meta": {
"total": 1
},
"plans": [
{
"adult_individual_annual_max": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"adult_individual_deductible": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"audience": "small_group",
"benefits": {
"bridges": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"crowns": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"denture_relines_rebases": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"denture_repair_and_adjustments": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"dentures": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"emergency_treatment": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"endodontics": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"fluoride_treatment": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"implants": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"inlays": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"onlays": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"oral_exam": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"oral_surgery": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"orthodontics_adult": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"orthodontics_child": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"periodontal_maintenance": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"periodontics": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"prophylaxis_cleaning": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"radiograph_bitewings": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"radiograph_other": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"restoration_fillings": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"sealant": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"simple_extraction": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"space_maintainers": {
"coverage_tier": "basic",
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
}
},
"benefits_summary_url": "http://www.example.com/benefits_summary.pdf",
"carrier": {
"id": "bae1d0e1-80dc-48f4-918d-6c492340cc1c",
"issuer_id": "A0027",
"logo_url": "https://d1hm12jr612u3r.cloudfront.net/images/carriers/174/1438891372/thumb.png?1438891372",
"name": "Guardian"
},
"carrier_disclaimers": "See Summary of Benefits and Coverage (SBC) for more details.",
"child_individual_annual_max": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"child_individual_deductible": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"child_individual_moop": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"copay_schedule": true,
"coverage_tiers": {
"basic": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"major": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"preventive": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
}
},
"family_deductible": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"id": "uaLcmyru",
"identifiers": [
{
"type": "contract_id",
"value": "abc123"
}
],
"issuer_name": "Guardian",
"logo_url": "http://www.example.com/logo.jpg",
"name": "Select Care Silver, Age 29 Rider",
"network_size": 5000,
"networks": [
{
"id": 1,
"name": "Open Choice",
"provider_directory_url": "https://www.example.com/find-a-doctor"
}
],
"out_of_network_reimbursement_type": "MAC",
"plan_documents": [
{
"type": "summary_of_benefits_and_coverage",
"url": "https://www.example.com/summary_of_benefits_and_coverage.pdf"
}
],
"plan_type": "HMO",
"premium": 533.24,
"premium_source": "carrier",
"premium_subsidized": 321.5,
"providers": [
{
"addresses": [
{
"accepting_new_patients": true,
"city": "New York",
"external_id": "50c2d41e021f0eb5baaa6f134f15bd29",
"id": "589c907f-28c2-3d14-8916-1144a5191ba2",
"latitude": 45.55,
"longitude": 14.55,
"pcp": true,
"pcp_id": "123456",
"phone_numbers": [
"2122223333",
"9172223334"
],
"state": "NY",
"street_line_1": "123 Fake Street",
"street_line_2": "Apt 10",
"zip_code": "11215"
}
],
"in_network": true,
"npi": 1234567890
}
],
"quoted_via_carrier_api": false,
"source": "carrier",
"stand_alone": false,
"usual_customary_reasonable_percentile": 80
}
]
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"meta": {
"type": "object",
"properties": {
"total": {
"type": "number",
"description": "Number of entities returned"
}
},
"description": "Meta-data"
},
"plans": {
"type": "array",
"description": "Dental plan search results"
}
}
}
Search PlansPOST/plans/dental/search{?page,per_page}
Version History
v8
: In the response schema, benefits are represented as objects with tier and limit keys.
Additionally, fields for UCR Percentile, Coverage Tiers, Copay Schedules, and OON Reimbursement Type were added. The documentation for this endpoint references this latest available version.
v6
: Previous supported version. The response schema returns benefits as strings.
Endpoint Description
Determine the available Plans and their Premiums for a particular Family in a given location. This endpoint can also be used to search available group Plans in a specific zip code and county.
For details on searching for Plans and their related data, see the Quoting Dental Plans section.
Response Parameters
Identifiers
The identifiers
key contains various identifiers that can be used to identify the plan with the Carrier during enrollment.
Identifier Type | Description |
---|---|
contract_code | An issuer identifier for the plan. |
contract_id | An issuer identifier for the plan. |
issuer_internal_id | An issuer identifier for the plan. |
package_code | An issuer identifier for the package for which this plan can be offered with. |
URI Parameters
- page
number
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Vision Plans ¶
Vision Plans ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Headers
Content-Type: application/json
Body
{
"vision_plan": {
"audience": "small_group",
"benefits": {
"additional_pairs_of_eyeglasses": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"contact_lenses_conventional": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"contact_lenses_disposable": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"contact_lenses_medically_necessary": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"eye_exam": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"eyeglass_lenses_bifocal": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"eyeglass_lenses_lenticular": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"eyeglass_lenses_single_vision": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"eyeglass_lenses_trifocal": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"frame": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"laser_vision_correction": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"photochromatic_lenses": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"polarized_lenses": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"premium_antireflective_coating": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"premium_contact_lens_fit_and_follow_up": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"premium_progressive_lenses": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"retinal_imaging": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"standard_antireflective_coating": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"standard_contact_lens_fit_and_follow_up": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"standard_polycarbonate_lenses_adult": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"standard_polycarbonate_lenses_child": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"standard_progressive_lenses": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"standard_scratch_resistance": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"tint": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"uv_coating": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
}
},
"benefits_summary_url": "http://www.example.com/benefits_summary.pdf",
"carrier": {
"id": "bae1d0e1-80dc-48f4-918d-6c492340cc1c",
"issuer_id": "A0027",
"logo_url": "https://d1hm12jr612u3r.cloudfront.net/images/carriers/174/1438891372/thumb.png?1438891372",
"name": "Guardian"
},
"carrier_disclaimers": "See Summary of Benefits and Coverage (SBC) for more details.",
"exam_copay": "$50",
"id": "uaLcmyru",
"identifiers": [
{
"type": "issuer_internal_id",
"value": "Identifier 1"
}
],
"issuer_name": "Guardian",
"logo_url": "http://www.example.com/logo.jpg",
"materials_copay": "$120",
"name": "Some Vision Plan",
"plan_type": "PPO",
"premium": 533.24,
"premium_source": "carrier",
"quoted_via_carrier_api": false,
"service_frequency": {
"contacts": "1 item(s) per 12 month(s)",
"exams": "1 exam(s) per 12 month(s)",
"frames": "1 item(s) per 12 month(s)",
"lenses": "1 item(s) per 12 month(s)"
},
"source": "carrier",
"stand_alone": false
}
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"vision_plan": {
"type": "object",
"properties": {
"audience": {
"type": "string",
"description": "The vision plan audience"
},
"benefits": {
"type": "object",
"properties": {
"additional_pairs_of_eyeglasses": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Additional Pairs of Eyeglasses benefit string"
},
"contact_lenses_conventional": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Contact Lenses - Conventional benefit string"
},
"contact_lenses_disposable": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Contact Lenses - Disposable benefit string"
},
"contact_lenses_medically_necessary": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Contact Lenses - Medically Necessary benefit string"
},
"eye_exam": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Eye Exam benefit string"
},
"eyeglass_lenses_bifocal": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Eyeglass Lenses - Bifocal benefit string"
},
"eyeglass_lenses_lenticular": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Eyeglass Lenses - Lenticular benefit string"
},
"eyeglass_lenses_single_vision": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Eyeglass Lenses - Single Vision benefit string"
},
"eyeglass_lenses_trifocal": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Eyeglass Lenses - Trifocal benefit string"
},
"frame": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Frame benefit string"
},
"laser_vision_correction": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Laser Vision Correction benefit string"
},
"photochromatic_lenses": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Photochromatic Lenses benefit string"
},
"polarized_lenses": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Polarized Lenses benefit string"
},
"premium_antireflective_coating": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Premium Anti-Reflective Coating benefit string"
},
"premium_contact_lens_fit_and_follow_up": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Premium Contact Lens Fit and Follow-Up benefit string"
},
"premium_progressive_lenses": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Premium Progressive Lenses benefit string"
},
"retinal_imaging": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Retinal Imaging benefit string"
},
"standard_antireflective_coating": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Standard Anti-Reflective Coating benefit string"
},
"standard_contact_lens_fit_and_follow_up": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Standard Contact Lens Fit and Follow-Up benefit string"
},
"standard_polycarbonate_lenses_adult": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Standard Polycarbonate Lenses - Adult benefit string"
},
"standard_polycarbonate_lenses_child": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Standard Polycarbonate Lenses - Child benefit string"
},
"standard_progressive_lenses": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Standard Progressive Lenses benefit string"
},
"standard_scratch_resistance": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Standard Scratch-Resistance Coating benefit string"
},
"tint": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "Tint benefit string"
},
"uv_coating": {
"type": "object",
"properties": {
"in_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"out_of_network": {
"type": [
"string",
"null"
],
"description": "Benefit amount"
}
},
"required": [
"in_network",
"limit",
"out_of_network"
],
"description": "UV Coating benefit string"
}
},
"description": "Vision Plan Benefits"
},
"benefits_summary_url": {
"type": "string",
"description": "Link to the summary of benefits and coverage (SBC) document."
},
"carrier": {
"type": "object",
"properties": {
"id": {
"type": "string",
"description": "Carrier unique identifier"
},
"issuer_id": {
"type": "string",
"description": "Issuer Identifier"
},
"logo_url": {
"type": "string",
"description": "Link to a copy of the insurance carrier's logo"
},
"name": {
"type": "string",
"description": "Name of the insurance carrier"
}
},
"description": "Carrier Subsidiary associated to this Plan"
},
"carrier_disclaimers": {
"type": "string",
"description": "Most recent Disclaimer issued for this Plan"
},
"exam_copay": {
"type": "string",
"description": "The vision plan exam coplay"
},
"id": {
"type": "string",
"description": "The vision plan identifier"
},
"identifiers": {
"type": "array",
"description": "List of identifiers of this Plan"
},
"issuer_name": {
"type": "string",
"description": "Name of the insurance carrier"
},
"logo_url": {
"type": "string",
"description": "Link to a copy of the insurance carrier's logo"
},
"materials_copay": {
"type": "string",
"description": "The vision plan materials copay"
},
"name": {
"type": "string",
"description": "The vision plan name"
},
"plan_type": {
"type": "string",
"description": "Category of the plan (e.g. EPO, HMO, PPO, POS, Indemnity, PACE,HMO w/POS, Cost, FFS, MSA)"
},
"premium": {
"type": "number",
"description": "Cumulative premium amount"
},
"premium_source": {
"type": "string",
"description": "Source of the base pricing data"
},
"quoted_via_carrier_api": {
"type": "boolean",
"description": "The quotes for this plan will be provided by the carrier api"
},
"service_frequency": {
"type": "object",
"properties": {
"contacts": {
"type": "string",
"description": "The vision plan contacts"
},
"exams": {
"type": "string",
"description": "The vision plan exams"
},
"frames": {
"type": "string",
"description": "The vision plan frames"
},
"lenses": {
"type": "string",
"description": "The vision plan lenses"
}
},
"description": "Vision Plan Benefits"
},
"source": {
"type": "string",
"description": "Source of the plan benefit data"
},
"stand_alone": {
"type": "boolean",
"description": "Stand alone flag for vision plan"
}
},
"description": "Vision Plan response"
}
}
}
Show PlanGET/plans/vision/{id}{?year}
Version History
v8
: In the response schema, benefits are represented as objects with tier and limit keys.
Additionally, fields for Exam Copay, Materials Copay, and Service Frequencies were added. The documentation for this endpoint references this latest available version.
v6
: Previous supported version. The response schema returns benefits as strings.
Endpoint Description
Show the details of a specific Plan. This includes all benefits for the Plan.
Response Parameters
Identifiers
The identifiers
key contains various identifiers that can be used to identify the plan with the Carrier during enrollment.
Identifier Type | Description |
---|---|
contract_code | An issuer identifier for the plan. |
contract_id | An issuer identifier for the plan. |
issuer_internal_id | An issuer identifier for the plan. |
package_code | An issuer identifier for the package for which this plan can be offered with. |
Version 8 Added Fields
Key | Description |
---|---|
exam_copay |
The plan’s copayment for exams. |
materials_copay |
The plan’s copayment for materials. |
service_frequency |
The frequency at which services are offered. Keys for exams , lenses , frames , and contacts are included. |
Version 8 Benefits Schema
The new version supports the same benefits and grammar rules for in_network
, out_of_network
, and limit
, but structures data as an object instead of a string.
"benefits": {
"eye_exam": {
"in_network": "IN_NETWORK_COST_SHARE",
"out_of_network": "OUT_OF_NETWORK_COST_SHARE",
"limit": "BENEFIT_LIMIT"
}
}
URI Parameters
- id
string
(required) Example: Eczwf4mmID of the Plan
- year
number
(optional) Example: 2024Plan year (defaults to current year)
Vision Plans ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Body
{
"applicants": [
{
"age": 21,
"child": false,
"gender": "F"
}
],
"enrollment_date": "2024-03-08",
"fips_code": "36081",
"market": "individual",
"page": 1,
"per_page": 20,
"zip_code": "11423"
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"applicants": {
"type": "array",
"description": "Applicants for desired plans."
},
"enrollment_date": {
"type": "string",
"description": "Date of enrollment"
},
"fips_code": {
"type": "string",
"description": "County code to determine eligibility"
},
"market": {
"type": "string",
"description": "The audience of plan to search for. Possible values are individual, shop, small_group, medicare_advantage, large_group, level_funded"
},
"page": {
"type": "number",
"description": "Selected page of paginated response."
},
"per_page": {
"type": "number",
"description": "Results per page of response."
},
"zip_code": {
"type": "string",
"description": "5-digit zip code - this helps determine pricing."
}
},
"required": [
"market"
]
}
Headers
Content-Type: application/json
Body
{
"meta": {
"total": 1
},
"plans": [
{
"audience": "small_group",
"benefits": {
"additional_pairs_of_eyeglasses": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"contact_lenses_conventional": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"contact_lenses_disposable": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"contact_lenses_medically_necessary": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"eye_exam": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"eyeglass_lenses_bifocal": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"eyeglass_lenses_lenticular": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"eyeglass_lenses_single_vision": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"eyeglass_lenses_trifocal": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"frame": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"laser_vision_correction": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"photochromatic_lenses": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"polarized_lenses": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"premium_antireflective_coating": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"premium_contact_lens_fit_and_follow_up": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"premium_progressive_lenses": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"retinal_imaging": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"standard_antireflective_coating": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"standard_contact_lens_fit_and_follow_up": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"standard_polycarbonate_lenses_adult": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"standard_polycarbonate_lenses_child": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"standard_progressive_lenses": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"standard_scratch_resistance": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"tint": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
},
"uv_coating": {
"in_network": "30% after deductible",
"limit": "1 time(s) per year",
"out_of_network": "50% after deductible"
}
},
"benefits_summary_url": "http://www.example.com/benefits_summary.pdf",
"carrier": {
"id": "bae1d0e1-80dc-48f4-918d-6c492340cc1c",
"issuer_id": "A0027",
"logo_url": "https://d1hm12jr612u3r.cloudfront.net/images/carriers/174/1438891372/thumb.png?1438891372",
"name": "Guardian"
},
"carrier_disclaimers": "See Summary of Benefits and Coverage (SBC) for more details.",
"exam_copay": "$50",
"id": "uaLcmyru",
"identifiers": [
{
"type": "issuer_internal_id",
"value": "Identifier 1"
}
],
"issuer_name": "Guardian",
"logo_url": "http://www.example.com/logo.jpg",
"materials_copay": "$120",
"name": "Some Vision Plan",
"plan_type": "PPO",
"premium": 533.24,
"premium_source": "carrier",
"quoted_via_carrier_api": false,
"service_frequency": {
"contacts": "1 item(s) per 12 month(s)",
"exams": "1 exam(s) per 12 month(s)",
"frames": "1 item(s) per 12 month(s)",
"lenses": "1 item(s) per 12 month(s)"
},
"source": "carrier",
"stand_alone": false
}
]
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"meta": {
"type": "object",
"properties": {
"total": {
"type": "number",
"description": "Number of entities returned"
}
},
"description": "Meta-data"
},
"plans": {
"type": "array",
"description": "Vision plan search results"
}
}
}
Search PlansPOST/plans/vision/search{?page,per_page}
Version History
v8
: In the response schema, benefits are represented as objects with tier and limit keys.
Additionally, fields for Exam Copay, Materials Copay, and Service Frequencies were added. The documentation for this endpoint references this latest available version.
v6
: Previous supported version. The response schema returns benefits as strings.
Endpoint Description
Determine the available Plans and their Premiums for a particular Family in a given location. This endpoint can also be used to search available group Plans in a specific zip code and county.
For details on searching for Plans and their related data, see the Quoting Vision Plans section.
Response Parameters
Identifiers
The identifiers
key contains various identifiers that can be used to identify the plan with the Carrier during enrollment.
Identifier Type | Description |
---|---|
contract_code | An issuer identifier for the plan. |
contract_id | An issuer identifier for the plan. |
issuer_internal_id | An issuer identifier for the plan. |
package_code | An issuer identifier for the package for which this plan can be offered with. |
URI Parameters
- page
number
(optional) Example: 1Page of paginated response
- per_page
number
(optional) Example: 1Responses per page
Life Plans ¶
Life Plans ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Headers
Content-Type: application/json
Body
{
"life_plan": {
"accelerated_life_benefit": false,
"accidental_death_dismemberment_covered_members": {
"child": true,
"employee": true,
"spouse": true
},
"accidental_death_dismemberment_included": true,
"audience": "small_group",
"benefit_reduction_schedules": [
{
"age": 65,
"reduction_amount": 35
}
],
"benefits": {
"child": {
"increment": "$10,000",
"maximum": "$50,000",
"minimum": "$10,000"
},
"employee": {
"increment": "$10,000",
"maximum": "$50,000",
"minimum": "$10,000"
},
"spouse": {
"increment": "$10,000",
"maximum": "$50,000",
"minimum": "$10,000"
}
},
"benefits_summary_url": "https://d2ed110nmrd591.cloudfront.net/blobs/wigcdFDPSjHGkJ5BvYGUsdkZ.pdf",
"carrier": {
"id": "bae1d0e1-80dc-48f4-918d-6c492340cc1c",
"issuer_id": "A0027",
"logo_url": "https://d1hm12jr612u3r.cloudfront.net/images/carriers/174/1438891372/thumb.png?1438891372",
"name": "Guardian"
},
"carrier_disclaimers": "See Summary of Benefits and Coverage (SBC) for more details.",
"convertible_after_termination": false,
"disabled_premium_waiver": false,
"effective_date": "2021-01-01",
"expiration_date": "2022-12-31",
"guaranteed_issue_bands": [
{
"child": "$10,000",
"employee": "$50,000",
"maximum_age": 64,
"maximum_group_size": 10,
"minimum_age": 0,
"minimum_group_size": 2,
"spouse": "$20,000"
}
],
"id": "uaLcmyru",
"identifiers": [
{
"type": "contract_id",
"value": "abc123"
}
],
"name": "Life 15 A",
"plan_years": [
2021,
2022
],
"premium_increase": "false",
"quoted_via_carrier_api": false,
"source": "carrier_direct",
"updated_at": "2021-11-01",
"voluntary": false
}
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"life_plan": {
"type": "object",
"properties": {
"accelerated_life_benefit": {
"type": "boolean",
"description": "Indicates if the member is paid a lump sum when diagnosed with a terminal condition"
},
"accidental_death_dismemberment_covered_members": {
"type": "object",
"properties": {
"child": {
"type": "boolean",
"description": "Coverage included for child"
},
"employee": {
"type": "boolean",
"description": "Coverage included for employee"
},
"spouse": {
"type": "boolean",
"description": "Coverage included for spouse"
}
},
"description": "Member types that are covered for AD&D as part of the plan"
},
"accidental_death_dismemberment_included": {
"type": "boolean",
"description": "Indicates if plan has an AD&D plan included at no extra charge"
},
"audience": {
"type": "string",
"description": "The life plan audience"
},
"benefit_reduction_schedules": {
"type": "array",
"description": "List detailing the amount by which benefits decrease as member reaches age milestone"
},
"benefits": {
"type": "object",
"properties": {
"child": {
"type": "object",
"properties": {
"increment": {
"type": "string",
"description": "Benefit increment"
},
"maximum": {
"type": "string",
"description": "Benefit maximum"
},
"minimum": {
"type": "string",
"description": "Benefit minimum"
}
},
"description": "Benefit for child"
},
"employee": {
"type": "object",
"properties": {
"increment": {
"type": "string",
"description": "Benefit increment"
},
"maximum": {
"type": "string",
"description": "Benefit maximum"
},
"minimum": {
"type": "string",
"description": "Benefit minimum"
}
},
"description": "Benefit for employee"
},
"spouse": {
"type": "object",
"properties": {
"increment": {
"type": "string",
"description": "Benefit increment"
},
"maximum": {
"type": "string",
"description": "Benefit maximum"
},
"minimum": {
"type": "string",
"description": "Benefit minimum"
}
},
"description": "Benefit for spouse"
}
},
"description": "Life plan benefits"
},
"benefits_summary_url": {
"type": "string",
"description": "Link to the summary of benefits and coverage (SBC) document."
},
"carrier": {
"type": "object",
"properties": {
"id": {
"type": "string",
"description": "Carrier unique identifier"
},
"issuer_id": {
"type": "string",
"description": "Issuer Identifier"
},
"logo_url": {
"type": "string",
"description": "Link to a copy of the insurance carrier's logo"
},
"name": {
"type": "string",
"description": "Name of the insurance carrier"
}
},
"description": "Carrier Subsidiary associated to this Plan"
},
"carrier_disclaimers": {
"type": "string",
"description": "Most recent Disclaimer issued for this Plan"
},
"convertible_after_termination": {
"type": "boolean",
"description": "Indicates if the member can continue coverage after the group plan has terminated"
},
"disabled_premium_waiver": {
"type": "boolean",
"description": "Indicates if the member must pay premium if totally disabled"
},
"effective_date": {
"type": "string",
"description": "Plan effective date"
},
"expiration_date": {
"type": "string",
"description": "Plan expiration date"
},
"guaranteed_issue_bands": {
"type": "array",
"description": "The amounts for which the buyer is not required to answer health questionnaires"
},
"id": {
"type": "string",
"description": "The life plan identifier"
},
"identifiers": {
"type": "array",
"description": "List of identifiers of this Plan"
},
"name": {
"type": "string",
"description": "Marketing name of the plan"
},
"plan_years": {
"type": "array",
"description": "The life plan years"
},
"premium_increase": {
"type": "string",
"description": "Indicates schedule for expected premium increases"
},
"quoted_via_carrier_api": {
"type": "boolean",
"description": "The quotes for this plan will be provided by the carrier api"
},
"source": {
"type": "string",
"description": "The life plan source"
},
"updated_at": {
"type": "string",
"description": "Time when plan was last updated"
},
"voluntary": {
"type": "boolean",
"description": "Voluntary type of the plan"
}
},
"description": "Life Plan response"
}
}
}
Show PlanGET/plans/life/{id}{?year}
Version History
v6
: The documentation for this endpoint references this latest available version.
Endpoint Description
Show the details of a specific Life Plan. This includes all benefits for the Plan.
For details on how to quote groups for Life insurance, see the Group Quoting section.
Response Parameters
Identifiers
The identifiers
key contains various identifiers that can be used to identify the plan with the Carrier during enrollment.
Identifier Type | Description |
---|---|
contract_id | An issuer identifier for the plan. |
URI Parameters
- id
string
(required) Example: NMQKsN5iID of the Plan
- year
number
(optional) Example: 2024Plan year (defaults to current year)
Life Plans ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Body
{
"enrollment_date": "2024-03-08",
"fips_code": "36081",
"market": "individual",
"page": 1,
"per_page": 20,
"zip_code": "11423"
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"enrollment_date": {
"type": "string",
"description": "Date of enrollment"
},
"fips_code": {
"type": "string",
"description": "County code to determine eligibility"
},
"market": {
"type": "string",
"description": "The audience of plan to search for. Possible values are individual, shop, small_group, medicare_advantage, large_group, level_funded"
},
"page": {
"type": "number",
"description": "Selected page of paginated response."
},
"per_page": {
"type": "number",
"description": "Results per page of response."
},
"zip_code": {
"type": "string",
"description": "5-digit zip code - this helps determine pricing."
}
},
"required": [
"market"
]
}
Headers
Content-Type: application/json
Body
{
"meta": {
"total": 1
},
"plans": [
{
"accelerated_life_benefit": false,
"accidental_death_dismemberment_covered_members": {
"child": true,
"employee": true,
"spouse": true
},
"accidental_death_dismemberment_included": true,
"audience": "small_group",
"benefit_reduction_schedules": [
{
"age": 65,
"reduction_amount": 35
}
],
"benefits": {
"child": {
"increment": "$10,000",
"maximum": "$50,000",
"minimum": "$10,000"
},
"employee": {
"increment": "$10,000",
"maximum": "$50,000",
"minimum": "$10,000"
},
"spouse": {
"increment": "$10,000",
"maximum": "$50,000",
"minimum": "$10,000"
}
},
"benefits_summary_url": "https://d2ed110nmrd591.cloudfront.net/blobs/wigcdFDPSjHGkJ5BvYGUsdkZ.pdf",
"carrier": {
"id": "bae1d0e1-80dc-48f4-918d-6c492340cc1c",
"issuer_id": "A0027",
"logo_url": "https://d1hm12jr612u3r.cloudfront.net/images/carriers/174/1438891372/thumb.png?1438891372",
"name": "Guardian"
},
"carrier_disclaimers": "See Summary of Benefits and Coverage (SBC) for more details.",
"convertible_after_termination": false,
"disabled_premium_waiver": false,
"effective_date": "2021-01-01",
"expiration_date": "2022-12-31",
"guaranteed_issue_bands": [
{
"child": "$10,000",
"employee": "$50,000",
"maximum_age": 64,
"maximum_group_size": 10,
"minimum_age": 0,
"minimum_group_size": 2,
"spouse": "$20,000"
}
],
"id": "uaLcmyru",
"identifiers": [
{
"type": "contract_id",
"value": "abc123"
}
],
"name": "Life 15 A",
"plan_years": [
2021,
2022
],
"premium_increase": "false",
"quoted_via_carrier_api": false,
"source": "carrier_direct",
"updated_at": "2021-11-01",
"voluntary": false
}
]
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"meta": {
"type": "object",
"properties": {
"total": {
"type": "number",
"description": "Number of entities returned"
}
},
"description": "Meta-data"
},
"plans": {
"type": "array",
"description": "Life plan search results"
}
}
}
Search PlansPOST/plans/life/search{?page,per_page}
Version History
v6
: The documentation for this endpoint references this latest available version.
Endpoint Description
This search endpoint allows you to see what plans are available in a particular geographic area. Plans will be returned with a list of available benefits
For details on how to quote groups for Life insurance, see the Group Quoting section.
Response Parameters
Identifiers
The identifiers
key contains various identifiers that can be used to identify the plan with the Carrier during enrollment.
Identifier Type | Description |
---|---|
contract_id | An issuer identifier for the plan. |
URI Parameters
- page
number
(optional) Example: 1Page of paginated response
- per_page
number
(optional) Example: 1Responses per page
Disability Plans ¶
Disability Plans ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Headers
Content-Type: application/json
Body
{
"disability_plan": {
"audience": "small_group",
"benefit": {
"amount": "50% of salary",
"maximum_amount": "$500",
"maximum_duration": "13 weeks"
},
"benefits_summary_url": "https://d2ed110nmrd591.cloudfront.net/blobs/i6XqimNu7KpSbJjKU5HeTSp1.pdf",
"carrier": {
"id": "bae1d0e1-80dc-48f4-918d-6c492340cc1c",
"issuer_id": "A0027",
"logo_url": "https://d1hm12jr612u3r.cloudfront.net/images/carriers/174/1438891372/thumb.png?1438891372",
"name": "Guardian"
},
"carrier_disclaimers": "See Summary of Benefits and Coverage (SBC) for more details.",
"disabled_premium_waiver": false,
"effective_date": "2021-01-01",
"expiration_date": "2022-12-31",
"id": "uaLcmyru",
"identifiers": [
{
"type": "contract_id",
"value": "abc123"
}
],
"name": "STD 8-8-13",
"own_occupation_disability_definition": "3 months",
"plan_years": [
2021,
2022
],
"quoted_via_carrier_api": false,
"source": "carrier_direct",
"term": "short_term",
"updated_at": "2021-11-01",
"voluntary": false,
"waiting_period_accident": "8 days",
"waiting_period_illness": "8 days"
}
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"disability_plan": {
"type": "object",
"properties": {
"audience": {
"type": "string",
"description": "The disability plan audience"
},
"benefit": {
"type": "object",
"properties": {
"amount": {
"type": "string",
"description": "Benefit amount"
},
"maximum_amount": {
"type": "string",
"description": "Benefit maximum amount"
},
"maximum_duration": {
"type": "string",
"description": "Benefit maximum duration"
}
},
"description": "Disability plan benefits"
},
"benefits_summary_url": {
"type": "string",
"description": "Link to the summary of benefits and coverage (SBC) document."
},
"carrier": {
"type": "object",
"properties": {
"id": {
"type": "string",
"description": "Carrier unique identifier"
},
"issuer_id": {
"type": "string",
"description": "Issuer Identifier"
},
"logo_url": {
"type": "string",
"description": "Link to a copy of the insurance carrier's logo"
},
"name": {
"type": "string",
"description": "Name of the insurance carrier"
}
},
"description": "Carrier Subsidiary associated to this Plan"
},
"carrier_disclaimers": {
"type": "string",
"description": "Most recent Disclaimer issued for this Plan"
},
"disabled_premium_waiver": {
"type": "boolean",
"description": "Indicates if the member must pay premium if they meet the criteria for disabled"
},
"effective_date": {
"type": "string",
"description": "Plan effective date"
},
"expiration_date": {
"type": "string",
"description": "Plan expiration date"
},
"id": {
"type": "string",
"description": "The disability plan identifier"
},
"identifiers": {
"type": "array",
"description": "List of identifiers of this Plan"
},
"name": {
"type": "string",
"description": "Marketing name of the plan"
},
"own_occupation_disability_definition": {
"type": "string",
"description": "Indicates the period of time before an applicant would be eligible for coverage"
},
"plan_years": {
"type": "array",
"description": "The disability plan years"
},
"quoted_via_carrier_api": {
"type": "boolean",
"description": "The quotes for this plan will be provided by the carrier api"
},
"source": {
"type": "string",
"description": "The disability plan source"
},
"term": {
"type": "string",
"description": "Indicates the type of term (long_term or short_term) coverage"
},
"updated_at": {
"type": "string",
"description": "Time when plan was last updated"
},
"voluntary": {
"type": "boolean",
"description": "Voluntary type of the plan"
},
"waiting_period_accident": {
"type": "string",
"description": "Period of time you must be disabled as a result of an accident before benefits begin"
},
"waiting_period_illness": {
"type": "string",
"description": "Period of time you must be disabled as a result of an illness before benefits begin"
}
},
"description": "Disability Plan response"
}
}
}
Show PlanGET/plans/disability/{id}{?year}
Version History
v6
: The documentation for this endpoint references this latest available version.
Endpoint Description
Show the details of a specific Disability Plan, either short-term or long-term, denoted by the term
field. This includes all benefits for the Plan.
For details on how to quote groups for Disability insurance, see the Group Quoting section.
Response Parameters
Identifiers
The identifiers
key contains various identifiers that can be used to identify the plan with the Carrier during enrollment.
Identifier Type | Description |
---|---|
contract_id | An issuer identifier for the plan. |
URI Parameters
- id
string
(required) Example: Ngchc4DLID of the Plan
- year
number
(optional) Example: 2024Plan year (defaults to current year)
Disability Plans ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Body
{
"enrollment_date": "2024-03-08",
"fips_code": "36081",
"market": "individual",
"page": 1,
"per_page": 20,
"zip_code": "11423"
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"enrollment_date": {
"type": "string",
"description": "Date of enrollment"
},
"fips_code": {
"type": "string",
"description": "County code to determine eligibility"
},
"market": {
"type": "string",
"description": "The audience of plan to search for. Possible values are individual, shop, small_group, medicare_advantage, large_group, level_funded"
},
"page": {
"type": "number",
"description": "Selected page of paginated response."
},
"per_page": {
"type": "number",
"description": "Results per page of response."
},
"zip_code": {
"type": "string",
"description": "5-digit zip code - this helps determine pricing."
}
},
"required": [
"market"
]
}
Headers
Content-Type: application/json
Body
{
"meta": {
"total": 1
},
"plans": [
{
"audience": "small_group",
"benefit": {
"amount": "50% of salary",
"maximum_amount": "$500",
"maximum_duration": "13 weeks"
},
"benefits_summary_url": "https://d2ed110nmrd591.cloudfront.net/blobs/i6XqimNu7KpSbJjKU5HeTSp1.pdf",
"carrier": {
"id": "bae1d0e1-80dc-48f4-918d-6c492340cc1c",
"issuer_id": "A0027",
"logo_url": "https://d1hm12jr612u3r.cloudfront.net/images/carriers/174/1438891372/thumb.png?1438891372",
"name": "Guardian"
},
"carrier_disclaimers": "See Summary of Benefits and Coverage (SBC) for more details.",
"disabled_premium_waiver": false,
"effective_date": "2021-01-01",
"expiration_date": "2022-12-31",
"id": "uaLcmyru",
"identifiers": [
{
"type": "contract_id",
"value": "abc123"
}
],
"name": "STD 8-8-13",
"own_occupation_disability_definition": "3 months",
"plan_years": [
2021,
2022
],
"quoted_via_carrier_api": false,
"source": "carrier_direct",
"term": "short_term",
"updated_at": "2021-11-01",
"voluntary": false,
"waiting_period_accident": "8 days",
"waiting_period_illness": "8 days"
}
]
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"meta": {
"type": "object",
"properties": {
"total": {
"type": "number",
"description": "Number of entities returned"
}
},
"description": "Meta-data"
},
"plans": {
"type": "array",
"description": "Disability plan search results"
}
}
}
Search PlansPOST/plans/disability/search{?page,per_page}
Version History
v6
: The documentation for this endpoint references this latest available version.
Endpoint Description
This search endpoint allows you to see what plans are available in a particular geographic area. Plans will be returned with a list of available benefits
For details on how to quote groups for Disability insurance, see the Group Quoting section.
Response Parameters
Identifiers
The identifiers
key contains various identifiers that can be used to identify the plan with the Carrier during enrollment.
Identifier Type | Description |
---|---|
contract_id | An issuer identifier for the plan. |
URI Parameters
- page
number
(optional) Example: 1Page of paginated response
- per_page
number
(optional) Example: 1Responses per page
Accident Plans ¶
Accident Plans ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Headers
Content-Type: application/json
Body
{
"accident_plan": {
"24_hour": false,
"accidental_death_benefit": {
"child": "$20,000",
"employee": "$300,000",
"spouse": "$50,000"
},
"accidental_death_dismemberment_included": false,
"ambulance": {
"benefit": "$50",
"limit": "1 time(s) per year"
},
"audience": "small_group",
"benefits_summary_url": "https://d2ed110nmrd591.cloudfront.net/blobs/i6XqimNu7KpSbJjKU5HeTSp1.pdf",
"burns": {
"benefit": "$50",
"limit": "1 time(s) per year"
},
"carrier": {
"id": "bae1d0e1-80dc-48f4-918d-6c492340cc1c",
"issuer_id": "A0027",
"logo_url": "https://d1hm12jr612u3r.cloudfront.net/images/carriers/174/1438891372/thumb.png?1438891372",
"name": "Guardian"
},
"carrier_disclaimers": "See Summary of Benefits and Coverage (SBC) for more details.",
"common_carrier_death_benefit": {
"child": "$20,000",
"employee": "$300,000",
"spouse": "$50,000"
},
"diagnostic_exam": {
"benefit": "$50",
"limit": "1 time(s) per year"
},
"dislocations": {
"benefit": "$50",
"limit": "1 time(s) per year"
},
"effective_date": "2021-01-01",
"emergency_room_treatment": {
"benefit": "$50",
"limit": "1 time(s) per year"
},
"expiration_date": "2022-12-31",
"eye_injury": {
"benefit": "$50",
"limit": "1 time(s) per year"
},
"fractures": {
"benefit": "$50",
"limit": "1 time(s) per year"
},
"hospital_admission": {
"benefit": "$50",
"limit": "1 time(s) per year"
},
"hospital_admission_icu": {
"benefit": "$50",
"limit": "1 time(s) per year"
},
"hospital_confinement": {
"benefit": "$50",
"limit": "1 time(s) per year"
},
"hospital_confinement_icu": {
"benefit": "$50",
"limit": "1 time(s) per year"
},
"id": "uaLcmyru",
"identifiers": [
{
"type": "contract_id",
"value": "abc123"
}
],
"name": "STD 8-8-13",
"outpatient_therapy": {
"benefit": "$50",
"limit": "1 time(s) per year"
},
"plan_years": [
2021,
2022
],
"portability": "included",
"quoted_via_carrier_api": false,
"rate_guarantee": "true",
"source": "carrier_direct",
"treatment_doctors_office_initial": {
"benefit": "$50",
"limit": "1 time(s) per year"
},
"treatment_follow_up": {
"benefit": "$50",
"limit": "1 time(s) per year"
},
"treatment_urgent_care_initial": {
"benefit": "$50",
"limit": "1 time(s) per year"
},
"updated_at": "2021-11-01",
"voluntary": false,
"wellness": {
"benefit": "$50",
"limit": "1 time(s) per year"
}
}
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"accident_plan": {
"type": "object",
"properties": {
"24_hour": {
"type": "boolean",
"description": "Plan 24 hour option"
},
"accidental_death_benefit": {
"type": "object",
"properties": {
"child": {
"type": "string",
"description": "Guaranteed amount for child"
},
"employee": {
"type": "string",
"description": "Guaranteed amount for employee"
},
"spouse": {
"type": "string",
"description": "Guaranteed amount for spouse"
}
},
"description": "Member types that are covered for accidental death as part of the plan"
},
"accidental_death_dismemberment_included": {
"type": "boolean",
"description": "Indicates if plan has an AD&D plan included at no extra charge"
},
"ambulance": {
"type": "object",
"properties": {
"benefit": {
"type": "string",
"description": "Benefit amount"
},
"limit": {
"type": "string",
"description": "Benefit limit"
}
},
"description": "The Ambulance Benefit associated with the plan, if applicable"
},
"audience": {
"type": "string",
"description": "The accident plan audience"
},
"benefits_summary_url": {
"type": "string",
"description": "Link to the summary of benefits and coverage (SBC) document."
},
"burns": {
"type": "object",
"properties": {
"benefit": {
"type": "string",
"description": "Benefit amount"
},
"limit": {
"type": "string",
"description": "Benefit limit"
}
},
"description": "The Burns Benefit associated with the plan, if applicable"
},
"carrier": {
"type": "object",
"properties": {
"id": {
"type": "string",
"description": "Carrier unique identifier"
},
"issuer_id": {
"type": "string",
"description": "Issuer Identifier"
},
"logo_url": {
"type": "string",
"description": "Link to a copy of the insurance carrier's logo"
},
"name": {
"type": "string",
"description": "Name of the insurance carrier"
}
},
"description": "Carrier Subsidiary associated to this Plan"
},
"carrier_disclaimers": {
"type": "string",
"description": "Most recent Disclaimer issued for this Plan"
},
"common_carrier_death_benefit": {
"type": "object",
"properties": {
"child": {
"type": "string",
"description": "Guaranteed amount for child"
},
"employee": {
"type": "string",
"description": "Guaranteed amount for employee"
},
"spouse": {
"type": "string",
"description": "Guaranteed amount for spouse"
}
},
"description": "Member types that are covered for common carrier death as part of the plan"
},
"diagnostic_exam": {
"type": "object",
"properties": {
"benefit": {
"type": "string",
"description": "Benefit amount"
},
"limit": {
"type": "string",
"description": "Benefit limit"
}
},
"description": "The Diagnostic Exam Benefit associated with the plan, if applicable"
},
"dislocations": {
"type": "object",
"properties": {
"benefit": {
"type": "string",
"description": "Benefit amount"
},
"limit": {
"type": "string",
"description": "Benefit limit"
}
},
"description": "The Dislocations Benefit associated with the plan, if applicable"
},
"effective_date": {
"type": "string",
"description": "Plan effective date"
},
"emergency_room_treatment": {
"type": "object",
"properties": {
"benefit": {
"type": "string",
"description": "Benefit amount"
},
"limit": {
"type": "string",
"description": "Benefit limit"
}
},
"description": "The Emergency Room Treatment Benefit associated with the plan, if applicable"
},
"expiration_date": {
"type": "string",
"description": "Plan expiration date"
},
"eye_injury": {
"type": "object",
"properties": {
"benefit": {
"type": "string",
"description": "Benefit amount"
},
"limit": {
"type": "string",
"description": "Benefit limit"
}
},
"description": "The Eye Injury Benefit associated with the plan, if applicable"
},
"fractures": {
"type": "object",
"properties": {
"benefit": {
"type": "string",
"description": "Benefit amount"
},
"limit": {
"type": "string",
"description": "Benefit limit"
}
},
"description": "The Fractures Benefit associated with the plan, if applicable"
},
"hospital_admission": {
"type": "object",
"properties": {
"benefit": {
"type": "string",
"description": "Benefit amount"
},
"limit": {
"type": "string",
"description": "Benefit limit"
}
},
"description": "The Hospital Admission Benefit associated with the plan, if applicable"
},
"hospital_admission_icu": {
"type": "object",
"properties": {
"benefit": {
"type": "string",
"description": "Benefit amount"
},
"limit": {
"type": "string",
"description": "Benefit limit"
}
},
"description": "The Hospital ICU Admission Benefit associated with the plan, if applicable"
},
"hospital_confinement": {
"type": "object",
"properties": {
"benefit": {
"type": "string",
"description": "Benefit amount"
},
"limit": {
"type": "string",
"description": "Benefit limit"
}
},
"description": "The Hospital Confinement Benefit associated with the plan, if applicable"
},
"hospital_confinement_icu": {
"type": "object",
"properties": {
"benefit": {
"type": "string",
"description": "Benefit amount"
},
"limit": {
"type": "string",
"description": "Benefit limit"
}
},
"description": "The Hospital ICU Confinement Benefit associated with the plan, if applicable"
},
"id": {
"type": "string",
"description": "The accident plan identifier"
},
"identifiers": {
"type": "array",
"description": "List of identifiers of this Plan"
},
"name": {
"type": "string",
"description": "Marketing name of the plan"
},
"outpatient_therapy": {
"type": "object",
"properties": {
"benefit": {
"type": "string",
"description": "Benefit amount"
},
"limit": {
"type": "string",
"description": "Benefit limit"
}
},
"description": "The Outpatient Therapy Benefit associated with the plan, if applicable"
},
"plan_years": {
"type": "array",
"description": "The accident plan years"
},
"portability": {
"type": "string",
"description": "Plan portability"
},
"quoted_via_carrier_api": {
"type": "boolean",
"description": "The quotes for this plan will be provided by the carrier api"
},
"rate_guarantee": {
"type": "string",
"description": "Indicates the guaranteed rate"
},
"source": {
"type": "string",
"description": "The accident plan source"
},
"treatment_doctors_office_initial": {
"type": "object",
"properties": {
"benefit": {
"type": "string",
"description": "Benefit amount"
},
"limit": {
"type": "string",
"description": "Benefit limit"
}
},
"description": "The Initial Doctor's Office Treatment Benefit associated with the plan, if applicable"
},
"treatment_follow_up": {
"type": "object",
"properties": {
"benefit": {
"type": "string",
"description": "Benefit amount"
},
"limit": {
"type": "string",
"description": "Benefit limit"
}
},
"description": "The Treatment Follow Up Benefit associated with the plan, if applicable"
},
"treatment_urgent_care_initial": {
"type": "object",
"properties": {
"benefit": {
"type": "string",
"description": "Benefit amount"
},
"limit": {
"type": "string",
"description": "Benefit limit"
}
},
"description": "The Initial Urgent Care Treatment Benefit associated with the plan, if applicable"
},
"updated_at": {
"type": "string",
"description": "Time when plan was last updated"
},
"voluntary": {
"type": "boolean",
"description": "Voluntary type of the plan"
},
"wellness": {
"type": "object",
"properties": {
"benefit": {
"type": "string",
"description": "Benefit amount"
},
"limit": {
"type": "string",
"description": "Benefit limit"
}
},
"description": "The Wellness Benefit associated with the plan, if applicable"
}
},
"description": "Accident Plan response"
}
}
}
Show PlanGET/plans/accident/{id}{?year}
Version History
v6
: The documentation for this endpoint references this latest available version.
Endpoint Description
Show the details of a specific Accident Plan. This includes all benefits for the Plan.
For details on how to quote groups for Accident insurance, see the Group Quoting section.
Response Parameters
Identifiers
The identifiers
key contains various identifiers that can be used to identify the plan with the Carrier during enrollment.
Identifier Type | Description |
---|---|
contract_id | An issuer identifier for the plan. |
URI Parameters
- id
string
(required) Example: L1jzke75ID of the Plan
- year
number
(optional) Example: 2022Plan year (defaults to current year)
Accident Plans ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Body
{
"enrollment_date": "2024-03-08",
"fips_code": "36081",
"market": "individual",
"page": 1,
"per_page": 20,
"zip_code": "11423"
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"enrollment_date": {
"type": "string",
"description": "Date of enrollment"
},
"fips_code": {
"type": "string",
"description": "County code to determine eligibility"
},
"market": {
"type": "string",
"description": "The audience of plan to search for. Possible values are individual, shop, small_group, medicare_advantage, large_group, level_funded"
},
"page": {
"type": "number",
"description": "Selected page of paginated response."
},
"per_page": {
"type": "number",
"description": "Results per page of response."
},
"zip_code": {
"type": "string",
"description": "5-digit zip code - this helps determine pricing."
}
},
"required": [
"market"
]
}
Headers
Content-Type: application/json
Body
{
"meta": {
"total": 1
},
"plans": [
{
"24_hour": false,
"accidental_death_benefit": {
"child": "$20,000",
"employee": "$300,000",
"spouse": "$50,000"
},
"accidental_death_dismemberment_included": false,
"ambulance": {
"benefit": "$50",
"limit": "1 time(s) per year"
},
"audience": "small_group",
"benefits_summary_url": "https://d2ed110nmrd591.cloudfront.net/blobs/i6XqimNu7KpSbJjKU5HeTSp1.pdf",
"burns": {
"benefit": "$50",
"limit": "1 time(s) per year"
},
"carrier": {
"id": "bae1d0e1-80dc-48f4-918d-6c492340cc1c",
"issuer_id": "A0027",
"logo_url": "https://d1hm12jr612u3r.cloudfront.net/images/carriers/174/1438891372/thumb.png?1438891372",
"name": "Guardian"
},
"carrier_disclaimers": "See Summary of Benefits and Coverage (SBC) for more details.",
"common_carrier_death_benefit": {
"child": "$20,000",
"employee": "$300,000",
"spouse": "$50,000"
},
"diagnostic_exam": {
"benefit": "$50",
"limit": "1 time(s) per year"
},
"dislocations": {
"benefit": "$50",
"limit": "1 time(s) per year"
},
"effective_date": "2021-01-01",
"emergency_room_treatment": {
"benefit": "$50",
"limit": "1 time(s) per year"
},
"expiration_date": "2022-12-31",
"eye_injury": {
"benefit": "$50",
"limit": "1 time(s) per year"
},
"fractures": {
"benefit": "$50",
"limit": "1 time(s) per year"
},
"hospital_admission": {
"benefit": "$50",
"limit": "1 time(s) per year"
},
"hospital_admission_icu": {
"benefit": "$50",
"limit": "1 time(s) per year"
},
"hospital_confinement": {
"benefit": "$50",
"limit": "1 time(s) per year"
},
"hospital_confinement_icu": {
"benefit": "$50",
"limit": "1 time(s) per year"
},
"id": "uaLcmyru",
"identifiers": [
{
"type": "contract_id",
"value": "abc123"
}
],
"name": "STD 8-8-13",
"outpatient_therapy": {
"benefit": "$50",
"limit": "1 time(s) per year"
},
"plan_years": [
2021,
2022
],
"portability": "included",
"quoted_via_carrier_api": false,
"rate_guarantee": "true",
"source": "carrier_direct",
"treatment_doctors_office_initial": {
"benefit": "$50",
"limit": "1 time(s) per year"
},
"treatment_follow_up": {
"benefit": "$50",
"limit": "1 time(s) per year"
},
"treatment_urgent_care_initial": {
"benefit": "$50",
"limit": "1 time(s) per year"
},
"updated_at": "2021-11-01",
"voluntary": false,
"wellness": {
"benefit": "$50",
"limit": "1 time(s) per year"
}
}
]
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"meta": {
"type": "object",
"properties": {
"total": {
"type": "number",
"description": "Number of entities returned"
}
},
"description": "Meta-data"
},
"plans": {
"type": "array",
"description": "Accident plan search results"
}
}
}
Search PlansPOST/plans/accident/search{?page,per_page}
Version History
v6
: The documentation for this endpoint references this latest available version.
Endpoint Description
This search endpoint allows you to see what plans are available in a particular geographic area. Plans will be returned with a list of available benefits
For details on how to quote groups for Accident insurance, see the Group Quoting section.
Response Parameters
Identifiers
The identifiers
key contains various identifiers that can be used to identify the plan with the Carrier during enrollment.
Identifier Type | Description |
---|---|
contract_id | An issuer identifier for the plan. |
URI Parameters
- page
number
(optional) Example: 1Page of paginated response
- per_page
number
(optional) Example: 1Responses per page
Critical Illness Plans ¶
Critical Illness Plans ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Headers
Content-Type: application/json
Body
{
"critical_illness_plan": {
"audience": "small_group",
"benefit_reduction_schedules": [
{
"age": 80,
"reduction_amount": "50%"
}
],
"benefits": {
"addisons_disease": {
"first_occurrence": "100%",
"limit": "1 time(s) per year",
"second_occurrence": "50%"
},
"als_lou_gehrigs_disease": {
"first_occurrence": "100%",
"limit": "1 time(s) per year",
"second_occurrence": "50%"
},
"alzheimers_disease": {
"first_occurrence": "100%",
"limit": "1 time(s) per year",
"second_occurrence": "50%"
},
"coma": {
"first_occurrence": "100%",
"limit": "1 time(s) per year",
"second_occurrence": "50%"
},
"coronary_artery_bypass_surgery": {
"first_occurrence": "100%",
"limit": "1 time(s) per year",
"second_occurrence": "50%"
},
"coronary_artery_disease": {
"first_occurrence": "100%",
"limit": "1 time(s) per year",
"second_occurrence": "50%"
},
"heart_attack": {
"first_occurrence": "100%",
"limit": "1 time(s) per year",
"second_occurrence": "50%"
},
"invasive_cancer": {
"first_occurrence": "100%",
"limit": "1 time(s) per year",
"second_occurrence": "50%"
},
"kidney_failure": {
"first_occurrence": "100%",
"limit": "1 time(s) per year",
"second_occurrence": "50%"
},
"loss_of_hearing": {
"first_occurrence": "100%",
"limit": "1 time(s) per year",
"second_occurrence": "50%"
},
"loss_of_sight": {
"first_occurrence": "100%",
"limit": "1 time(s) per year",
"second_occurrence": "50%"
},
"major_organ_transplant": {
"first_occurrence": "100%",
"limit": "1 time(s) per year",
"second_occurrence": "50%"
},
"non_invasive_cancer": {
"first_occurrence": "100%",
"limit": "1 time(s) per year",
"second_occurrence": "50%"
},
"organ_failure": {
"first_occurrence": "100%",
"limit": "1 time(s) per year",
"second_occurrence": "50%"
},
"paralysis": {
"first_occurrence": "100%",
"limit": "1 time(s) per year",
"second_occurrence": "50%"
},
"stroke": {
"first_occurrence": "100%",
"limit": "1 time(s) per year",
"second_occurrence": "50%"
},
"wellness": {
"benefit": "$100",
"limit": "1 time(s) per year"
}
},
"benefits_summary_url": "http://www.example.com/benefits_summary.pdf",
"carrier": {
"id": "bae1d0e1-80dc-48f4-918d-6c492340cc1c",
"issuer_id": "A0027",
"logo_url": "https://d1hm12jr612u3r.cloudfront.net/images/carriers/174/1438891372/thumb.png?1438891372",
"name": "Guardian"
},
"carrier_disclaimers": "See Summary of Benefits and Coverage (SBC) for more details.",
"effective_date": "2022-12-31",
"exclusion_period": "6 month(s)",
"expiration_date": "2022-12-31",
"guaranteed_issue_bands": [
{
"child": "$5,000",
"employee": "$10,000",
"maximum_group_size": 20,
"minimum_group_size": 10,
"spouse": "$5,000"
}
],
"id": "uaLcmyru",
"identifiers": [
{
"type": "contract_id",
"value": "abc123"
}
],
"insured_benefits": {
"child": {
"increment": "$1,000",
"maximum": "$10,000",
"minimum": "$5,000"
},
"employee": {
"increment": "$1,000",
"maximum": "$10,000",
"minimum": "$5,000"
},
"spouse": {
"increment": "$1,000",
"maximum": "$10,000",
"minimum": "$5,000"
}
},
"issuer_name": "Guardian",
"look_back_period": "3 month(s)",
"name": "Critical Illness Plan 1",
"plan_years": [
2021,
2022
],
"portability": "included",
"premium_increase": "attained age",
"quoted_via_carrier_api": false,
"rate_guarantee": "true",
"second_occurrence_suspension_period": "6 month(s)",
"source": "carrier",
"treatment_free_period": "6 month(s)",
"voluntary": true
}
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"critical_illness_plan": {
"type": "object",
"properties": {
"audience": {
"type": "string",
"description": "The critical illness plan audience"
},
"benefit_reduction_schedules": {
"type": "array",
"description": "Benefit reduction schedules for Critical Illness plans"
},
"benefits": {
"type": "object",
"properties": {
"addisons_disease": {
"type": "object",
"properties": {
"first_occurrence": {
"type": [
"string",
"null"
],
"description": "First Occurrence"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"second_occurrence": {
"type": [
"string",
"null"
],
"description": "Second Occurrence"
}
},
"required": [
"first_occurrence",
"limit",
"second_occurrence"
],
"description": "Addison's disease benefit for Critical Illness plans"
},
"als_lou_gehrigs_disease": {
"type": "object",
"properties": {
"first_occurrence": {
"type": [
"string",
"null"
],
"description": "First Occurrence"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"second_occurrence": {
"type": [
"string",
"null"
],
"description": "Second Occurrence"
}
},
"required": [
"first_occurrence",
"limit",
"second_occurrence"
],
"description": "ALS (Lou Gehrig's Disease) benefit for Critical Illness plans"
},
"alzheimers_disease": {
"type": "object",
"properties": {
"first_occurrence": {
"type": [
"string",
"null"
],
"description": "First Occurrence"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"second_occurrence": {
"type": [
"string",
"null"
],
"description": "Second Occurrence"
}
},
"required": [
"first_occurrence",
"limit",
"second_occurrence"
],
"description": "Alzheimer's disease benefit for Critical Illness plans"
},
"coma": {
"type": "object",
"properties": {
"first_occurrence": {
"type": [
"string",
"null"
],
"description": "First Occurrence"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"second_occurrence": {
"type": [
"string",
"null"
],
"description": "Second Occurrence"
}
},
"required": [
"first_occurrence",
"limit",
"second_occurrence"
],
"description": "Coma benefit for Critical Illness plans"
},
"coronary_artery_bypass_surgery": {
"type": "object",
"properties": {
"first_occurrence": {
"type": [
"string",
"null"
],
"description": "First Occurrence"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"second_occurrence": {
"type": [
"string",
"null"
],
"description": "Second Occurrence"
}
},
"required": [
"first_occurrence",
"limit",
"second_occurrence"
],
"description": "Coronary artery bypass surgery benefit for Critical Illness plans"
},
"coronary_artery_disease": {
"type": "object",
"properties": {
"first_occurrence": {
"type": [
"string",
"null"
],
"description": "First Occurrence"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"second_occurrence": {
"type": [
"string",
"null"
],
"description": "Second Occurrence"
}
},
"required": [
"first_occurrence",
"limit",
"second_occurrence"
],
"description": "coronary_artery_disease benefit for Critical Illness plans"
},
"heart_attack": {
"type": "object",
"properties": {
"first_occurrence": {
"type": [
"string",
"null"
],
"description": "First Occurrence"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"second_occurrence": {
"type": [
"string",
"null"
],
"description": "Second Occurrence"
}
},
"required": [
"first_occurrence",
"limit",
"second_occurrence"
],
"description": "Heart attack benefit for Critical Illness plans"
},
"invasive_cancer": {
"type": "object",
"properties": {
"first_occurrence": {
"type": [
"string",
"null"
],
"description": "First Occurrence"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"second_occurrence": {
"type": [
"string",
"null"
],
"description": "Second Occurrence"
}
},
"required": [
"first_occurrence",
"limit",
"second_occurrence"
],
"description": "Invasive cancer benefit for Critical Illness plans"
},
"kidney_failure": {
"type": "object",
"properties": {
"first_occurrence": {
"type": [
"string",
"null"
],
"description": "First Occurrence"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"second_occurrence": {
"type": [
"string",
"null"
],
"description": "Second Occurrence"
}
},
"required": [
"first_occurrence",
"limit",
"second_occurrence"
],
"description": "Kidney failure benefit for Critical Illness plans"
},
"loss_of_hearing": {
"type": "object",
"properties": {
"first_occurrence": {
"type": [
"string",
"null"
],
"description": "First Occurrence"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"second_occurrence": {
"type": [
"string",
"null"
],
"description": "Second Occurrence"
}
},
"required": [
"first_occurrence",
"limit",
"second_occurrence"
],
"description": "Loss of hearing benefit for Critical Illness plans"
},
"loss_of_sight": {
"type": "object",
"properties": {
"first_occurrence": {
"type": [
"string",
"null"
],
"description": "First Occurrence"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"second_occurrence": {
"type": [
"string",
"null"
],
"description": "Second Occurrence"
}
},
"required": [
"first_occurrence",
"limit",
"second_occurrence"
],
"description": "Loss of sight benefit for Critical Illness plans"
},
"major_organ_transplant": {
"type": "object",
"properties": {
"first_occurrence": {
"type": [
"string",
"null"
],
"description": "First Occurrence"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"second_occurrence": {
"type": [
"string",
"null"
],
"description": "Second Occurrence"
}
},
"required": [
"first_occurrence",
"limit",
"second_occurrence"
],
"description": "Major organ transplant benefit for Critical Illness plans"
},
"non_invasive_cancer": {
"type": "object",
"properties": {
"first_occurrence": {
"type": [
"string",
"null"
],
"description": "First Occurrence"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"second_occurrence": {
"type": [
"string",
"null"
],
"description": "Second Occurrence"
}
},
"required": [
"first_occurrence",
"limit",
"second_occurrence"
],
"description": "Non-invasive cancer benefit for Critical Illness plans"
},
"organ_failure": {
"type": "object",
"properties": {
"first_occurrence": {
"type": [
"string",
"null"
],
"description": "First Occurrence"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"second_occurrence": {
"type": [
"string",
"null"
],
"description": "Second Occurrence"
}
},
"required": [
"first_occurrence",
"limit",
"second_occurrence"
],
"description": "Organ failure benefit for Critical Illness plans"
},
"paralysis": {
"type": "object",
"properties": {
"first_occurrence": {
"type": [
"string",
"null"
],
"description": "First Occurrence"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"second_occurrence": {
"type": [
"string",
"null"
],
"description": "Second Occurrence"
}
},
"required": [
"first_occurrence",
"limit",
"second_occurrence"
],
"description": "Paralysis benefit for Critical Illness plans"
},
"stroke": {
"type": "object",
"properties": {
"first_occurrence": {
"type": [
"string",
"null"
],
"description": "First Occurrence"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
},
"second_occurrence": {
"type": [
"string",
"null"
],
"description": "Second Occurrence"
}
},
"required": [
"first_occurrence",
"limit",
"second_occurrence"
],
"description": "Stroke benefit for Critical Illness plans"
},
"wellness": {
"type": "object",
"properties": {
"benefit": {
"type": [
"string",
"null"
],
"description": "Benefit"
},
"limit": {
"type": [
"string",
"null"
],
"description": "Benefit limit"
}
},
"required": [
"benefit",
"limit"
],
"description": "Wellness benefit for Critical Illness plans"
}
},
"description": "CriticalIllness Plan Benefits"
},
"benefits_summary_url": {
"type": "string",
"description": "Link to the summary of benefits and coverage (SBC) document."
},
"carrier": {
"type": "object",
"properties": {
"id": {
"type": "string",
"description": "Carrier unique identifier"
},
"issuer_id": {
"type": "string",
"description": "Issuer Identifier"
},
"logo_url": {
"type": "string",
"description": "Link to a copy of the insurance carrier's logo"
},
"name": {
"type": "string",
"description": "Name of the insurance carrier"
}
},
"description": "Carrier Subsidiary associated to this Plan"
},
"carrier_disclaimers": {
"type": "string",
"description": "Most recent Disclaimer issued for this Plan"
},
"effective_date": {
"type": "string",
"description": "Effective date for Critical Illness plans"
},
"exclusion_period": {
"type": "string",
"description": "Exclusion period for Critical Illness plans"
},
"expiration_date": {
"type": "string",
"description": "Expiration date for Critical Illness plans"
},
"guaranteed_issue_bands": {
"type": "array",
"description": "Guaranteed issue bands for Critical Illness plans"
},
"id": {
"type": "string",
"description": "The critical illness plan identifier"
},
"identifiers": {
"type": "array",
"description": "List of identifiers of this Plan"
},
"insured_benefits": {
"type": "object",
"properties": {
"child": {
"type": "object",
"properties": {
"increment": {
"type": [
"string",
"null"
],
"description": "Benefit increment amount"
},
"maximum": {
"type": [
"string",
"null"
],
"description": "Maximum benefit amount"
},
"minimum": {
"type": [
"string",
"null"
],
"description": "Minimum benefit amount"
}
},
"required": [
"increment",
"maximum",
"minimum"
],
"description": "Child benefit amounts"
},
"employee": {
"type": "object",
"properties": {
"increment": {
"type": [
"string",
"null"
],
"description": "Benefit increment amount"
},
"maximum": {
"type": [
"string",
"null"
],
"description": "Maximum benefit amount"
},
"minimum": {
"type": [
"string",
"null"
],
"description": "Minimum benefit amount"
}
},
"required": [
"increment",
"maximum",
"minimum"
],
"description": "Employee benefit amounts"
},
"spouse": {
"type": "object",
"properties": {
"increment": {
"type": [
"string",
"null"
],
"description": "Benefit increment amount"
},
"maximum": {
"type": [
"string",
"null"
],
"description": "Maximum benefit amount"
},
"minimum": {
"type": [
"string",
"null"
],
"description": "Minimum benefit amount"
}
},
"required": [
"increment",
"maximum",
"minimum"
],
"description": "Spouse benefit amounts"
}
},
"required": [
"child",
"employee",
"spouse"
],
"description": "Insured benefit amounts for Critical Illness plans"
},
"issuer_name": {
"type": "string",
"description": "Name of the insurance carrier"
},
"look_back_period": {
"type": "string",
"description": "Look back period for Critical Illness plans"
},
"name": {
"type": "string",
"description": "Marketing name of the plan"
},
"plan_years": {
"type": "array",
"description": "Plan years for Critical Illness plans"
},
"portability": {
"type": "string",
"description": "Portability for Critical Illness plans"
},
"premium_increase": {
"type": "string",
"description": "Premium increase for Critical Illness plans"
},
"quoted_via_carrier_api": {
"type": "boolean",
"description": "The quotes for this plan will be provided by the carrier api"
},
"rate_guarantee": {
"type": "string",
"description": "Rate guarantee for Critical Illness plans"
},
"second_occurrence_suspension_period": {
"type": "string",
"description": "Second occurrence suspension period for Critical Illness plans"
},
"source": {
"type": "string",
"description": "Source for Critical Illness plans"
},
"treatment_free_period": {
"type": "string",
"description": "Treatment free period for Critical Illness plans"
},
"voluntary": {
"type": "boolean"
}
},
"description": "CriticalIllness Plan response"
}
}
}
Show PlanGET/plans/critical_illness/{id}{?year}
Version History
v6
: The documentation for this endpoint references this latest available version.
Endpoint Description
Show the details of a specific Critical Illness Plan. This includes all benefits for the Plan.
For more details on displaying Plans and their related data, see the Quoting section.
Response Parameters
Identifiers
The identifiers
key contains various identifiers that can be used to identify the plan with the Carrier during enrollment.
Identifier Type | Description |
---|---|
contract_id | An issuer identifier for the plan. |
URI Parameters
- id
string
(required) Example: CgFmdiDhID of the Plan
- year
number
(optional) Example: 2022Plan year (defaults to current year)
Critical Illness Plans ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Body
{
"applicants": [
{
"age": 21,
"child": false,
"gender": "F"
}
],
"enrollment_date": "2024-03-08",
"fips_code": "36081",
"market": "individual",
"page": 1,
"per_page": 20,
"zip_code": "11423"
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"applicants": {
"type": "array",
"description": "Applicants for desired plans."
},
"enrollment_date": {
"type": "string",
"description": "Date of enrollment"
},
"fips_code": {
"type": "string",
"description": "County code to determine eligibility"
},
"market": {
"type": "string",
"description": "The audience of plan to search for. Possible values are individual, shop, small_group, medicare_advantage, large_group, level_funded"
},
"page": {
"type": "number",
"description": "Selected page of paginated response."
},
"per_page": {
"type": "number",
"description": "Results per page of response."
},
"zip_code": {
"type": "string",
"description": "5-digit zip code - this helps determine pricing."
}
},
"required": [
"market"
]
}
Headers
Content-Type: application/json
Body
{
"meta": {
"total": 1
},
"plans": [
{
"audience": "small_group",
"benefit_reduction_schedules": [
{
"age": 80,
"reduction_amount": "50%"
}
],
"benefits": {
"addisons_disease": {
"first_occurrence": "100%",
"limit": "1 time(s) per year",
"second_occurrence": "50%"
},
"als_lou_gehrigs_disease": {
"first_occurrence": "100%",
"limit": "1 time(s) per year",
"second_occurrence": "50%"
},
"alzheimers_disease": {
"first_occurrence": "100%",
"limit": "1 time(s) per year",
"second_occurrence": "50%"
},
"coma": {
"first_occurrence": "100%",
"limit": "1 time(s) per year",
"second_occurrence": "50%"
},
"coronary_artery_bypass_surgery": {
"first_occurrence": "100%",
"limit": "1 time(s) per year",
"second_occurrence": "50%"
},
"coronary_artery_disease": {
"first_occurrence": "100%",
"limit": "1 time(s) per year",
"second_occurrence": "50%"
},
"heart_attack": {
"first_occurrence": "100%",
"limit": "1 time(s) per year",
"second_occurrence": "50%"
},
"invasive_cancer": {
"first_occurrence": "100%",
"limit": "1 time(s) per year",
"second_occurrence": "50%"
},
"kidney_failure": {
"first_occurrence": "100%",
"limit": "1 time(s) per year",
"second_occurrence": "50%"
},
"loss_of_hearing": {
"first_occurrence": "100%",
"limit": "1 time(s) per year",
"second_occurrence": "50%"
},
"loss_of_sight": {
"first_occurrence": "100%",
"limit": "1 time(s) per year",
"second_occurrence": "50%"
},
"major_organ_transplant": {
"first_occurrence": "100%",
"limit": "1 time(s) per year",
"second_occurrence": "50%"
},
"non_invasive_cancer": {
"first_occurrence": "100%",
"limit": "1 time(s) per year",
"second_occurrence": "50%"
},
"organ_failure": {
"first_occurrence": "100%",
"limit": "1 time(s) per year",
"second_occurrence": "50%"
},
"paralysis": {
"first_occurrence": "100%",
"limit": "1 time(s) per year",
"second_occurrence": "50%"
},
"stroke": {
"first_occurrence": "100%",
"limit": "1 time(s) per year",
"second_occurrence": "50%"
},
"wellness": {
"benefit": "$100",
"limit": "1 time(s) per year"
}
},
"benefits_summary_url": "http://www.example.com/benefits_summary.pdf",
"carrier": {
"id": "bae1d0e1-80dc-48f4-918d-6c492340cc1c",
"issuer_id": "A0027",
"logo_url": "https://d1hm12jr612u3r.cloudfront.net/images/carriers/174/1438891372/thumb.png?1438891372",
"name": "Guardian"
},
"carrier_disclaimers": "See Summary of Benefits and Coverage (SBC) for more details.",
"effective_date": "2022-12-31",
"exclusion_period": "6 month(s)",
"expiration_date": "2022-12-31",
"guaranteed_issue_bands": [
{
"child": "$5,000",
"employee": "$10,000",
"maximum_group_size": 20,
"minimum_group_size": 10,
"spouse": "$5,000"
}
],
"id": "uaLcmyru",
"identifiers": [
{
"type": "contract_id",
"value": "abc123"
}
],
"insured_benefits": {
"child": {
"increment": "$1,000",
"maximum": "$10,000",
"minimum": "$5,000"
},
"employee": {
"increment": "$1,000",
"maximum": "$10,000",
"minimum": "$5,000"
},
"spouse": {
"increment": "$1,000",
"maximum": "$10,000",
"minimum": "$5,000"
}
},
"issuer_name": "Guardian",
"look_back_period": "3 month(s)",
"name": "Critical Illness Plan 1",
"plan_years": [
2021,
2022
],
"portability": "included",
"premium": 533.24,
"premium_increase": "attained age",
"premium_source": "carrier",
"quoted_via_carrier_api": false,
"rate_guarantee": "true",
"second_occurrence_suspension_period": "6 month(s)",
"source": "carrier",
"treatment_free_period": "6 month(s)",
"voluntary": true
}
]
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"meta": {
"type": "object",
"properties": {
"total": {
"type": "number",
"description": "Number of entities returned"
}
},
"description": "Meta-data"
},
"plans": {
"type": "array",
"description": "CriticalIllness plan search results"
}
}
}
Search PlansPOST/plans/critical_illness/search{?page,per_page}
Version History
v6
: The documentation for this endpoint references this latest available version.
Endpoint Description
This search endpoint allows you to see what plans are available in a particular geographic area. Plans will be returned with a list of available benefits
For details on how to quote groups for Critical Illness insurance, see the Group Quoting section.
Response Parameters
Identifiers
The identifiers
key contains various identifiers that can be used to identify the plan with the Carrier during enrollment.
Identifier Type | Description |
---|---|
contract_id | An issuer identifier for the plan. |
URI Parameters
- page
number
(optional) Example: 1Page of paginated response
- per_page
number
(optional) Example: 1Responses per page
Hospital Indemnity Plans ¶
Hospital Indemnity Plans ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Headers
Content-Type: application/json
Body
{
"hospital_indemnity_plan": {
"audience": "small_group",
"benefits": {
"hospital_admission": {
"benefit": "$50",
"limit": "1 time(s) per year"
},
"hospital_admission_icu": {
"benefit": "$50",
"limit": "1 time(s) per year"
},
"hospital_confinement": {
"benefit": "$50",
"limit": "1 time(s) per year"
},
"hospital_confinement_icu": {
"benefit": "$50",
"limit": "1 time(s) per year"
},
"wellness": {
"benefit": "$50",
"limit": "1 time(s) per year"
}
},
"benefits_summary_url": "http://www.example.com/benefits_summary.pdf",
"carrier": {
"id": "bae1d0e1-80dc-48f4-918d-6c492340cc1c",
"issuer_id": "A0027",
"logo_url": "https://d1hm12jr612u3r.cloudfront.net/images/carriers/174/1438891372/thumb.png?1438891372",
"name": "Guardian"
},
"carrier_disclaimers": "See Summary of Benefits and Coverage (SBC) for more details.",
"effective_date": "2021-01-01",
"exclusion_period": "6 month(s)",
"expiration_date": "2022-12-31",
"icu_admission_paid_in_addition_to_hospital": false,
"icu_confinement_paid_in_addition_to_hospital": false,
"id": "uaLcmyru",
"identifiers": [
{
"type": "contract_id",
"value": "abc123"
}
],
"issuer_name": "Guardian",
"look_back_period": "6 month(s)",
"name": "Hospital Indemnity Plan 1",
"plan_years": [
2021,
2022
],
"portability": "included",
"premium_increase": "attained age",
"quoted_via_carrier_api": false,
"rate_guarantee": "true",
"source": "carrier_direct",
"treatment_free_period": "6 month(s)",
"voluntary": true
}
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"hospital_indemnity_plan": {
"type": "object",
"properties": {
"audience": {
"type": "string",
"description": "The hospital indemnity plan audience"
},
"benefits": {
"type": "object",
"properties": {
"hospital_admission": {
"type": "object",
"properties": {
"benefit": {
"type": "string",
"description": "Benefit amount"
},
"limit": {
"type": "string",
"description": "Benefit limit"
}
},
"description": "The Hospital Admission Benefit associated with the plan, if applicable"
},
"hospital_admission_icu": {
"type": "object",
"properties": {
"benefit": {
"type": "string",
"description": "Benefit amount"
},
"limit": {
"type": "string",
"description": "Benefit limit"
}
},
"description": "The Hospital ICU Admission Benefit associated with the plan, if applicable"
},
"hospital_confinement": {
"type": "object",
"properties": {
"benefit": {
"type": "string",
"description": "Benefit amount"
},
"limit": {
"type": "string",
"description": "Benefit limit"
}
},
"description": "The Hospital Confinement Benefit associated with the plan, if applicable"
},
"hospital_confinement_icu": {
"type": "object",
"properties": {
"benefit": {
"type": "string",
"description": "Benefit amount"
},
"limit": {
"type": "string",
"description": "Benefit limit"
}
},
"description": "The Hospital ICU Confinement Benefit associated with the plan, if applicable"
},
"wellness": {
"type": "object",
"properties": {
"benefit": {
"type": "string",
"description": "Benefit amount"
},
"limit": {
"type": "string",
"description": "Benefit limit"
}
},
"description": "The Wellness Benefit associated with the plan, if applicable"
}
},
"description": "HospitalIndemnity Plan Benefits"
},
"benefits_summary_url": {
"type": "string",
"description": "Link to the summary of benefits and coverage (SBC) document."
},
"carrier": {
"type": "object",
"properties": {
"id": {
"type": "string",
"description": "Carrier unique identifier"
},
"issuer_id": {
"type": "string",
"description": "Issuer Identifier"
},
"logo_url": {
"type": "string",
"description": "Link to a copy of the insurance carrier's logo"
},
"name": {
"type": "string",
"description": "Name of the insurance carrier"
}
},
"description": "Carrier Subsidiary associated to this Plan"
},
"carrier_disclaimers": {
"type": "string",
"description": "Most recent Disclaimer issued for this Plan"
},
"effective_date": {
"type": "string",
"description": "Plan effective date"
},
"exclusion_period": {
"type": "string",
"description": "The exclusion period for pre-existing condition limitations"
},
"expiration_date": {
"type": "string",
"description": "Plan expiration date"
},
"icu_admission_paid_in_addition_to_hospital": {
"type": "boolean",
"description": "Indicates if the ICU admission benefit is paid in addition to the hospital admission benefit"
},
"icu_confinement_paid_in_addition_to_hospital": {
"type": "boolean",
"description": "Indicates if the ICU confinement benefit is paid in addition to the hospital confinement benefit"
},
"id": {
"type": "string",
"description": "The hospital indemnity plan identifier"
},
"identifiers": {
"type": "array",
"description": "List of identifiers of this Plan"
},
"issuer_name": {
"type": "string",
"description": "Name of the insurance carrier"
},
"look_back_period": {
"type": "string",
"description": "The look back period for pre-existing condition limitations"
},
"name": {
"type": "string",
"description": "Marketing name of the plan"
},
"plan_years": {
"type": "array",
"description": "The hospital indemnity plan years"
},
"portability": {
"type": "string",
"description": "Plan portability"
},
"premium_increase": {
"type": "string",
"description": "Indicates the method for determining premium increased based on the age of the insured"
},
"quoted_via_carrier_api": {
"type": "boolean",
"description": "The quotes for this plan will be provided by the carrier api"
},
"rate_guarantee": {
"type": "string",
"description": "Indicates the guaranteed rate"
},
"source": {
"type": "string",
"description": "The hospital indemnity plan source"
},
"treatment_free_period": {
"type": "string",
"description": "The treatment free period for pre-existing condition limitations"
},
"voluntary": {
"type": "boolean"
}
},
"description": "HospitalIndemnity Plan response"
}
}
}
Show PlanGET/plans/hospital_indemnity/{id}{?year}
Version History
v6
: The documentation for this endpoint references this latest available version.
Endpoint Description
Show the details of a specific Hospital Indemnity Plan. This includes all benefits for the Plan.
For more details on displaying Plans and their related data, see the Quoting section.
Response Parameters
Identifiers
The identifiers
key contains various identifiers that can be used to identify the plan with the Carrier during enrollment.
Identifier Type | Description |
---|---|
contract_id | An issuer identifier for the plan. |
URI Parameters
- id
string
(required) Example: WPxC66AFID of the Plan
- year
number
(optional) Example: 2022Plan year (defaults to current year)
Hospital Indemnity Plans ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Body
{
"applicants": [
{
"age": 21,
"child": false,
"gender": "F"
}
],
"enrollment_date": "2024-03-08",
"fips_code": "36081",
"market": "individual",
"page": 1,
"per_page": 20,
"zip_code": "11423"
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"applicants": {
"type": "array",
"description": "Applicants for desired plans."
},
"enrollment_date": {
"type": "string",
"description": "Date of enrollment"
},
"fips_code": {
"type": "string",
"description": "County code to determine eligibility"
},
"market": {
"type": "string",
"description": "The audience of plan to search for. Possible values are individual, shop, small_group, medicare_advantage, large_group, level_funded"
},
"page": {
"type": "number",
"description": "Selected page of paginated response."
},
"per_page": {
"type": "number",
"description": "Results per page of response."
},
"zip_code": {
"type": "string",
"description": "5-digit zip code - this helps determine pricing."
}
},
"required": [
"market"
]
}
Headers
Content-Type: application/json
Body
{
"meta": {
"total": 1
},
"plans": [
{
"audience": "small_group",
"benefits": {
"hospital_admission": {
"benefit": "$50",
"limit": "1 time(s) per year"
},
"hospital_admission_icu": {
"benefit": "$50",
"limit": "1 time(s) per year"
},
"hospital_confinement": {
"benefit": "$50",
"limit": "1 time(s) per year"
},
"hospital_confinement_icu": {
"benefit": "$50",
"limit": "1 time(s) per year"
},
"wellness": {
"benefit": "$50",
"limit": "1 time(s) per year"
}
},
"benefits_summary_url": "http://www.example.com/benefits_summary.pdf",
"carrier": {
"id": "bae1d0e1-80dc-48f4-918d-6c492340cc1c",
"issuer_id": "A0027",
"logo_url": "https://d1hm12jr612u3r.cloudfront.net/images/carriers/174/1438891372/thumb.png?1438891372",
"name": "Guardian"
},
"carrier_disclaimers": "See Summary of Benefits and Coverage (SBC) for more details.",
"effective_date": "2021-01-01",
"exclusion_period": "6 month(s)",
"expiration_date": "2022-12-31",
"icu_admission_paid_in_addition_to_hospital": false,
"icu_confinement_paid_in_addition_to_hospital": false,
"id": "uaLcmyru",
"identifiers": [
{
"type": "contract_id",
"value": "abc123"
}
],
"issuer_name": "Guardian",
"look_back_period": "6 month(s)",
"name": "Hospital Indemnity Plan 1",
"plan_years": [
2021,
2022
],
"portability": "included",
"premium": 533.24,
"premium_increase": "attained age",
"premium_source": "carrier",
"quoted_via_carrier_api": false,
"rate_guarantee": "true",
"source": "carrier_direct",
"treatment_free_period": "6 month(s)",
"voluntary": true
}
]
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"meta": {
"type": "object",
"properties": {
"total": {
"type": "number",
"description": "Number of entities returned"
}
},
"description": "Meta-data"
},
"plans": {
"type": "array",
"description": "HospitalIndemnity plan search results"
}
}
}
Search PlansPOST/plans/hospital_indemnity/search{?page,per_page}
Version History
v6
: The documentation for this endpoint references this latest available version.
Endpoint Description
This search endpoint allows you to see what plans are available in a particular geographic area. Plans will be returned with a list of available benefits
For details on how to quote groups for Hospital Indemnity insurance, see the Group Quoting section.
Response Parameters
Identifiers
The identifiers
key contains various identifiers that can be used to identify the plan with the Carrier during enrollment.
Identifier Type | Description |
---|---|
contract_id | An issuer identifier for the plan. |
URI Parameters
- page
number
(optional) Example: 1Page of paginated response
- per_page
number
(optional) Example: 1Responses per page
Carriers ¶
Carriers ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Headers
Content-Type: application/json
Body
{
"carriers": [
{
"id": "bae1d0e1-80dc-48f4-918d-6c492340cc1c",
"issuers": [
{
"issuer_id": "49116",
"issuer_id_type": "hios_issuer_id",
"lines_of_coverage": {},
"logo_url": "https://d1hm12jr612u3r.cloudfront.net/images/carriers/174/1438891372/thumb.png?1438891372",
"name": "UHC of California",
"state_code": "CA"
}
],
"lines_of_coverage": [
"medical"
],
"markets": [
"small_group"
],
"name": "UnitedHealthcare",
"states": [
"CA",
"DE",
"TX"
]
}
],
"meta": {
"total": 1
}
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"carriers": {
"type": "array",
"description": "List of Carriers"
},
"meta": {
"type": "object",
"properties": {
"total": {
"type": "number",
"description": "Number of entities returned"
}
},
"description": "Meta-data"
}
}
}
Carrier SearchGET/carriers{?search_term,state_code,issuer_id,line_of_coverage,market,carrier_id,page,per_page}
Version History
v6
: The documentation for this endpoint references this latest available version.
Endpoint Description
The Carrier Search endpoint provides a unique identifier for each carrier across the country. Within the body of each carrier object, the endpoint returns each issuer that the carrier provides insurance through. The Carrier ID can be used in the Group Quoting and Networks endpoints for filtering purposes.
The carriers
returned in this endpoint are filtered by the parameters sent in the request. The issuers
, lines_of_coverage
, markets
, and states
returned for each carrier
are not filtered by the request parameters; they are aggregated across the associated carrier
.
URI Parameters
- search_term
string
(optional) Example: UnitedFull or partial proprietary name of a carrier
- state_code
string
(optional) Example: CAThe state where the issuer has plans in
- issuer_id
number
(optional) Example: 49116The issuer identifier
- line_of_coverage
string
(optional) Example: medicalThe line of coverage the issuer has plans in. Options are
medical
,dental
,vision
,medicaid
, andmedicare_advantage
- market
string
(optional) Example: small_groupThe market the issuer has plans for. Options are
individual
,small_group
, andlevel_funded
- carrier_id
string
(optional) Example: bae1d0e1-80dc-48f4-918d-6c492340cc1cThe carrier identifier
- page
number
(optional) Example: 1Page of paginated response
- per_page
number
(optional) Example: 10Responses per page
Card Scanning API ¶
Card Scanning API ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Body
{
"card_image_back_url": "http://example.com/back_image.jpg",
"card_image_front_url": "http://example.com/front_image.jpg",
"line_of_coverage": "medical",
"market": "small_group",
"state_code": "CA"
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"card_image_back_url": {
"type": "string",
"description": "The url image of the back of the insurance card"
},
"card_image_front_url": {
"type": "string",
"description": "The url image of the front of the insurance card"
},
"line_of_coverage": {
"type": "string",
"description": "The line of coverage of the plan"
},
"market": {
"type": "string",
"description": "The market for which the plan was offered to"
},
"state_code": {
"type": "string",
"description": "The state where the plan was purchased"
}
}
}
Headers
Content-Type: application/json
Body
{
"id": "24ddb277-31d4-4437-853f-5e163c0766d9",
"networks": [
{
"carrier_name": "UnitedHealthcare",
"carriers": [
{
"id": "bae1d0e1-80dc-48f4-918d-6c492340cc1c",
"name": "UnitedHealthcare"
}
],
"id": 1,
"last_imported_at": "2022-09-01",
"name": "Open Choice",
"source": "carrier_direct"
}
]
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"id": {
"type": "string",
"description": "ID of the Scan"
},
"networks": {
"type": "array",
"description": "List of ranked Networks"
}
}
}
Create a ScanPOST/scans
Version History
v6
: The documentation for this endpoint references this latest available version.
Endpoint Description
Use this endpoint to create a health insurance card scan to determine the provider network the card member has access to. The id
for the network can be passed in the network_ids
key in Provider Search to search for in-network providers.
The networks
returned in the response are sorted in order of matching, with the first result being the best match.
Request Parameters
Field | Type | Notes |
---|---|---|
card_image_front_url (required) |
string |
The url image of the front of the insurance card. Accepted formats are jpg , jpeg , or png . The max file size is 5MB. The URL must use HTTPS. |
card_image_back_url (required) |
string |
The url image of the back of the insurance card. Accepted formats are jpg , jpeg , or png . The max file size is 5MB. The URL must use HTTPS. |
line_of_coverage (optional) |
string |
The options are: medical , dental , or medicare_advantage . |
market (optional) |
string |
The options are: individual , small_group , or large_group . |
state_code (optional) |
string |
The state where the plan was purchased. Examples are NY , CA , etc. |
Networks ¶
Networks ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Headers
Content-Type: application/json
Body
{
"meta": {
"total": 1
},
"networks": [
{
"alternate_names": [
"Open Choice EPO"
],
"carrier_ids": [
"33333",
"H2649"
],
"carrier_name": "UnitedHealthcare",
"carriers": [
{
"id": "bae1d0e1-80dc-48f4-918d-6c492340cc1c",
"name": "UnitedHealthcare"
}
],
"id": 1,
"last_imported_at": "2022-09-01",
"lines_of_coverage": [
"medical"
],
"markets": [
"individual",
"small_group"
],
"name": "Open Choice",
"source": "carrier_direct",
"state_codes": [
"CA",
"NY"
]
}
]
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"meta": {
"type": "object",
"properties": {
"total": {
"type": "number",
"description": "Number of entities returned"
}
},
"description": "Meta-data"
},
"networks": {
"type": "array",
"description": "Networks that fit the requested criterion."
}
}
}
Network SearchGET/networks{?search_term,line_of_coverage,carrier_id,market,state_code,effective_date,last_imported,page,per_page}
Version History
v7
: Added various parameters for searching and additional fields to the response. The documentation for this endpoint references this latest available version.
v6
: Previous supported version. Limited to carrier_id
, market
, state
, and effective_date
search parameters.
Endpoint Description
The network search endpoint enables you to find networks by many parameters.
A network encompasses a list of the doctors, other health care providers, and hospitals that a plan has contracted with to provide medical care to its Members. This endpoint is paginated.
Response Parameters
Source
The source
response key provides insight on how the network data is acquired by Ideon. The possible values are detailed below.
Source Value | Notes |
---|---|
carrier_direct |
The network data is acquired directly from the carrier. |
carrier_indirect |
The network data is acquired indirectly from the carrier. |
cms |
The network data is acquired from the CMS. |
URI Parameters
- search_term
string
(optional) Example: Enhanced PPOFull or partial name of the network
- line_of_coverage
string
(optional) Example: medicalThe line of coverage of the network. Possible values are
medical
,medicare_advantage
,dental
- carrier_id
string
(optional) Example: bae1d0e1-80dc-48f4-918d-6c492340cc1cCarrier ID (e.g. bae1d0e1-80dc-48f4-918d-6c492340cc1c) or HIOS Issuer ID (e.g. 10544) or Medicare Contract Issuer ID (e.g. H2649)
- market
string
(optional) Example: individualType of Plan to which this network is attached. Possible values are
individual
,small_group
,large_group
- state_code
string
(optional) Example: CAA state code (e.g. CA) in which the network is available
- effective_date
string
(optional) Example: 2022-01-01Use this to specify a date on which the network must be or have been active
- last_imported
string
(optional) Example: 2022-01-01Use this to specify a filter to only show networks imported since the given date.
- page
number
(optional) Example: 1Page of paginated response
- per_page
number
(optional) Example: 10Responses per page
Networks ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Headers
Content-Type: application/json
Body
{
"network": {
"alternate_names": [
"Open Choice EPO"
],
"carrier_ids": [
"33333",
"H2649"
],
"carrier_name": "UnitedHealthcare",
"carriers": [
{
"id": "bae1d0e1-80dc-48f4-918d-6c492340cc1c",
"name": "UnitedHealthcare"
}
],
"id": 1,
"last_imported_at": "2022-09-01",
"lines_of_coverage": [
"medical"
],
"markets": [
"individual",
"small_group"
],
"name": "Open Choice",
"source": "carrier_direct",
"state_codes": [
"CA",
"NY"
]
}
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"network": {
"type": "object",
"properties": {
"alternate_names": {
"type": "array",
"description": "List of Alternate names for the Network"
},
"carrier_ids": {
"type": "array",
"description": "List of Carrier External Identifiers"
},
"carrier_name": {
"type": "string",
"description": "Name of the Network Carrier"
},
"carriers": {
"type": "array",
"description": "List of Network Carriers"
},
"id": {
"type": "number",
"description": "Primary key"
},
"last_imported_at": {
"type": "string",
"description": "Last date the Network data was imported"
},
"lines_of_coverage": {
"type": "array",
"description": "Lines of coverage"
},
"markets": {
"type": "array",
"description": "List of markets"
},
"name": {
"type": "string",
"description": "Name of the Network"
},
"source": {
"type": "string",
"description": "Source of the Network data"
},
"state_codes": {
"type": "array",
"description": "List of state codes"
}
},
"description": "Network details"
}
}
}
Display a NetworkGET/networks/{id}
Version History
v7
: Added additional fields to the response. The documentation for this endpoint references this latest available version.
v6
: Previous supported version.
Endpoint Description
The network details endpoint enables you to get information about a network by providing its id
.
A network encompasses a list of the doctors, other health care providers, and hospitals that a plan has contracted with to provide medical care to its Members.
URI Parameters
- id
number
(required) Example: 100001Primary key of the network
Networks ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Body
{
"network_ids": [
900001
],
"radius": 100,
"zip_code": "11423"
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"network_ids": {
"type": "array",
"description": "List of Networks with which to compare the base Network"
},
"radius": {
"type": "number",
"description": "Radius from the provided Zip Code within which to search"
},
"zip_code": {
"type": "string",
"description": "Zip Code to use as a search origin"
}
},
"required": [
"network_ids",
"radius",
"zip_code"
]
}
Headers
Content-Type: application/json
Body
{
"network_comparisons": [
{
"accepting_insurance_count": 50,
"base_network_id": 1,
"base_network_unique_count": 100,
"comparison_network_id": 2,
"comparison_network_unique_count": 200,
"network_overlap_count": 300
}
],
"networks": [
{
"carrier_name": "UnitedHealthcare",
"carriers": [
{
"id": "bae1d0e1-80dc-48f4-918d-6c492340cc1c",
"name": "UnitedHealthcare"
}
],
"id": 1,
"last_imported_at": "2022-09-01",
"name": "Open Choice",
"source": "carrier_direct"
}
]
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"network_comparisons": {
"type": "array",
"description": "NetworkComparisons"
},
"networks": {
"type": "array",
"description": "Networks"
}
}
}
Compare Multiple NetworksPOST/networks/{id}/network_comparisons
Version History
v7
: Added carrier brand name to the response. The documentation for this endpoint references this latest available version.
v6
: Previous supported version.
Endpoint Description
Compare provider counts in a given area between a base network and one or more comparison networks.
Comparison of provider counts within a radius requires that you provide a zip_code
and
radius
to use as a search area. The response returns the total number of unique
Providers
in the Base Network
(i.e. those who are not present in the Comparison Network
),
The number of unique Provider
s in the Comparison Network
(i.e. those who are not present
in the Base Network
), and the count of Provider
s who are in both Network
s
URI Parameters
- id
number
(required) Example: 100001Primary key of the base network
Networks ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Body
{
"network_ids": [
100356
],
"npis": [
123456789,
234565673,
981237923
]
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"network_ids": {
"type": "array",
"description": "List of Vericred Network identifiers"
},
"npis": {
"type": "array",
"description": "List of Provider NPIs"
}
}
}
Headers
Content-Type: application/json
Body
{
"disruption_analysis": [
{
"disruption_percentage": 33.33,
"in_network_npis": [
123456789,
234565673
],
"network_id": 100356,
"out_of_network_npis": [
981237923
]
}
],
"meta": {
"total": 1
}
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"disruption_analysis": {
"type": "array",
"description": "Disruption Analysis for each requested Network"
},
"meta": {
"type": "object",
"properties": {
"total": {
"type": "number",
"description": "Number of entities returned"
}
},
"description": "Meta-data"
}
}
}
Disruption AnalysisPOST/networks/disruption_analysis{?page,per_page}
Version History
v6
: The documentation for this endpoint references this latest available version.
Endpoint Description
Calculate the percentage of provider NPIs that are out-of-network for a set of networks. If you are interested in using this endpoint, please contact [email protected] for more details.
The maximum number of npis
and network_ids
that can be sent in a single call is 100, counted independently of each other.
URI Parameters
- page
number
(optional) Example: 1Page of paginated response
- per_page
number
(optional) Example: 1Responses per page
NetworkSizes ¶
NetworkSizes ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Body
{
"network_ids": [
1
],
"state_ids": [
"['CA']"
]
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"network_ids": {
"type": "array",
"description": "List of Network Ids"
},
"state_ids": {
"type": "array",
"description": "List of State Ids"
}
}
}
Headers
Content-Type: application/json
Body
{
"meta": {
"total": 1
},
"network_sizes": [
{
"count": 100,
"network_id": 123,
"state_id": "CA"
}
]
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"meta": {
"type": "object",
"properties": {
"total": {
"type": "number",
"description": "Number of entities returned"
}
},
"description": "Meta-data"
},
"network_sizes": {
"type": "array",
"description": "Network Sizes"
}
}
}
Network SizesPOST/network_sizes/search
Version History
v6
: The documentation for this endpoint references this latest available version.
Endpoint Description
The number of in-network Providers for each network/state combination provided. This data is recalculated nightly.
NetworkSizes ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Headers
Content-Type: application/json
Body
{
"meta": {
"total": 1
},
"network_sizes": [
{
"count": 100,
"network_id": 123,
"state_id": "CA"
}
]
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"meta": {
"type": "object",
"properties": {
"total": {
"type": "number",
"description": "Number of entities returned"
}
},
"description": "Meta-data"
},
"network_sizes": {
"type": "array",
"description": "Network Sizes"
}
}
}
State Network SizesGET/states/{state_id}/network_sizes{?page,per_page}
Version History
v6
: The documentation for this endpoint references this latest available version.
Endpoint Description
The number of in-network Providers for each network in a given state. This data is recalculated nightly. The endpoint is paginated.
URI Parameters
- state_id
string
(required) Example: CAState code
- page
number
(optional) Example: 1Page of paginated response
- per_page
number
(optional) Example: 1Responses per page
Providers ¶
Providers ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Body
{
"accepts_insurance": true,
"ids": [
1013955475,
1558302844
],
"last_imported": "2022-01-01",
"network_ids": [
200251
],
"page": 1,
"per_page": 2,
"plan_ids": [
"99eA4hhn",
"88582NY0230001",
"H3328-003-0"
],
"plan_year": 2024,
"polygon": 1,
"radius": 1,
"search_term": "John Smith",
"sort": "distance",
"sort_seed": 1,
"specialty_ids": [
"0b1a7a567e",
"4c12f8d69a",
"41c2491831"
],
"type": "individual",
"zip_code": "11423"
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"accepts_insurance": {
"type": "boolean",
"description": "Limit results to Providers who accept at least one insurance plan. Note that the inverse of this filter is not supported and any value will evaluate to true"
},
"ids": {
"type": "array",
"description": "List of NPIs"
},
"last_imported": {
"type": "string",
"description": "Only show networks last updated since this date"
},
"network_ids": {
"type": "array",
"description": "List of Vericred network ids"
},
"page": {
"type": "number",
"description": "Page number"
},
"per_page": {
"type": "number",
"description": "Number of records to return per page"
},
"plan_ids": {
"type": "array",
"description": "List of Vericred IDs, HIOS ids and Medicare contract codes"
},
"plan_year": {
"type": "number",
"description": "The year when the plans are offered. Defaults to current year"
},
"polygon": {
"type": "number",
"description": "Define a custom search polygon, mutually exclusive with zip_code search"
},
"radius": {
"type": "number",
"description": "Radius (in miles) to use to limit results"
},
"search_term": {
"type": "string",
"description": "String to search by"
},
"sort": {
"type": "string",
"description": "specify sort mode (distance or random)"
},
"sort_seed": {
"type": "number",
"description": "Seed value for random sort. Randomly-ordered searches with the same seed return results in consistent order."
},
"specialty_ids": {
"type": "array",
"description": "List of Specialty ids"
},
"type": {
"type": "string",
"description": "Either individual, organization, or hospital"
},
"zip_code": {
"type": "string",
"description": "Zip Code to search near"
}
},
"required": [
"search_term"
]
}
Headers
Content-Type: application/json
Body
{
"meta": {
"total": 1
},
"providers": [
{
"addresses": [
{
"accepting_new_patients": true,
"city": "New York",
"external_id": "50c2d41e021f0eb5baaa6f134f15bd29",
"id": "589c907f-28c2-3d14-8916-1144a5191ba2",
"latitude": 45.55,
"longitude": 14.55,
"pcp": true,
"pcp_id": "123456",
"phone_numbers": [
"2122223333",
"9172223334"
],
"state": "NY",
"street_line_1": "123 Fake Street",
"street_line_2": "Apt 10",
"zip_code": "11215"
}
],
"doing_business_as_name": "Ideon",
"first_name": "John",
"gender": "F",
"id": 1234567890,
"last_name": "Smith",
"middle_name": "Danger",
"network_ids": [
200251
],
"networks": [
{
"addresses": [
{
"accepting_new_patients": true,
"city": "New York",
"external_id": "50c2d41e021f0eb5baaa6f134f15bd29",
"id": "589c907f-28c2-3d14-8916-1144a5191ba2",
"latitude": 45.55,
"longitude": 14.55,
"pcp": true,
"pcp_id": "123456",
"phone_numbers": [
"2122223333",
"9172223334"
],
"state": "NY",
"street_line_1": "123 Fake Street",
"street_line_2": "Apt 10",
"zip_code": "11215"
}
],
"carrier_name": "UnitedHealthcare",
"carriers": [
{
"id": "bae1d0e1-80dc-48f4-918d-6c492340cc1c",
"name": "UnitedHealthcare"
}
],
"group_affiliations": [
{
"name": "ATLANTICARE REGIONAL MEDICAL CENTER"
}
],
"hospital_affiliations": [
{
"name": "ATLANTICARE REGIONAL MEDICAL CENTER"
}
],
"id": 1,
"languages": [
{
"id": "a852ab0e-64cb-36ee-ab77-3b38e1cb6d8f",
"iso_639_2": "ase",
"iso_639_3": "ase",
"name": "American Sign Language"
}
],
"last_imported_at": "2022-09-01",
"name": "Open Choice",
"pcp": true,
"pcp_id": "123456",
"source": "carrier_direct",
"specialties": [
{
"id": "76a2744d4a",
"name": "Anesthesiology",
"sub_specialty": "Hospice and Palliative Medicine",
"taxonomy_code": "261QI0500X"
}
],
"tier": "Tier 2"
}
],
"npi_specialty": {
"id": "1a2b34c5d6",
"name": "Clinic/Center",
"sub_specialty": "Infusion Therapy",
"taxonomy_code": "261QI0500X"
},
"npis": [
1234567890
],
"organization_name": "Vericred Inc",
"phone": "2125558700",
"presentation_name": "Dr. John D. Smith Jr.",
"specialty": "Internal Medicine",
"suffix": "Jr.",
"title": "Dr.",
"type": "organization"
}
]
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"meta": {
"type": "object",
"properties": {
"total": {
"type": "number",
"description": "Number of entities returned"
}
},
"description": "Meta-data"
},
"providers": {
"type": "array",
"description": "Providers that fit the requested criterion."
}
}
}
Provider SearchPOST/providers/search
Version History
v7
: In this version, provider-level addresses are returned in an array. The documentation for this endpoint references this latest available version.
v6
: Previous supported version.
Endpoint Description
Search for Providers
by a search string, network(s) participating, geography, specialty, and more.
Request Parameters - Provider Data
Search Term and Order of Results
All searches can take a search_term
, which is used as a component in
the score (and thus the ranking/order) of the results. This is
combined with the proximity to the location in ranking results. For
example, we would want “Dr. John Smith” who is 5 miles away from a
given Zip Code to appear before “Dr. John Smith” who is 100 miles away.
The weighting also allows for non-exact matches. In our prior example, we would want “Dr. Jon Smith” who is 2 miles away to appear before the exact match “Dr. John Smith” who is 100 miles away because it is more likely that the user just entered an incorrect name.
The free text search also supports Specialty name search and “body part” Specialty name search. So, searching “John Smith nose” would return “Dr. John Smith”, the ENT Specialist before “Dr. John Smith” the Internist.
Accepts Insurance
In addition, we can filter Providers
by whether or not they accept
any insurance. Our data set includes over 4 million Providers
,
some of whom do not accept any insurance at all. This filter makes
it more likely that the user will find his or her practitioner in some
cases.
Last Imported
While our provider network information is updated frequently, each
network is updated on a different cadence depending on when we acquire
the data from the Carrier. The last_imported
body parameter, allows
you to set a minimum date for showing network information depending
on when the last date we recieved updated information. Setting a
last_imported
of “2024-01-01”, for example, would only return Provider
Networks if that network was updated on 2024-01-01 or later.
Request Parameters - Location Information
All Provider
searches that do not specify plan_ids
or
network_ids
require some type of location information.
We use this information either to weight results or to filter results,
depending on the type.
Zip Code
When providing the zip_code
parameter, we order the Providers
returned based on their score, which incorporates their proximity to
the given Zip Code and the closeness of match to the search text. If
a radius
is also provided, we filter out Providers
who are outside
of that radius from the center of the Zip Code provided.
Center Point
Instead of a zip_code
, you could provide a center_point
object in the request,
containing an exact lat
and lon
. This is useful if you want to show Providers
that are near an exact location. If a radius
is also provided, we filter out
Providers
who are outside of that radius from the center point provided.
This is mutually exclusive with zip_code
and radius
.
{ "center_point": { "lat": 40.712776, "lon": -74.005974 }}
Polygon
When providing the polygon
parameter, we filter providers who are
outside the bounds of the shape provided. This is mutually exclusive
with zip_code
and radius
.
Request Parameters - Filters
Network IDs
This endpoint supports filtering provider search results to only those
that are in-network for specific provider networks. To do so, you can
provide a network_ids
key in the request that includes a list of the
identifiers for each network to filter on. Please note that the
network_ids
response key will only appear if it is used in the
request. The use of this filter is reserved for paying customers.
Specialty
When providing the specialty_ids
parameter, we filter providers to
those who practice those specialties. To find the specialty_ids, please
use the Specialty Search endpoint.
Plan/Network Information
We can also filter based on Plan
and Network
participation, using plan_ids
and network_ids
, respectively. These filters are mutually exclusive and return the union of the resulting sets for each Plan
or Network
. I.e. if you provider Plan A and Plan B, you will receive Providers
who accept either Plan
. The same is true for Networks
. When passing plan_ids, you can also pass a plan_year
parameter to filter on the year that plan(s) is offered. If plan_year
is not provided, we will default the value to the current year. The plan identifiers filter supports Ideon plan IDs returned from the Medical and Dental endpoints, as well as, HIOS IDs and Medicare contract codes.
Request Examples
Find Dr. Foo near Brooklyn
{ "search_term": "Foo", "zip_code": "11215" }
Find all Providers within 5 miles of Brooklyn who accept a Plan
{ "zip_code": "11215", "radius": 5, "plan_ids": ["88582NY0230001"] }
Find all Pediatric Urologists within 25 miles of Las Vegas
{"search_term": "", "radius": 25, "type": "individual", "zip_code": "89113", "specialty_ids": ["3cf0e4165b"]}
Find all providers on a map of Brooklyn ordered by a combination of proximity to the center point of the map and relevance to the search term “ENT”
{
"polygon": [
{"lon":-74.0126609802,"lat":40.6275684851 },
{"lon":-74.0126609802,"lat":40.7097269508 },
{"lon":-73.9367866516,"lat":40.7097269508 },
{"lon":-73.9367866516,"lat":40.6275684851 }
],
"search_term" : "ENT"
}
Response Parameters
For a detailed look at the response fields, please navigate to the Provider Detail endpoint.
Providers ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Headers
Content-Type: application/json
Body
{
"provider": {
"city": "New York",
"doing_business_as_name": "Ideon",
"first_name": "John",
"gender": "F",
"id": 1234567890,
"last_name": "Smith",
"latitude": 45.55,
"longitude": 14.55,
"middle_name": "Danger",
"network_ids": [
200251
],
"networks": [
{
"addresses": [
{
"accepting_new_patients": true,
"city": "New York",
"external_id": "50c2d41e021f0eb5baaa6f134f15bd29",
"id": "589c907f-28c2-3d14-8916-1144a5191ba2",
"latitude": 45.55,
"longitude": 14.55,
"pcp": true,
"pcp_id": "123456",
"phone_numbers": [
"2122223333",
"9172223334"
],
"state": "NY",
"street_line_1": "123 Fake Street",
"street_line_2": "Apt 10",
"zip_code": "11215"
}
],
"carrier_name": "UnitedHealthcare",
"carriers": [
{
"id": "bae1d0e1-80dc-48f4-918d-6c492340cc1c",
"name": "UnitedHealthcare"
}
],
"group_affiliations": [
{
"name": "ATLANTICARE REGIONAL MEDICAL CENTER"
}
],
"hospital_affiliations": [
{
"name": "ATLANTICARE REGIONAL MEDICAL CENTER"
}
],
"id": 1,
"languages": [
{
"id": "a852ab0e-64cb-36ee-ab77-3b38e1cb6d8f",
"iso_639_2": "ase",
"iso_639_3": "ase",
"name": "American Sign Language"
}
],
"last_imported_at": "2022-09-01",
"name": "Open Choice",
"pcp": true,
"pcp_id": "123456",
"source": "carrier_direct",
"specialties": [
{
"id": "76a2744d4a",
"name": "Anesthesiology",
"sub_specialty": "Hospice and Palliative Medicine",
"taxonomy_code": "261QI0500X"
}
],
"tier": "Tier 2"
}
],
"npi_specialty": {
"id": "1a2b34c5d6",
"name": "Clinic/Center",
"sub_specialty": "Infusion Therapy",
"taxonomy_code": "261QI0500X"
},
"npis": [
1234567890
],
"organization_name": "Vericred Inc",
"phone": "2125558700",
"presentation_name": "Dr. John D. Smith Jr.",
"specialty": "Internal Medicine",
"state": "NY",
"state_id": 1,
"street_line_1": "123 Fake Street",
"street_line_2": "Apt 10",
"suffix": "Jr.",
"title": "Dr.",
"type": "organization",
"zip_code": "11215"
}
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"provider": {
"type": "object",
"properties": {
"city": {
"type": "string",
"description": "City name (e.g. Springfield)."
},
"doing_business_as_name": {
"type": "string",
"description": "name the provider may be doing business as for type: organization"
},
"first_name": {
"type": "string",
"description": "Given name for the provider."
},
"gender": {
"type": "string",
"description": "Provider's gender (M or F)"
},
"id": {
"type": "number",
"description": "National Provider Index (NPI) number"
},
"last_name": {
"type": "string",
"description": "Family name for the provider."
},
"latitude": {
"type": "number",
"description": "Latitude of provider"
},
"longitude": {
"type": "number",
"description": "Longitude of provider"
},
"middle_name": {
"type": "string",
"description": "Middle name for the provider."
},
"network_ids": {
"type": "array",
"description": "Array of network ids"
},
"networks": {
"type": "array",
"description": "Provider networks"
},
"npi_specialty": {
"type": "object",
"properties": {
"id": {
"type": "string",
"description": "Specialty id"
},
"name": {
"type": "string",
"description": "Specialty name"
},
"sub_specialty": {
"type": "string",
"description": "Specialty sub specialty"
},
"taxonomy_code": {
"type": "string",
"description": "CMS Healthcare Provider Taxonomy Code"
}
},
"description": "Specialty details"
},
"npis": {
"type": "array",
"description": "The National Provider Index (NPI) numbers associated with this provider."
},
"organization_name": {
"type": "string",
"description": "name for the providers of type: organization."
},
"phone": {
"type": "string",
"description": "Office phone for the provider"
},
"presentation_name": {
"type": "string",
"description": "Preferred name for display (e.g. Dr. Francis White may prefer Dr. Frank White)"
},
"specialty": {
"type": "string",
"description": "Name of the primary Specialty"
},
"state": {
"type": "string",
"description": "State code for the provider's address (e.g. NY)."
},
"state_id": {
"type": "number",
"description": "Foreign key to States"
},
"street_line_1": {
"type": "string",
"description": "First line of the provider's street address."
},
"street_line_2": {
"type": "string",
"description": "Second line of the provider's street address."
},
"suffix": {
"type": "string",
"description": "Suffix for the provider's name (e.g. Jr)"
},
"title": {
"type": "string",
"description": "Professional title for the provider (e.g. Dr)."
},
"type": {
"type": "string",
"description": "Type of NPI number (individual provider vs organization)."
},
"zip_code": {
"type": "string",
"description": "Postal code for the provider's address (e.g. 11215)"
}
},
"description": "The requested provider."
}
}
}
Show ProviderGET/providers/{npi}{?year,state}
Version History
v7
: The hios_ids
and network_ids
response keys have been deprecated in this version. The documentation for this endpoint references this latest available version.
v6
: Previous supported version.
Endpoint Description
Retrieve information on a provider by passing a specific NPI.
Response Parameters
Provider
Field | Type | Notes |
---|---|---|
id | integer |
The NPI of the Provider |
type | string |
The type of Provider: either individual or organization |
organization_name | string |
The name of the Organization, applicable for the organization type |
presentation_name | string |
The full name of the Provider |
doing_business_as_name | string |
The name the provider may be doing business as for the organization type |
first_name | string |
The first name of the Provider, applicable for the individual type |
middle_name | string |
The middle name of the Provider, applicable for the individual type |
last_name | string |
The last name of the Provider, applicable for the individual type |
title | string |
The title of the Provider, applicable for the individual type |
gender | string |
The gender of the Provider, applicable for the individual type |
street_line_1 | string |
The street address (line 1) of the Provider address from CMS’ NPI Registry |
street_line_2 | string |
The street address (line 2) of the Provider address from CMS’ NPI Registry |
city | string |
The city of the Provider address from CMS’ NPI Registry |
state | string |
The state of the Provider address from CMS’ NPI Registry |
zip_code | string |
The zip code of the Provider address from CMS’ NPI Registry |
latitude | float |
The latitude of the Provider address from CMS’ NPI Registry |
longitude | float |
The longitude of the Provider address from CMS’ NPI Registry |
specialty | string |
The primary specialty of the Provider from CMS’ NPI Registry |
phone | string |
The primary phone number of the Provider from CMS’ NPI Registry |
npis | list |
A list of NPIs that the provider is registered with, inclusive of the NPI in the id field |
hios_ids | list |
(deprecation pending) A list of plan identifiers where the Provider is in-network. Use Provider Plans for this function. |
network_ids | list |
(deprecation pending) A list of Ideon identifiers for Networks where the Provider is participating. Refer to networks going forward using Version 7 of the API. |
networks | list<Network> |
(Use Version 7) A list of Ideon Networks where the Provider is participating. See below for the Object schema |
Networks
Field | Type | Notes |
---|---|---|
id | integer |
A Ideon-generated ID of the network |
name | string |
The name of the network |
carrier_name | string |
The name of the Carrier for this network |
tier | string |
The network tier which the provider belongs for the Network, e.g. “Tier 1” |
accepting_new_patients | boolean |
Is the provider accepting new patients for the network? |
pcp | boolean |
Is this provider a Primary Care Physician? |
pcp_id | string |
The PCP ID if applicable for this provider for the Network |
specialties | list<Specialty> |
A list of Ideon Specialties where the Provider is participating. See below for the Object schema |
addresses | list<Address> |
A list of Ideon Addresses where the Provider is participating. See below for the Object schema |
languages | list<Language> |
A list of normalized languages that the provider speaks. See below for the Object schema |
group_affiliations | list<Affiliation> |
A list of group affiliations where the Provider is participating. See below for the Object schema |
hospital_affiliations | list<Affiliation> |
A list of hospital affiliations where the Provider is participating. See below for the Object schema |
Specialties
Field | Type | Notes |
---|---|---|
id | string |
A Ideon-generated ID of the Specialty |
name | string |
The name of the Specialty |
sub_specialty | string |
The name of the sub-specialty |
taxonomy_code | string |
CMS Healthcare Provider Taxonomy Code |
For a full list of specialties, please use our Specialties endpoint. This data can be cached for faster performance.
Addresses
Field | Type | Notes |
---|---|---|
id | string |
A Ideon-generated ID of the Address |
street_line_1 | string |
The street address (line 1) of the Provider address |
street_line_2 | string |
The street address (line 2) of the Provider address |
city | string |
The city of the Provider address |
state | string |
The state of the Provider address |
zip_code | string |
The zip code of the Provider address |
latitude | float |
The latitude of the Provider address |
longitude | float |
The longitude of the Provider address |
phone_numbers | list |
The phone numbers associated with the Provider address |
external_id | string |
The identifier used by the Carrier for the Provider address |
pcp | boolean |
Is this provider a Primary Care Physician at the Provider address? |
pcp_id | string |
The PCP ID if applicable for this provider for the Network at the Provider address |
Languages
Field | Type | Notes |
---|---|---|
id | string |
A Ideon-generated ID of the language |
iso_639_2 | string |
The ISO 639_2 code for the language. For more information visit here |
iso_639_3 | string |
The ISO 639_3 code for the language. For more information visit here |
name | string |
The name of the language |
Affiliations
Field | Type | Notes |
---|---|---|
name | string |
The name of the affiliation for the Provider |
URI Parameters
- npi
string
(required) Example: 1234567890NPI number
- year
string
(optional) Example: 2016Only show plan ids for the given year
- state
string
(optional) Example: NYOnly show plan ids for the given state
Providers ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Headers
Content-Type: application/json
Body
{
"meta": {
"total": 1
},
"plans": [
{
"carrier": {
"id": "bae1d0e1-80dc-48f4-918d-6c492340cc1c",
"issuer_id": "A0027",
"logo_url": "https://d1hm12jr612u3r.cloudfront.net/images/carriers/174/1438891372/thumb.png?1438891372",
"name": "Guardian"
},
"carrier_name": "Aetna",
"external_ids": [
{
"type": "contract_id",
"value": "abc123"
}
],
"id": "88582NY0230001",
"line_of_coverage": "medical",
"market": "small_group",
"name": "Aetna PPO 20/5000",
"networks": [
{
"name": "Open Choice",
"tier": "Tier 1"
}
]
}
]
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"meta": {
"type": "object",
"properties": {
"total": {
"type": "number",
"description": "Number of entities returned"
}
},
"description": "Meta-data"
},
"plans": {
"type": "array",
"description": "Provider plan search results"
}
}
}
Provider Plan SearchGET/providers/{npi}/plans{?line_of_coverage,year,market}
Version History
v7
: The documentation for this endpoint references this latest available version.
Endpoint Description
Retrieve the plans a provider accepts by specifying the provider NPI.
Response Parameters
External Id Types
Plan external_ids
are returned as a list, with each item containing
both a type
and a value
. Below is a list of possible types:
Type | Description |
---|---|
hios_id | The HIOS ID of the plan. This type will be returned for under-65 ACA medical plans. |
contract_id | A contract identifier for the plan. This will be returned for all Medicare Advantage plans and any other plan that contains external contract ids. |
package_code | A package code for the plan. This value will be returned if there is a package in which the plan is bundled. |
URI Parameters
- npi
string
(required) Example: 1234567890NPI number
- line_of_coverage
string
(required) Example: medicalThe line of coverage the plans are in. Options are
medical
,medicare_advantage
,dental
, orvision
.- year
string
(required) Example: 2019The year the plans are effective in.
- market
string
(optional) Example: small_groupThe market the plans are for. Options are
individual
,small_group
,large_group
.
Specialties ¶
Specialties ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Headers
Content-Type: application/json
Body
{
"meta": {
"total": 1
},
"specialties": [
{
"category": "Allopathic & Osteopathic Physicians",
"code": "207LC0200X",
"id": "76a2744d4a",
"name": "Anesthesiology",
"sub_specialty": "Hospice and Palliative Medicine"
}
]
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"meta": {
"type": "object",
"properties": {
"total": {
"type": "number",
"description": "Number of entities returned"
}
},
"description": "Meta-data"
},
"specialties": {
"type": "array",
"description": "Specialties"
}
}
}
Specialty SearchGET/specialties{?search_term,code,page,per_page}
Version History
v6
: The documentation for this endpoint references this latest available version.
Endpoint Description
Use this endpoint to find provider specialties. These specialties can be used to filter providers in the Provider Search.
URI Parameters
- search_term
string
(optional) Example: AnesthesiologyFull or partial name of a specialty or subspecialty
- code
string
(optional) Example: 207LC0200XCMS Healthcare Provider Taxonomy Code
- page
number
(optional) Example: 1Page of paginated response
- per_page
number
(optional) Example: 1Responses per page
Drugs ¶
Drugs ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Headers
Content-Type: application/json
Body
{
"drug_packages": [
{
"active_ingredient_strength": "10mg",
"description": "Zyrtec 10 mg tablet",
"id": "52959-0482-01",
"non_proprietary_name": "Zyrtec",
"proprietary_name": "Zyrtec"
}
],
"id": "a9f4a8f8ccbd42be",
"med_id": 1,
"name": "Zyrtec 10 mg tablet",
"rx_cui_id": "1014678"
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"drug_packages": {
"type": "array",
"description": "Drug packages"
},
"id": {
"type": "string",
"description": "Primary key"
},
"med_id": {
"type": "number",
"description": "Foreign key to Meds (can be nil)"
},
"name": {
"type": "string",
"description": "The name of the Drug"
},
"rx_cui_id": {
"type": "string",
"description": "Foreign key to Rx-Norm"
}
}
}
Drug SearchGET/drugs{?search_term,rx_cui,require_formulary}
Version History
v7
: Drug packages are returned within each drug object. The documentation for this endpoint references this latest available version.
v6
: Previous supported version.
Endpoint Description
Search for drugs by proprietary name or RxCUI.
This endpoint requires input of either search_term
or rx_cui
.
URI Parameters
- search_term
string
(optional) Example: ZyrtecFull or partial proprietary name of drug
- rx_cui
string
(optional) Example: 1010234Foreign key to Rx-Norm
- require_formulary
boolean
(optional) Example: trueOnly display drugs that are in formularies
Drugs ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Headers
Content-Type: application/json
Body
{
"coverages": [
{
"drug_package_id": "01002-1200-11",
"plan_id": "88582NY0230001",
"prior_authorization": true,
"quantity_limit": true,
"step_therapy": true,
"tier": "generic"
}
],
"meta": {
"total": 1
}
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"coverages": {
"type": "array",
"description": "Drug coverage search results"
},
"meta": {
"type": "object",
"properties": {
"total": {
"type": "number",
"description": "Number of entities returned"
}
},
"description": "Meta-data"
}
}
}
Drug Coverage SearchGET/drugs/{id}/coverages{?year,line_of_coverage,state_code,market}
Version History
v7
: The tier generic is deprecated. All covered generic drugs will either have the preferred_generic or non_preferred_generic tier. The documentation for this endpoint references this latest available version.
v6
: Previous supported version.
Endpoint Description
Drug coverages are the specific tier level, quantity limit, prior authorization and step therapy for a given Drug/Plan combination. This endpoint returns all drug coverages for a given Drug.
Response Parameters
Tiers
Tier | Description |
---|---|
preferred_generic | Unbranded drugs, with the same active ingredients as their brand-name equivalents. The preferred tier typically comes with lower cost shares than generic tier drugs. |
non_preferred_generic | All other covered generic drugs with the highest generic copayment. |
generic* | Unbranded drugs, with the same active ingredients as their brand-name equivalents, and generally available at a lower cost than brand-name equivalents. |
preferred_brand | Brand-name drugs included within a preferred tier on the health plan’s formulary. Generally more expensive than generics, and less expensive than non-preferred drugs. |
non_preferred_brand | Brand-name drugs included within a non-preferred tier on the health plan’s formulary. These generally have higher cost shares. |
specialty | Specialty drugs used to treat complex health conditions and and included within a preferred tier on the health plan’s formulary. May require special handling or monitoring. Generally less expensive than other specialty drugs. |
non_preferred_specialty | Specialty drugs used to treat complex health conditions and included within a non-preferred tier on the health plan’s formulary. May require special handling or monitoring. Generally have higher cost shares. |
not_covered | Specifically excluded from the health plan. |
not_listed | Neither included nor excluded from the health plan. Most plans provide some default level of coverage for unlisted drugs. |
URI Parameters
- id
string
(required) Example: bb1f3523f0ID of the Drug
- year
string
(required) Example: 2019Plan Year
- line_of_coverage
string
(required) Example: medicalLine of coverage (medical or medicare_advantage)
- state_code
string
(required) Example: CATwo-character state code
- market
string
(optional) Example: individualPlan Market (individual or small_group)
Formularies ¶
Formularies ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Headers
Content-Type: application/json
Body
{
"formularies": [
{
"id": 123,
"name": "Aetna 3 Tier"
}
],
"meta": {
"total": 1
}
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"formularies": {
"type": "array",
"description": "List of formularies."
},
"meta": {
"type": "object",
"properties": {
"total": {
"type": "number",
"description": "Number of entities returned"
}
},
"description": "Meta-data"
}
}
}
Formulary SearchGET/formularies{?search_term,rx_bin,rx_group,rx_pcn}
Version History
v6
: The documentation for this endpoint references this latest available version.
Endpoint Description
Search for drug formularies by search term string or other identifiers.
URI Parameters
- search_term
string
(optional) Example: HIX PPOFull or partial name of the formulary
- rx_bin
string
(optional) Example: 123456RX BIN Number (found on an insurance card)
- rx_group
string
(optional) Example: HEALTHRX Group String (found on an insurance card)
- rx_pcn
string
(optional) Example: 9999RX PCN Number (found on an insurance card)
Formularies ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Headers
Content-Type: application/json
Body
{
"coverage": {
"drug_package_id": "01002-1200-11",
"plan_id": "88582NY0230001",
"prior_authorization": true,
"quantity_limit": true,
"step_therapy": true,
"tier": "generic"
},
"drug_package": {
"description": "Claritin 24 hour 100 ct.",
"id": "07777-3105-01",
"med_id": 1,
"rx_cui_id": "83629828"
},
"formulary": {
"id": 123,
"name": "Aetna 3 Tier"
}
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"coverage": {
"type": "object",
"properties": {
"drug_package_id": {
"type": "string",
"description": "User provided Drug Package Identifier"
},
"plan_id": {
"type": "string",
"description": "Plan Identifier"
},
"prior_authorization": {
"type": "boolean",
"description": "Prior authorization required"
},
"quantity_limit": {
"type": "boolean",
"description": "Quantity limit exists"
},
"step_therapy": {
"type": "boolean",
"description": "Step Treatment required"
},
"tier": {
"type": "string",
"description": "Tier Name"
}
},
"description": "DrugCoverage"
},
"drug_package": {
"type": "object",
"properties": {
"description": {
"type": "string",
"description": "Package description"
},
"id": {
"type": "string",
"description": "National Drug Code ID (Package)"
},
"med_id": {
"type": "number",
"description": "Med ID"
},
"rx_cui_id": {
"type": "string",
"description": "Rx CUI ID"
}
},
"description": "DrugPackage"
},
"formulary": {
"type": "object",
"properties": {
"id": {
"type": "number",
"description": "Primary key"
},
"name": {
"type": "string",
"description": "Name of the Formulary"
}
},
"description": "Formulary"
}
}
}
Formulary Drug Package SearchGET/formularies/{formulary_id}/drug_packages/{ndc_package_code}
Version History
v7
: The tier generic is deprecated. All covered generic drugs will either have the preferred_generic or non_preferred_generic tier. The documentation for this endpoint references this latest available version.
v6
: Previous supported version.
Endpoint Description
Search for drug coverages by Formulary and Drug Package ID.
Response Parameters
Tiers
Tier | Description |
---|---|
preferred_generic | Unbranded drugs, with the same active ingredients as their brand-name equivalents. The preferred tier typically comes with lower cost shares than generic tier drugs. |
non_preferred_generic | All other covered generic drugs with the highest generic copayment. |
generic* | Unbranded drugs, with the same active ingredients as their brand-name equivalents, and generally available at a lower cost than brand-name equivalents. |
preferred_brand | Brand-name drugs included within a preferred tier on the health plan’s formulary. Generally more expensive than generics, and less expensive than non-preferred drugs. |
non_preferred_brand | Brand-name drugs included within a non-preferred tier on the health plan’s formulary. These generally have higher cost shares. |
specialty | Specialty drugs used to treat complex health conditions and and included within a preferred tier on the health plan’s formulary. May require special handling or monitoring. Generally less expensive than other specialty drugs. |
non_preferred_specialty | Specialty drugs used to treat complex health conditions and included within a non-preferred tier on the health plan’s formulary. May require special handling or monitoring. Generally have higher cost shares. |
not_covered | Specifically excluded from the health plan. |
not_listed | Neither included nor excluded from the health plan. Most plans provide some default level of coverage for unlisted drugs. |
URI Parameters
- formulary_id
string
(required) Example: 123ID of the Formulary in question
- ndc_package_code
string
(required) Example: 01002-1200-11ID of the DrugPackage in question
ZipCounties ¶
ZipCounties ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Headers
Content-Type: application/json
Body
{
"counties": [
{
"fips_code": "33025",
"id": 1,
"name": "Bergen County",
"state_code": "NJ",
"state_id": 123,
"state_live": true,
"state_live_for_business": false
}
],
"states": [
{
"code": "NY",
"fips_number": "36",
"id": 37,
"last_date_for_individual": "2019-12-31",
"last_date_for_shop": "2019-12-31",
"live_for_business": true,
"live_for_consumers": true,
"name": "New York"
}
],
"zip_codes": [
{
"code": "11385",
"id": 1
}
],
"zip_counties": [
{
"county_id": 5,
"id": 1,
"zip_code_id": 4
}
]
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"counties": {
"type": "array",
"description": "Counties that exist in the provided zip prefix."
},
"states": {
"type": "array",
"description": "States that exist in the provided zip prefix."
},
"zip_codes": {
"type": "array",
"description": "ZipCodes that exist in the provided zip prefix."
},
"zip_counties": {
"type": "array",
"description": "ZipCounties that exist in the provided zip prefix."
}
}
}
Search for Zip CountiesGET/zip_counties{?zip_prefix}
Version History
v6
: The documentation for this endpoint references this latest available version.
Endpoint Description
Our Plan
endpoints require a zip code and a fips (county) code. This
is because plan pricing requires both of these elements. Users are unlikely
to know their fips code, so we provide this endpoint to look up a ZipCounty
by zip code and return both the selected zip and fips codes.
URI Parameters
- zip_prefix
string
(required) Example: 1002Partial five-digit Zip
ZipCounties ¶
Headers
Content-Type: application/json
Vericred-Api-Key: api-doc-key
Headers
Content-Type: application/json
Body
{
"counties": [
{
"fips_code": "33025",
"id": 1,
"name": "Bergen County",
"state_code": "NJ",
"state_id": 123,
"state_live": true,
"state_live_for_business": false
}
],
"states": [
{
"code": "NY",
"fips_number": "36",
"id": 37,
"last_date_for_individual": "2019-12-31",
"last_date_for_shop": "2019-12-31",
"live_for_business": true,
"live_for_consumers": true,
"name": "New York"
}
],
"zip_codes": [
{
"code": "11385",
"id": 1
}
],
"zip_county": {
"county_id": 5,
"id": 1,
"zip_code_id": 4
}
}
Schema
{
"$schema": "http://json-schema.org/draft-04/schema#",
"type": "object",
"properties": {
"counties": {
"type": "array",
"description": "Counties that exist in the provided zip prefix."
},
"states": {
"type": "array",
"description": "States that exist in the provided zip prefix."
},
"zip_codes": {
"type": "array",
"description": "ZipCodes that exist in the provided zip prefix."
},
"zip_county": {
"type": "object",
"properties": {
"county_id": {
"type": "number",
"description": "ID of the parent County in Vericred's API"
},
"id": {
"type": "number",
"description": "Primary key"
},
"zip_code_id": {
"type": "number",
"description": "ID of the parent Zip Code in Vericred's API"
}
},
"description": "ZipCounty data"
}
}
}
Show an Individual Zip CountyGET/zip_counties/{id}
Version History
v6
: The documentation for this endpoint references this latest available version.
Endpoint Description
Our Plan
endpoints require a zip code and a fips (county) code. This
is because plan pricing requires both of these elements. Users are unlikely
to know their fips code, so we provide this endpoint to returns the details
for a ZipCounty
by zip code and return both the selected zip and fips codes.
URI Parameters
- id
number
(required) Example: 12345Unique ID for ZipCounty
Bulk Plan and Rate Data ¶
Ideon’s bulk plan data allows you to bring full sets of plan data into your database. The flat files we provide allow you to calculate availability and pricing for any plan as well as view the details of the plan.
Location
Bulk plan data is sold by market (individual or small group), state, and time period. The time period for individual plans is 1 year and the time period for small group plans is 1 quarter.
Ideon will provide you a key and secret for AWS S3, where the files are stored.
s3://vericred-emr-workers/production/plans/USERNAME/ADAPTER/individual/STATE/YEAR/*.json
s3://vericred-emr-workers/production/plans/USERNAME/ADAPTER/small_group/STATE/YEAR/QUARTER/*.json
e.g. s3://vericred-emr-workers/production/plans/vericred_customer/csv/small_group/NY/2017/Q4/*.json
Your USERNAME will be provided when we provision your key
Adapters
We generate files as single lines of JSON and as CSV. Certain customers also have a custom ETL, in which case their ETL name will be the adapter name.
Fields and Relationships
Whenever possible we use globally unique keys as ids in our export format. For example, a county_id
is actually its fips_code
. A state_id
is actually the state_code
(e.g. NY). And a zip_code_id
is the zip code itself. When the field is a primary key for the resource in the file it is called id
and when it is a foreign key to another resource, it is called RESOURCE_NAME_id
(e.g. in the counties.csv
file the id
is the fips_code
, while in the plan_counties.csv
file the foreign key to counties is called county_id
.
Handling Deletions of Plans
When plans are deleted, they and their pricings, are removed from the files that are exported nightly. To help manage the deletion process, we publish a list of deleted plans for each year. The list can be found at s3://vericred-emr-workers/production/plans/deleted_plans/YEAR_deleted_plans.csv
. The list is for all states and includes just the id
of the Plan, year, and datetime at which the plan was deleted.
Bulk Plans
Major Medical Plans are available in bulk format. The file generated contains the same Benefits Fields in the same format as is returned from the API. The relevant file is updated as changes are made to the underlying data set and is named plans.{csv,json}
.
Note that Dental and Vision Plams are not available in bulk.
Bulk Rates
Major Medical Rates are available in bulk format. The file generated contains the Sheet Rates for each Plan in each Rating Area over a period. The period covered in a given file set will either be a Quarter (for Small Group) or a Year (for Individual). However, the Rates contained in the file may be active for all or part of the period, as designated by their effective_date
and expiration_date
There is one Rate for each age (0-65) and one Rate for tobacco users for each age (0-65). A given Plan often has many Rates for a given period because it may be available in many Rating Areas
Note that Dental and Vision Plams are not available in bulk.
Bulk Service Areas
We denote Service Areas for each Carrier in two files: service_areas.{csv,json}
, which contains meta-data about the Service Area like its name
, and service_area_zip_counties.{csv,json}
, which contains the actual definition of the Service Area. Each record in the plans.{csv,json}
file has a service_area_id
that corresponds to a record in the service_areas.{csv,json}
file.
Counties ¶
CountiesGET/s3-prefix/counties.{csv,json}
The counties file is a list of the counties in the given state.
{
"id": "09001",
"name": "Fairfield County",
"state_id": "CT"
}
Field | Type | Description |
---|---|---|
id | String | Fips code for the County |
name | String | Human-readable name for the County |
state_id | String | Foreign key to the state – the state code |
Issuers ¶
IssuersGET/s3-prefix/issuers.{csv,json}
All valid issuers for the given state
{
"id": "73836",
"name": "Moda Health",
"state_id": "AK"
}
Field | Type | Description |
---|---|---|
id | String | Hios Issuer ID for this Issuer |
name | String | Name of the Issuer |
state_id | String | Foreign key to the state – the state code |
PlanCounties ¶
PlanCountiesGET/s3-prefix/plan_counties.{csv,json}
Relationships between plans and counties. These define "service areas” or areas in which a given plan is offered. Each plan in the plans file will have one or more rows in this file.
{
"id": 1,
"plan_id": "84982AK0080001",
"county_id": "02016"
}
Field | Type | Description |
---|---|---|
id | String | Primary key for this resource (internal Ideon ID) |
name | String | HIOS id foreign key for a plan |
state_id | String | Fips code foreign key for a county |
Plans ¶
PlansGET/s3-prefix/plans.{csv,json}
(See Benefits summary format above.)
{
"abortion_rider": false,
"actively_marketed": true,
"actuarial_value": 61.7,
"adult_dental": false,
"age29_rider": false,
"ambulance": "In-Network: $0 after deductible / Out-of-Network: $0 after deductible",
"benefits_summary_url": "https://ideonapi.com/wp-content/uploads/2016/09/Ideon_final-copy.pdf",
"buy_link": null,
"carrier_disclaimers": "Employees must work at least 30 hours per week to qualify.",
"carrier_name": "Sample Insurance",
"child_dental": "In-Network: $0 after deductible / Out-of-Network: 20% after deductible",
"child_eye_exam": "In-Network: $0 / Out-of-Network: 20% after deductible | limit: 1 exam(s) per year",
"child_eyewear": "In-Network: $0 after deductible / Out-of-Network: 20% after deductible | limit: 1 item(s) per year",
"chiropractic_services": true,
"coinsurance": 0,
"covered_ages": "allows adult and child-only",
"customer_service_phone_number": null,
"diagnostic_test": "In-Network: $0 after deductible / Out-of-Network: 20% after deductible",
"display_name": "Sample Bronze Plan",
"dp_rider": false,
"drug_formulary_url": "https://ideonapi.com/wp-content/uploads/2016/09/Ideon_final-copy.pdf",
"durable_medical_equipment": "In-Network: $0 after deductible / Out-of-Network: 20% after deductible",
"effective_date": "2019-01-01",
"embedded_deductible": "embedded",
"emergency_room": "In-Network: $0 after deductible / Out-of-Network: $0 after deductible",
"essential_health_benefits_percentage": 100,
"expiration_date": "2019-12-31",
"family_drug_deductible": "In-Network: $550 per person / Out-of-Network: $1,650 per person",
"family_drug_moop": "In-Network: $550 per person / Out-of-Network: $1,650 per person",
"family_medical_deductible": "In-Network: $13,100 / Out-of-Network: $39,300",
"family_medical_moop": "In-Network: $13,100 / Out-of-Network: $47,400",
"formulary_name": "AultCare MarketPlace HIX OH",
"fp_rider": false,
"gated": false,
"generic_drugs": "In-Network: $0 after deductible / Out-of-Network: $0 after deductible",
"habilitation_services": "In-Network: $0 after deductible / Out-of-Network: 20% after deductible",
"hios_issuer_id": 12345,
"home_health_care": "In-Network: $0 after deductible / Out-of-Network: 20% after deductible | limit: 100 visit(s) per year",
"hospice_service": "In-Network: $0 after deductible / Out-of-Network: 20% after deductible",
"hsa_eligible": true,
"id": "12345OH0090062",
"imaging": "In-Network: $0 after deductible / Out-of-Network: 20% after deductible",
"imaging_center": "In-Network: $0 after deductible / Out-of-Network: 20% after deductible",
"imaging_physician": "In-Network: $10 plus 20% after deductible / Out-of-Network: 20% after deductible",
"individual_drug_deductible": "In-Network: $550 / Out-of-Network: $1,650",
"individual_drug_moop": "In-Network: $550 / Out-of-Network: $1,650",
"individual_medical_deductible": "In-Network: $6,550 / Out-of-Network: $19,650",
"individual_medical_moop": "In-Network: $6,550 / Out-of-Network: $23,700",
"infertility_rider": true,
"inpatient_birth": "In-Network: $0 after deductible / Out-of-Network: 20% after deductible",
"inpatient_birth_physician": "In-Network: $0 after deductible / Out-of-Network: 20% after deductible",
"inpatient_facility": "In-Network: $0 after deductible / Out-of-Network: 20% after deductible",
"inpatient_mental_health": "In-Network: $0 after deductible / Out-of-Network: 20% after deductible",
"inpatient_physician": "In-Network: $0 after deductible / Out-of-Network: 20% after deductible",
"inpatient_substance": "In-Network: $0 after deductible / Out-of-Network: 20% after deductible",
"issuer_plan_code": "",
"key_benefits_complete": true,
"lab_test": "In-Network: $0 after deductible / Out-of-Network: 20% after deductible",
"level": "bronze",
"logo_url": "https://ideonapi.com/wp-content/uploads/2016/09/Ideon_final-copy.pdf",
"mail_order_rx": 1,
"name": "Sample Bronze Plan",
"network_name": "PPO",
"network_size": 1000,
"non_preferred_brand_drugs": "In-Network: $0 after deductible / Out-of-Network: $0 after deductible",
"nonpreferred_generic_drug_share": "In-Network: Not Applicable / Out-of-Network: Not Applicable",
"nonpreferred_specialty_drug_share": "In-Network: Not Applicable / Out-of-Network: Not Applicable",
"off_market": true,
"on_market": true,
"out_of_network_coverage": true,
"outpatient_ambulatory_care_center": "In-Network: $0 after deductible / Out-of-Network: 20% after deductible",
"outpatient_facility": "In-Network: $0 after deductible / Out-of-Network: 20% after deductible",
"outpatient_mental_health": "In-Network: $0 after deductible / Out-of-Network: 20% after deductible",
"outpatient_physician": "In-Network: $0 after deductible / Out-of-Network: 20% after deductible",
"outpatient_substance": "In-Network: $0 after deductible / Out-of-Network: 20% after deductible",
"package_codes": "",
"plan_ancestry": [
{
"id": "12345OH0090062",
"year": "2018"
}
],
"plan_calendar": "plan_year",
"plan_coinsurance": "In-Network: 0% / Out-of-Network: 0%",
"plan_market": "both_markets",
"plan_type": "PPO",
"postnatal_care": "In-Network: $0 after deductible / Out-of-Network: 20% after deductible",
"preferred_brand_drugs": "In-Network: $0 after deductible / Out-of-Network: $0 after deductible",
"prenatal_care": "In-Network: $0 after deductible / Out-of-Network: 20% after deductible",
"prenatal_postnatal_care": "In-Network: $0 after deductible / Out-of-Network: 20% after deductible",
"preventative_care": "In-Network: $0 / Out-of-Network: 20% after deductible",
"primary_care_physician": "In-Network: $0 after deductible / Out-of-Network: 20% after deductible",
"rehabilitation_services": "In-Network: $0 after deductible / Out-of-Network: 20% after deductible | limit: 40 visit(s) per year",
"sbc_name": "Bronze 6550",
"service_area_id": "12345-2019-OHS002",
"skilled_nursing": "In-Network: $0 after deductible / Out-of-Network: 20% after deductible | limit: 90 day(s) per year",
"skilled_nursing_facility_365": "unknown",
"source": "carrier",
"specialist": "In-Network: $0 after deductible / Out-of-Network: 20% after deductible",
"specialty_drugs": "In-Network: Not Applicable / Out-of-Network: Not Applicable",
"telemedicine": true,
"type": "ACAPlan2018",
"updated_at": "2019-05-21",
"urgent_care": "In-Network: $0 after deductible / Out-of-Network: $0 after deductible"
}
Note: All cost share values are from the perspective of the patient.
Field | Type | Examples | Description |
---|---|---|---|
abortion_rider | Boolean | true, false | Does the plan provide a degree of coverage for abortions when there is no public funding? |
actuarial_value | Decimal | 0.0 to 100.0 | (New in 2018) The total average cost for covered benefits that a plan will cover. |
adult_dental | Boolean | true, false | Does this plan offer adult dental coverage? |
age29_rider | Boolean | true, false | True if dependents up to age 29 are allowed |
ambulance | Benefit | Description of the benefit for ambulance services - this is called “Emergency medical transportion” on an SBC | |
benefits_summary_url | URL | Link to Ideon’s hosted version of the Plan’s SBC | |
buy_link | URL | Link to the appropriate government marketplace where the user can buy this plan | |
carrier_disclaimers | String | Any disclaimers received from the carrier. | |
carrier_name | String | Name of Carrier who offers this Plan | |
child_dental | Benefit | Description of the benefit for child dental services - this is called “Dental check-up” on an SBC | |
child_eye_exam | Benefit | Description of the benefit for child eye exam - this is called “Eye exam” on an SBC | |
child_eyewear | Benefit | Description of the benefit for child eyewear - this is called “Glasses” on an SBC | |
chiropractic_services | Boolean | true, false | Does the plan provide a degree of coverage for chiropractic services? |
customer_service_phone_number | String | The customer service phone number for the Carrier where available | |
coinsurance | Decimal | 0.0 to 100.0 | Percentage, between 0.0 and 100.0. The standard cost share for substantially all benefits |
diagnostic_test | Benefit | Description of the benefit for diagnostic tests - this is called “Diagnostic test (x-ray, blood work)” on an SBC | |
dp_rider | Boolean | true, false | True if plan does not cover domestic partnerships |
drug_formulary_url | URL | URL for details on the drug formulary where available | |
durable_medical_equipment | Benefit | Description of the benefit for durable medical equipment - this is called “Durable medical equipment” on an SBC | |
effective_date | String | 2019-01-01 | The first date for which this Plan is valid |
embedded_deductible | Enumerated | embedded, non_embedded, or unknown | Insurance starts paying once an individual meets their deductible (embedded) versus paying once the family meets its deductible (non-embedded). |
emergency_room | Benefit | Description of the benefit for emergency room visits - this is called “Emergency room services” on an SBC | |
expiration_date | String | 2019-12-31 | The last date for which this Plan is valid |
family_drug_deductible | Benefit | Details on the drug deductible for a family - if it is included in the medical deductible, that is noted here | |
family_drug_moop | Benefit | Details on the drug maximum out-of-pocket for a family - if it is included in the medical maximum-out-of-pocket, that is noted here | |
family_medical_deductible | Benefit | Details on the medical deductible for a family | |
family_medical_moop | Benefit | Details on the medical maximum-out-of-pocket for a family | |
formulary_name | String | Human-readable name of the Plan’s Formulary | |
fp_rider | Boolean | true, false | True if plan does not cover family planning |
gated | Boolean | true, false | Gated plans require primary care physician referral while non-gated plans do not. HMOs and POS plans are gated by default, while EPOs and PPOs are typically non-gated. |
generic_drugs | Benefit | Description of the benefit for generic drugs - this is called “Generic drugs” on an SBC | |
habilitation_services | Benefit | Description of the benefit for habilitation services - this is called “Habilitation services” on an SBC | |
hios_issuer_id | String | HIOS issuer ID for the Carrier who offers this plan - foreign key to Issuers | |
home_health_care | Benefit | Description of the benefit for home health care - this is called “Home health care” on an SBC | |
hospice_service | Benefit | Description of the benefit for hospice service - this is called “Hospice service” on an SBC | |
id | String | HIOS ID for the Plan | |
imaging | Benefit | Description of the benefit for imaging - this is called “Imaging (CT/PET scans, MRIs)” on an SBC | |
imaging_center | Benefit | Description of the benefit for imaging performed in a hospital or other health center | |
imaging_physician | Benefit | Description of the benefit for imaging performed at the physician | |
individual_drug_deductible | Benefit | Details on the drug deductible for an individual - if it is included in the medical deductible, that is noted here | |
individual_drug_moop | Benefit | Details on the drug maximum out-of-pocket for an individual - if it is included in the medical maximum-out-of-pocket, that is noted here | |
individual_medical_deductible | Benefit | Details on the medical deductible for an individual | |
individual_medical_moop | Benefit | Details on the medical maximum-out-of-pocket for an individual | |
infertility_rider | Boolean | true, false | Does the plan provide a degree of coverage for infertility care? |
inpatient_birth | Benefit | Description of the benefit for inpatient birth - this is called “Delivery and all inpatient services” on an SBC | |
inpatient_birth_physician | Benefit | Description of the benefit for inpatient birth physician - this is called “Delivery and all inpatient services” on an SBC | |
inpatient_facility | Benefit | Description of the benefit for inpatient facility fees - this is called “Facility fee (e.g., ambulatory surgery center)” under “If you have a hospital stay” on an SBC | |
inpatient_mental_health | Benefit | Description of the benefit for inpatient mental health - this is called “Mental/Behavioral health inpatient services” on an SBC | |
inpatient_physician | Benefit | Description of the benefit for inpatient physician fees - this is called “Physician/surgeon fees” under “If you have a hospital stay” on an SBC | |
inpatient_substance | Benefit | Description of the benefit for inpatient substance use treatment - this is called “Substance use disorder inpatient services” on an SBC | |
issuer_plan_code | String | Plan code provided by the issuer | |
key_benefits_complete | Boolean | true, false | Indicates whether the plan has meaningful descriptions for these benefits: individual_medical_deductible, family_medical_deductible, individual_medical_moop, family_medical_moop, primary_care_physician. |
lab_test | Benefit | (New in 2018) Description of the benefit for lab tests | |
level | String | catastrophic, bronze, expanded_bronze, silver, gold, platinum | Metal level of the Plan |
logo_url | URL | Link to Ideon’s copy of the Carrier’s logo | |
mail_order_rx | Decimal | 1.5 | Multiple of standard Rx cost share tiers for prescriptions filled through mail order. 1.5 would indicate mail-order prescriptions would be covered at 150% the normal rate. |
name | String | Marketing name of the Plan | |
network_size | Number | Size of the network for this Plan | |
non_preferred_brand_drugs | Benefit | Description of the benefit for non-preferred brand drugs - this is called “Category 2 Formulary Brand drugs” on an SBC | |
off_market | Boolean | true, false | Is this Plan available off of the public marketplace? |
on_market | Boolean | true, false | Is this Plan available on the public marketplace? |
out_of_network_coverage | Boolean | true, false | Does this Plan offer out-of-network benefits? |
outpatient_ambulatory_care_center | Benefit | (New in 2018) Description of the benefit for outpatient ambulatory care | |
outpatient_facility | Benefit | Description of the benefit for outpatient facility fees - this is called “Facility fee (e.g., ambulatory surgery center)” under “If you have outpatient surgery” on an SBC | |
outpatient_mental_health | Benefit | Description of the benefit for outpatient mental health - this is called “Mental/Behavioral health outpatient services” on an SBC | |
outpatient_physician | Benefit | Description of the benefit for outpatientt physician fees - this is called “Physician/surgeon fees” under “If you have outpatient surgery” on an SBC | |
outpatient_substance | Benefit | Description of the benefit for outpatient substance use treatment - this is called “Substance use disorder outpatient services” on an SBC | |
package_codes | String | NY-CORE-1|NY-CORE-2 | Pipe-delimited list of specific plan groups that are sold by certain carriers. |
plan_ancestry | Object | The plan identifiers and years indicating the previous plans that this plan replaces. | |
plan_calendar | Enumerated | plan_year, calendar_year, or unknown | (New in 2018) Describes whether or not accumulations of cost sharing towards deductibles and MOOPs resets with the calendar year or the plan year. |
plan_coinsurance | Benefit | Description of the standard cost share for substantially all benefits. | |
plan_market | Enumerated | individual, small_group | What markets is this plan available for (individual, small_group or both_markets) |
plan_type | String | Is this Plan an HMO, PPO, etc | |
preferred_brand_drugs | Benefit | Description of the benefit for preferred brand drugs - this is called “Category 1 Formulary Brand drugs” on an SBC | |
prenatal_care | Benefit | (New in 2018) Description of the benefit for prenatal care - this is called “Prenatal care” on an SBC | |
postnatal_care | Benefit | (New in 2018) Description of the benefit for postnatal care - this is called “Postnatal care” on an SBC | |
prenatal_postnatal_care | Benefit | Description of the benefit for prenatal and postnatal care combined - this is called “Prenatal and postnatal care” on an SBC | |
preventative_care | Benefit | Description of the benefit for preventative care - this is called “Preventive care/ screening/immunization” on an SBC | |
primary_care_physician | Benefit | Description of the benefit for the customer’s PCP - this is called “Primary care visit to treat an injury or illness” on an SBC | |
rehabilitation_services | Benefit | Description of the benefit for rehabilitation services - this is called “Rehabilitation services” on an SBC | |
skilled_nursing | Benefit | Description of the benefit for skilled nursing services - this is called “Skilled nursing care” on an SBC | |
skilled_nursing_facility_365 | Enumerated | unlimited or unknown | (New in 2018) Value showing the variations for unlimited skilled nursing facility days. (Applies to New York plans only) |
specialist | Benefit | Description of the benefit for seeing a specialist - this is called “Specialist visit” on an SBC | |
specialty_drugs | Benefit | Description of the benefit for specialty drugs - this is called “Specialty drugs” on an SBC | |
telemedicine | Boolean | Does the plan provide a degree of coverage for telemedicine services? | |
updated_at | String | 2019-12-31 | The last date for which this Plan was updated. |
urgent_care | Benefit | Description of the benefit for urgent care - this is called “Urgent care” on an SBC |
Pricings ¶
PricingsGET/s3-prefix/pricings.{csv,json}
Pricing data for each Rating Area/Age/Plan combination. Ideon supplies one row per combination in age-banded states (i.e. ages 0-64 for each Plan in each relevant Rating Area). In community rated states, Ideon supplies one row per Plan/Rating Area combination with all of the relevant community pricing. The default age for this pricing is 21.
{
"rate": {
"age_0": "204.94",
"age_0_tobacco": "204.94",
"age_1": "204.94",
"age_1_tobacco": "204.94",
"age_2": "204.94",
"age_2_tobacco": "204.94",
"age_3": "204.94",
"age_3_tobacco": "204.94",
"age_4": "204.94",
"age_4_tobacco": "204.94",
"age_5": "204.94",
"age_5_tobacco": "204.94",
"age_6": "204.94",
"age_6_tobacco": "204.94",
"age_7": "204.94",
"age_7_tobacco": "204.94",
"age_8": "204.94",
"age_8_tobacco": "204.94",
"age_9": "204.94",
"age_9_tobacco": "204.94",
"age_10": "204.94",
"age_10_tobacco": "204.94",
"age_11": "204.94",
"age_11_tobacco": "204.94",
"age_12": "204.94",
"age_12_tobacco": "204.94",
"age_13": "204.94",
"age_13_tobacco": "204.94",
"age_14": "204.94",
"age_14_tobacco": "204.94",
"age_15": "223.16",
"age_15_tobacco": "223.16",
"age_16": "230.12",
"age_16_tobacco": "230.12",
"age_17": "237.09",
"age_17_tobacco": "237.09",
"age_18": "244.59",
"age_18_tobacco": "244.59",
"age_19": "252.09",
"age_19_tobacco": "252.09",
"age_20": "259.86",
"age_20_tobacco": "259.86",
"age_21": "267.89",
"age_21_tobacco": "267.89",
"age_22": "267.89",
"age_22_tobacco": "267.89",
"age_23": "267.89",
"age_23_tobacco": "267.89",
"age_24": "267.89",
"age_24_tobacco": "267.89",
"age_25": "268.97",
"age_25_tobacco": "268.97",
"age_26": "274.32",
"age_26_tobacco": "274.32",
"age_27": "280.75",
"age_27_tobacco": "280.75",
"age_28": "291.2",
"age_28_tobacco": "291.2",
"age_29": "299.77",
"age_29_tobacco": "299.77",
"age_30": "304.06",
"age_30_tobacco": "304.06",
"age_31": "310.49",
"age_31_tobacco": "310.49",
"age_32": "316.92",
"age_32_tobacco": "316.92",
"age_33": "320.94",
"age_33_tobacco": "320.94",
"age_34": "325.22",
"age_34_tobacco": "325.22",
"age_35": "327.37",
"age_35_tobacco": "327.37",
"age_36": "329.51",
"age_36_tobacco": "329.51",
"age_37": "331.65",
"age_37_tobacco": "331.65",
"age_38": "333.8",
"age_38_tobacco": "333.8",
"age_39": "338.08",
"age_39_tobacco": "338.08",
"age_40": "342.37",
"age_40_tobacco": "342.37",
"age_41": "348.8",
"age_41_tobacco": "348.8",
"age_42": "354.96",
"age_42_tobacco": "354.96",
"age_43": "363.53",
"age_43_tobacco": "363.53",
"age_44": "374.25",
"age_44_tobacco": "374.25",
"age_45": "386.84",
"age_45_tobacco": "386.84",
"age_46": "401.84",
"age_46_tobacco": "401.84",
"age_47": "418.72",
"age_47_tobacco": "418.72",
"age_48": "438.01",
"age_48_tobacco": "438.01",
"age_49": "457.03",
"age_49_tobacco": "457.03",
"age_50": "478.46",
"age_50_tobacco": "478.46",
"age_51": "499.62",
"age_51_tobacco": "499.62",
"age_52": "522.93",
"age_52_tobacco": "522.93",
"age_53": "546.5",
"age_53_tobacco": "546.5",
"age_54": "571.95",
"age_54_tobacco": "571.95",
"age_55": "597.4",
"age_55_tobacco": "597.4",
"age_56": "625.0",
"age_56_tobacco": "625.0",
"age_57": "652.86",
"age_57_tobacco": "652.86",
"age_58": "682.59",
"age_58_tobacco": "682.59",
"age_59": "697.33",
"age_59_tobacco": "697.33",
"age_60": "727.06",
"age_60_tobacco": "727.06",
"age_61": "752.78",
"age_61_tobacco": "752.78",
"age_62": "769.66",
"age_62_tobacco": "769.66",
"age_63": "790.82",
"age_63_tobacco": "790.82",
"age_64": "803.68",
"age_64_tobacco": "803.68",
"age_65": "803.68",
"age_65_tobacco": "803.68",
"single": null,
"single_and_children": null,
"single_and_spouse": null,
"child_only": null,
"family": null,
"effective_date": "2019-10-01",
"expiration_date": "2019-12-31",
"plan_id": "12345ME1231231",
"source": "carrier"
}
}
Field | Type | Description |
---|---|---|
age_0…65 (tobacco) | String | The rate for the given age. If tobacco is appended to the name, then the rate for smokers of tobacco. |
effective_date | String | Start date on which the pricing is applicable |
expiration_date | String | End date on which the pricing is applicable |
plan_id | String | Foreign key HIOS ID for the Plan |
premium_child_only | Number | Premium for one or more children - only valid in community-rated states, null everywhere else |
premium_family | Number | Premium for two adults and one or more children - only valid in community-rated states, null everywhere else |
premium_single | Number | Premium for a single applicant of the relevant age |
premium_single_and_children | Number | Premium for one adult and one or more children - only valid in community-rated states, null everywhere else |
premium_single_and_spouse | Number | Premium for two adults - only valid in community-rated states, null everywhere else |
premium_single_smoker | Number | Premium for a single applicant of the relevant age who uses tobacco |
rating_area_id | String | Foreign key to RatingArea |
updated_at | String | The last date for which the rate set was updated. |
RatingAreas ¶
RatingAreasGET/s3-prefix/rating_areas.{csv,json}
All relevant RatingAreas for the given State
{
"id":"TX26",
"state_id":"TX"
}
Field | Type | Description |
---|---|---|
id | String | Unique ID of the RatingArea |
state_id | String | Foreign key to State - the State code |
ServiceAreas ¶
ServiceAreasGET/s3-prefix/service_areas.{csv,json}
All relevant ServiceAreas for the given State
{
"id":"21032-2017-COS003",
"issuer_id":"21032",
"name":"Northern Colorado"
}
Field | Type | Description |
---|---|---|
id | String | Unique ID of the ServiceArea |
issuer_id | String | Foreign key to Issuer |
name | String | Rating Area Name |
ZipCounties ¶
ZipCountiesGET/s3-prefix/zip_counties.{csv,json}
ZipCode-County combinations are the most granular way to define RatingAreas because some RatingAreas are defined by ZipCode and some by County. This file lists every combination of ZipCode and County in the relevant state and which RatingArea it is assigned to. From a given ZipCode/County, you can find a RatingArea’s ID. From that, you can find Pricing for all Plans in that RatingArea
{
"id": 255730,
"rating_area_id": "TX26",
"county_id": "48121",
"zip_code_id": "75034"
}
Field | Type | Description |
---|---|---|
id | Integer | Ideon’s internal ID |
rating_area_id | String | Foreign key to RatingArea |
county_id | String | Foreign key to County - the fips code |
zip_code_id | String | Zip Code |