Qualifying Life Events

Manage Member Coverage using Qualifying Life Events

Subscriber and dependent coverage can be added and managed using different types of Qualifying Life Events. A Qualifying Life Event represents a set of coverages in our system, as even an initial enrollment serves as a QLE in our system.

More details on each element are provided in the full mapping guide for QLEs and their Plan Elections.

See Qualifying Life Event Mapping for details about each event type supported by Ideon.

In order to create or change coverages for an enrolled family using a Qualifying Life Event:

1. Formulate the Request

2. Send Request / Receive Response

3. Check the Status

Formulate the Request

There are various event types that can be used to add, remove, or change the insurance coverage information for a subscriber and their dependents. Using this one endpoint, you can manage all the coverage behavior for the family.

Note that the volume field value is a zero-decimal currency, which means you provide the cents within the integer. For example, $800.00 is represented as 80000.

POST /subscribers/:id/qualifying_life_events

{
    "qualifying_life_event": {
        "event": "initial_enrollment",
        "date": "2020-01-01",
        "eligibility_start_date": "2020-01-01",
        "coverage_period_id": "COVERAGE_PERIOD_UUID",
        "plan_elections": {
            "medical": {
                "plan_id": "PLAN_UUID",
                "type": "election",
                "coverages": [
                    {
                        "member_id": "SUBSCRIBER_UUID",
                        "status": "employer_sponsored",
                        "start_date": "2020-01-01"
                    },
                    {
                        "member_id": "DEPENDENT_UUID",
                        "status": "employer_sponsored",
                        "start_date": "2020-01-01"
                    }
                ]
            }
        }
    }
}

Qualifying Life Events are used to manage the coverage plan elections made by subscribers and their dependents.

Send Request / Receive Response

The request is sent to Ideon using a POST /subscribers/:id/qualifying_life_events endpoint.

Ideon will provide one of two responses to the requestor.

• The first option is that the request was received successfully and the coverage period was created on our system: 201 - Resource Created Successfully.

• The second option is that syntax and semantic errors exist: 422 - Unprocessable Entity. This includes the violation of carrier specific business rules.

Success

If the request passes validation, the requestor will be informed of the successful receipt and provided a copy of the Qualifying Life Event. In the response body the requestor will find the UUID associated with the resource, which can be used for your records: qualifying_life_event.id.

{
    "qualifying_life_event": {
        "id": "a37ecd06-5d97-46e4-9b4e-dcde6a03246f",
        "type": "initial_enrollment",
        "date": "2020-01-01",
        "eligibility_start_date": "2020-01-01",
        "coverage_period_id": "COVERAGE_PERIOD_UUID",
        "plan_elections": {
            "medical": {
                "plan_id": "PLAN_UUID",
                "type": "election",
                "coverages": [
                    {
                        "member_id": "SUBSCRIBER_UUID",
                        "status": "employer_sponsored",
                        "start_date": "2020-01-01"
                    },
                    {
                        "member_id": "DEPENDENT_UUID",
                        "status": "employer_sponsored",
                        "start_date": "2020-01-01"
                    }
                ]
            }
        }
    }
}

Check the Status

Once you've made a successful Qualifying Life Event, you can confirm the changes by request the GET /subscribers/:id endpoint. For more information about statuses, check the previous step in creating a Member