Plan Elections

This page contains additional information on Plan Elections for each product line, and their specific requirements.

Each plan election entry can be either an Election of coverage, or a Waiver of coverage.

Example JSON

The plan elections object contains:

• a product line (medical)

• one plan_id per product line,

  • or one plan_id listed with each member_id

• a type of either election or waiver

  • the combination of this Type and the Product Line determine the schema used for coverages

• an array of coverages

  • each entry in coverages represents a unique covered member for that given product line

  • each coverage is associated with several coverage date fields

  • each coverage has a benefit status of either employer_sponsored or cobra

Election

"plan_elections": {
      "medical": {
        "plan_id": "a37ecd06-5d97-46e4-9b4e-dcde6a03246f", 
        "type": "election",
        "coverages": [
          {
            "member_id": "a37ecd06-5d97-46e4-9b4e-dcde6a03246f",
            "start_date": "2020-01-01",
            "status": "employer_sponsored"
          }
        ]
      }
    },

Waiver

"plan_elections": {
      "dental": {
            "type": "waiver",
            "waiver_signature_date": "2024-07-01",
            "waiver_reason": "not reelecting"
       }  
    },

Required Fields - Elections

The fields listed below are Required to create plan elections of the election type

Field	Description
type	Provide the text "election"
coverages	This object contains information for each covered member under the product line. Each coverage will contain a member_id, start_date, and status which create a specific coverage record in our system.
plan_id	This can be provided at the plan level, or at the member level in each entry to coverages

Within coverages, each product line has specific requirements based on what carriers require to process elections. Here is a summary of these differences and schemas:

Field	Description
member_id	This field holds the uuid for the given covered member Each plan election entry will likely have an employee member_id In the case of dependent only cobra coverages, you can send a dependent as the sole (and primary) electee of the coverage
start_date	This is the most recent effective date with the carrier for that member_id and product line combination Start Dates can be updated at carriers by the following events: Re-hires Eligibility changes Plan or Classification changes Our scenario guide for Plan Start Dates has a complete description of the desired behavior.
volume	This is the Approved benefit amount for a given plan. Required for the following plan election product lines: - voluntary_life - voluntary_accidental_death_dismemberment - voluntary_life_accidental_death_dismemberment - critical_illness Occasionally carriers require this element for other product lines i.e., short term disability elections, based on plan design. Example: Plan designs which allows employees to elect 10k increments up to 50k. In this case, provide the specific benefit amount approved per member.
status	Required element that provides a benefit status of either Employer Sponsored or COBRA. If your platform system does not administer COBRA coverages, you can always supply a value of employer_sponsored. Accepted values: employer_sponsored, cobra

Situationally Required Fields - Elections

The following fields are Situationally Required by carriers on their transmissions. Please include this information as part of your initial implementation, as these fields will be required based on supported lines of coverage, per carrier.

Field	Description
end_date	This field allows a member to provide a specific end_date for a given election. This is provided per member, per product line. For an employee's termination of employment event, please provide an end_date for all employer_sponsored coverages. If a member is electing cobra coverages, please provide a termination of employment event, and then a cobra election event with a new benefit start date.
requested_volume	This is the elected amount requested by the member, which may differ from the volume amount. It is recommended to supply this for the following plan election product lines: - voluntary_life - voluntary_accidental_death_dismemberment - voluntary_life_accidental_death_dismemberment - critical_illness Occasionally carriers desire this element for other product lines i.e., short term disability elections, based on plan design. Example: Plan designs which allows employees to elect 10k increments up to 50k. In this case, provide the specific benefit amount elected and approved per member.
issued_age	This integer field is required if a carrier sells products in which premiums are based on Issued Age.
policy_premium_amount	This field can be provided when Carriers require a total premium amount on the transmission. Carriers use this amount for reconciliation of the elected option and billing.
employee_contribution_amount	This field can be provided when Carriers requires data on the amount an employee pays for the coverage. Carriers use this amount for reconciliation of the elected option and billing.
employer_contribution_amount	This field can be provided when Carriers requires data on the amount an employer pays for the coverage. Carriers use this amount for reconciliation of the elected option and billing.
income_data	This object allows a platform to send Benefit-specific income data. This is required when different product lines are salary-based, but the "salary" amount is calculated on different bases. type* Describes the type of income data: benefit_salary, base_salary effective_date* Date on which this salary amount becomes effective amount* integer amount, in cents

Optional Fields - Elections

These fields are truly Optional but can be helpful to provide.

Field	Description
external_identifier	This is an identifier that your system can use or generate to identify the plan election.
signature_date	This is the date on which the member signed-up for this specific coverage.
signature_type	This fields notes the way in which a member signed-up for benefits. Accepted values: physical, digital, voice
carrier_identifiers	This object allows you to pass carrier_identifiers formatted for transmission to carriers, which allows your team to configure and provide assignments for members.
providers	This object holds information regarding a member's known providers, for this product line.

Required Fields - Waivers

The only required field to send a waiver in the plan elections is type

Field	Provide?	Description
type	Required	Provide the text "waiver"
waiver_signature_date	Optional	This field can be used to provide the date that the member waived this product line.
waiver_reason	Optional	This is a free text field that allows you to pass a description of why a member waived a coverage, if desired.