Termination of Employment

Scenario description and support for ending all benefits due to termination of the members employment.

Checklist

• Identify Termination Event

  • Confirm the current status of the subscriber & coverages

  • Gather details for the Termination Event

• Send Demographic Update Request

• Send Coverage End Date(s)

Components

1. Identify Termination Event

2. Send Demographic Update Request

3. Send Coverage End Date(s)

4. Carrier Transmission

Identify Termination Event

Confirm the current status of the subscriber & coverages

In order to terminate a member and their coverages, they first must be created and enrolled.

Given a previously created subscriber, the platform should confirm that they have previously enrolled the member and family members in coverage. This would have been created by sending a POST request to subscriber/{{id}}/qualifying_life_events .

Gather details for the Termination Event

After validating that the member is enrolled a user or process in the platform system identifies that this member's employment is terminated, and now the member requires an end date on the coverage.

Your system should gather information and determine two items to send:

1. a request that provides a new employment status and adds an employment_end_date

2. one or more requests to terminate coverages with a specific end_date

Send Demographic Update Request

Description

Using a PUT request, send a a demographic update request with the latest information.

This new information should include the employment_details fields status and employment_end_date

• status is a required value, but this value would change from it's current value to terminated given the Event

• employment_end_date is a situationally required field. This value should be the last day worked for the employee.

Example PUT/ subscribers/{id}

Update Subscriber
{
    "subscriber": {
        "external_identifier": "Subscriber1",
        "location_id": "{{primary_location_id}}",
        "first_name": "Employee",
        "last_name": "Ideonu",
        "birth_date": "1991-05-30",
        "gender": "male",
        "social_security_number": "123999999",
        "employment_details": {
            "start_date": "2025-01-01",
            "end_date": "2025-07-12",                   <- last day worked
            "status": "terminated"                      <- updated status
        },
        "residential_address": {
            "address_line_1": "34 B Street",
            "city": "Winchester",
            "state": "VA",
            "zip": "22603"
        }
    }
}

Note: No demographic updates are needed for dependents when terminating the subscriber's employment

It's common for this Employment End Date to be different than the Coverage End date. The coverage End Date could be the date of the event, but many policies allow coverage through the end of the same month.

This employment end date must be before or equal to the coverage End Date.

Example:

• Employment End Date is July 12th 2025

• Your Coverage End Date could be:

  • July 12th 2025,

  • July 31st 2025,

  • or another date as dictated by the policy

Send Coverage End Date(s)

Description

After sending the employment end date, create a qualifying life event request that contains end_date s for each coverage and member

1. If you don't have the current coverages for the subscriber, use a GET call to retrieve the latest qualifying_life_events for the member

2. Once you know the current state (for which Carriers, Products, and Members should I have a coverage end date?), prepare a QLE request that has an End Date

   1.  "start_date": "2024-10-01",
       "end_date": "2024-12-31",

3. Each coverage period (carrier + time period combination) in which the member has coverage needs a seperate qualifying_life_event.

4. Example:

   1. Member has Medical with kaiser, Dental and Vision with guardian

   2. Two coverage periods need ended coverage

      1. kaiser coverage period, QLE includes medical plan and end_date

      2. guardian coverage period, QLE includes dental plan, vision plan, and end_dates for each

Note: Each Dependent covered needs an end_date value, or you will recieve an API validation error for {product_line} coverages require a coverage for subscriber, member id {member_id}, but only saw coverages for {perceived_member_ids}

Request

{
    "qualifying_life_event": {
        "event": "termination_of_employment",
        "date": "{{date_of_employment_termination_event}}",
        "eligibility_start_date": "{{date}}",
        "coverage_period_id": "{{coverage_period_id}}",
        "plan_elections": {
            "dental": {
                "plan_id": "{{dental_plan_id}}",
                "type": "election",
                "coverages": [
                    {
                        "member_id": "{{subscriber_id}}",
                        "status": "employer_sponsored",
                        "start_date": "2024-10-01",
                        "end_date": "2024-12-31"
                    }
                ]
            },
            "vision": {
                "plan_id": "{{vision_plan_id}}",
                "type": "election",
                "coverages": [
                    {
                        "member_id": "{{subscriber_id}}",
                        "status": "employer_sponsored",
                        "start_date": "2024-10-01",
                        "end_date": "2024-12-31"
                    }
                ]
            }
        }
    }
}

Carrier Transmission

Description

• When Ideon receives this Termination of Employment, we identify the state of the member at the Carrier, if possible:

• For API:

  • If the member doesn't have an End Date at the Carrier, we send a termination to the Carrier in their preferred format.

  • If the member already has an End Date at the Carrier, we mark the coverage as synced

• For EDI:

  • We transmit the end date on the next EDI file, and await the next carrier error report

  • Some Carriers require that we send the Termination date for several files, based on their system needs