New Group Installment
Applying for health insurance for the first time with a Carrier
Overview
Ideon supports the application of a group for the first time with Carrier partners, we refer to this process as "Group Installment". The new group installment process allows an employer to offer insurance plans to employees. Group setup typically occurs after an employer has worked with a carrier/broker to receive a quote regarding the costs associated with a specific carrier, types of coverage, and plan selection. Once the employer has selected the carrier and plan(s) they will offer to employees, they can begin the group setup process to establish a new group with the carrier and begin enrolling employees.
The following steps can be used to install a group with a Carrier:
Create the Group Installment
Add the Coverage Period
Add the Plans that are being offered
(Optional) Add Employment Classifications
Add the Subscribers and Dependents
Add Qualifying Life Events
Complete the Setup
1. Create the Group Installment
The first step is to send over the information relating to the Group, or Employer. This information includes the name, tax number, address locations, and Carrier for which to initiate coverage. This information is sent via the POST /group_installments endpoint. Note that some information could be conditionally required based on the Carrier, which we will cover in the carrier-specific sections below.
{
"group": {
"external_identifier": "Group1",
"insurance_market": "small_group",
"employer": {
"organization_name": "Acme Ins Co",
"fein": "222222222",
"established_date": "1999-08-13",
"employer_type": "corporation",
"census": {
"employees": 25,
"full_time_equivalent_employees": 20,
"eligible_employees": 18
}
...
},
"group_setup": {
"carrier_name": "humana"
...
},
"primary_location": {
"external_identifier": "Location1",
"type": "physical",
"employer_address": {
"address_line_1": "30 W Live Oak Ave",
"city": "Defuniak Springs",
"state": "FL",
"zip": "32435",
"fips_county_code": "12131"
...
}
...
}
...
}
}Producer Information
Producer(s) of Record
Producers help sell and manage plans and products that groups choose to buy, and are eligible to receive a commission. The producer(s) sign the master employer / group application in order to place the business. As part of group setup, the details about the producer(s) and their producer agency (if applicable) are sent to the carrier. A carrier will confirm the identity of both producer(s) and producer agencies to confirm they are licensed and authorized to sell various products. Producer(s) of record have the ability to manage the group and the groups employees on their behalf after the initial group setup is completed. There are two scenarios in which producer information is sent to carriers:
Producer is writing the business on behalf of an agency that they work for and is affiliated with a Producer Agency
Producer is independent and does not work on behalf of an agency
In both cases the same information is required by carriers as part of the group setup process. The scenarios below showcase how producer information is sent as part of group setup via a POST to /groups. As a general rule, if there are multiple producers, the commission split between them should sum to 100.
The information for the producer of record includes details about the producer including the date the producer signed the master employer application.
{
"group": {
...
"producers_of_record": [{
"first_name": "Arya",
"last_name": "Stark",
"national_producer_number": "12345678",
"social_security_number": "222222222",
"fein": "222222222",
"state_license_number": "12345678",
"carrier_producer_identifier": "87654321",
"signature_date": "2001-01-01"
...
}]
...
}
}2. Add the Coverage Period
The Coverage Period is a representation of the plan year that the group has with a Carrier. This information lets the Ideon team know when the coverage will begin and with which Carrier.
{
"coverage_period": {
"external_identifier": "CUSTOM_COVERAGE_PERIOD",
"carrier_name": "humana",
"enrollment_type": "initial_installment",
"coverage_start_date": "2022-01-01",
"coverage_end_date": "2022-12-31",
"open_enrollment_start_date": "2021-12-15",
"open_enrollment_end_date": "2022-12-31"
...
}
}Employer's Signature
As part of a coverage period, an employer may need to sign-off on the information they are providing to the carrier. Traditionally a paper Master Employer Application or Master Group Application is provided to a carrier on behalf of the employer with the employer's group setup information. The application includes the name, title, and date of an authorized employer representative. This signature serves as an acknowledgement that the information provided about the group and its employees is accurate.
An authorized employer representative:
{
"coverage_period": {
...
"group_application_signature": {
"name": "Jon Snow",
"title": "Director of Human Resources",
"date": "2021-10-01"
}
...
}
}3. Add the Plans that are being offered
When the employer creates the group with the carrier they will need to provide the plans they intend to offer their employees. Each plan that is offered also needs to have a policy_premium_method that determines member premiums.
API Documentation for Creating Plans
Indicate the premium rating method as "age_banded"
{
"plan": {
"external_identifier": "ppo_high_plan",
"description": "Medical PPO - High",
"product_line": "medical",
"product_type": "preferred_provider_organization",
"premium_level": "high",
"policy_premium_method": "age_banded"
...
}
}4. (Conditional) Add Employment Classifications
Employment Classifications can be set up in order to create classes, divisions, departments, or subgroups that represent different groupings for which employees may be grouped. These groups or 'buckets' are often created to allow for segmenting plan offerings or benefits, or simply as a means of making invoicing and billing easier.
{
"employment_classification": {
"external_identifier": "Class1",
"description": "All Eligible Employees in California",
"start_date": "2022-01-01",
"end_date": "2022-12-31",
"type": "class"
...
}
}5. Add the Subscribers and Dependents
Subscribers and dependent information can be loaded in together in a single request to Ideon.
{
"subscriber": {
"external_identifier": "ABC-132A54",
"location_id": "LOCATION_UUID",
"first_name": "John",
"last_name": "Smith",
"social_security_number": "222222222",
"gender": "male",
"marital_status": "registered_domestic_partner",
"birth_date": "1991-01-01",
"class": {
"employment_classification_id": "EMPLOYMENT_CLASSIFICATION_UUID",
"effective_date": "2022-01-01"
},
"employment_details": {
"start_date": "2019-01-01",
"status": "full_time",
"annual_earnings": 230000,
"earnings_effective_date": "2019-11-13",
"wage_frequency": "annually",
"hours_per_week": 40.0
...
},
"residential_address": {
"address_line_1": "50 Orchard Street",
"city": "Kansas City",
"state": "MO",
"zip": "64108"
...
},
"dependents": [{
"external_identifier": "Dependent1",
"first_name": "Joanna",
"last_name": "Smith",
"social_security_number": "333333333",
"gender": "female",
"subscriber_relationship": "registered_domestic_partner",
"birth_date": "1992-02-03"
...
}]
...
}
}6. Add Qualifying Life Events
A qualifying life event allows Ideon to enroll or manage the product lines and effective dates of an enrolled family. This qualifying life event likely will be initiated by a standard life-event e.g. new hire, birth, death, termination of employment, or open enrollment. For purposes of the initial installment with the Carrier, the first Qualifying Life Events should have a type of initial_enrollment or newly_eligible.
{
"qualifying_life_event": {
"type": "initial_enrollment",
"date": "2021-12-01",
"eligibility_start_date": "2022-01-01",
"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": "2022-01-01"
},
{
"member_id": "DEPENDENT_UUID",
"status": "employer_sponsored",
"start_date": "2022-01-01"
}
]
}
...
}
...
}
}Providers
Depending on the member's coverages, first-time HMO enrollments may require the member's Primary Care Physician (PCP) selection.
A PCP selection can be provided for a member when enrolling in an HMO health plan.
{
"qualifying_life_event": {
...
"plan_elections": {
"medical": {
...
"coverages": [{
...
"providers": [{
"type": "primary_care_provider",
"first_name": "Indiana",
"last_name": "Jones",
"service_provider_identifier": "1234ABC"
...
}]
}]
}
...
}
}
}7. Complete the Setup
Notifying Ideon that you've loaded in all of the necessary information is the final step in the process. The Complete Setup endpoint will create the work order in the Ideon system, notifying the team to configure the data, QA it, and send it over to the Carrier for enrollment.
The Ideon Operations team will coordinate with the Carrier in case any additional information is needed due to policy requirements.
Once the group has been installed with the carrier, Ideon will update the Coverage Period automatically and the Group could be eligible to move to the Member Management phase, depending on the carrier connected. From that point, your system only has to keep the member and election information in sync (see Continued Maintenance) and Ideon will deliver that information to the Carrier.
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