Federal, state, and carrier rules for eligibility and rating
Ideon's rating engine for individual quoting supports two main rules for eligibility and rating: the eligible children cap and the maximum age of child dependents. For both of these, Ideon supports the standard values, with a few carrier-specific exceptions. At this time, nuanced business rules - as seen in the CMS PUF file, for example - are not included.
Eligible Children Cap for Rating
For all individual medical quotes, up to a maximum of three children age 20 or younger will be rated for premiums. Additional children under the age of 20 do not incur additional charges for family health insurance policies. This logic is implemented in Ideon's rating engine. Children 21 and older are always included for premium calculation. The oldest three children age 20 or younger are rated for premiums; additional children are not.
Maximum Age of Child Dependents
Ideon's rating engine includes logic to evaluate eligibility of child dependents based on their age. Child dependents are defined by the child parameter in the list of applicants for a quote request. For most carriers and plans, child dependents age 25 or younger are eligible. Certain carriers allow for child dependents up to age 26 or above. If a child is ineligible in the evaluation of this rule, the Medical Plan Search endpoint will return a 200 response but include no quoted plans. A quick workaround to circumvent this rule is to set the child parameter to false to allow for rating.
