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Benefit plan detail fields

Zywave works with carrier partners to gather benefit plan designs and standardize in a manner that allows for consistency across carriers. We have a standard list of required plan details for each plan type, however there are a number of optional fields that are additionally populated when provided.

Plan Attributes are found in the /plans/v2.0/quote/{quoteId}/plan/{planId} endpoint and vary by plan type. We recommend calling a sample response to get the most recent plan attributes available.

Examples of the type of data considered a plan attribute: (list is not exhaustive and varies by plan type)

Field name Example data Required
Funding type Self-funded, Level-funded, Fully-insured Yes
Metallic level Platinum, Gold, Silver, Bronze, Expanded Bronze No
Network name varies by carrier No
Insurance type EPO, HMO, PPO, Indemnity No
HRA or HSA Compatibility HRA, HSA, Traditional, Hybrid No

Below is a list of standard fields by plan type obtained through the /plans/v2.0/quote/{quoteId}/plan endpoint.

Plan Type Name
Medical Individual Deductible
Medical Family Deductible
Medical Individual Out-of-Pocket Max
Medical Family Out-of-Pocket Max
Medical Coinsurance (Policy Holder Portion)
Medical Primary Care/Office
Medical Specialist Care
Medical Preventative Care
Medical Skilled Nursing Facility
Medical Telemedicine
Medical Physical Therapy
Medical Chiropractic Therapy
Medical Speech Therapy
Medical Diagnostics
Medical X-Ray
Medical Imaging
Medical Emergency Room
Medical Urgent Care
Medical Durable Medical Equipment (DME)
Medical Annual RX Deductible Individual
Medical Annual RX Deductible Family
Medical Rx - Tier 1 Retail
Medical Rx - Tier 1 Mail Order
Medical Rx - Tier 2 Retail
Medical Rx - Tier 2 Mail Order
Medical Rx - Tier 3 Retail
Medical Rx - Tier 3 Mail Order
Medical Rx - Tier 4 Retail
Medical Rx - Tier 4 Mail Order
Medical Rx - Tier 5 Retail
Medical Rx - Tier 5 Mail Order
Medical Rx - Tier 6 Retail
Medical Rx - Tier 6 Mail Order
Medical Home Health Care
Medical Hospital Outpatient Surgery Physician Fee
Medical Hospital Outpatient Surgery Facility Fee
Medical Emergency Transportation
Medical Hospital Inpatient Physician Fee
Medical Hospital Inpatient Facility Fee
Medical Mental Health Inpatient
Medical Mental Health Outpatient
Medical Substance Use Inpatient
Medical Substance Use Outpatient
Medical Virtual Visits
Medical Occupational Therapy
Medical Lab
Dental Endodontics Surgical
Dental Endodontics Non-surgical
Dental Periodontics Surgical
Dental Periodontics Non-surgical
Dental Preventive Coinsurance
Dental Basic Coinsurance
Dental Major Coinsurance
Dental Ortho Coinsurance
Dental Ortho Lifetime Maximum
Dental Waiting Period - Major
Dental Individual Deductible
Dental Family Deductible
Dental Calendar Year Max Benefit
Dental Endodontic Therapy
Dental Periodontics
Vision Contact Frequency
Vision Exam Frequency
Vision Frame Frequency
Vision Frames
Vision Frames Copay
Vision Laser Vision Correction
Vision Lens Frequency
Vision Materials Copay
Vision Retail Contact Lens Allowance
Vision Vision Exam Copay