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.
Additional Plan Attributes found in the /plans/v2.0/quote/{quoteId}/plan/{planId} endpoint:
| Field name | Example data | Required |
|---|---|---|
| Funding type | Self-funded, Level-funded, Fully-insured | Yes |
| Metallic level | Platinum, Gold, Silver, Bronze, Expanded Bronze | No |
| Network 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/{planId}/benefititem 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 |