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 |