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Common questions

What are Coverage Groups and how do I use them?

Zywave defines a coverage group as plans offered for each plan type. An employer offers multiple Medical plans, and employees are segmented into a 'coverage group' based on which of these medical plans they choose to enroll in.

Scenario 1: You are quoting a prospect or new group and don't have any coverage history. Your census would likely include one coverage group per plan type, which would return a rate for every covered individual, excluding any waived individuals. In this case, the coverage group could be named by plan type - Medical, Dental, or Vision.

Scenario 2: You are quoting an existing group and have coverage history. This employer currently has 3 medical plan offerings for employees to choose from: 50% of employees are enrolled in Plan A, 30% Plan B and the remaining Plan C. Your census should define which plan offering, or coverage group, each member is enrolled in. This will allow a like-for-like comparison, assuming many employees will choose to stay in a similar plan design in the next plan year. In this case, there would be 3 coverage groups for Medical - Plan A, Plan B and Plan C.

Each eligible plan in a quote will be returned with a total premium per coverage group.

How does Broker TIN and/or NPN impact my quote results?

Some carriers require the broker be Appointed in order for plans/rates to be returned in a quote. If this detail is not included in the quote request, or the NPN/TIN are not appointed, the impacted carrier plans will not be returned in the quote results. Examples of carriers with Appointment currently in place include UnitedHealthcare and Guardian Life Insurance Company.

Carrier Appointment is state specific. Contact your carrier representative to be added to the appointment list in your market.

Both TIN and NPN are sent in the POST/plans/v2.0/quote call.

Does SIC impact my quote results?

In some ancillary plans, SIC (Standard Industrial Classification) is used to determine eligibility and as a rate multiplier when determining the group premium. Confirm that the SIC included is both valid and accurate to ensure accurate quote results.

SIC code is sent in the POST/plans/v2.0/quote call.

Can effective date or group size impact which carrier plans and rates are returned?

Yes, if a quote has an effective date that is not the 1st or 15th of the month, there is a good chance your quote will include fewer carrier's plans. This is because our carrier API partners have requirements around accepted quote effective date.

Group size requirements (min and max) may also be applied by the carrier API.

What rate details are provided for each plan?

There are few options for getting your quote rate results depending on the level of detail needed.

Total composite and age-banded premium (where applicable) will be returned with the list of plans in the GET quote/quoteID/quotedplan call.

Rates for individual plans included in a quote can be found in quote/plan specific calls:

Rates for all quoted plans are available in the GET /plans/v2.0/quote/{quoteId}/memberrate and GET /plans/v2.0/quote/{quoteId}/planrate endpoints. (These return 500 records per call.)

Can I get Rating Area definitions?

Under the Affordable Care Act, each state divided up the areas of the state into Rating Areas. Depending on the state, these geographical units will either be made up of counties, metropolitan statistical areas or three-digit zip codes. The Rating Area API allows users to get details around the Rating Area definitions.

How is Quote Status defined?

Started = Quote record is created

Rating = Retrieving plans and rates

Rated = Quoting is complete

Completed = status not in use

SoldFinal = Quote contains at least one plan marked sold (via the UI)

Duplicating = Similar to the Rating status, this is status of new quote during duplication process. Duplicate quote can only be initiated via the UI.

Do quotes expire?

Any quoted plans and associated rates which are not selected for proposal are deleted 100 days after run date. Calling the following endpoints after this will result in a 404 error:

/plans/v2.0/quote/{quoteId}/plan/{planId}/benefititem

/plans/v2.0/quote/{quoteId}/quotedplan/{quotedPlanId}/memberrate

/plans/v2.0/quote/{quoteId}/plan/{planId}

/plans/v2.0/quote/{quoteId}/plan/{planId}/planrate

/plans/v2.0/quote/{quoteId}/quotedplan

/plans/v2.0/quote/{quoteId}/plan/{planId}/sbc

This excludes plans selected for the proposal, which can only be initiated via the UI.

Why don't I see "fill in the blank" in my Quoted plans results?

Validation in the API will prevent calls from proceeding if an error is found. Third party APIs may also have additional validation which prevent their plans from being included on a quote. Use the https://api.zywave.com/docs/spec/plans-api#get-/plans/v2.0/quote/-quoteId-/errors endpoint to help troubleshoot when you don't get expected quote results.

In addition to data validation, some carriers use Appointment to allow quoting based on broker NPN. The list of carriers using appointment, and appointed brokers on a carriers list, can change at any time. Refer to the Employee Benefits Small Group Carrier Map for information regarding which carriers use appointment. https://www.zywave.com/small-group-rates/