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.
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.
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.
Total composite and age-banded premium (where applicable) will be returned with the list of plans in the GET quote/quoteID/quotedplan call.
Full age-banded rate tables and/or composite rates are available in the GET /plans/v2.0/quote/{quoteId}/plan/{planId}/planrate call.
Rates by quoted member are available in the GET /plans/v2.0/quote/{quoteId}/quotedplan/{quotedPlanId}/memberrate call.
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.
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.
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.