Enrollments

Overview

The Enrollments API serves as the definitive record of a consumer’s participation in various benefit plans. While an Election represents the financial commitment a user makes, an Enrollment represents the actual existence, duration, and status of the coverage itself. These endpoints allow developers to query a consumer’s full benefit portfolio across different employers, plan years, or specific plans.

Key Features

• Flexible Identification: Query enrollments using multiple identifier types, including Employee Number, Employer-specific IDs, or Person IDs.
• Coverage Lifecycle: Track the state of benefits from initial enrollment through termination, including effective date ranges.
• Contextual Filtering: Pivot results by employer_id, plan_year_id, or plan_id to isolate specific benefit segments.

Use Cases

• Member Dashboards: Listing all active coverage (Medical, Dental, HSA) for a consumer.
• Eligibility Checks: Verifying if a consumer is currently enrolled in a specific plan before authorizing a transaction.
• Benefit Audits: Reviewing a consumer’s enrollment history across different plan years or employers.

Scopes & Permissions

Core Concepts

Mandatory Identifiers (List Endpoint)

The List Enrollments endpoint requires a specific identity pairing to successfully locate a consumer:

• consumer_id: The string value of the identifier.
• consumer_identifier_type: Must be one of the following:
  • EMPLOYEE_NUMBER
  • EMPLOYER_EMPLOYEE_ID
  • PERSON_ID

Enrollment Attributes

An enrollment record links a Consumer to a Plan for a specific window of time. Key attributes include:

• status: The current standing (for example, Enrolled, Terminated, Pending).
• effective_start_date: The first day coverage is active.
• effective_end_date: The last day of the benefit cycle or the date of termination.

Pagination

The list endpoint utilizes zero-based pagination to manage large participant portfolios.

Error Handling

Idempotency

Both enrollment endpoints use the GETmethod. They are idempotent and safe, meaning they do not modify any coverage records or server states and can be called repeatedly with the same result.