Waiving/Canceling Coverage

1. Waiving/canceling previously active or upcoming coverage
   If a member has active or upcoming coverage, termination/cancellation of that coverage must be explicit and any plan switches or waives must explictly terminate the previous coverage
2. Waiving with no existing coverage
   If a coverage has never been in the system, it will be implictly waived. Empty coverage blocks are not required for carriers without coverage for a given household.
   Even if you have not previously sent a coverage, it may have been pulled from the carrier system. Read more about omitted coverage handling or using the Tracking API to pull missing_from_platform enrollments.

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Example Snapshots

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During an Open Enrollment Period

For upcoming elections, you do not generally need to provide “empty” coverage blocks for coverages that a member does not choose, whether they are choosing one carrier over another, waiving an entire line of coverage, or waiving coverage for a dependent.

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When using continue-on-omission

When your omitted coverage policy is set to continue, it is important that you provided an effective_end_date for each coverage you want to terminate. Because this setting allows you to omit active coverages from a snapshot, it is posible to end up with unexpected surplus coverage. Enrolling a member in a new coverage will not automatically terminate their previous coverage.

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When using terminate-on-omission

When your omitted coverage policy is set to terminate, any coverages not included in the snapshot will be terminated.

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Waiving/canceling previously active or upcoming coverage

If you need to waive or cancel coverage for a member after you’ve already sent that coverage in a previous snapshot (or the coverage was already pulled from the carrier system), set the effective_end_date to one day before the effective_start_date. This is often used to correct a mistake or reflect a member’s changed decision.

Ensure that you add a relevant event to the events array to reflect the nature of the change.

{
    "snapshot_mode": "current_open",
    "employee": {}, // omitted for brevity
    "dependents": [], // omitted for brevity
    "coverages": [
        {
            "carrier_id": "2d370e0e-fd73-45e0-8828-796d2cacaeef",
            "line_of_coverage": "dental",
            "plan_id": "84a6c0a6-4ae9-484b-ab8d-af1ab6551efe",
            "enrolled_members": [
                {
                    "custom_individual_id": "150D001",
                    "individual_type": "employee",
                    "event_id": "10002",
                    "effective_start_date": "2023-04-01",
                    "effective_end_date": "2023-03-31",
                    "latest_change_effective_date": "2023-03-20"
                },
                {
                    "custom_individual_id": "150D0C2",
                    "individual_type": "dependent",
                    "event_id": "10002",
                    "effective_start_date": "2023-04-01",
                    "effective_end_date": "2023-03-31",
                    "latest_change_effective_date": "2023-03-20"
                }

            ]
        }
    ],
    "events": [
        {
            "id": "10002",
            "date": "2023-03-20",
            "type": "coverage",
            "reason": "offline_change"
        }
    ]
}