When sending a member snapshot, you will need to send an effective_end_date for each enrolled member for a given coverage block.

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Active coverages

While effective_end_date is a required field, a defined end date should only be provided if the member’s coverage is expected to terminate on that specific date. Otherwise, the member’s effective_end_date should be sent as datemax (9999-12-31). Even if the plan year is scheduled to end on a specific date, the member’s coverage should not use that end date, as this will indicate a future-scheduled termination. In other words, if the member is expected to continue coverage indefinitely, send datemax.

Example
{
    "coverages": [
        {
            "carrier_id": "2d370e0e-fd73-45e0-8828-796d2cacaeef",
            "line_of_coverage": "dental",
            "plan_id": "61b6d125-8bbf-483a-9920-f23d9442403d",
            "enrolled_members": [
                {
                    "individual_type": "employee",
                    "custom_individual_id": "1",
                    "effective_start_date": "2022-10-01",
                    "effective_end_date": "9999-12-31",
                    "latest_change_effective_date": "2022-10-01",
                    "event_id": "7"
                }
            ],
        }
    ]
}

For Open Enrollment elections, specifically plan switching scenarios, the member’s effective_end_date should be sent as the plan end date and a separate coverage block should be created for the new plan.

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Splitting coverage blocks for continuous coverage

When splitting a coverage block into multiple due to a specific aspect of the configuration (e.g. benefit class), the effective_end_date should be set with a defined value even though the coverage is not ending. The second block takes care of signifying the open-ended nature of the coverage.

Ensure your coverage blocks do not have a gap in dates
Example
{
    "coverages": [
        {
            "plan_id": "4655eed5-ee44-49e1-a0a9-aa3a6fd52aa5",
            "carrier_config": {
                "benefit_class": "511",
            },
            "enrolled_members": [
                {
                    "effective_start_date": "2024-12-01",
                    "effective_end_date": "2024-12-31",
                }
            ],
        },
        {
            "plan_id": "4655eed5-ee44-49e1-a0a9-aa3a6fd52aa5",
            "carrier_config": {
                "benefit_class": "001",
            },
            "enrolled_members": [
                {
                    "effective_start_date": "2025-01-01",
                    "effective_end_date": "9999-12-31",
                }
            ],
        }
    ],
}

​
Waived/canceled coverages

If a coverage needs to be waived or canceled before it begins, the effective_end_date should be set to one day before the effective_start_date.

Example
{
    "coverages": [
        {
            "carrier_id": "2d370e0e-fd73-45e0-8828-796d2cacaeef",
            "line_of_coverage": "dental",
            "plan_id": "61b6d125-8bbf-483a-9920-f23d9442403d",
            "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"
                }
            ],
        }
    ]
}

Waiving/canceling coverage

Read more

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Terminated coverages

When a coverage is terminated after having been active, the effective_end_date should be set to the last day of coverage.

If the coverage termination is due to an employment termination and your platform supports COBRA, this field requires special handling. Please see the COBRA documentation for more information.

Terminating coverage

Code example

COBRA

Read more

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