Qualifying Life Event (QLE)

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The Member Request workflow is now deprecated in favor of Member Snapshot

Qualifying Life Event

The QLE member request is used to make changes to existing employees, dependents and coverages due to a qualifying life event.

Create Qualifying Life Event Member Request

The Event Object

Each Qualifying Life Event requires an event parameter in the body which provides information about the type of the event as well as the date of its occurance. The schema for the event must follow this structure:

Event Types Available

The QLE Coverages Object

The coverages array contains one entry for each carrier with which you would like to make changes to coverage. The carrier_id along with the schema of the carrier_config object will be provided by the Noyo team. You can reference the group carrier configuration resource to get additional carrier-specific data. The lines_of_coverage object allows the following keys:

Signature Date

Within each entry in the coverages array you can optionally specify a signature_date. The signature_date is the date when the employee or employer signed for the change to be made. If a signature_date is not provided we will communicate the date the member request was received by the Noyo system as the signature_date to the carrier.

Coverage Actions

Within each object inside of lines_of_coverage you may provide three different actions: adding_coverage, removing_coverage, and modifying_coverage. More information about each of these is below.

Adding Coverage

The adding_coverage action is used to add new coverage for a member with a carrier. You must provide an adding_coverage entry for each employee or dependent that is enrolling in coverage with the carrier. The plan_id field is optional in each action. If you do not specify a plan_id, we will try to automatically select an available plan for the member based on the current group plans. When the group has more than one eligible plan for a member, you will need to specify the plan_id in the request. Plan IDs can be retrieved using the group plans endpoint.

Adding medical, dental, vision, accident, cancer or hospital_indemnity coverage

Medical, dental, vision, accident, cancer and hospital indemnity coverage do not require any information beyond the member information and the selected plan.

Adding life, add, std, ltd or critical_illness coverage

Life, AD&D, STD, LTD and critical illness coverage also optionally accept volume parameter in dollars (e.g. $50,000 should be sent as 50000).

Removing Coverage

The removing_coverage action is used to remove coverage from a member with a carrier. The structure of the removing_coverage action is below:

Modifying Coverage

The modifying_coverage action is used to make changes to an existing coverage for a member / plan combination, given that the member already has coverage on that plan with the carrier. For example, you can use the modifying_coverage action to change the volume of coverage for a member's existing life or disability plan, or provide a new carrier_config to remain on the same plan but move the member into a new subgroup or benefit class.

Modifying medical, dental, vision, accident, cancer or hospital_indemnity coverage

Medical, dental, vision, accident, cancer and hospital_indemnity coverage do not require any information beyond the member information and the selected plan.

Modifying life, add, std, ltd and critical_illness coverage

Life, AD&D, STD, LTD and critical illness coverage also optionally accept volume parameter in dollars (e.g. $50,000 should be sent as 50000).

Qualifying Life Event Member Request Result

Sample Request Result

{
    "dental": [{
        "member_id": "72af10df-a8b3-46f1-a114-ac36d4b8a6ea",
        "member_type": "employee",
        "individual_enrollment_id": "ff033377-59e2-40df-8206-8cec3a725411"
    }, {
        "member_id": "165d4537-be5f-4744-8a97-a5b10fcb75b1",
        "member_type": "dependent",
        "individual_enrollment_id": "ff033377-59e2-40df-8206-8cec3a725411"
    }],
    "vision": [{
        "member_id": "72af10df-a8b3-46f1-a114-ac36d4b8a6ea",
        "member_type": "employee",
        "individual_enrollment_id": "08f9e430-9686-4b07-9e2c-6b26b8133dc3"
    }, {
        "member_id": "165d4537-be5f-4744-8a97-a5b10fcb75b1",
        "member_type": "dependent",
        "individual_enrollment_id": "08f9e430-9686-4b07-9e2c-6b26b8133dc3"
    }]
}

Upon the successful completion of all the transactions in the qualifying life event member request, the status of the member request will be updated to completed and the result of the member request will be an object with a key for each coverage (e.g. dental, vision) and an array with the following:

Qualifying Life Event Transactions

One or more qualifying life event transactions will created based on the requested changes in the coverages array. For some carriers, there may be a single transaction including all of the requested changes, while other carriers may require separate transactions for each action type (i.e. one transaction per action per carrier).

Qualifying Life Event Member Transaction completed Result

Upon the successful completion of the transaction, the status of the member transaction will be updated and the result of the member transaction will be in the same format as the member request result.