aflac Claims API
Claims submission and status retrieval operations.
OpenAPI Specification
openapi: 3.0.3
info:
title: Aflac Enterprise Connect Claims API
description: The Aflac Enterprise Connect (AEC) API enables benefits administrators, HR platforms, and third-party enrollment systems to integrate with Aflac's supplemental insurance platform. It provides REST API access to benefits enrollment, policy management, claims status, and eligibility verification for group and individual supplemental insurance products.
version: '1.0'
contact:
name: Aflac Enterprise Connect Support
url: https://docs.enterprise-connect.aflac.com
x-generated-from: documentation
servers:
- url: https://api.enterprise-connect.aflac.com/v1
description: Production Server
- url: https://sandbox.enterprise-connect.aflac.com/v1
description: Sandbox Server
security:
- oauth2: []
tags:
- name: Claims
description: Claims submission and status retrieval operations.
paths:
/claims:
get:
operationId: listClaims
summary: Aflac List Claims
description: Retrieve a list of supplemental insurance claims for a policyholder or group.
tags:
- Claims
parameters:
- name: policy_id
in: query
description: Filter claims by policy ID.
schema:
type: string
example: POL-987654
- name: employee_id
in: query
description: Filter claims by employee ID.
schema:
type: string
example: EMP-789012
- name: status
in: query
description: Filter by claim status.
schema:
type: string
enum:
- submitted
- in_review
- approved
- denied
- paid
example: approved
responses:
'200':
description: A list of claims.
content:
application/json:
schema:
$ref: '#/components/schemas/ClaimList'
examples:
listClaims200Example:
summary: Default listClaims 200 response
x-microcks-default: true
value:
items:
- {}
total: 1
'401':
description: Unauthorized.
content:
application/json:
schema:
$ref: '#/components/schemas/Error'
examples:
listClaims401Example:
summary: Default listClaims 401 response
x-microcks-default: true
value:
error: example_value
message: example_value
request_id: '500123'
x-microcks-operation:
delay: 0
dispatcher: FALLBACK
post:
operationId: submitClaim
summary: Aflac Submit Claim
description: Submit a new supplemental insurance claim for review and payment.
tags:
- Claims
requestBody:
required: true
description: Claim submission payload.
content:
application/json:
schema:
$ref: '#/components/schemas/ClaimRequest'
examples:
submitClaimRequestExample:
summary: Default submitClaim request
x-microcks-default: true
value:
policy_id: '500123'
claim_type: accident
incident_date: '2025-03-15'
description: Example description
responses:
'201':
description: Claim submitted successfully.
content:
application/json:
schema:
$ref: '#/components/schemas/Claim'
examples:
submitClaim201Example:
summary: Default submitClaim 201 response
x-microcks-default: true
value:
claim_id: '500123'
policy_id: '500123'
employee_id: '500123'
claim_type: accident
status: submitted
incident_date: '2025-03-15'
submission_date: '2025-03-15T14:30:00Z'
benefit_amount: 99.99
denial_reason: example_value
'400':
description: Invalid claim data.
content:
application/json:
schema:
$ref: '#/components/schemas/Error'
examples:
submitClaim400Example:
summary: Default submitClaim 400 response
x-microcks-default: true
value:
error: example_value
message: example_value
request_id: '500123'
x-microcks-operation:
delay: 0
dispatcher: FALLBACK
/claims/{claim_id}:
get:
operationId: getClaim
summary: Aflac Get Claim
description: Retrieve a specific claim record and its processing status.
tags:
- Claims
parameters:
- name: claim_id
in: path
required: true
description: Unique claim identifier.
schema:
type: string
example: CLM-112233
responses:
'200':
description: Claim details and status.
content:
application/json:
schema:
$ref: '#/components/schemas/Claim'
examples:
getClaim200Example:
summary: Default getClaim 200 response
x-microcks-default: true
value:
claim_id: '500123'
policy_id: '500123'
employee_id: '500123'
claim_type: accident
status: submitted
incident_date: '2025-03-15'
submission_date: '2025-03-15T14:30:00Z'
benefit_amount: 99.99
denial_reason: example_value
'404':
description: Claim not found.
content:
application/json:
schema:
$ref: '#/components/schemas/Error'
examples:
getClaim404Example:
summary: Default getClaim 404 response
x-microcks-default: true
value:
error: example_value
message: example_value
request_id: '500123'
x-microcks-operation:
delay: 0
dispatcher: FALLBACK
components:
schemas:
ClaimList:
type: object
description: Paginated list of claims.
properties:
items:
type: array
description: Array of claim records.
items:
$ref: '#/components/schemas/Claim'
example:
- example_value
total:
type: integer
description: Total number of matching claims.
example: 30
ClaimRequest:
type: object
description: Request payload for submitting a new claim.
required:
- policy_id
- claim_type
- incident_date
properties:
policy_id:
type: string
description: Policy against which to file the claim.
example: POL-987654
claim_type:
type: string
description: Type of claim event.
enum:
- accident
- critical_illness
- cancer_diagnosis
- hospitalization
- disability
example: accident
incident_date:
type: string
format: date
description: Date of the qualifying event.
example: '2025-02-10'
description:
type: string
description: Description of the incident or diagnosis.
example: Employee sustained a broken arm in a workplace accident.
Error:
type: object
description: API error response.
properties:
error:
type: string
description: Error code.
example: not_found
message:
type: string
description: Human-readable error description.
example: The requested resource was not found.
request_id:
type: string
description: Unique request ID for support reference.
example: req-a1b2c3d4e5
Claim:
type: object
description: A supplemental insurance claim record.
properties:
claim_id:
type: string
description: Unique claim identifier.
example: CLM-112233
policy_id:
type: string
description: Policy associated with the claim.
example: POL-987654
employee_id:
type: string
description: Claimant employee identifier.
example: EMP-789012
claim_type:
type: string
description: Type of claim event.
enum:
- accident
- critical_illness
- cancer_diagnosis
- hospitalization
- disability
example: accident
status:
type: string
description: Current claim processing status.
enum:
- submitted
- in_review
- approved
- denied
- paid
example: approved
incident_date:
type: string
format: date
description: Date of the qualifying event.
example: '2025-02-10'
submission_date:
type: string
format: date-time
description: Timestamp when the claim was submitted.
example: '2025-02-15T09:30:00Z'
benefit_amount:
type: number
description: Approved benefit payment amount in USD.
example: 1500.0
denial_reason:
type: string
description: Reason for denial if the claim was denied.
example: Condition not covered under policy terms.
securitySchemes:
oauth2:
type: oauth2
description: OAuth 2.0 client credentials flow for server-to-server API access.
flows:
clientCredentials:
tokenUrl: https://auth.enterprise-connect.aflac.com/oauth/token
scopes:
enrollment:read: Read enrollment records
enrollment:write: Create and update enrollments
claims:read: Read claim records
claims:write: Submit claims
eligibility:read: Verify eligibility
groups:read: Read group records