Centers for Medicare and Medicaid Services Enrollments API
Enrollment grouping validation and information.
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OpenAPI Specification
openapi: 3.2.0
info:
title: Marketplace Enrollments API
version: '1'
description: '# About
The Marketplace API delivers data that helps users find and evaluate health care insurance plans, providers, and coverage information on the marketplace.'
servers:
- url: https://marketplace.api.healthcare.gov/api/v1
security:
- API Key: []
tags:
- name: Enrollments
description: Enrollment grouping validation and information.
paths:
/enrollment/validate:
x-summary: Validate Enrollment Groups
post:
tags:
- Enrollments
description: 'Verify extended enrollment groups. The endpoint assumes an effective date of Jan 1 on enrollees ages unless effective_age is provided on the enrollees.
If `is_custom` is true, the endpoint will validate that each group has available plans for enrollment, otherwise it will only verify that there are no address, hardship, or CSR conflicts.
### Note
Use this JSON example in the **POST** Body in the request pane to view results
```
{
"maxAPTC": 0,
"year": 2019,
"is_custom": false,
"division": "HealthCare",
"enrollment_groups": [
{
"id": "a8007732-1425-43e3-81fc-f0e7b9331474",
"effective_date": "2019-01-01",
"csr": "Exchange variant (no CSR)",
"enrollees": [
"1"
],
"subscriber_id": "xxxxxxxxxx",
"relationships": [
{
"super_id": "1234567",
"sub_id": "7654321",
"relationship": ""
}
]
}
],
"enrollees": [
{
"id": "1234567",
"name": "John",
"gender": "Male",
"dob": "1975-01-01",
"location": {
"city": "Philadelphia",
"state": "PA",
"street_1": "123 Fake Street",
"street_2": "Apt. 237",
"zipcode": "19123",
"countyfips": "42101"
},
"csr": "Exchange variant (no CSR)",
"is_filer": true,
"has_hardship": true,
"relationship": "",
"allowed_metal_levels": [
"Catastrophic"
],
"allowed_plan_ids": [
"15614PA0010004"
],
"current_enrollment": {
"plan_id": "15614PA0010004",
"effective_date": "2018-07-07",
"is_smoker": false
}
}
]
}
```'
parameters:
- $ref: '#/components/parameters/apikey'
responses:
'200':
description: The extended enrollment info is valid
content:
application/json:
schema:
properties:
suggested_groups:
type: array
items:
$ref: '#/components/schemas/FlattenedEnrollmentGroup'
'400':
description: The extended enrollment info is not valid
content:
application/json:
schema:
properties:
suggested_groups:
type: array
items:
$ref: '#/components/schemas/FlattenedEnrollmentGroup'
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/ExtendedEnrollment'
description: Extended enrollment information
summary: Create enrollment validate
x-summary-source: derived
operationId: postEnrollmentValidate
x-operation-id-source: derived
components:
schemas:
ExtendedEnrollment:
properties:
maxAPTC:
description: The max aptc value for the enrollment
type: number
format: float
year:
x-example: 2019
description: The year coverage is being sought for
type: number
format: integer
is_custom:
description: Is this a default enrollment grouping provided by an FFM GetEnrollment request, or a custom grouping?
type: boolean
division:
$ref: '#/components/schemas/ProductDivisionEnum'
enrollment_groups:
items:
properties:
id:
description: The enrollment group id (uuid)
type: string
pattern: ^[0-9a-f-]+$
csr:
$ref: '#/components/schemas/CostSharingReductionEnum'
enrollees:
description: Enrollee ids
type: array
items:
type: string
subscriber_id:
type: string
relationships:
type: array
items:
$ref: '#/components/schemas/RelationshipEdge'
effective_date:
description: Date coverage goes into effect (ISO-8601 YYYY-MM-DD)
type: string
pattern: ^[0-9]{4}-[0-9]{2}-[0-9]{2}$
x-example: '2020-01-01'
type: array
enrollees:
type: array
items:
$ref: '#/components/schemas/ExtendedEnrollee'
GenderEnum:
enum:
- Male
- Female
type: string
Relationship:
description: Should match one of the [listed valid relationships](#introduction/more-information-about-households).
type: string
properties: {}
RelationshipEdge:
properties:
super_id:
type: string
description: enrollee id
sub_id:
type: string
description: enrollee id
relationship:
$ref: '#/components/schemas/Relationship'
ProductDivisionEnum:
enum:
- HealthCare
- Dental
type: string
FlattenedEnrollmentGroup:
properties:
id:
type: string
csr:
$ref: '#/components/schemas/CostSharingReductionEnum'
enrollees:
type: array
items:
$ref: '#/components/schemas/ExtendedEnrollee'
grouping_reason:
type: string
year:
x-example: 2019
type: number
format: integer
subscriber_id:
type: string
relationships:
type: array
items:
$ref: '#/components/schemas/RelationshipEdge'
effective_date:
type: string
pattern: ^[0-9]{4}-[0-9]{2}-[0-9]{2}$
x-example: '2020-01-01'
CostSharingReductionEnum:
type: string
description: Cost-sharing reduction (CSR)
enum:
- Exchange variant (no CSR)
- Zero Cost Sharing Plan Variation
- Limited Cost Sharing Plan Variation
- 73% AV Level Silver Plan CSR
- 87% AV Level Silver Plan CSR
- 94% AV Level Silver Plan CSR
- Non-Exchange variant
- Unknown CSR
properties: {}
CurrentEnrollment:
description: Current/existing enrollment information used to determine tobacco status for CiC enrollments. This will ensure rate calculation is done correctly.
required:
- plan_id
- effective_date
- uses_tobacco
properties:
plan_id:
$ref: '#/components/schemas/PlanID'
effective_date:
description: Date plan went into effect (ISO-8601 YYYY-MM-DD)
type: string
pattern: ^[0-9]{4}-[0-9]{2}-[0-9]{2}$
x-example: '2020-01-01'
uses_tobacco:
type: boolean
type: object
PlanID:
type: string
pattern: ^[0-9]{5}[A-Z]{2}[0-9]{7}$
properties: {}
MetalLevelEnum:
enum:
- Catastrophic
- Silver
- Bronze
- Gold
- Platinum
type: string
properties: {}
Address:
properties:
city:
type: string
state:
type: string
street_1:
type: string
street_2:
type: string
zipcode:
type: string
countyfips:
description: 5-digit county FIPS code
type: string
type: object
ExtendedEnrollee:
properties:
id:
description: The enrollee's id (uuid)
type: string
pattern: ^[a-f0-9-]+$
name:
description: The enrollee's name
type: string
gender:
$ref: '#/components/schemas/GenderEnum'
dob:
description: The enrollee's date of birth (iso8601 date)
type: string
pattern: ^[0-9]{4}-[0-9]{2}-[0-9]{2}$
location:
$ref: '#/components/schemas/Address'
csr:
$ref: '#/components/schemas/CostSharingReductionEnum'
is_filer:
type: boolean
effective_age:
type: integer
description: Effective age of the enrollee at time of enrollment.
has_hardship:
type: boolean
relationship:
$ref: '#/components/schemas/Relationship'
allowed_metal_levels:
type: array
items:
$ref: '#/components/schemas/MetalLevelEnum'
allowed_plan_ids:
type: array
items:
$ref: '#/components/schemas/PlanID'
current_enrollment:
$ref: '#/components/schemas/CurrentEnrollment'
parameters:
apikey:
name: apikey
description: API key used for authentication
in: query
required: true
x-example: d687412e7b53146b2631dc01974ad0a4
schema:
type: string
securitySchemes:
API_Key:
x-summary: API Key Auth
description: Your API key should be included as a query parameter with the request. You can [fill out this form](https://cms.gov1.qualtrics.com/jfe/form/SV_4N2GHCJfNuX7n8x) to request an API key.
type: apiKey
in: query
name: apikey
x-example: d687412e7b53146b2631dc01974ad0a4