UnitedHealthcare · Example Payload

Provider Eligibility Response Example

Health InsuranceHealthcareFHIRClaimsEligibility

Provider Eligibility Response Example is an example object payload from UnitedHealthcare, with 14 top-level fields. It illustrates the shape of data this provider's APIs accept or return.

Top-level fields

memberIdmemberNamecoverageStatusplanNamegroupNumbereffectiveDateterminationDatedeductibledeductibleMetoutOfPocketMaxoutOfPocketMetcopaycoinsurancenetworkStatus

Example Payload

{
  "memberId": "987654321",
  "memberName": "Jane Smith",
  "coverageStatus": "ACTIVE",
  "planName": "UnitedHealthcare Choice Plus PPO",
  "groupNumber": "GRP-001234",
  "effectiveDate": "2026-01-01",
  "terminationDate": null,
  "deductible": 1500.0,
  "deductibleMet": 450.0,
  "outOfPocketMax": 4500.0,
  "outOfPocketMet": 450.0,
  "copay": 30.0,
  "coinsurance": 20.0,
  "networkStatus": "IN_NETWORK"
}

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