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APIs for Insurance Group Benefits Management
Enhance your insurance group benefits management with APIs.
- Insurance Bulk Census Management (POST)
- Insurance Group Census Members (POST, PATCH, DELETE)
- Insurance Group Census Members Delete (POST)
- Insurance Person Accounts and Users (POST)
- Insurance Contacts and Users
- Insurance Member Rating (POST)
- Insurance Member Plans (POST)
- Insurance Member Plans (PATCH)
- Insurance Member Plans Delete (POST)
- Insurance Census Summary Sync (POST)
- Insurance Member Eligible Plans (GET)
- Insurance Contract from Quote (POST)
- Insurance Group Rating (POST)
- Individual Enrollment (POST)
Insurance Bulk Census Management (POST)
Use the Insurance Bulk Census Management (POST) API to process group census data in bulk for a specific group census ID. This API helps insurers efficiently manage large volumes of member data, including both primary members and dependents, during onboarding, renewal, or open enrollment.
This API reads member data from the CSV file attached to the group census record, validates the content, and creates or updates member and dependent records. It applies duplicate detection, checks primary and dependent relationships, and runs the default flow to apply group class assignments and plan configuration. Use this API when you need to process large census files instead of adding members individually.
Behind the scenes, the API invokes the Process Group Census Member Data flow, which validates, transforms, and saves census member records. You can extend and customize this flow according to your business needs.
You can use this API as part of automated enrollment workflows where census data is collected from HR systems or third-party administrators. After processing, the resulting Group Census and related records are available for downstream operations such as plan configuration, group rating, quote generation, and policy creation.
How It Works
- Retrieves census metadata and the attached CSV file.
- Validates member rows for required data and parent and child associations.
- Updates existing members and creates new members.
- Collects errors and returns them in the API response or saves them for review.
- For enrollment census types, also updates plan details based on business rules.
When to use it
- Uploading a new census file for a group policy.
- Reprocessing a corrected CSV file after fixing validation errors.
- Automating onboarding workflows where census data originates from external HR or payroll systems.
Insurance Group Census Members (POST, PATCH, DELETE)
Use the Insurance Group Census Members (POST, PATCH, DELETE) API to add, update, or delete member records within a specific group census.
- Use POST to add one or more members and their dependents to a group census.
- Use PATCH to update existing member details.
- Use DELETE to remove all members from a specified group census.
The API processes both primary members and dependents and applies the necessary validation rules to keep the census accurate, consistent, rating, or quoting. It evaluates relationships between primary and dependent members, performs duplicate detection, and applies group class and enrollment logic through the Process Group Census Member Data flow unless you specify a different flow.
The API takes the groupCensusId in the path and processes only the member records provided in the request. You typically use this API when onboarding new member data, correcting demographic fields such as name, birthdate, or group class, or preparing the census for downstream steps like plan selection.
The DELETE method removes all members linked to the specified groupCensusId. This differs from the Insurance Group Census Members Delete (POST) API, which deletes only the individual members whose IDs you provide in the request. Use DELETE when you need to clear and reset the full census before reprocessing, and use the targeted deletion API when you want to remove only specific members.
Insurance Group Census Members Delete (POST)
Use the Insurance Group Census Members Delete (POST) API to remove one or more census members associated with a specific group census ID. This API helps insurers keep census data clean and accurate by removing members who are no longer eligible, active, or relevant for enrollment, rating, or quoting processes.
When a member is deleted, all associated dependent records are removed as well. Deleted records cannot be restored, so use this API when a member must be fully excluded from census-driven processes such as plan configuration, group rating, or contract creation. In the request, you specify the Group Census Member IDs for the member records you want to delete.
Insurance Person Accounts and Users (POST)
Use the Insurance Person Accounts and Users (POST) API to create person accounts and portal users for group census members. The person account is used to link the member to the appropriate policy, and the portal user allows the member to log in to the customer community portal.
After records are created and the required permission sets are assigned, members can access the community portal to view information around themselves, dependents, existing policies based on the workflow configured by the system administrator. They can also use the portal experience to configure plans and complete their enrollment based on the carrier’s digital workflow configuration.
This API can create person accounts for all members in a group census or for a specific list of census members. It supports duplicate detection to avoid creating multiple accounts for the same person and uses field mappings to align census member data with account fields.
Insurance Contacts and Users
Use the Insurance Contacts and Users (POST) API to create contact records and optional portal users for group census members. This API helps convert census member data into standard Salesforce Contact records that can participate in enrollment, communication, and policy processes. When portal users are created, members can access the customer community to review plans or complete self-service enrollment steps.
This API supports processing all members of a group census or specific members identified in the request. It prevents duplicate contact creation by using matching fields and applies field mappings to align census member data with contact fields. After the contact and portal user records are created and the required permission sets are assigned, members can access the community portal to review plans and complete their enrollment.
You can also integrate this API into the Group Enrollment flow to automate portal user creation during the enrollment process. By customizing the Create Contacts and Users From Group Census or Members invocable action in the enrollment flow, you can set Create Portal User to true and provide a valid profile ID. This enables automatic creation of portal users for each member when enrollment data is processed.
For batch processing, configure a batch job that references the customized enrollment flow. The batch job creates portal users for primary members in bulk, based on their group census records.
Insurance Member Rating (POST)
Use the Insurance Member Rating (POST) API to calculate premiums and contribution amounts for individual members in a group census. This API evaluates each member’s selected plans and coverages, determines pricing at the coverage level, and rolls those amounts up to the plan and member levels.
The API supports both employee and employer contribution calculations, making it a key step before enrollment or group rating.
The API uses the member’s plan and coverage data as input and returns the calculated premiums and contributions. Each response includes detailed pricing results, contribution amounts, and any error messages encountered during rating.
Use this API when you need to:
- Calculate member-level premiums and contributions before enrollment.
- Validate or preview pricing for selected plans and coverages.
Insurance Member Plans (POST)
Use POST to add new plans for a group census member. The request includes the member ID and a list of plans to add. The API adds all specified plans in a single operation and returns the member’s updated plan list and errors that occurred during processing.
Insurance Member Plans (PATCH)
Use PATCH to update existing plan selections for a member by adding new plans or deleting existing ones.
The API processes all changes as a single transaction, so either all updates succeed or none are applied. The response lists which plans were updated or removed and includes any validation errors.
When a primary member opts in to a plan, dependents don’t automatically receive the same plan selection. Dependents can choose the same plan with different coverage options or opt out of the plan category.
If the primary member changes their plan selection, all dependent plan selections for that plan are removed and must be reconfigured. When a primary member opts out of a plan category, dependents cannot enroll in that category.
Insurance Member Plans Delete (POST)
Use the Insurance Member Plans Delete (POST) API to delete one or more plans for a group census member. This API removes the specified member plan records and their related details from the group census.
When you provide a root plan ID as an input, the API removes the plan and all related coverages for the member and returns the outcome of the deletion request.
Use this API to remove plans that a member no longer wants or to fix incorrect plan selections. When you delete a plan, all related plan records are removed from the member’s configuration.
Insurance Census Summary Sync (POST)
Use the Insurance Census Summary Sync (POST) API to recalculate and refresh summary data for a group census. This API updates the Group Census Summary and Group Census Group Class Summary records so they reflect the latest member and dependent information after any add, update, or delete operations.
The API uses the group census ID to perform the synchronization and doesn’t require a request payload. It returns updated summary counts, such as the total number of members, dependents, and opt-outs, along with group class–level breakdowns.
You can use this API after adding, updating, or deleting members or dependents in a group census to make sure that the summary data reflects the latest member information.
Insurance Member Eligible Plans (GET)
Use the Insurance Member Eligible Plans (GET) API to retrieve the contract group plans for which a group census member and their dependents are eligible. Eligibility is determined by configuration such as group class assignments, and contract setup.
The API takes the group census member ID as input and returns plan and coverage details available to each member based on eligibility rules defined for the group census. You can choose to include or exclude dependent eligibility by using the request parameter. The response lists each member’s eligible plans and coverages by product category, along with information such as plan names and subscription status.
You can use this API as part of the group enrollment process to display available plans before members select or update their plan preferences. It ensures that each member and dependent sees only the plans they’re eligible for based on group class and contract configuration.
Insurance Contract from Quote (POST)
Use the Insurance Contract from Quote (POST) API to create a group benefits contract from an approved quote. This API converts a quote into a contract record with defined terms, dates, and optional additional fields.
The API takes the quote ID and contract details as input and returns a response that indicates whether contract creation has started successfully along with a tracking ID for the asynchronous job. As part of asynchronous job, the API creates contract group plans for each of the root products and coverages configured in the quote, along with attributes. If applicable, It also creates records which are used for identification of group plan eligibility for members based on their group class.
The API validates the quote, creates the contract, and applies contract details such as start and end dates, enrollment periods, and term duration. You can also include additional fields to set values for entities such as Contract, Insurance Contract, and Contract Group Plan during contract creation.
You can use this API after quote approval, once the customer agrees to purchase coverage. If you’re invoking this API from a flow, make sure to enable Manually assign variables (advanced) when mapping outputs. The output field asyncBulkRequestId isn’t supported with automatic variable mapping.
Insurance Group Rating (POST)
Use the Insurance Group Rating (POST) API to calculate premiums for all quote line items in a group benefits quote. You can rate the entire quote or specific root plans to calculate premiums for their associated quote line items.
The API takes the quoteId in the path and uses your request inputs to start the rating process. You can provide a list of quote line item IDs to rate specific products or omit the list to rate the full quote. You can also send a ratingDate to control the pricing date that applies to the calculation. The API triggers an asynchronous rating process, so you receive an immediate response while the calculation continues in the background.
The API validates the input quote and processes the rating using the group rating engine. It calculates premiums based on the rating date and configuration rules defined for the products in the quote.
Use this API when you finalize plan selections and need accurate premiums for quoting or when you update member or coverage data and want to refresh pricing for one or more plans.
Individual Enrollment (POST)
Use the Individual Enrollment (POST) API to enroll a group census member in a group benefits insurance plan and create the corresponding policy records. The API processes enrollment for a primary member and their dependents under the specified root contract group plan.
The API takes the memberId in the path and uses the plan ID you provide in the request. You can also specify a flowName to run custom enrollment logic, or rely on the default Process Group Census Member Data flow. The API validates the member and plan details, checks eligibility, applies enrollment rules, and generates one or more policy records for the family.
You can use this API as part of the individual enrollment workflow, where members review eligible plans, view premiums and contributions, and complete their enrollment. The API automates policy creation for selected plans once eligibility and rating validations are complete.
