InsEnrollmentService:getMemberEnrollments

Class: InsEnrollmentService

Method: getMemberEnrollments

There are two flows to invoke the getMemberEnrollments service:

• Insurance Policy Flow: It’s triggered when the value of isFsc is true.

  • Person Accounts flow is triggered when isFsc is true and GroupCensusMember__c.AccountId__c field is populated.

  • Non-Person Accounts flow is triggered when GroupCensusMember__c.AccountId__c field isn’t populated.

• Asset Flow: It’s triggered when the value of IsFsc is false.

How It Works When Using Insurance Policy Records

The Insurance Policy flow is applicable when the value of isFsc is true. The service does the following:

1. If no effectiveDate is provided in the input, the service uses the contractId parameter to retrieve Contract.EnrollmentStartDate__c. See effectiveDate and contractId parameters in the Remote Options section for more information.

2. Returns the policies as InsurancePolicy records. For Insurance Policy, the service supports both the Person Accounts flow and the Non-Person Accounts flow explained as:

   Person Accounts Flow

   This flow is applicable when census members are associated to person accounts.

   1. If groupAccountId is the input, the service uses ACR to retrieve the personAccountIds of the census members associated with the groupAccountId. It returns all Insurance Policies where nameInsuredId matches these personAccountIds and effectiveDate match the effectiveDate provided in the input.

   2. If censusMemberIds is the input, the service retrieves the GroupCensusMember__c records. See censusMemberIds parameter in Remote Options section for more information. If the AccountId__c field of the census members is populated, then we use these personAccountIds (GroupCensusMember__c.AccountId__c). It returns all Insurance Policies where nameInsuredId matches personAccountIds and effectiveDate match the effectiveDate provided in the input.

   Non-Person Accounts Flow

   This flow is applicable when census members are associated to contacts.

   1. The service uses accountId to retrieve the InsurancePolicy object for the census members. It’s a mandatory parameter for non-person accounts flow.

   2. If censusMemberIds field is provided in the input, the service retrieves the GroupCensusMember__c records. If the AccountId__c field of the census members isn’t populated, then the service retrieves the policies of the members using the GroupCensusMember__c.ContactId__c, accountId, and effectiveDate. The type of policy that gets retrieved depends on the isFsc parameter, and the custom setting for defaultIsFSCOption as is described in this table:

      Custom Settings > Insurance Configuration Setup>defaultIsFSCOption	IsFsc Parameter	Policies Retrieved
      True	NA	InsurancePolicy
      False	True	InsurancePolicy
      NA	True	InsurancePolicy

3. The service retrieves the parties, InsurancePolicyParticipant or AssetPartyRelationship__c of the InsurancePolicy or Asset records, respectively. For FSC, AssetPartyRelationship__c only has records for the primary members' dependents. InsurancePolicyParticipant has records for both the primary members and their dependents.

4. If omitChildProducts field is false, then the service retrieves the coverages (AssetCoverage__c) of the policies and their corresponding product metadata. See omitChildProducts parameter in Remote Options section for more information.

5. Each policy is then grouped by the primary member.

How It Works for Assets

Assets flow is applicable when the value of isFsc is false. For assets records, we don't support Person Account.

The service does the following:

1. If no effectiveDate is provided in the input, the service uses the contractId parameter to retrieve Contract.EnrollmentStartDate__c. See effectiveDate and contractId parameters in the Remote Options section for more information.

2. The service uses accountId to retrieve the Asset object for the census members. It’s a mandatory parameter for Non-FSC accounts flow.

3. The service uses censusMemberIds to retrieve the GroupCensusMember__c records. See censusMemberIds parameter in the Remote Options section for more information.

4. If AccountId__c field of the census members isn’t populated, the service retrieves the policies of the members using the GroupCensusMember__c.ContactId__c, accountId, and effectiveDate fields. The type of policy that gets retrieved depends on the isFsc parameter, and the custom setting for defaultIsFSCOption as is described in this table.

   Custom Settings > Insurance Configuration Setup>defaultIsFSCOption	IsFsc Parameter	Policies Retrieved
   False	False	Asset
   NA	False	Asset

5. The service retrieves the parties. For Non-FSC, it retrieves InsurancePolicyParticipant or AssetPartyRelationship__c, of the InsurancePolicy or Asset records.

   • AssetPartyRelationship__c only has records for the primary members' dependents.

   • InsurancePolicyParticipant has records for both the primary members and their dependents.

6. If omitChildProducts field is false, the service retrieves the coverages (InsurancePolicyCoverage or AssetCoverage__c) of the policies and their corresponding product metadata. See omitChildProducts parameter in Remote Options section for more information.

7. Each policy is then grouped by the primary member.

Remote Options

The service uses either the contractId to get the effectiveDate from enrollmentStartDate or it uses effectiveDate directly, which takes precedence over contractId if both are used.

Input JSON

This service doesn’t take an input JSON.

Output JSON

Here's the format of the output JSON:

• The output JSON is a list of census members, with First Name, Last Name, Census Member Id, and Contact Id, with its enrollments.

• The Enrollments node has product details and Dependents nodes if there are dependents. It also includes child Products and coverage details.

• The Dependents node consists of First Name, Last Name, Id, RelationshipType, ContactId, and PartyId.

{
  "totalSize": numberOfPrimaryMembersRetrievedWithEnrollments,
  "records": [
    {
      "FirstName": "primaryMemberFirstName",
      "LastName": "primaryMemberLastName",
      "Id": "primaryMemberGroupCensusMemberId",
      "contactId": "primaryMemberContactId",
      "enrollments": {
        "totalSize": primary member's number of enrollments,
        "records": [
          {
            "policyNumber": "policy number",
            "Id": "policy Id",
            "productId": "policy's product id",
            "accountId": "policy's account id",
            "primaryMemberContactId": "primaryMemberContactId",
            "productName": "policy's product name",
            "Name": "policy's product name",
            "EffectiveStart": "policy effective date",
            "EffectiveEnd": "policy expiration date",
            "Price": 0,
            "planId": "policy product's plan id",
            "contractId": "contract id",
            "ProductCode": "product code",
            "RecordTypeName__c": "Product",
            "attributeCategories": {},
            "Term": "policy term",
            "attributeSelectedValues": "{}",
            "childProducts": {
              "totalSize": numberOfChildProductsOfThePolicyProduct,
              "records": [
                {
                  "productId": "productIdOfTheChildProduct",
                  "productName": "productNameOfTheChildProduct",
                  "ProductCode": "productCodeOfTheChildProduct",
                  "Name": "productNameOfTheChildProduct",
                  "pciId": "productChildItemIdOfTheChildProduct",
                  "isOptional": ifThisIsAnOptionalCoverage,
                  "attributeSelectedValues": "{}",
                  "isSelected": true,
                  "Id": "coverageId",
                  "PricingSource": "pricingSource",
                  "attributeCategories": {}
                }
              ]
            },
            "dependents": {
              "totalSize": primary member's number of dependents,
              "records": [
                {
                  "Id": "record id",
                  "FirstName": "dependentsFirstName",
                  "LastName": "dependentsLastName",
                  "relationshipType": "relationshipType",
                  "partyId": "contact's party id",
                  "contactId": "dependent's contact Id"
                }
              ]
            }
          }
        ]
      }
    }
  ]
}

Here's an example of output JSON:

{
  "totalSize": 1,
  "records": [
    {
      "FirstName": "Scott",
      "LastName": "Matthews",
      "Id": "a386F000000yq5LQAQ",
      "contactId": "0036F00002Q4wlSQAR",
      "enrollments": {
        "totalSize": 1,
        "records": [
          {
            "policyNumber": "AA232SDTJ",
            "Id": "02i6F000004XE2jQAG",
            "productId": "01t6F000007sLsaQAE",
            "accountId": "0016F00002GIY4mQAH",
            "primaryMemberContactId": "0036F00002Q4wlSQAR",
            "productName": "BoMedicalProduct",
            "Name": "BoMedicalProduct",
            "EffectiveStart": "2018-04-12",
            "EffectiveEnd": "2019-02-09",
            "Price": 0,
            "planId": "a1u6F0000035QYxQAM",
            "contractId": "8006F000001GhodQAC",
            "ProductCode": "BMP",
            "RecordTypeName__c": "Product",
            "attributeCategories": {
              "totalSize": 1,
              "records": [
                {
                  "productAttributes": {
                    "records": [
                      {
                        "userValues": null,
                        "values": [
                          {
                            "disabled": true,
                            "readonly": true
                          }
                        ],
                        "isNotTranslatable": false,
                        "cloneable": true,
                        "hidden": false,
                        "hasRules": false,
                        "displaySequence": 0,
                        "label": "TestAttribute_2.2",
                        "attributeId": "a1R6F00000FNrpDUAT",
                        "filterable": true,
                        "disabled": true,
                        "readonly": true,
                        "required": false,
                        "multiselect": false,
                        "inputType": "number",
                        "dataType": "currency",
                        "code": "bfb83baa-662e-674e-9c04-2bad2dc545e1"
                      }
                    ],
                    "totalSize": 1
                  },
                  "id": "a1Q6F000009rHU0UAM",
                  "Name": "AlvinProdCattegory2",
                  "Code__c": "d7539648-3485-0218-802c-c493e727fa67"
                }
              ]
            },
            "Term": "Custom",
            "attributeSelectedValues": "{}",
            "childProducts": {
              "totalSize": 1,
              "records": [
                {
                  "productId": "01t6F00000Akx48QAB",
                  "productName": "Serious Illness",
                  "ProductCode": "SERILL",
                  "Name": "Serious Illness",
                  "pciId": "a2Q6F000001JiqHUAS",
                  "isOptional": false,
                  "attributeSelectedValues": "{}",
                  "isSelected": true,
                  "Id": "01t6F00000Akx48QAU",
                  "PricingSource": "SIPremSelected",
                  "attributeCategories": {
                    "totalSize": 1,
                    "records": [
                      {
                        "productAttributes": {
                          "records": [
                            {
                              "userValues": null,
                              "values": [
                                {
                                  "disabled": false,
                                  "readonly": false
                                }
                              ],
                              "isNotTranslatable": false,
                              "cloneable": true,
                              "hidden": false,
                              "hasRules": false,
                              "displaySequence": 1,
                              "label": "SI Amount Override",
                              "attributeId": "a1R6F00000LE7ESUA1",
                              "filterable": true,
                              "disabled": false,
                              "readonly": false,
                              "required": false,
                              "multiselect": false,
                              "inputType": "number",
                              "dataType": "currency",
                              "code": "SIOVER"
                            },
                            {
                              "rules": [
                                {
                                  "actions": {
                                    "Hide": {
                                      "client": {
                                        "params": {}
                                      },
                                      "remote": {
                                        "params": {}
                                      },
                                      "rest": {
                                        "link": null,
                                        "method": null,
                                        "params": {}
                                      }
                                    }
                                  },
                                  "expression": "%SERILL.SIOVER% > 0",
                                  "ruleType": "Hide"
                                }
                              ],
                              "userValues": null,
                              "values": [
                                {
                                  "disabled": false,
                                  "readonly": false
                                }
                              ],
                              "isNotTranslatable": false,
                              "cloneable": true,
                              "hidden": false,
                              "hasRules": true,
                              "displaySequence": 9,
                              "label": "SIB Multiplier",
                              "attributeId": "a1R6F00000LE7ERUA1",
                              "filterable": true,
                              "disabled": false,
                              "readonly": false,
                              "required": false,
                              "multiselect": false,
                              "inputType": "number",
                              "dataType": "number",
                              "code": "SIB"
                            },
                            {
                              "rules": [
                                {
                                  "actions": {
                                    "Hide": {
                                      "client": {
                                        "params": {}
                                      },
                                      "remote": {
                                        "params": {}
                                      },
                                      "rest": {
                                        "link": null,
                                        "method": null,
                                        "params": {}
                                      }
                                    }
                                  },
                                  "expression": "%SERILL.SIOVER% > 0",
                                  "ruleType": "Hide"
                                }
                              ],
                              "userValues": null,
                              "values": [
                                {
                                  "disabled": false,
                                  "readonly": false
                                }
                              ],
                              "isNotTranslatable": false,
                              "cloneable": true,
                              "hidden": false,
                              "hasRules": true,
                              "displaySequence": 10,
                              "label": "SIB Max",
                              "attributeId": "a1R6F00000LE7EQUA1",
                              "filterable": true,
                              "disabled": false,
                              "readonly": false,
                              "required": false,
                              "multiselect": false,
                              "inputType": "number",
                              "dataType": "currency",
                              "code": "SI"
                            }
                          ],
                          "totalSize": 3
                        },
                        "id": "a1Q6F00000ATYVIUA5",
                        "Name": "Benefit Calculation",
                        "Code__c": "11c2dcbf-500e-1180-4581-ff5000cb0ca6",
                        "displaySequence": 12
                      }
                    ]
                  }
                }
              ]
            },
            "dependents": {
              "totalSize": 2,
              "records": [
                {
                  "Id": "a0o6F00000WsgPtQAJ",
                  "FirstName": "Joan",
                  "LastName": "Robbins",
                  "relationshipType": "Child",
                  "partyId": "a376F000008BJIvQAJ",
                  "contactId": "a376F000008BJIvQAO"
                },
                {
                  "partyId": "a0o6F00000Wsh8QQAF",
                  "Id": "a0o6F00000Wsh8QQAR",
                  "First Name": "Max",
                  "Last Name": "Robbins",
                  "relationshipType": "Spouse",
                  "contactId": "a376F000008BJIwQAO"
                }
              ]
            }
          }
        ]
      }
    }
  ]
}