Schemas

Address line one.

City.

State or territory code.

ZIP code.

County FIPS ID.

Address line two.

County name.

Agency TIN.

Agency name.

Member address payload.

Agency email address.

Agent first name.

Agent last name.

Member address payload.

Agent NPN.

Agent phone number.

Agent email address.

Account type.

Account holder name.

Routing number.

Account number.

Carrier identifier (UUID).

Plan HIOS identifier (UUID).

Enrolled members list.

Plan type (hmo, ppo, pos, epo, indemnity).

Plan metal level (bronze, silver, gold, platinum, catastrophic, expanded_bronze).

Carrier-specific configuration blob.

Agent payload.

Agency payload.

Payment payload.

Card type.

Card holder name.

Card number.

Card expiration date.

Card security code.

Shared person payload for employees and dependents.

Relationship to employee (spouse, child, domestic-partner).

Child subtype (biological, step, foster, adopted, legal-custody). Required when relationship is child.

Company payload. Identifies the company the enrollment belongs to.

Enrollment action type (new_enrollment, change, or termination).

Employee payload.

Coverage payload.

Managing third party payload. Identifies the party that collected and manages the enrollment when it is not the submitting trading partner.

Optional dependents payload array.

Optional events payload array.

Shared person payload for employees and dependents.

Employment details payload.

Hire date (ISO-8601 string).

Full-time start date (ISO-8601 string).

Rehire date (ISO-8601 string).

Retirement date (ISO-8601 string).

Termination date (ISO-8601 string).

Employment status (full-time, part-time, contract, disabled, terminated, retired).

Employment date payload.

Occupation name.

Salary payload.

Partner individual identifier for employee or dependent.

Coverage member action (enroll, continue, change, or terminate).

Enrollment effective start date.

Enrollment effective end date.

Optional event identifier from events list.

PCP details payload.

Prior coverage being replaced by this enrollment.

Event local payload identifier.

Event type (coverage or demographic).

Event date (ISO-8601).

Qualifying-event reason. Must be one of the recognized snake_case values (see enum).

Primary care provider first name.

Primary care provider last name.

Primary care provider NPI.

Primary care provider carrier identifier.

Monthly premium amount.

Monthly employer contribution amount.

Member address payload.

Credit card payload.

Bank account payload.

Contact email address.

Contact phone number.

Preferred language (en, es).

Preferred contact method.

Tobacco usage details.

Disability details.

Indicates military status.

Indicates student status.

Indicates disability.

Indicates hearing impairment.

Indicates visual impairment.

Indicates speech impairment.

Trading partner's unique ID for the person (e.g. UserID).

Person first name.

Person last name.

Date of birth (ISO-8601 string).

Sex value (F, M, U, or X).

Member address payload.

Member address payload.

Person middle name.

Person name suffix.

Social Security Number.

Marital status (single, married, divorced, widowed, separated, domestic-partner, common-law, or civil-union).

Person contact details.

Extended person details.

Indicates tobacco user.

Duration of tobacco usage.

Salary amount.

Salary type.

Salary unit.

Effective date (ISO-8601 string).

Snapshot identifier returned from submission.

External processing status (pending, processing, complete, error).

Item-level outcomes for transactions in the submitted snapshot payload.

Name of the prior insurer.

Coverage type (group, individual).

Prior policy number.

Prior group number.

Prior coverage start date.

Prior coverage end date.

When true the prior coverage end date is set to the day before the new enrollment effective date.

Whether the subscriber consents to receive notices and communications via email. Maps to Anthem AgreeToElectronicCommunication. Default: true. For VA and NV states the inverse drives NotAgreeToElectronicCommunication.

Whether the subscriber has purchased a standalone pediatric dental plan for dependent children under 19. Maps to Anthem IsAgreePediatricDentalMarketPlacePurchase. Default: false.

Whether the subscriber elects to enroll in the Donate Life registry. Maps to Anthem IsDonateLifeRegistry. Required for NY enrollments. Default: false.

Whether the subscriber requires enrollment materials in an alternate communication format. Maps to Anthem IsCommunicationImpairment. Required for TX (Wellpoint) enrollments. Default: false.

The alternate communication format required when communication_impairment is true. Maps to Anthem CommunicationImpairmentFormat. One of BRAILLE, LARGE_PRINT, AUDIO, OTHER. Required for TX when communication_impairment is true.

The specific alternate medium when communication_impairment_format is OTHER. Maps to Anthem CommunicationImpairmentFormatOther. One of ENCRYPT_AUDIO_CD, ENCRYPT_DATA_CD.

Whether the applicant has other health coverage attributable to a disability. Maps to Anthem IsOtherHealthCovDisability. Required for NY enrollments. Default: false.

Whether an employer of fifty (50) or fewer eligible employees is paying for or reimbursing premiums. Maps to Anthem IsEmployerPremReimbusement. Required for CO enrollments. Default: true.

Whether the employer maintained a small-group health benefit plan. Maps to Anthem IsEmployerHealthBenifitPlan. For a valid ICHRA this is false (the ICHRA is offered instead of a group plan); a true value makes the applicant ineligible in CO (Anthem E0504). Default: false.

Whether the employer reimburses health expenses under the arrangement. Maps to Anthem IsEmployerHealthReimbursement. Default: true.

Whether the subscriber wants to establish an HSA. Maps to Anthem IsEstablishHSA. Default: false.

Whether the subscriber's current coverage is already with Anthem. When true and the enrollment window is not open enrollment, the submission will require manual processing. Default: false.

Whether any dependent child over 26 is incapable of self-sustaining employment due to impairment. Maps to Anthem HaveDependentWithDisability. Default: false.

Anthem-specific encrypted agent identifier. Maps to Application.Agent.AgentTIN. Must contain only alphabetic characters. Required for valid submission.

Anthem-specific encrypted agency identifier. Maps to Application.Agent.ParentAgent.AgentTIN. Must contain only alphabetic characters. Required for valid submission.

Whether the enrollment was assisted by a licensed agent. Maps to Application.IsAgentAssisted and StatementOfAccountability.IsAgentAssisted. Default: true.

Whether the applicant is unable to read English. Maps to StatementOfAccountability.IsNotReadEnglish. Default: false.

Whether the applicant is unable to speak English. Maps to StatementOfAccountability.IsNotSpeakEnglish. Default: false.

Whether the applicant is unable to write English. Maps to StatementOfAccountability.IsNotWriteEnglish. Default: false.

Whether the applicant has limited English proficiency. Maps to StatementOfAccountability.IsLimitedEnglish. Default: false.

Whether the applicant agrees to electronic signature. Maps to ESignature.IsAgreeToElectronicSignature. Default: true.

Whether the applicant has read the completed application. Maps to ESignature.IsReadCompletedApp. Default: true.

Whether the applicant agrees to member communications. Maps to ESignature.IsAgreeToMemCommunication. Default: true.

Whether the applicant has read and understands the enrollment form. Maps to ESignature.IsReadUnderstandEnrollForm. Default: true.

Per-member flag overrides. Members are identified by their partner_individual_id.

The partner_individual_id matching the employee or dependent entry this record applies to.

Whether this member is a legal US resident. Maps to Demographic.IsUSResident. Default: true.

Whether this member is currently incarcerated. Maps to Demographic.IsIncarceration. Default: false.

Whether this member identifies as non-binary. Only consumed for CO state where Anthem accepts gender value X. Maps to Demographic.Gender override. Default: false.

Whether this member identifies as Chinese. Maps to StatementOfAccountability.IsChinese for the employee (primary applicant) only. Default: false.

Whether this member identifies as Korean. Maps to StatementOfAccountability.IsKorean for the employee (primary applicant) only. Default: false.

Whether this member identifies as Vietnamese. Maps to StatementOfAccountability.IsVietnamese for the employee (primary applicant) only. Default: false.

Whether this member prefers Spanish. Maps to StatementOfAccountability.IsSpanish for the employee (primary applicant) only. Default: false.

Whether this member prefers Tagalog. Maps to StatementOfAccountability.IsTagalog for the employee (primary applicant) only. Default: false.

Whether any household member is eligible for Medicare. Default: false. When true the enrollment will require manual processing.

Whether any household member is currently enrolled in Medicare. Default: false. When true the enrollment will require manual processing.

Whether any household member is currently enrolled in Medicaid. Default: false. When true the enrollment will require manual processing.

Kaiser medical group identifier for the enrolling group. Required.

Kaiser facility code within the medical group. Optional.

Kaiser region code identifying the geographic service area. Required.

Whether the enrollee has confirmed a triggering event for their SEP. Applies to KNW, MAS, WAS regions only. Sent to Kaiser as Y/N.

Whether the enrollee is replacing current coverage. COL region only.

Reason the enrollee is replacing current coverage. COL region only. Kaiser API values: Additional benefits, Fewer benefits, No change, Other.

Whether the enrollee is a member of a federally recognized Native American tribe. COL DORA section only.

Enrollment action applied to a snapshot member record.

Stable family key (e.g. "anthem", "kaiser"). Use this when correlating across capability matrices and snapshot submissions.

Human-friendly family name for display.

Per-plan-year capabilities. Most recent plan year first. The matrix resolution rule is most-recent-≤-N: a snapshot for plan year 2027 resolves against the highest registered plan year that is ≤ 2027.

Carrier registries (HIOS IDs etc.) the trading partner is configured to submit to under this family.

The plan year these capabilities apply from (inclusive, most-recent-≤-N resolution).

JSON Schema for the carrier_specific_config payload required when submitting a snapshot at this plan year. Null if no contract is registered.

Contract-validation rule groups for this plan year. ADDITIVE: a submission applies the family-wide group (empty appliesTo) PLUS every scoped group whose appliesTo it matches — scoped groups never replace the family-wide group (this is the opposite of constraints and routableChangeTypes, which resolve most-specific-wins). The family-wide group, when it has rules, is listed first; it is omitted entirely when the family has no baseline rules. Identify it by an empty appliesTo, not by position.

Enrollment constraint groups — permitted actions, event reasons, and date windows. Each group's appliesTo names the states / registries it covers; an empty appliesTo means the whole family.

The change types routable at this plan year, scoped by appliesTo — each entry lists the SnapshotEnrollmentActions routable for the states / carrier registries it names. An empty appliesTo means the whole family.

The carrier identifier (e.g. HIOS ID) — value to put in coverage.carrier_id when submitting a snapshot.

Stable registry key (e.g. "anthem_27603_ca").

Two-letter state code if registry is state-bound; null otherwise.

Transmission channel (e.g. "API", "EDI").

Trading-partner-scoped identifier uniquely identifying this managing third party.

Managing third party name.

Managing third party TIN.

Managing third party email address.

Managing third party phone number.

Partner-assigned company identifier.

Company name.

Company TIN.

Two-letter state codes the item applies to. Empty when the item is family-wide or issuer-scoped without a state.

Carrier ids (HIOS IDs) the item applies to — the values used in coverage.carrier_id. Empty when the item is family-wide.

The enrollment constraint rules in this group — permitted actions, event reasons, and date windows.

The path to the property on the inbound snapshot or carrier_specific_config that the rule applies to. Uses snake_case JSON names and [*] to denote collection elements.

The kind of rule being applied (e.g. "Required", "NotEmpty"). Suffix " (conditional)" indicates the rule is gated by a When/Unless clause.

Human-readable description sourced from the validator's WithMessage(...). Null when no custom message was provided (default templates are not projected). When the rule is conditional, this typically describes the gating predicate too.

The rule's concrete arguments rendered as a human-readable phrase (e.g. "one of: HMO, PPO", "≥ 0", "length 1–10"), extracted from the underlying validator. Null when the rule kind carries no arguments.

Human-readable summary of what this group enforces. Null when no description was authored.

The individual property-level rules in this group, projected from the underlying FluentValidation validators. Each rule names the property path on the inbound snapshot/config and the kind of check (e.g. "Required").

The SnapshotEnrollmentAction values routable for this scope.

External snapshot identifier for status polling.

Per-item results for all submitted items.

Caller-assigned individual identifier echoed back from the inbound payload.

Per-item dry-run outcomes, one per submitted snapshot item.

Caller-assigned individual identifier echoed back from the inbound payload.

Terminal outcome the submission would reach: succeeded, failed, needs_review, rejected_by_validation, deferred_to_edi, or could_not_be_completed.