GET api/benefitcheck?memberNo={memberNo}&benefitCodeNo={benefitCodeNo}&dateOfService={dateOfService}&excludeClaimsAfterDateOfService={excludeClaimsAfterDateOfService}
Retrieves the claim amounts for specified intervals (Period, Month, and Lifetime), along with the Max Out of Pocket (MOOP) and deductible values set up on the plan for a given member.
Request Information
URI Parameters
| Name | Description | Type | Additional information |
|---|---|---|---|
| memberNo |
The unique identifier for the member whose data is to be retrieved. |
integer |
Required |
| benefitCodeNo |
The benefit code number used to filter claim totals (optional). |
integer |
Default value is 0 |
| dateOfService |
The date of service used to calculate the current period for benefit values (optional, defaults to the current date). If excludeClaimsAfterDateOfService is true, this will be the last date for claims included in the benefit totals. |
date |
None. |
| excludeClaimsAfterDateOfService |
Indicates whether to limit claims to those up to the specified dateOfService (optional, defaults to false). If true, claims are limited to dates up to the dateOfService. If false, dateOfService is only used to determine the current benefit period. |
boolean |
Default value is False |
Body Parameters
None.
Response Information
Resource Description
An object containing: A list of claim totals for three intervals (Month, Period, Lifetime).A list of max out of pocket values for the member's plan.A list of deductible values for the member's plan. Each MOOP and deductible includes a value indicating if it has been met for the period.
BenefitCheckModel| Name | Description | Type | Additional information |
|---|---|---|---|
| ClaimHistories |
Collection of objects showing claim history for different time periods |
Collection of AuditClaimHistoryModel |
None. |
| MaxOutOfPockets |
Collection of Max Out Of Pocket Checks associated with a plan/member whose benefit details are being requested |
Collection of MOOPCheckModel |
None. |
| Deductibles |
Collection of Deductible Checks associated with a plan/member whose benefit details are being requested |
Collection of DeductibleCheckModel |
None. |
Response Formats
application/json, text/json, application/json-patch+json
Sample:
{
"claimHistories": [
{
"amountAppliedToPeriodicDeductibleMember": 1.0,
"amountAppliedToPeriodicDeductibleFamily": 1.0,
"amountEligibleTowardsDeductibleMember": 1.0,
"amountEligibleTowardsDeductibleFamily": 1.0,
"amountEligibleTowardsOutOfPocketLimitMember": 1.0,
"amountEligibleTowardsOutOfPocketLimitFamily": 1.0,
"planPaidAmountMember": 1.0,
"planPaidAmountFamily": 1.0,
"planIncentiveAmountMember": 1.0,
"startDate": "2025-07-16T15:12:18.9921369-05:00",
"endDate": "2025-07-16T15:12:18.9921369-05:00",
"interval": "sample string 1",
"benefitCodeDescription": "sample string 2",
"rxDeductibleMember": 1.0,
"rxDeductibleFamily": 1.0,
"rxDeductibleAppliedMember": 1.0,
"rxDeductibleAppliedFamily": 1.0,
"rxOutOfPocketLimitMember": 1.0,
"rxOutOfPocketLimitFamily": 1.0,
"rxPlanPaidAmountMember": 1.0,
"rxPlanPaidAmountFamily": 1.0,
"accumulatorDeductibleMember": 1.0,
"accumulatorDeductibleFamily": 1.0,
"accumulatorDeductibleAppliedMember": 1.0,
"accumulatorDeductibleAppliedFamily": 1.0,
"accumulatorOutOfPocketLimitMember": 1.0,
"accumulatorOutOfPocketLimitFamily": 1.0,
"accumulatorPlanPaidAmountMember": 1.0,
"accumulatorPlanPaidAmountFamily": 1.0,
"otherClaimDeductibleMember": 1.0,
"otherClaimDeductibleFamily": 1.0,
"otherClaimDeductibleAppliedMember": 1.0,
"otherClaimDeductibleAppliedFamily": 1.0,
"otherClaimOutOfPocketLimitMember": 1.0,
"otherClaimOutOfPocketLimitFamily": 1.0,
"otherClaimPlanPaidAmountMember": 1.0,
"otherClaimPlanPaidAmountFamily": 1.0,
"claimAdjDeductibleMember": 1.0,
"claimAdjDeductibleFamily": 1.0,
"claimAdjDeductibleAppliedMember": 1.0,
"claimAdjDeductibleAppliedFamily": 1.0,
"claimAdjOutOfPocketLimitMember": 1.0,
"claimAdjOutOfPocketLimitFamily": 1.0,
"claimAdjPlanPaidAmountMember": 1.0,
"claimAdjPlanPaidAmountFamily": 1.0
},
{
"amountAppliedToPeriodicDeductibleMember": 1.0,
"amountAppliedToPeriodicDeductibleFamily": 1.0,
"amountEligibleTowardsDeductibleMember": 1.0,
"amountEligibleTowardsDeductibleFamily": 1.0,
"amountEligibleTowardsOutOfPocketLimitMember": 1.0,
"amountEligibleTowardsOutOfPocketLimitFamily": 1.0,
"planPaidAmountMember": 1.0,
"planPaidAmountFamily": 1.0,
"planIncentiveAmountMember": 1.0,
"startDate": "2025-07-16T15:12:18.9921369-05:00",
"endDate": "2025-07-16T15:12:18.9921369-05:00",
"interval": "sample string 1",
"benefitCodeDescription": "sample string 2",
"rxDeductibleMember": 1.0,
"rxDeductibleFamily": 1.0,
"rxDeductibleAppliedMember": 1.0,
"rxDeductibleAppliedFamily": 1.0,
"rxOutOfPocketLimitMember": 1.0,
"rxOutOfPocketLimitFamily": 1.0,
"rxPlanPaidAmountMember": 1.0,
"rxPlanPaidAmountFamily": 1.0,
"accumulatorDeductibleMember": 1.0,
"accumulatorDeductibleFamily": 1.0,
"accumulatorDeductibleAppliedMember": 1.0,
"accumulatorDeductibleAppliedFamily": 1.0,
"accumulatorOutOfPocketLimitMember": 1.0,
"accumulatorOutOfPocketLimitFamily": 1.0,
"accumulatorPlanPaidAmountMember": 1.0,
"accumulatorPlanPaidAmountFamily": 1.0,
"otherClaimDeductibleMember": 1.0,
"otherClaimDeductibleFamily": 1.0,
"otherClaimDeductibleAppliedMember": 1.0,
"otherClaimDeductibleAppliedFamily": 1.0,
"otherClaimOutOfPocketLimitMember": 1.0,
"otherClaimOutOfPocketLimitFamily": 1.0,
"otherClaimPlanPaidAmountMember": 1.0,
"otherClaimPlanPaidAmountFamily": 1.0,
"claimAdjDeductibleMember": 1.0,
"claimAdjDeductibleFamily": 1.0,
"claimAdjDeductibleAppliedMember": 1.0,
"claimAdjDeductibleAppliedFamily": 1.0,
"claimAdjOutOfPocketLimitMember": 1.0,
"claimAdjOutOfPocketLimitFamily": 1.0,
"claimAdjPlanPaidAmountMember": 1.0,
"claimAdjPlanPaidAmountFamily": 1.0
}
],
"maxOutOfPockets": [
{
"isPeriodMOOPMet": true,
"moop": {
"url": "sample string 4",
"id": 5,
"groupPlanNo": 1,
"description": "sample string 2",
"personAmount": 1.0,
"familyAmount": 1.0,
"memberPortalDescription": "sample string 3",
"maxOutOfPocketRates": [
{
"url": "sample string 3",
"id": 4,
"effectiveStartDate": "2025-07-16T15:12:18.9921369-05:00",
"personAmount": 1.0,
"familyAmount": 1.0,
"maxOutOfPocketNo": 2
},
{
"url": "sample string 3",
"id": 4,
"effectiveStartDate": "2025-07-16T15:12:18.9921369-05:00",
"personAmount": 1.0,
"familyAmount": 1.0,
"maxOutOfPocketNo": 2
}
]
}
},
{
"isPeriodMOOPMet": true,
"moop": {
"url": "sample string 4",
"id": 5,
"groupPlanNo": 1,
"description": "sample string 2",
"personAmount": 1.0,
"familyAmount": 1.0,
"memberPortalDescription": "sample string 3",
"maxOutOfPocketRates": [
{
"url": "sample string 3",
"id": 4,
"effectiveStartDate": "2025-07-16T15:12:18.9921369-05:00",
"personAmount": 1.0,
"familyAmount": 1.0,
"maxOutOfPocketNo": 2
},
{
"url": "sample string 3",
"id": 4,
"effectiveStartDate": "2025-07-16T15:12:18.9921369-05:00",
"personAmount": 1.0,
"familyAmount": 1.0,
"maxOutOfPocketNo": 2
}
]
}
}
],
"deductibles": [
{
"isPeriodDeductibleMet": true,
"deductible": {
"url": "sample string 4",
"id": 5,
"groupPlanNo": 1,
"description": "sample string 2",
"personAmount": 1.0,
"familyAmount": 1.0,
"memberPortalDescription": "sample string 3",
"deductibleRates": [
{
"url": "sample string 3",
"id": 4,
"effectiveStartDate": "2025-07-16T15:12:18.9921369-05:00",
"personAmount": 1.0,
"familyAmount": 1.0,
"deductibleNo": 2
},
{
"url": "sample string 3",
"id": 4,
"effectiveStartDate": "2025-07-16T15:12:18.9921369-05:00",
"personAmount": 1.0,
"familyAmount": 1.0,
"deductibleNo": 2
}
]
}
},
{
"isPeriodDeductibleMet": true,
"deductible": {
"url": "sample string 4",
"id": 5,
"groupPlanNo": 1,
"description": "sample string 2",
"personAmount": 1.0,
"familyAmount": 1.0,
"memberPortalDescription": "sample string 3",
"deductibleRates": [
{
"url": "sample string 3",
"id": 4,
"effectiveStartDate": "2025-07-16T15:12:18.9921369-05:00",
"personAmount": 1.0,
"familyAmount": 1.0,
"deductibleNo": 2
},
{
"url": "sample string 3",
"id": 4,
"effectiveStartDate": "2025-07-16T15:12:18.9921369-05:00",
"personAmount": 1.0,
"familyAmount": 1.0,
"deductibleNo": 2
}
]
}
}
]
}