Input
{
"application": {
"legalAttestations": {
"absentParentAgreementIndicator": false,
"changeInformationAgreementIndicator": false,
"medicaidRequirementAgreementIndicator": false,
"renewEligibilityYearQuantity": 1,
"nonIncarcerationAgreementIndicator": true,
"penaltyOfPerjuryAgreementIndicator": true,
"renewalAgreementIndicator": true,
"terminateCoverageOtherMecFoundAgreementIndicator": false
},
"insuranceApplicationSecurityQuestionType": "FIRST_JOB_CITY_OR_TOWN",
"insuranceApplicationSecurityQuestionAnswer": "Fluffy",
"applicationSignatures": [
{
"applicationSignatureType": "APPLICANT",
"applicationSignatureText": "Susan Griffith",
"applicationSignatureDate": "2016-12-31"
}
],
"applicationAssistors": [
{
"applicationAssistorType": "AGENT_BROKER",
"assistorOrganizationId": "",
"assistorOrganizationName": "",
"assistorFirstName": "Leaf",
"assistorLastName": "Perri",
"assistorMiddleName": "J",
"assistorSuffix": "Jr.",
"assistorNationalProducerNumber": 6403428819,
"assistorSystemUserName": "",
"creationDateTime": "2017-01-10T10:06:00+00:00"
}
],
"requestingFinancialAssistanceIndicator": true,
"contactMemberIdentifier": "12345",
"contactMethod": [
"EMAIL",
"E_TEXT",
"MAIL"
],
"contactInformation": {
"email": "'susangriffith@gmail.com`",
"primaryPhoneNumber": {
"type": "HOME",
"number": "1234567890",
"ext": "1"
},
"secondaryPhoneNumber": {
"type": "HOME",
"number": "1234567890",
"ext": "1"
},
"mobileNotificationPhoneNumber": "1234567890"
},
"spokenLanguageType": "ENGLISH",
"writtenLanguageType": "ENGLISH",
"coverageState": "AK",
"comments": "UpdateApplication from prior year application",
"accountHolderIdentityProofedIndicator": true
},
"household": {
"familyRelationships": [
[
"1234",
"SPOUSE",
"5678",
{
"resideTogetherIndicator": true,
"caretakerRelativeIndicator": true
}
]
],
"legalRelationships": [
[
"1234",
"WARD",
"56789"
]
],
"taxRelationships": [
[
"1234",
"TAX_FILER",
"56789"
]
]
},
"members": {
"8392883213": {
"requestingCoverageIndicator": true,
"demographic": {
"ssn": "999888888",
"birthDate": "1980-01-01",
"name": {
"firstName": "Susan",
"middleName": "Carrie",
"lastName": "Griffith",
"suffix": "Jr."
},
"ssnAlternateName": {
"firstName": "Susan",
"middleName": "Carrie",
"lastName": "Griffith",
"suffix": "Jr."
},
"sex": "FEMALE",
"maritalStatus": "MARRIED",
"noHomeAddressIndicator": true,
"liveOutsideStateTemporarilyIndicator": false,
"hispanicOriginIndicator": false,
"americanIndianAlaskanNativeIndicator": false,
"ethnicity": [
"CUBAN"
],
"otherEthnicityText": "MIXED",
"race": [
"AMERICAN_INDIAN_OR_ALASKAN_NATIVE"
],
"otherRaceText": "KENYAN",
"sexAssignedAtBirth": "OTHER",
"sexAssignedAtBirthOtherText": "X DESIGNATION",
"gender": "DIFFERENT_TERM",
"genderDifferentTermText": "NON-BINARY",
"sexualOrientation": "DIFFERENT_TERM",
"sexualOrientationDifferentTermText": "PANSEXUAL",
"mailingAddress": {
"streetName1": "34 Elsmere Blvd",
"streetName2": "Apt 102",
"cityName": "Wilmington",
"stateCode": "AK",
"plus4Code": "4565",
"zipCode": "20124",
"countyName": "County",
"countyFipsCode": "04535"
},
"homeAddress": {
"streetName1": "34 Elsmere Blvd",
"streetName2": "Apt 102",
"cityName": "Wilmington",
"stateCode": "AK",
"plus4Code": "4565",
"zipCode": "20124",
"countyName": "County",
"countyFipsCode": "04535"
},
"transientAddress": {
"streetName1": "34 Elsmere Blvd",
"streetName2": "Apt 102",
"cityName": "Wilmington",
"stateCode": "AK",
"plus4Code": "4565",
"zipCode": "20124",
"countyName": "County",
"countyFipsCode": "04535"
}
},
"income": {
"annualTaxIncome": {
"incomeAmount": 30000,
"incomeLessExplainedIndicator": true,
"unknownIncomeIndicator": false,
"variableIncomeIndicator": false,
"receivedUnemploymentCompensationIndicator": true,
"taxHouseholdIncomeDiscrepancyDescriptionText": "Free text from member",
"taxHouseholdIncomeDifferenceReasonType": [
"HOUSEHOLD_MEMBER_CHANGE",
"SELF_EMPLOYMENT_INCOME_FLUCTUATION",
"JOB_CHANGE",
"WORK_LOCATION_CHANGE",
"OTHER"
],
"variableIncomeDescriptionText": "Free text"
},
"currentIncome": {
"currentIncome1": {
"incomeAmount": 25000,
"tribalIncomeAmount": 5000,
"incomeSourceType": "JOB",
"incomeFrequencyType": "WEEKLY",
"estimatedForAptcIndicator": true,
"jobIncome": {
"averageWeeklyWorkDays": 4,
"averageWeeklyWorkHours": 40,
"incomeDifferenceReason": "STOP_WORKING",
"employerName": "Pizza Hut",
"otherIncomeDifferenceReason": "Member Input"
},
"otherDeductionDescription": "Member Input",
"selfEmploymentIncomeDescription": "Member Input",
"unemploymentIncome": {
"expirationDate": "2016-12-31",
"incomeDescription": "DE"
},
"otherIncomeDescription": "Member Input"
}
}
},
"family": {
"liveWithParentOrSiblingIndicator": true,
"babyDueQuantity": 1,
"taxDependentIndicator": false,
"taxFilerIndicator": true,
"taxReturnFilingStatusType": "SINGLE_FILER",
"claimsDependentIndicator": false,
"claimingTaxFilerNotOnApplicationIndicator": true,
"livesWithCustodialParentNotOnApplicationIndicator": false,
"fosterCareIndicator": false,
"fosterCareEndAge": 18,
"medicaidDuringFosterCareIndicator": false,
"fosterCareState": "AK",
"medicaidFamilyNotProvidedIndicator": false,
"taxFilerNotProvidedIndicator": false,
"parentCaretakerIndicator": false,
"pregnancyIndicator": true,
"fullTimeStatusIndicator": true,
"studentsParentLivingInExchangeStateIndicator": true,
"parentLivesInStudentStateIndicator": true,
"absentParentIndicator": false,
"resideWithBothParentIndicator": false,
"attestedHeadOfHouseholdIndicator": false,
"liveApartFromSpouseIndicator": true
},
"lawfulPresence": {
"lawfulPresenceGrantDate": "2017-01-01",
"lawfulPresenceStatusIndicator": false,
"livedInUs5yearIndicator": false,
"noAlienNumberIndicator": true,
"citizenshipIndicator": true,
"naturalizedCitizenIndicator": false,
"lawfulPresenceDocumentation": {
"PERMANENT_RESIDENT_CARD_I_551": {
"documentExpirationDate": "2017-01-01",
"alienNumber": "A82329",
"employmentAuthorizationCategoryIdentifier": "4123421341",
"sevisId": "23211",
"i94Number": "3213212",
"passportNumber": "12345689080",
"passportIssuingCountry": "USA",
"cardNumber": "212222",
"naturalizationCertificateNumber": "1211111",
"citizenshipNumber": "22222111",
"documentAlternateName": {
"firstName": "Susan",
"middleName": "Carrie",
"lastName": "Griffith",
"suffix": "Jr."
},
"noIdentifiersProvidedIndicator": false,
"otherTypeText": ""
},
"TEMPORARY_I_551_STAMP_ON_PASSPORT_OR_I_94_I_94A": {
"documentExpirationDate": "2017-01-01",
"alienNumber": "A82329",
"employmentAuthorizationCategoryIdentifier": "4123421341",
"sevisId": "23211",
"i94Number": "3213212",
"passportNumber": "12345689080",
"passportIssuingCountry": "USA",
"cardNumber": "212222",
"naturalizationCertificateNumber": "1211111",
"citizenshipNumber": "22222111",
"documentAlternateName": {
"firstName": "Susan",
"middleName": "Carrie",
"lastName": "Griffith",
"suffix": "Jr."
},
"noIdentifiersProvidedIndicator": false,
"otherTypeText": ""
},
"MACHINE_READABLE_IMMIGRANT_VISA_WITH_TEMPORARY_I_551_LANGUAGE": {
"documentExpirationDate": "2017-01-01",
"alienNumber": "A82329",
"employmentAuthorizationCategoryIdentifier": "4123421341",
"sevisId": "23211",
"i94Number": "3213212",
"passportNumber": "12345689080",
"passportIssuingCountry": "USA",
"cardNumber": "212222",
"naturalizationCertificateNumber": "1211111",
"citizenshipNumber": "22222111",
"documentAlternateName": {
"firstName": "Susan",
"middleName": "Carrie",
"lastName": "Griffith",
"suffix": "Jr."
},
"noIdentifiersProvidedIndicator": false,
"otherTypeText": ""
},
"EMPLOYMENT_AUTHORIZATION_CARD_I_766": {
"documentExpirationDate": "2017-01-01",
"alienNumber": "A82329",
"employmentAuthorizationCategoryIdentifier": "4123421341",
"sevisId": "23211",
"i94Number": "3213212",
"passportNumber": "12345689080",
"passportIssuingCountry": "USA",
"cardNumber": "212222",
"naturalizationCertificateNumber": "1211111",
"citizenshipNumber": "22222111",
"documentAlternateName": {
"firstName": "Susan",
"middleName": "Carrie",
"lastName": "Griffith",
"suffix": "Jr."
},
"noIdentifiersProvidedIndicator": false,
"otherTypeText": ""
},
"ARRIVAL_DEPARTURE_RECORD_IN_FOREIGN_PASSPORT_I_94": {
"documentExpirationDate": "2017-01-01",
"alienNumber": "A82329",
"employmentAuthorizationCategoryIdentifier": "4123421341",
"sevisId": "23211",
"i94Number": "3213212",
"passportNumber": "12345689080",
"passportIssuingCountry": "USA",
"cardNumber": "212222",
"naturalizationCertificateNumber": "1211111",
"citizenshipNumber": "22222111",
"documentAlternateName": {
"firstName": "Susan",
"middleName": "Carrie",
"lastName": "Griffith",
"suffix": "Jr."
},
"noIdentifiersProvidedIndicator": false,
"otherTypeText": ""
},
"ARRIVAL_DEPARTURE_RECORD_IN_UNEXPIRED_FOREIGN_PASSPORT_I_94": {
"documentExpirationDate": "2017-01-01",
"alienNumber": "A82329",
"employmentAuthorizationCategoryIdentifier": "4123421341",
"sevisId": "23211",
"i94Number": "3213212",
"passportNumber": "12345689080",
"passportIssuingCountry": "USA",
"cardNumber": "212222",
"naturalizationCertificateNumber": "1211111",
"citizenshipNumber": "22222111",
"documentAlternateName": {
"firstName": "Susan",
"middleName": "Carrie",
"lastName": "Griffith",
"suffix": "Jr."
},
"noIdentifiersProvidedIndicator": false,
"otherTypeText": ""
},
"FOREIGN_PASSPORT": {
"documentExpirationDate": "2017-01-01",
"alienNumber": "A82329",
"employmentAuthorizationCategoryIdentifier": "4123421341",
"sevisId": "23211",
"i94Number": "3213212",
"passportNumber": "12345689080",
"passportIssuingCountry": "USA",
"cardNumber": "212222",
"naturalizationCertificateNumber": "1211111",
"citizenshipNumber": "22222111",
"documentAlternateName": {
"firstName": "Susan",
"middleName": "Carrie",
"lastName": "Griffith",
"suffix": "Jr."
},
"noIdentifiersProvidedIndicator": false,
"otherTypeText": ""
},
"REENTRY_PERMIT": {
"documentExpirationDate": "2017-01-01",
"alienNumber": "A82329",
"employmentAuthorizationCategoryIdentifier": "4123421341",
"sevisId": "23211",
"i94Number": "3213212",
"passportNumber": "12345689080",
"passportIssuingCountry": "USA",
"cardNumber": "212222",
"naturalizationCertificateNumber": "1211111",
"citizenshipNumber": "22222111",
"documentAlternateName": {
"firstName": "Susan",
"middleName": "Carrie",
"lastName": "Griffith",
"suffix": "Jr."
},
"noIdentifiersProvidedIndicator": false,
"otherTypeText": ""
},
"REFUGEE_TRAVEL_DOCUMENT": {
"documentExpirationDate": "2017-01-01",
"alienNumber": "A82329",
"employmentAuthorizationCategoryIdentifier": "4123421341",
"sevisId": "23211",
"i94Number": "3213212",
"passportNumber": "12345689080",
"passportIssuingCountry": "USA",
"cardNumber": "212222",
"naturalizationCertificateNumber": "1211111",
"citizenshipNumber": "22222111",
"documentAlternateName": {
"firstName": "Susan",
"middleName": "Carrie",
"lastName": "Griffith",
"suffix": "Jr."
},
"noIdentifiersProvidedIndicator": false,
"otherTypeText": ""
},
"CERTIFICATE_OF_ELIGIBILITY_FOR_NONIMMIGRANT_STUDENT_STATUS_I_20": {
"documentExpirationDate": "2017-01-01",
"alienNumber": "A82329",
"employmentAuthorizationCategoryIdentifier": "4123421341",
"sevisId": "23211",
"i94Number": "3213212",
"passportNumber": "12345689080",
"passportIssuingCountry": "USA",
"cardNumber": "212222",
"naturalizationCertificateNumber": "1211111",
"citizenshipNumber": "22222111",
"documentAlternateName": {
"firstName": "Susan",
"middleName": "Carrie",
"lastName": "Griffith",
"suffix": "Jr."
},
"noIdentifiersProvidedIndicator": false,
"otherTypeText": ""
},
"CERTIFICATE_OF_ELIGIBILITY_FOR_EXCHANGE_VISITOR_STATUS_DS_2019": {
"documentExpirationDate": "2017-01-01",
"alienNumber": "A82329",
"employmentAuthorizationCategoryIdentifier": "4123421341",
"sevisId": "23211",
"i94Number": "3213212",
"passportNumber": "12345689080",
"passportIssuingCountry": "USA",
"cardNumber": "212222",
"naturalizationCertificateNumber": "1211111",
"citizenshipNumber": "22222111",
"documentAlternateName": {
"firstName": "Susan",
"middleName": "Carrie",
"lastName": "Griffith",
"suffix": "Jr."
},
"noIdentifiersProvidedIndicator": false,
"otherTypeText": ""
},
"NOTICE_OF_ACTION_I_797": {
"documentExpirationDate": "2017-01-01",
"alienNumber": "A82329",
"employmentAuthorizationCategoryIdentifier": "4123421341",
"sevisId": "23211",
"i94Number": "3213212",
"passportNumber": "12345689080",
"passportIssuingCountry": "USA",
"cardNumber": "212222",
"naturalizationCertificateNumber": "1211111",
"citizenshipNumber": "22222111",
"documentAlternateName": {
"firstName": "Susan",
"middleName": "Carrie",
"lastName": "Griffith",
"suffix": "Jr."
},
"noIdentifiersProvidedIndicator": false,
"otherTypeText": ""
},
"CERTIFICATION_FROM_HHS_ORR": {
"documentExpirationDate": "2017-01-01",
"alienNumber": "A82329",
"employmentAuthorizationCategoryIdentifier": "4123421341",
"sevisId": "23211",
"i94Number": "3213212",
"passportNumber": "12345689080",
"passportIssuingCountry": "USA",
"cardNumber": "212222",
"naturalizationCertificateNumber": "1211111",
"citizenshipNumber": "22222111",
"documentAlternateName": {
"firstName": "Susan",
"middleName": "Carrie",
"lastName": "Griffith",
"suffix": "Jr."
},
"noIdentifiersProvidedIndicator": false,
"otherTypeText": ""
},
"ORR_ELIGIBILITY_LETTER": {
"documentExpirationDate": "2017-01-01",
"alienNumber": "A82329",
"employmentAuthorizationCategoryIdentifier": "4123421341",
"sevisId": "23211",
"i94Number": "3213212",
"passportNumber": "12345689080",
"passportIssuingCountry": "USA",
"cardNumber": "212222",
"naturalizationCertificateNumber": "1211111",
"citizenshipNumber": "22222111",
"documentAlternateName": {
"firstName": "Susan",
"middleName": "Carrie",
"lastName": "Griffith",
"suffix": "Jr."
},
"noIdentifiersProvidedIndicator": false,
"otherTypeText": ""
},
"CUBAN_HAITAN_ENTRANT": {
"documentExpirationDate": "2017-01-01",
"alienNumber": "A82329",
"employmentAuthorizationCategoryIdentifier": "4123421341",
"sevisId": "23211",
"i94Number": "3213212",
"passportNumber": "12345689080",
"passportIssuingCountry": "USA",
"cardNumber": "212222",
"naturalizationCertificateNumber": "1211111",
"citizenshipNumber": "22222111",
"documentAlternateName": {
"firstName": "Susan",
"middleName": "Carrie",
"lastName": "Griffith",
"suffix": "Jr."
},
"noIdentifiersProvidedIndicator": false,
"otherTypeText": ""
},
"DOCUMENT_INDICATING_WITHHOLDING_OF_REMOVAL": {
"documentExpirationDate": "2017-01-01",
"alienNumber": "A82329",
"employmentAuthorizationCategoryIdentifier": "4123421341",
"sevisId": "23211",
"i94Number": "3213212",
"passportNumber": "12345689080",
"passportIssuingCountry": "USA",
"cardNumber": "212222",
"naturalizationCertificateNumber": "1211111",
"citizenshipNumber": "22222111",
"documentAlternateName": {
"firstName": "Susan",
"middleName": "Carrie",
"lastName": "Griffith",
"suffix": "Jr."
},
"noIdentifiersProvidedIndicator": false,
"otherTypeText": ""
},
"ADMINISTRATIVE_STAY_BY_DHS": {
"documentExpirationDate": "2017-01-01",
"alienNumber": "A82329",
"employmentAuthorizationCategoryIdentifier": "4123421341",
"sevisId": "23211",
"i94Number": "3213212",
"passportNumber": "12345689080",
"passportIssuingCountry": "USA",
"cardNumber": "212222",
"naturalizationCertificateNumber": "1211111",
"citizenshipNumber": "22222111",
"documentAlternateName": {
"firstName": "Susan",
"middleName": "Carrie",
"lastName": "Griffith",
"suffix": "Jr."
},
"noIdentifiersProvidedIndicator": false,
"otherTypeText": ""
},
"OTHER": {
"documentExpirationDate": "2017-01-01",
"alienNumber": "A82329",
"employmentAuthorizationCategoryIdentifier": "4123421341",
"sevisId": "23211",
"i94Number": "3213212",
"passportNumber": "12345689080",
"passportIssuingCountry": "USA",
"cardNumber": "212222",
"naturalizationCertificateNumber": "1211111",
"citizenshipNumber": "22222111",
"documentAlternateName": {
"firstName": "Susan",
"middleName": "Carrie",
"lastName": "Griffith",
"suffix": "Jr."
},
"noIdentifiersProvidedIndicator": false,
"otherTypeText": ""
},
"CERTIFICATE_OF_CITIZENSHIP": {
"documentExpirationDate": "2017-01-01",
"alienNumber": "A82329",
"employmentAuthorizationCategoryIdentifier": "4123421341",
"sevisId": "23211",
"i94Number": "3213212",
"passportNumber": "12345689080",
"passportIssuingCountry": "USA",
"cardNumber": "212222",
"naturalizationCertificateNumber": "1211111",
"citizenshipNumber": "22222111",
"documentAlternateName": {
"firstName": "Susan",
"middleName": "Carrie",
"lastName": "Griffith",
"suffix": "Jr."
},
"noIdentifiersProvidedIndicator": false,
"otherTypeText": ""
},
"CERTIFICATE_OF_NATURALIZATION": {
"documentExpirationDate": "2017-01-01",
"alienNumber": "A82329",
"employmentAuthorizationCategoryIdentifier": "4123421341",
"sevisId": "23211",
"i94Number": "3213212",
"passportNumber": "12345689080",
"passportIssuingCountry": "USA",
"cardNumber": "212222",
"naturalizationCertificateNumber": "1211111",
"citizenshipNumber": "22222111",
"documentAlternateName": {
"firstName": "Susan",
"middleName": "Carrie",
"lastName": "Griffith",
"suffix": "Jr."
},
"noIdentifiersProvidedIndicator": false,
"otherTypeText": ""
},
"NS1_MEMBERS_OF_A_FEDERALLY_RECOGNIZED_INDIAN_TRIBE": {
"documentExpirationDate": "2017-01-01",
"alienNumber": "A82329",
"employmentAuthorizationCategoryIdentifier": "4123421341",
"sevisId": "23211",
"i94Number": "3213212",
"passportNumber": "12345689080",
"passportIssuingCountry": "USA",
"cardNumber": "212222",
"naturalizationCertificateNumber": "1211111",
"citizenshipNumber": "22222111",
"documentAlternateName": {
"firstName": "Susan",
"middleName": "Carrie",
"lastName": "Griffith",
"suffix": "Jr."
},
"noIdentifiersProvidedIndicator": false,
"otherTypeText": ""
},
"NS4_NON_CITIZEN_WHO_IS_LAWFULLY_PRESENT_IN_AMERICAN_SAMOA": {
"documentExpirationDate": "2017-01-01",
"alienNumber": "A82329",
"employmentAuthorizationCategoryIdentifier": "4123421341",
"sevisId": "23211",
"i94Number": "3213212",
"passportNumber": "12345689080",
"passportIssuingCountry": "USA",
"cardNumber": "212222",
"naturalizationCertificateNumber": "1211111",
"citizenshipNumber": "22222111",
"documentAlternateName": {
"firstName": "Susan",
"middleName": "Carrie",
"lastName": "Griffith",
"suffix": "Jr."
},
"noIdentifiersProvidedIndicator": false,
"otherTypeText": ""
},
"VAWA_SELF_PETITIONER": {
"documentExpirationDate": "2017-01-01",
"alienNumber": "A82329",
"employmentAuthorizationCategoryIdentifier": "4123421341",
"sevisId": "23211",
"i94Number": "3213212",
"passportNumber": "12345689080",
"passportIssuingCountry": "USA",
"cardNumber": "212222",
"naturalizationCertificateNumber": "1211111",
"citizenshipNumber": "22222111",
"documentAlternateName": {
"firstName": "Susan",
"middleName": "Carrie",
"lastName": "Griffith",
"suffix": "Jr."
},
"noIdentifiersProvidedIndicator": false,
"otherTypeText": ""
}
}
},
"insuranceCoverage": {
"enrolledInIchraIndicator": false,
"offeredIchraIndicator": true,
"hraOffers": [
{
"hraType": "ICHRA",
"startDate": "2019-01-01",
"noticeDate": "2019-01-01",
"enrolledInOfferFromSameEmployerIndicator": false,
"enrolledInOfferFromSameEmployerUntilStartDateIndicator": true
},
{
"hraType": "ICHRA",
"primaryInsuredMemberIdentifier": "3948576",
"startDate": "2019-01-01",
"endDate": "2019-12-31",
"employeeSelfOnlyOfferAmount": 4000,
"employeeSelfOnlyOfferFrequencyType": "MONTHLY",
"primaryInsuredMemberNotInTaxHhIndicator": false,
"employer": {
"name": "Pizza Hut",
"employerIdentificationNumber": "341234",
"streetName1": "123 Main St",
"streetName2": "Apt 100",
"cityName": "Wilmington",
"stateCode": "AK",
"zipCode": "12345",
"plus4Code": "1111",
"countryCode": "001",
"countyName": "Wilmington",
"countyFipsCode": "019832",
"employerPhoneNumber": "7038675309",
"contact": {
"name": {
"firstName": "Susan",
"middleName": "Carrie",
"lastName": "Griffith",
"suffix": "Jr."
},
"email": "employer.contact@gmail.com",
"phoneNumber": "7038675309"
}
}
}
],
"enrolledCoverages": [
{
"insuranceMarketType": "MEDICARE",
"insurancePolicyMemberId": "12345678",
"insurancePolicyNumber": "10000abcd0001",
"insurancePlanName": "Prime Plan 1"
}
],
"employerSponsoredCoverageOffers": {
"escOffer1": {
"cobraAvailableIndicator": false,
"doNotKnowLcsopPremiumIndicator": false,
"employeeWillDropCoverageIndicator": true,
"lcsopPremium": 100,
"lcsopPremiumFrequencyType": "WEEKLY",
"lcsopName": "Name",
"employerOffersMinValuePlan": "YES",
"familyPlanPremiumAmount": 100,
"familyPlanPremiumFrequencyType": "WEEKLY",
"employerOffersFamilyMinValuePlanIndicator": true,
"planToEnrollEscIndicator": true,
"planToEnrollEscDate": "2017-01-01",
"employer": {
"name": "Pizza Hut",
"employerIdentificationNumber": "341234",
"streetName1": "123 Main St",
"streetName2": "Apt 100",
"cityName": "Wilmington",
"stateCode": "AK",
"zipCode": "12345",
"plus4Code": "1111",
"countryCode": "001",
"countyName": "Wilmington",
"countyFipsCode": "019832",
"employerPhoneNumber": "7038675309",
"contact": {
"name": {
"firstName": "Susan",
"middleName": "Carrie",
"lastName": "Griffith",
"suffix": "Jr."
},
"email": "employer.contact@gmail.com",
"phoneNumber": "7038675309"
}
},
"employerWillChangeLcsopPremiumIndicator": false,
"employerWillNoLongerOfferLcsopIndicator": false,
"employeeStatus": "WORKING",
"escEnrolledIndicator": true,
"newEmployeeLcsopPremiumAmount": "1000",
"newLcsopPremiumFrequencyType": "WEEKLY",
"retireePlanCoverageIndicator": false,
"waitingPeriodIndicator": false,
"primaryInsuredMemberIdentifier": "2347128934",
"insurancePolicyMemberId": "12345678",
"insurancePolicyNumber": "10000abcd0001",
"insurancePlanName": "Prime Plan 1"
}
},
"offeredEmployeeCoverage": "YES"
},
"medicaid": {
"medicaidDeniedDate": "2017-01-01",
"medicaidDeniedDueToImmigrationIndicator": false,
"medicaidDeniedIndicator": false,
"parent1WeeklyWorkHourQuantity": 40,
"parent2WeeklyWorkHourQuantity": 40,
"unpaidBillIndicator": false,
"coveredDependentChildIndicator": false,
"enrolledInHealthCoverageIndicator": true,
"insuranceCoverage": [
{
"insurancePolicyMemberId": "12345678",
"insurancePolicyNumber": "10000abcd0001",
"insurancePlanName": "Prime Plan 1",
"insuranceMarketType": "TRICARE"
}
],
"informationChangeSinceMedicaidDeniedIndicator": true,
"immigrationStatusFiveYearIndicator": true,
"immigrationStatusChangeSinceDeniedIndicator": true,
"informationChangeSinceMedicaidEndedIndicator": true,
"medicaidEndIndicator": true,
"medicaidEndDate": "'2020"
},
"chip": {
"coverageEndedIndicator": false,
"stateHealthBenefitIndicator": true,
"coverageEndedReasonType": "MEDICAL_NEEDS_NOT_COVERED",
"coverageEndedReasonText": "OTHER"
},
"nonMagi": {
"blindOrDisabledIndicator": false,
"longTermCareIndicator": false
},
"other": {
"appliedDuringOeOrLifeChangeIndicator": true,
"changeInCircumstance": {
"GAINING_LAWFUL_PRESENCE": {
"changeDate": "2017-01-01"
},
"RELEASE_FROM_INCARCERATION": {
"changeDate": "2017-01-01"
},
"LOSS_OF_MEC": {
"changeDate": "2017-01-01",
"lossMecIssuerName": "abcXYZ"
},
"FUTURE_LOSS_OF_MEC": {
"changeDate": "2017-01-01",
"lossMecIssuerName": "abcXYZ"
},
"RELOCATION": {
"changeDate": "2017-01-01",
"movedFromForeignCountryIndicator": false,
"coverage60DayBeforeMoveIndicator": true,
"precedingZipCode": "20171",
"precedingStateCode": "VA",
"precedingCountyName": "Fairfax"
},
"MARRIAGE": {
"changeDate": "2017-01-01",
"coverage60DayBeforeMarriageIndicator": false,
"liveInForeignCountry60DayBeforeMarriageIndicator": false
},
"ADOPTION": {
"changeDate": "2017-01-01"
}
},
"americanIndianAlaskanNative": {
"federallyRecognizedTribeName": "Sioux",
"personRecognizedTribeIndicator": false,
"receiveItuIndicator": false,
"eligibleForItuIndicator": true
},
"veteranIndicator": false,
"incarcerationType": "NOT_INCARCERATED",
"reconcilePtcIndicatorType": "TRUE",
"veteranSelfIndicator": true,
"nonMemberVeteranRelationshipTypes": [
"DECEASED_SPOUSE",
"DECEASED_PARENT_STEPPARENT",
"PARENT_STEPPARENT",
"SPOUSE"
]
}
}
},
"removedMembers": {
"312534598": {
"demographic": {
"name": {
"firstName": "Susan",
"middleName": "Carrie",
"lastName": "Griffith",
"suffix": "Jr."
},
"deathDate": "2020-10-10",
"divorceDate": "2020-10-10",
"birthDate": "1980-01-01"
},
"removalReasonType": "DEATH"
}
}
}