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Member Individual API V2 Service Overview

1. Purpose​

This service allows approved partners of UnitedHealthcare to access key information about individual members in real time. It helps partners retrieve current membership details and associated benefits by submitting basic identifying information. The goal is to streamline access to member data for business processes that require timely and accurate information.

2. Who can use this service​

  • Authorized Business Partners: Brokers, external organizations, and other entities with a formal relationship with UnitedHealthcare.
  • Partner Teams: Individuals responsible for integrating member data into business workflows, such as onboarding, eligibility checks, or reporting.
  • Access is restricted to approved collaborators and is not available to the general public.

3. What information is available​

The service provides access to broad categories of member-related data, including:

  • Membership and Enrollment Details: Basic facts such as names, birth dates, group affiliations, and active status.
  • Coverage and Benefit Categories: High-level benefit types like medical, dental, vision, life insurance, and accidental death/dismemberment.
  • Demographic and Administrative Attributes: Information used to identify members, such as group numbers and optional identifiers.
  • Status Timelines: Indicators of whether a member is currently active, was recently active, or will be active soon.

4. Benefits of this service​

  • Real-Time Access: Partners can retrieve member data instantly, improving synchronization between systems.
  • Operational Efficiency: Reduces the need for manual lookups or multiple system queries.
  • Enhanced Customer Service: Supports faster and more accurate responses to member inquiries.
  • Workflow Integration: Enables seamless incorporation of member data into partner applications and processes.

5. Example uses​

  • Enrollment Reconciliation: Confirm that submitted member data has been correctly processed.
  • Customer Onboarding: Retrieve plan and coverage details during new member setup.
  • Eligibility Verification: Check if a member is currently active before proceeding with services.
  • Reporting and Analytics: Use summary member data to populate dashboards and generate insights.

6. Important notes​

  • Data Sensitivity: Member information is protected and should be handled with care.
  • Evolving Service: The scope and structure of the service may change over time.
  • Limited Scope: Not all benefit types or detailed classifications are included.
  • Input Accuracy Matters: Precise identifying information improves lookup results.
  • Technical Details Omitted: This overview focuses on what the service provides, not how it operates.
  • Brand Guidelines: UnitedHealthcare and Optum are registered trademarks; use them appropriately in partner materials.