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EYEMED

Fetch eligibility

Check member eligibility and vision benefits.

POSThttps://preview.ontross.com/api/integrations/eyemed/fetch-eligibility
Request Fields
input.member_id
string
EyeMed member number from the vision card.
Example
"71029938403"
Default
"24364409902"
input.date_of_service
string
Date of service, defaulting to today for eligibility lookups.
Example
"03/16/2026"
input.provider_npi
string
NPI selecting the provider from EyeMed's dropdown after a member search.
Example
"4819422589"
Default
""
input.location
string
Text from the provider's service location option, matched by substring.
Example
"413 ELMWOOD AVENUE"
Default
""
auth_id
string
required
Saved connection to run this operation through, from the Authentication page. It decides which practice and login the call uses.
Example
"00000000-0000-4000-8000-000000000000"
Output Fields
eligibility
array
Eligibility tabs, each listing services and their frequency.
eligibility[].tab_name
string
Eligibility tab heading EyeMed displays.
Example
"In Network"
eligibility[].services
array
Rows under this tab or category.
eligibility[].services[].service
string
Vision service the row describes, like exam or lenses.
Example
"Exam"
eligibility[].services[].eligible
string
Whether the service is available, as EyeMed words it.
Example
"Yes"
eligibility[].services[].eligible_as_of
string
Date the service becomes available, blank when already open.
Example
"01/01/2027"
eligibility[].services[].frequency
string
How often the service is covered, such as every 24 months.
Example
"Once every 12 months"
benefits
array
Benefit tabs with their categories and member costs.
benefits[].name
string
Benefit tab heading EyeMed displays.
Example
"In Network"
benefits[].categories
array
Benefit groups shown under one tab.
benefits[].categories[].category
string
Benefit group heading for these services.
Example
"Lenses"
benefits[].categories[].services
array
Rows under this tab or category.
benefits[].categories[].services[].service
string
Vision service the row describes, like exam or lenses.
Example
"Exam"
benefits[].categories[].services[].cost
string
Member's cost for the service, worded as EyeMed shows it.
Example
"$10 copay"
declining_balance_packages
array
Dollar or unit allowances and what remains on them.
declining_balance_packages[].benefit_category_id
string
EyeMed's code for that benefit category.
Example
"FRAMES"
declining_balance_packages[].benefit_category
string
Vision benefit group the limit covers, like frames.
Example
"Frames"
declining_balance_packages[].in_network_elig
boolean
True when the category is covered in network.
Example
true
declining_balance_packages[].out_network_elig
boolean
True when the category is covered out of network.
Example
false
declining_balance_packages[].disclaimers
array
Caveats EyeMed attaches to the benefit category.
declining_balance_packages[].limit_id
string
EyeMed's code for this specific limit.
Example
"LIM000123"
declining_balance_packages[].description
string
EyeMed's wording for this declining balance limit.
Example
"Annual frame allowance"
declining_balance_packages[].amount_basis
string
What the allowance is measured in, dollars or units.
Example
"Dollars"
declining_balance_packages[].start_amount
number
Allowance the member started the period with.
Example
150
declining_balance_packages[].remaining_balance
number
How much of the allowance the member has left.
Example
75
declining_balance_packages[].family_individual
string
Whether the limit pools across the family or per member.
Example
"Individual"
declining_balance_packages[].limit_repln_count
integer
How many times the limit refreshes in the period.
Example
1
declining_balance_packages[].period
string
Window the limit resets over, such as benefit year.
Example
"Benefit Year"
declining_balance_packages[].applicable_network_type
string
Networks the limit covers, in or out of network.
Example
"In Network"
declining_balance_packages[].balance_applied_against
string
What spending draws down this balance.
Example
"Retail cost"
declining_balance_packages[].applicable
string
Whether this limit applies to the member right now.
Example
"Yes"
declining_balance_packages[].services_applicable
array
Which services draw against this limit.
declining_balance_packages[].services_applicable[].benefit_category_order
integer
Where EyeMed sorts this category for display.
Example
1
declining_balance_packages[].services_applicable[].benefit_category_id
string
EyeMed's code for that benefit category.
Example
"FRAMES"
declining_balance_packages[].services_applicable[].benefit_category_name
string
Readable name of the benefit category.
Example
"Frames"
declining_balance_packages[].services_applicable[].eligible_category_order
integer
Where EyeMed sorts that eligibility category.
Example
1
declining_balance_packages[].services_applicable[].eligible_category_id
string
EyeMed's code for the eligibility category.
Example
"FRAMES"
declining_balance_packages[].services_applicable[].eligible_category_name
string
Readable name of the eligibility category.
Example
"Frames"
declining_balance_packages[].services_applicable[].network_ind
string
Whether the applicable service is in or out of network.
Example
"IN"
declining_balance_packages[].services_applicable[].demographic_type
string
Which member group the limit targets, such as dependents.
Example
"Dependent"
declining_balance_packages[].services_applicable[].demographic_beg_age
integer
Youngest age the limit applies to.
Example
0
declining_balance_packages[].services_applicable[].demographic_end_age
integer
Oldest age the limit applies to.
Example
18
page_html
string
Full raw HTML of the eligibility page, for auditing.
Code
curl --request POST \
  --url https://preview.ontross.com/api/integrations/eyemed/fetch-eligibility \
  --header 'X-API-Key: REPLACE_KEY_VALUE' \
  --header 'content-type: application/json' \
  --data '{"input":{"member_id":"71029938403","date_of_service":"03/16/2026","provider_npi":"4819422589","location":"413 ELMWOOD AVENUE"},"auth_id":"auth_uuid_here"}'
Request BODY
{
  "input": {
    "member_id": "71029938403",
    "date_of_service": "03/16/2026",
    "provider_npi": "4819422589",
    "location": "413 ELMWOOD AVENUE"
  },
  "auth_id": "auth_uuid_here"
}
Response BODY
{
  "id": "string",
  "workflow_id": "string",
  "auth_id": "string",
  "status": "string",
  "input": {},
  "output": {
    "eligibility": [],
    "benefits": [],
    "declining_balance_packages": [],
    "page_html": "<html><head><title>Eligibility</title></head><body><div id=\"facets-eligibility-table\"></div></body></html>"
  },
  "files": null,
  "created_at": "2019-08-24T14:15:22Z",
  "started_at": "2019-08-24T14:15:22Z",
  "completed_at": "2019-08-24T14:15:22Z"
}