Eligible response structure | Mantys Eligibility API

The ten fields a front desk acts on when a check comes back eligible, and where each one lives in the response.

A finished check whose eligibility_result.status is "found" and whose data_dump.data.is_eligible is true carries far more than that verdict. What a front desk has to act on sits four levels down, spread across patient_info, policy_network and copay_analysis, under names that do not always match what the payer portal called them.

The card below is that set of fields, arranged the way a client renders them. The layout is ours, but the data is not: it is one completed production check at TPA002, raised on a card number, with the member's name, identifiers, birth date and phone replaced and everything else left exactly as the API returned it. Select any field to see the path it lives at, its type, and the thing that catches people out.

Select any field on the card. Every value on it comes from one real completed check, with the member's identifiers replaced. Nothing here calls the API.

Eligibility resultEligible

NameLayla Hassan Mahmoud

TPA codeTPA002

Emirates ID784-1991-4726185-9

Member ID7C41-05B9-4E28-1D63

Payer detailsDUBAI INSURANCE COMPANY - INS005no plan name · MOH · sponsor INS005Valid 2026-01-01 to 2027-06-30

Network(s)OP@PCPOP (Out Patient)plan unmatchedSpRef@RN3SP (Specialist Physician) Referralplan unmatched

Gatekeeper PolicyNot MentionedAnd yet the boolean beside it is true, and the warning below quotes the portal saying "Gatekeeper: Yes".

Copay detailsOutpatient · PCPcopaydeductibleLAB10.00MEDICINES10.00PROCEDURE00RADIOLOGY10.00DIAGNOSTICS00CONSULTATION050.0PHYSIOTHERAPY00DENTAL CONSULTATION & PROCEDURE00Resolved against one of 2 networks on this policy

WarningsWARNING: GP referral is required for specialist referral. "Gatekeeper: Yes" "This Policy is a Referral Policy* which requires a Referral from the assigned Gatekeeper**."

DocumentsClaim Formclaim_formClaim Form Imageclaim_form_imageTable of Benefitstable_of_benefitsMember Eligibility Documentmember_eligibility_document

Name

string

The member name as the payer holds it, not the name you sent on the request. Send name only as a search hint; read this field back for display.

It is an empty string, not null, when the portal showed no name. A truthiness check works; a !== null check does not.

Full reference for Name

Two things on that card are worth reading twice, and neither is an error. is_gatekeeper says "Not Mentioned" while is_general_physician_referral_required_for_specialist_referral says true and the warning below it quotes the portal saying "Gatekeeper: Yes"; the tri-state is the field that is wrong, and it is the one a client tends to render. And the outpatient consultation reads copay: "0" with deductible: "50.0", so a front desk shown only the copay is told to charge nothing on a visit that carries 50 AED.

The same fields in two more responses

One capture cannot show how much these fields vary between payers. Below are two more, each rendered whole, scrubbed the same way and both eligible. They carry the same member as the card above, which is a property of the scrubbing and not of the checks: one invented member stands in for every real one across the whole site, so a repeated identifier means the values matched, never that a real person holds three policies.

TPA004, eligible on a card number

.json

{
"id": "00000000-0000-4000-a000-000000000001",
"tenant_id": "yourorg",
"clinic_id": "00000000-0000-4000-a000-000000000002",
"created_at": "2026-05-08T06:28:46.230000",
"updated_at": "2026-05-08T06:30:52.245000",
"task_id": "00000000-0000-4000-a000-000000000001",
"status": "PROCESS_COMPLETE",
"request_dump": {
"name": "Layla",
"phone": "971-50-2274318",
"id_type": "CARDNUMBER",
"tpa_name": "TPA004",
"payerName": "",
"doctorName": "",
"extra_args": {
"title": "",
"value": "",
"request_start_time": 1778221726.2185426,
"is_member_present_at_the_facility": true
},
"visit_type": "OUTPATIENT",
"emirates_id": "7C41-05B9-4E28-1D63",
"practice_id": "00000000-0000-4000-a000-000000000002",
"user_id": "00000000-0000-4000-a000-000000000003",
"dob": null,
"mode": "prod",
"test_mode": false
},
"interim_results": {
"tpa_name": "TPA004",
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"referral_documents": [
{
"tag": "Member Eligibility - Main Page",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"tag": "Member Eligibility - Details Modal",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"tag": "Member Eligibility - Alternative Screenshot",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"tag": "Consultation / Claim Form",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"tag": "Prescription Form",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
}
]
},
"is_search_all": false,
"search_all_status": null,
"created_by_user_id": null,
"eligibility_result": {
"id": "00000000-0000-4000-a000-000000000001:TPA004",
"tenant_id": "yourorg",
"clinic_id": "00000000-0000-4000-a000-000000000002",
"created_at": "2026-05-08T06:30:55.631000",
"updated_at": "2026-05-08T06:30:55.631000",
"data_dump": {
"tpa": "TPA004",
"data": {
"payer_id": "TPA004",
"is_eligible": true,
"patient_info": {
"policy_holder_dob": "14-Jul-1991",
"policy_holder_name": "Layla Hassan Mahmoud",
"patient_emirates_id": "784-1991-4726185-9",
"policy_primary_member_id": "7C41-05B9-4E28-1D63",
"policy_primary_dha_member_id": "I019-004-372641508-01"
},
"copay_analysis": {
"copay_details": [
{
"remarks": "Citation: Copay 20% Max 50.00 AED applicable for \n                                                                    :\n\nConsultation / Evaluation and Management, Teleconsultations",
"visit_type": "Consultation",
"copay_amount": null,
"cost_sharing": {
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 20,
"applicable_location": "Outside UAE",
"copay_maximum_scope": null,
"copay_maximum_amount": 50,
"coinsurance_percentage": null
},
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_max_scope": null,
"copay_max_amount": 50,
"copay_percentage": "20",
"coinsurance_percentage": null
},
{
"remarks": "Citation: Copay 20%  applicable for \n                                                                    :\n\nDialysis",
"visit_type": "Dialysis",
"copay_amount": null,
"cost_sharing": {
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 20,
"applicable_location": "Outside UAE",
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
},
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_max_scope": null,
"copay_max_amount": null,
"copay_percentage": "20",
"coinsurance_percentage": null
}
],
"waiting_period": "Not Specified",
"special_remarks": [
"No referral required for specialist consultation",
"Work Injury Covered"
],
"new_version_of_copay_analysis": {
"benefits": [
{
"limits": null,
"remarks": null,
"conditions": null,
"cost_sharing": [
{
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 20,
"applicable_location": "Outside UAE",
"copay_maximum_scope": null,
"copay_maximum_amount": 50,
"coinsurance_percentage": null
}
],
"coverage_status": "Covered",
"service_category_original": "Consultation / Evaluation and Management, Teleconsultations",
"service_category_standardized": "Consultation"
},
{
"limits": null,
"remarks": null,
"conditions": null,
"cost_sharing": [
{
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 20,
"applicable_location": "Outside UAE",
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
}
],
"coverage_status": "Covered",
"service_category_original": "Dialysis",
"service_category_standardized": "Dialysis"
}
],
"policy_info": {
"waiting_period": {
"waiting_period_time": 0,
"waiting_period_unit": "Days",
"waiting_period_starting_from": "policy_start_date"
},
"policy_period_end": null,
"policy_jurisdiction": "Not Specified",
"policy_period_start": null,
"beneficiary_start_date": null
},
"general_remarks": [
"No referral required for specialist consultation",
"Work Injury Covered"
],
"abbreviations_defined": [
]
}
},
"failure_reason": null,
"policy_network": {
"is_vip": "Not Mentioned",
"payer_name": "QATAR INSURANCE COMPANY - INS019",
"sponsor_id": "INS019",
"start_date": "2026-03-10",
"valid_upto": "2027-03-09",
"all_networks": [
{
"network": "GN",
"plan_code": "DXSHJ-P154",
"visit_type": "Out Mat",
"network_code": null,
"network_value": "General Network",
"raw_plan_string": "INS019 - QATAR INSURANCE COMPANY - NAS - GN -DXB-SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "Restricted Network [Applicable Tariff: General Network]"
}
],
"package_name": null,
"is_gatekeeper": "Not Mentioned",
"waiting_period": null,
"policy_authority": "DHA",
"policy_plan_name": null,
"applicable_tariff": null,
"work_site_covered": "Could not determine",
"policy_holder_name": null,
"network_payment_limit": "Not Mentioned",
"payer_name_as_in_text": "Qatar Insurance Company",
"is_consultation_excluded_from_payment_limit": false,
"is_general_physician_referral_required_for_specialist_referral": false
},
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"warning_messages": [
],
"policy_holder_dob": "14-Jul-1991",
"policy_holder_name": "Layla Hassan Mahmoud",
"referral_documents": [
{
"tag": "Member Eligibility - Main Page",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"tag": "Member Eligibility - Details Modal",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"tag": "Member Eligibility - Alternative Screenshot",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"tag": "Consultation / Claim Form",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"tag": "Prescription Form",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
}
],
"copay_details_to_fill": [
{
"name": "Outpatient",
"values_to_fill": {
"LAB": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"MEDICINES": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"RADIOLOGY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"DIAGNOSTICS": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"CONSULTATION": {
"copay": "20.0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "50.0",
"should_set_copay": true,
"_deductibleLegacy": "50.0"
},
"PHYSIOTHERAPY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"DENTAL CONSULTATION & PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
}
},
"primary_network": {
"network": "GN",
"network_status": null,
"matched_plan_name": null
},
"available_networks": [
{
"network": "GN",
"plan_code": "DXSHJ-P154",
"visit_type": "Out Mat",
"network_code": null,
"network_value": "General Network",
"raw_plan_string": "INS019 - QATAR INSURANCE COMPANY - NAS - GN -DXB-SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "Restricted Network [Applicable Tariff: General Network]"
}
],
"has_multiple_networks": false
},
{
"name": "Maternity",
"values_to_fill": {
"LAB": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"MEDICINES": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"RADIOLOGY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"DIAGNOSTICS": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"CONSULTATION": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"PHYSIOTHERAPY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"DENTAL CONSULTATION & PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
}
},
"primary_network": {
"network": "GN",
"network_status": null,
"matched_plan_name": null
},
"available_networks": [
{
"network": "GN",
"plan_code": "DXSHJ-P154",
"visit_type": "Out Mat",
"network_code": null,
"network_value": "General Network",
"raw_plan_string": "INS019 - QATAR INSURANCE COMPANY - NAS - GN -DXB-SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "Restricted Network [Applicable Tariff: General Network]"
}
],
"has_multiple_networks": false
},
{
"name": "Specialization",
"values_to_fill": {
"LAB": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_is_outpatient_fallback": true
},
"MEDICINES": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_is_outpatient_fallback": true
},
"PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_is_outpatient_fallback": true
},
"RADIOLOGY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_is_outpatient_fallback": true
},
"DIAGNOSTICS": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_is_outpatient_fallback": true
},
"CONSULTATION": {
"copay": "20.0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "50.0",
"should_set_copay": true,
"_deductibleLegacy": "50.0",
"_is_outpatient_fallback": true
},
"PHYSIOTHERAPY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_is_outpatient_fallback": true
},
"DENTAL CONSULTATION & PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_is_outpatient_fallback": true
}
},
"primary_network": {
"network": "GN",
"network_status": null,
"matched_plan_name": null
},
"available_networks": [
{
"network": "GN",
"plan_code": "DXSHJ-P154",
"visit_type": "Out Mat",
"network_code": null,
"network_value": "General Network",
"raw_plan_string": "INS019 - QATAR INSURANCE COMPANY - NAS - GN -DXB-SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "Restricted Network [Applicable Tariff: General Network]"
}
],
"has_multiple_networks": false
},
{
"name": "Inpatient",
"values_to_fill": {
"LAB": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"MEDICINES": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"RADIOLOGY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"DIAGNOSTICS": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"CONSULTATION": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"PHYSIOTHERAPY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"DENTAL CONSULTATION & PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
}
},
"primary_network": {
"network": "GN",
"network_status": null,
"matched_plan_name": null
},
"available_networks": [
{
"network": "GN",
"plan_code": "DXSHJ-P154",
"visit_type": "Out Mat",
"network_code": null,
"network_value": "General Network",
"raw_plan_string": "INS019 - QATAR INSURANCE COMPANY - NAS - GN -DXB-SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "Restricted Network [Applicable Tariff: General Network]"
}
],
"has_multiple_networks": false
}
],
"policy_holder_emirates_id": "784-1991-4726185-9",
"was_identified_by_aggregator": false
},
"status": "found"
},
"search_id": "7C41-05B9-4E28-1D63",
"tpa_name": "TPA004",
"task_id": "00000000-0000-4000-a000-000000000001",
"user_id": null,
"status": "found"
}
}

Highlighted: eligibility_result.data_dump.data.copay_details_to_fill.2. Every other key on the response is documented on Results.

The lit block is the copay category this payer never published. Specialization repeats the Outpatient block service for service, so CONSULTATION reads "20.0" with _copayMaxAmount: "50.0" because the outpatient consultation does, and every service copied that way carries _is_outpatient_fallback: true. Show that provenance rather than the number alone: it is the outpatient rate standing in, not a rate quoted for a specialist visit.

Three more things in the same document are worth scrolling to, none of them a degraded result. The five referral_documents carry tag and s3_url and no id, which is why tag is the field to display. is_gatekeeper is "Not Mentioned" here too, and here it is accurate: this policy text never addressed referrals at all, and no boolean or warning contradicts it. And warning_messages is [], which is the common case.

TPA003, one plan string parsed into two networks

.json

{
"id": "00000000-0000-4000-a000-000000000001",
"tenant_id": "yourorg",
"clinic_id": "00000000-0000-4000-a000-000000000002",
"created_at": "2026-04-09T20:24:31.905000",
"updated_at": "2026-04-09T20:36:45.710000",
"task_id": "00000000-0000-4000-a000-000000000001",
"status": "PROCESS_COMPLETE",
"request_dump": {
"phone": "971-50-2274318",
"id_type": "CARDNUMBER",
"tpa_name": "TPA003",
"payerName": "ALMADALLAH HEALTHCARE MANAGEMENT FZ-LLC",
"doctorName": "Dr Imran Qureshi",
"extra_args": {
"title": "LocationGroup",
"value": "OUTPATIENT"
},
"visit_type": "OUTPATIENT",
"emirates_id": "7C41-05B9-4E28-1D63",
"practice_id": "00000000-0000-4000-a000-000000000002",
"user_id": "00000000-0000-4000-a000-000000000003",
"name": null,
"dob": null,
"mode": "prod",
"test_mode": false
},
"interim_results": {
"tpa_name": "TPA003",
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"referral_documents": [
{
"id": "member_eligibility_document",
"tag": "Member Eligibility Document",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
}
]
},
"is_search_all": false,
"search_all_status": null,
"created_by_user_id": null,
"eligibility_result": {
"id": "00000000-0000-4000-a000-000000000001:TPA003",
"tenant_id": "yourorg",
"clinic_id": "00000000-0000-4000-a000-000000000002",
"created_at": "2026-04-09T20:36:46.151000",
"updated_at": "2026-04-09T20:36:46.151000",
"data_dump": {
"tpa": "TPA003",
"data": {
"payer_id": "TPA003",
"is_eligible": true,
"patient_info": {
"policy_holder_name": "Layla Hassan Mahmoud",
"patient_emirates_id": "784-1991-4726185-9",
"policy_primary_member_id": "7C41-05B9-4E28-1D63",
"policy_primary_dha_member_id": "Not Available"
},
"copay_analysis": {
"copay_details": [
{
"remarks": "Citation: Consultation   - 20 % | \n\n ",
"visit_type": "Consultation",
"copay_amount": null,
"cost_sharing": {
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 20,
"applicable_location": "Outside UAE",
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
},
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_max_scope": null,
"copay_max_amount": null,
"copay_percentage": "20.0",
"coinsurance_percentage": null
},
{
"remarks": "Citation: Pharmacy   - 20 % | \n\n ",
"visit_type": "Pharmacy",
"copay_amount": null,
"cost_sharing": {
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 20,
"applicable_location": "Outside UAE",
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
},
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_max_scope": null,
"copay_max_amount": null,
"copay_percentage": "20.0",
"coinsurance_percentage": null
},
{
"remarks": "Citation: Laboratory   - 20 % | \n\n ",
"visit_type": "Laboratory",
"copay_amount": null,
"cost_sharing": {
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 20,
"applicable_location": "Outside UAE",
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
},
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_max_scope": null,
"copay_max_amount": null,
"copay_percentage": "20.0",
"coinsurance_percentage": null
},
{
"remarks": "Citation: Radiology   - 20 % | \n\n ",
"visit_type": "Radiology",
"copay_amount": null,
"cost_sharing": {
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 20,
"applicable_location": "Outside UAE",
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
},
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_max_scope": null,
"copay_max_amount": null,
"copay_percentage": "20.0",
"coinsurance_percentage": null
},
{
"remarks": "Citation: Physiotherapy   - 20 % | \n\n ",
"visit_type": "Physiotherapy",
"copay_amount": null,
"cost_sharing": {
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 20,
"applicable_location": "Outside UAE",
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
},
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_max_scope": null,
"copay_max_amount": null,
"copay_percentage": "20.0",
"coinsurance_percentage": null
},
{
"remarks": "Citation: Other OP Services   - 20 % | \n\n ",
"visit_type": "Other Services",
"copay_amount": null,
"cost_sharing": {
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 20,
"applicable_location": "Outside UAE",
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
},
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_max_scope": null,
"copay_max_amount": null,
"copay_percentage": "20.0",
"coinsurance_percentage": null
}
],
"waiting_period": "waiting_period_time=0 waiting_period_unit='Days' waiting_period_starting_from='policy_start_date'",
"special_remarks": [
],
"new_version_of_copay_analysis": {
"benefits": [
{
"limits": null,
"remarks": null,
"conditions": null,
"cost_sharing": [
{
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 20,
"applicable_location": "Outside UAE",
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
}
],
"coverage_status": "Covered",
"service_category_original": null,
"service_category_standardized": "Consultation"
},
{
"limits": null,
"remarks": null,
"conditions": null,
"cost_sharing": [
{
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 20,
"applicable_location": "Outside UAE",
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
}
],
"coverage_status": "Covered",
"service_category_original": null,
"service_category_standardized": "Pharmacy"
},
{
"limits": null,
"remarks": null,
"conditions": null,
"cost_sharing": [
{
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 20,
"applicable_location": "Outside UAE",
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
}
],
"coverage_status": "Covered",
"service_category_original": null,
"service_category_standardized": "Laboratory"
},
{
"limits": null,
"remarks": null,
"conditions": null,
"cost_sharing": [
{
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 20,
"applicable_location": "Outside UAE",
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
}
],
"coverage_status": "Covered",
"service_category_original": null,
"service_category_standardized": "Radiology"
},
{
"limits": null,
"remarks": null,
"conditions": null,
"cost_sharing": [
{
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 20,
"applicable_location": "Outside UAE",
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
}
],
"coverage_status": "Covered",
"service_category_original": null,
"service_category_standardized": "Physiotherapy"
},
{
"limits": null,
"remarks": null,
"conditions": null,
"cost_sharing": [
{
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 20,
"applicable_location": "Outside UAE",
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
}
],
"coverage_status": "Covered",
"service_category_original": "Other OP Services",
"service_category_standardized": "Other Services"
}
],
"policy_info": {
"waiting_period": {
"waiting_period_time": 0,
"waiting_period_unit": "Days",
"waiting_period_starting_from": "policy_start_date"
},
"policy_period_end": null,
"policy_jurisdiction": "Not Specified",
"policy_period_start": null,
"beneficiary_start_date": null
},
"general_remarks": [
],
"abbreviations_defined": [
]
}
},
"failure_reason": null,
"policy_network": {
"is_vip": "Not Mentioned",
"payer_name": "DUBAI GOVERNMENT - PROGRAM 2 - INS002",
"sponsor_id": null,
"start_date": "2026-01-01",
"valid_upto": "2026-12-31",
"all_networks": [
{
"network": "GN",
"plan_code": "DXSHJ-P281",
"visit_type": "OP (Out Patient)",
"network_code": null,
"network_value": "GN",
"raw_plan_string": "INS002 - GOVERNMENT OF DUBAI (ENAYA SCHEME) - GOLD - DXB - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "GN"
},
{
"network": "Enaya Gold",
"plan_code": "DXSHJ-P281",
"visit_type": "OP (Out Patient)",
"network_code": null,
"network_value": "Enaya Gold",
"raw_plan_string": "INS002 - GOVERNMENT OF DUBAI (ENAYA SCHEME) - GOLD - DXB - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "Enaya Gold (CAT-B EXPAT)"
}
],
"package_name": null,
"is_gatekeeper": "Not Mentioned",
"waiting_period": null,
"policy_authority": "DHA",
"policy_plan_name": null,
"work_site_covered": "Could not determine",
"policy_holder_name": null,
"payer_name_as_in_text": "Dubai Government",
"is_general_physician_referral_required_for_specialist_referral": false
},
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"warning_messages": [
],
"policy_holder_name": "Layla Hassan Mahmoud",
"referral_documents": [
{
"id": "member_eligibility_document",
"tag": "Member Eligibility Document",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
}
],
"copay_details_to_fill": [
{
"name": "Outpatient",
"values_to_fill": {
"LAB": {
"copay": "20.0",
"deductible": "0",
"_copayAmount": "0",
"_maxDeductible": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0"
},
"MEDICINES": {
"copay": "20.0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0"
},
"PROCEDURE": {
"copay": "20.0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0"
},
"RADIOLOGY": {
"copay": "20.0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0"
},
"DIAGNOSTICS": {
"copay": "20.0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0"
},
"CONSULTATION": {
"copay": "20.0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0"
},
"PHYSIOTHERAPY": {
"copay": "20.0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0"
},
"DENTAL CONSULTATION & PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
}
},
"primary_network": {
"network": "GN",
"network_status": null,
"matched_plan_name": null
},
"available_networks": [
{
"network": "GN",
"plan_code": "DXSHJ-P281",
"visit_type": "OP (Out Patient)",
"network_code": null,
"network_value": "GN",
"raw_plan_string": "INS002 - GOVERNMENT OF DUBAI (ENAYA SCHEME) - GOLD - DXB - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "GN"
},
{
"network": "Enaya Gold",
"plan_code": "DXSHJ-P281",
"visit_type": "OP (Out Patient)",
"network_code": null,
"network_value": "Enaya Gold",
"raw_plan_string": "INS002 - GOVERNMENT OF DUBAI (ENAYA SCHEME) - GOLD - DXB - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "Enaya Gold (CAT-B EXPAT)"
}
],
"has_multiple_networks": true
},
{
"name": "Maternity",
"values_to_fill": {
"LAB": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"MEDICINES": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"RADIOLOGY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"DIAGNOSTICS": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"CONSULTATION": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"PHYSIOTHERAPY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"DENTAL CONSULTATION & PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
}
},
"primary_network": {
"network": "GN",
"network_status": null,
"matched_plan_name": null
},
"available_networks": [
{
"network": "GN",
"plan_code": "DXSHJ-P281",
"visit_type": "OP (Out Patient)",
"network_code": null,
"network_value": "GN",
"raw_plan_string": "INS002 - GOVERNMENT OF DUBAI (ENAYA SCHEME) - GOLD - DXB - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "GN"
},
{
"network": "Enaya Gold",
"plan_code": "DXSHJ-P281",
"visit_type": "OP (Out Patient)",
"network_code": null,
"network_value": "Enaya Gold",
"raw_plan_string": "INS002 - GOVERNMENT OF DUBAI (ENAYA SCHEME) - GOLD - DXB - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "Enaya Gold (CAT-B EXPAT)"
}
],
"has_multiple_networks": true
},
{
"name": "Specialization",
"values_to_fill": {
"LAB": {
"copay": "20.0",
"deductible": "0",
"_copayAmount": "0",
"_maxDeductible": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0",
"_is_outpatient_fallback": true
},
"MEDICINES": {
"copay": "20.0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0",
"_is_outpatient_fallback": true
},
"PROCEDURE": {
"copay": "20.0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0",
"_is_outpatient_fallback": true
},
"RADIOLOGY": {
"copay": "20.0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0",
"_is_outpatient_fallback": true
},
"DIAGNOSTICS": {
"copay": "20.0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0",
"_is_outpatient_fallback": true
},
"CONSULTATION": {
"copay": "20.0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0",
"_is_outpatient_fallback": true
},
"PHYSIOTHERAPY": {
"copay": "20.0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0",
"_is_outpatient_fallback": true
},
"DENTAL CONSULTATION & PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_is_outpatient_fallback": true
}
},
"primary_network": {
"network": "GN",
"network_status": null,
"matched_plan_name": null
},
"available_networks": [
{
"network": "GN",
"plan_code": "DXSHJ-P281",
"visit_type": "OP (Out Patient)",
"network_code": null,
"network_value": "GN",
"raw_plan_string": "INS002 - GOVERNMENT OF DUBAI (ENAYA SCHEME) - GOLD - DXB - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "GN"
},
{
"network": "Enaya Gold",
"plan_code": "DXSHJ-P281",
"visit_type": "OP (Out Patient)",
"network_code": null,
"network_value": "Enaya Gold",
"raw_plan_string": "INS002 - GOVERNMENT OF DUBAI (ENAYA SCHEME) - GOLD - DXB - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "Enaya Gold (CAT-B EXPAT)"
}
],
"has_multiple_networks": true
},
{
"name": "Inpatient",
"values_to_fill": {
"LAB": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"MEDICINES": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"RADIOLOGY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"DIAGNOSTICS": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"CONSULTATION": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"PHYSIOTHERAPY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"DENTAL CONSULTATION & PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
}
},
"primary_network": {
"network": "GN",
"network_status": null,
"matched_plan_name": null
},
"available_networks": [
{
"network": "GN",
"plan_code": "DXSHJ-P281",
"visit_type": "OP (Out Patient)",
"network_code": null,
"network_value": "GN",
"raw_plan_string": "INS002 - GOVERNMENT OF DUBAI (ENAYA SCHEME) - GOLD - DXB - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "GN"
},
{
"network": "Enaya Gold",
"plan_code": "DXSHJ-P281",
"visit_type": "OP (Out Patient)",
"network_code": null,
"network_value": "Enaya Gold",
"raw_plan_string": "INS002 - GOVERNMENT OF DUBAI (ENAYA SCHEME) - GOLD - DXB - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "Enaya Gold (CAT-B EXPAT)"
}
],
"has_multiple_networks": true
}
],
"policy_holder_emirates_id": "784-1991-4726185-9",
"was_identified_by_aggregator": false
},
"status": "found"
},
"search_id": "7C41-05B9-4E28-1D63",
"tpa_name": "TPA003",
"task_id": "00000000-0000-4000-a000-000000000001",
"user_id": null,
"status": "found"
}
}

Highlighted: eligibility_result.data_dump.data.policy_network.all_networks. Every other key on the response is documented on Results.

One raw_plan_string off the portal, read as two entries that share a plan_code: GN and Enaya Gold. Both have matched_plan_name: null, so neither was matched to a plan we hold, and has_multiple_networks is true on every copay category because available_networks has two entries. Render the network next to the copay number: on a response like this one there is no single network the numbers belong to.

Where this fits

This page is about reading one eligible body. The pages either side of it cover the rest:

Results

The envelope these fields sit in, and every other outcome a check can return.

Result objects

The full field-by-field reference, including the keys only some payers return.

Two fields carry most of the mistakes

Copay is scoped, never headline: one benefit can price differently per network and per emirate, so render the scope next to the number. And the gatekeeper rule is reported only in policy_network.is_gatekeeper, not in warning_messages, so a client that renders warnings alone drops it silently.