| carrier_name |
str |
Name of the insurance carrier |
[optional] |
| display_name |
str |
Alternate name for the Plan |
[optional] |
| effective_date |
str |
Effective date of coverage. |
[optional] |
| expiration_date |
str |
Expiration date of coverage. |
[optional] |
| identifiers |
list[PlanIdentifier] |
List of identifiers of this Plan |
[optional] |
| name |
str |
Marketing name of the plan |
[optional] |
| network_ids |
list[int] |
List of Vericred-generated network_ids |
[optional] |
| plan_type |
str |
Category of the plan (e.g. EPO, HMO, PPO, POS, Indemnity, PACE, Medicare-Medicaid, HMO w/POS, Cost, FFS, MSA) |
[optional] |
| service_area_id |
str |
Foreign key for service area |
[optional] |
| source |
str |
Source of the plan benefit data |
[optional] |
| type |
str |
The type of the Plan |
[optional] |
| adult_dental |
bool |
Does the plan provide dental coverage for adults? |
[optional] |
| age29_rider |
bool |
True if the plan allows dependents up to age 29 |
[optional] |
| ambulance |
str |
Benefits string for ambulance coverage |
[optional] |
| benefits_summary_url |
str |
Link to the summary of benefits and coverage (SBC) document. |
[optional] |
| buy_link |
str |
Link to a location to purchase the plan. |
[optional] |
| child_dental |
bool |
Does the plan provide dental coverage for children? |
[optional] |
| child_eyewear |
str |
Child eyewear benefits summary |
[optional] |
| child_eye_exam |
str |
Child eye exam benefits summary |
[optional] |
| customer_service_phone_number |
str |
Phone number to contact the insurance carrier |
[optional] |
| durable_medical_equipment |
str |
Benefits summary for durable medical equipment |
[optional] |
| diagnostic_test |
str |
Diagnostic tests benefit summary |
[optional] |
| dp_rider |
bool |
True if plan does not cover domestic partners |
[optional] |
| drug_formulary_url |
str |
Link to the summary of drug benefits for the plan |
[optional] |
| emergency_room |
str |
Description of costs when visiting the ER |
[optional] |
| family_drug_deductible |
str |
Deductible for drugs when a family is on the plan. |
[optional] |
| family_drug_moop |
str |
Maximum out-of-pocket for drugs when a family is on the plan |
[optional] |
| family_medical_deductible |
str |
Deductible when a family is on the plan |
[optional] |
| family_medical_moop |
str |
Maximum out-of-pocket when a family is on the plan |
[optional] |
| fp_rider |
bool |
True if plan does not cover family planning |
[optional] |
| generic_drugs |
str |
Cost for generic drugs |
[optional] |
| habilitation_services |
str |
Habilitation services benefits summary |
[optional] |
| hios_issuer_id |
str |
|
[optional] |
| home_health_care |
str |
Home health care benefits summary |
[optional] |
| hospice_service |
str |
Hospice service benefits summary |
[optional] |
| hsa_eligible |
bool |
Is the plan HSA eligible? |
[optional] |
| id |
str |
Government-issued HIOS plan ID |
[optional] |
| imaging |
str |
Benefits summary for imaging coverage |
[optional] |
| individual_drug_deductible |
str |
Deductible for drugs when an individual is on the plan |
[optional] |
| individual_drug_moop |
str |
Maximum out-of-pocket for drugs when an individual is on the plan |
[optional] |
| individual_medical_deductible |
str |
Deductible when an individual is on the plan |
[optional] |
| individual_medical_moop |
str |
Maximum out-of-pocket when an individual is on the plan |
[optional] |
| inpatient_birth |
str |
Inpatient birth benefits summary |
[optional] |
| inpatient_facility |
str |
Cost under the plan for an inpatient facility |
[optional] |
| inpatient_mental_health |
str |
Inpatient mental helath benefits summary |
[optional] |
| inpatient_physician |
str |
Cost under the plan for an inpatient physician |
[optional] |
| inpatient_substance |
str |
Inpatient substance abuse benefits summary |
[optional] |
| in_network_ids |
list[int] |
List of NPI numbers for Providers passed in who accept this Plan |
[optional] |
| level |
str |
Plan metal grouping (e.g. platinum, gold, silver, etc) |
[optional] |
| logo_url |
str |
Link to a copy of the insurance carrier's logo |
[optional] |
| non_preferred_brand_drugs |
str |
Cost under the plan for non-preferred brand drugs |
[optional] |
| on_market |
bool |
Is the plan on-market? |
[optional] |
| off_market |
bool |
Is the plan off-market? |
[optional] |
| out_of_network_coverage |
bool |
Does this plan provide any out of network coverage? |
[optional] |
| out_of_network_ids |
list[int] |
List of NPI numbers for Providers passed in who do not accept this Plan |
[optional] |
| outpatient_facility |
str |
Benefits summary for outpatient facility coverage |
[optional] |
| outpatient_mental_health |
str |
Benefits summary for outpatient mental health coverage |
[optional] |
| outpatient_physician |
str |
Benefits summary for outpatient physician coverage |
[optional] |
| outpatient_substance |
str |
Outpatient substance abuse benefits summary |
[optional] |
| plan_market |
str |
Market in which the plan is offered (on_marketplace, shop, etc) |
[optional] |
| preferred_brand_drugs |
str |
Cost under the plan for perferred brand drugs |
[optional] |
| prenatal_postnatal_care |
str |
Inpatient substance abuse benefits summary |
[optional] |
| preventative_care |
str |
Benefits summary for preventative care |
[optional] |
| premium_subsidized |
float |
Cumulative premium amount after subsidy |
[optional] |
| premium |
float |
Cumulative premium amount |
[optional] |
| premium_source |
str |
Source of the base pricing data |
[optional] |
| primary_care_physician |
str |
Cost under the plan to visit a Primary Care Physician |
[optional] |
| rehabilitation_services |
str |
Benefits summary for rehabilitation services |
[optional] |
| skilled_nursing |
str |
Benefits summary for skilled nursing services |
[optional] |
| specialist |
str |
Cost under the plan to visit a specialist |
[optional] |
| specialty_drugs |
str |
Cost under the plan for specialty drugs |
[optional] |
| urgent_care |
str |
Benefits summary for urgent care |
[optional] |
| actuarial_value |
float |
Percentage of total average costs for covered benefits that a plan will cover. |
[optional] |
| chiropractic_services |
str |
Chiropractic services benefits summary |
[optional] |
| coinsurance |
float |
Standard cost share for most benefits |
[optional] |
| embedded_deductible |
str |
Is the individual deductible for each covered person, embedded in the family deductible |
[optional] |
| gated |
bool |
Does the plan's network require a physician referral? |
[optional] |
| imaging_center |
str |
Imaging center benefits summary |
[optional] |
| imaging_physician |
str |
Imaging physician benefits summary |
[optional] |
| lab_test |
str |
Lab test benefits summary |
[optional] |
| mail_order_rx |
float |
Multiple of the standard Rx cost share for orders filled via mail order |
[optional] |
| nonpreferred_generic_drug_share |
str |
Non-preferred generic drugs benefits summary |
[optional] |
| nonpreferred_specialty_drug_share |
str |
Non-preferred specialty drugs benefits summary |
[optional] |
| outpatient_ambulatory_care_center |
str |
Outpatient ambulatory care center benefits summary |
[optional] |
| plan_calendar |
str |
Are deductibles and MOOPs reset on Dec-31 ("calendar year") or 365 days after enrollment date ("plan year")? |
[optional] |
| prenatal_care |
str |
Prenatal care benefits summary |
[optional] |
| postnatal_care |
str |
Post-natal care benefits summary |
[optional] |
| skilled_nursing_facility_365 |
str |
Does the plan cover full-time, year-round, nursing facilities? |
[optional] |
| match_percentage |
int |
Percentage of doctors who matched this Plan |
[optional] |
| perfect_match_percentage |
int |
Percentage of employees with 100% matchedch |
[optional] |
| employee_premium |
float |
Cumulative premium amount for employees |
[optional] |
| dependent_premium |
float |
Cumulative premium amount for dependents |
[optional] |