ACAPlanPre2018.md

VericredClient::ACAPlanPre2018

Properties

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