Healthcare Plan Details schema field group

Last update: 2023-12-15
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  • Schemas
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Healthcare Plan Details is a standard schema field group for the Plan class. It provides a single object-type field healthcarePlanDetails which captures properties related to a medical plan.

Property Data type Description
networkDetails Array of objects Lists the details of the insurer-defined network(s) of providers to which the beneficiary may seek treatment, and will be covered at the “in-network” rate. Each object includes the following properties:
  • networkID: (String) The insurer-specific ID for the network.
  • networkName: (String) The insurer-specific name for the network.
affiliations Array of strings A list of business entities that are affiliated with the plan.
coverageType String The plan coverage type. Accepted values are:
  • medical
  • dental
  • vision
  • accident
isActive Boolean Indicates whether the plan is active.
lastVerificationDate DateTime The date on which the plan was last verified.
payerID String The unique identifier for the payer (in other words, the insurance provider for the plan).
planLevel String Indicates the plan level. Accepted values are:
  • primary
  • secondary
  • tertiary
  • quaternary
planType String Indicates the plan type. Accepted values are:
  • hmo
  • epo
  • pos
  • hdhp
targetOwnerType String The type of owner a plan is for. Examples include individual, group, organization, and so on.

For more details on the field group, refer to the public XDM repository.

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