GET api/groups/{groupid}/groupplans/{id}
Gets a Plan for the specified group and plan identifier
Request Information
URI Parameters
| Name | Description | Type | Additional information |
|---|---|---|---|
| groupid |
Group identifier |
integer |
Required |
| id |
Plan identifier |
integer |
Required |
Body Parameters
None.
Response Information
Resource Description
A Plan
GroupPlanModel| Name | Description | Type | Additional information |
|---|---|---|---|
| PlanContractsUrl |
Gets or sets the link to the Plan Contracts resource for the plan |
string |
None. |
| DeductiblesUrl |
Gets or sets the link to the Deductibles resource for the plan |
string |
None. |
| MaxOutOfPocketsUrl |
Gets or sets the link to the Max Out of Pockets resource for the plan |
string |
None. |
| PlanBenefitLimitsUrl |
Gets or sets the link to the Plan Benefit Limits resource for the plan |
string |
None. |
| PlanIncentivesUrl |
Gets or sets the link to the Plan Incentive resource for the plan |
string |
None. |
| AppliedNetworksUrl |
Gets or sets the link to the Applied Networks resource for the plan |
string |
None. |
| AppliedPharmacyHeadquarterExceptionsUrl |
Gets or sets the link to the Applied Pharmacy Headquarter Exceptions resource for the plan |
string |
None. |
| PlanPricingGroupsUrl |
Gets or sets the link to the Plan Pricing Groups resource for the plan |
string |
None. |
| GroupNo |
Gets or sets the identifier for the Group/Employer Group/Branch |
integer |
None. |
| PlanName |
Gets or sets the name given to represent the Plan |
string |
None. |
| GroupName |
Gets or sets the alternative name given to the Group |
string |
None. |
| Description |
Gets or sets the description given to represent the plan |
string |
None. |
| Bin |
Gets or sets the BIN used for claims processing |
string |
None. |
| PCN |
Gets or sets the PCN used for claims processing |
string |
None. |
| ValidatePCN |
Gets or sets whether the PCN should match when processing claims |
boolean |
None. |
| EffectiveStartDate |
Gets or sets the date the plan is effective |
date |
None. |
| EffectiveEndDate |
Gets or sets the date the plan is no longer effective. If not provided, the plan is active indefinitely |
date |
None. |
| BasePerDiemUrl |
Gets or sets the link to the Base Per Diem resource for the plan |
string |
None. |
| BasePerDiemNo |
Gets or sets the identifier for the Base Per Diem used for the plan |
integer |
None. |
| NewStartDays |
Gets or sets the number of days that must lapse before drug is considered new. Ex: Setting to 365 days would require the member to have stopped therapy for 365 days before it's considered new therapy again. |
integer |
None. |
| MaxClaimDays |
Gets or sets the maximum number of days the plan allows for submitting a claim based on the date of service |
integer |
None. |
| MaxReversalDays |
Gets or sets the maximum number days the plan allows for reversing a claim |
integer |
None. |
| DefaultDrugTier |
Gets or sets the the default Tier captured if not specified on the formulary |
byte |
None. |
| EnforceFormularyLimits |
Gets or sets the option to enforce formulary limits |
boolean |
None. |
| StandardMessage |
Gets or sets the standard message in the claim header |
string |
None. |
| ApproveMessage |
Gets or sets the approve message in the claim header when claim is paid |
string |
None. |
| RequiredOverrideMessage |
Gets or sets the prior authorization message in the claim header when drug requires a PA |
string |
None. |
| NotCoveredMessage |
Gets or sets the not covered message in the claim header when drug is not covered |
string |
None. |
| OutOfPocketMessage |
Gets or sets the out of pocket message in the claim header when out of pocket limit has been reached |
string |
None. |
| HelpDeskPhoneNumber |
Gets or sets the help desk phone number |
string |
None. |
| UnknownDispenseFee |
Gets or sets the the catch-all dispense fee for the plan |
decimal number |
None. |
| UnknownUseSubmittedDispenseFee |
Gets or sets whether to use the submitted dispense fee for unknown/undefined drugs |
boolean |
None. |
| UnknownUseUsualAndCustomary |
Gets or sets whether to use Usual and Customary for unknown/undefined drugs |
boolean |
None. |
| UnknownUseGrossAmountDue |
Gets or sets whether to use Gross Amount Due for unknown/undefined drugs |
boolean |
None. |
| UnknownCoinsuranceUrl |
Gets or sets the link to the Coinsurance resource for unkown or undefined drugs |
string |
None. |
| UnknownCoinsuranceNo |
Gets or sets the identifier for the Copay/Coinsurance used for unknown or undefined drugs |
integer |
None. |
| UnknownOutOfPocketCoinsuranceUrl |
Gets or sets the link to the Coinsurance resource for unkown or undefined drugs after out of pocket limits have been reached |
string |
None. |
| UnknownOutOfPocketCoinsuranceNo |
Gets or sets the link to the identifier for the Copay/Coinsurance used for unknown or undefined drugs after out of pocket limits have been reached |
integer |
None. |
| CompoundPriceSubmittedDrugs |
Gets or sets the whether the plan will price each drug of a compound |
boolean |
None. |
| CompoundRequireValidNDC |
Gets or sets whether a valid NDC must be used in a compound claim |
boolean |
None. |
| CompoundMinimumDrugsToPrice |
Gets or sets the minimum number of drugs to price in the compound |
byte |
None. |
| CompoundMaxDrugsToPrice |
Gets or sets the maximum number of drugs to price in the compound (blank or null means all will be priced) |
byte |
None. |
| CompoundMinimumPrice |
Gets or sets the minimum indgredient cost for the compound |
decimal number |
None. |
| CompoundDefaultFee |
Gets or sets the default dispense fee to be applied for a compound (level of effort 0) |
decimal number |
None. |
| CompoundEffort1Fee |
Gets or sets the dispense fee for level of effort 1 |
decimal number |
None. |
| CompoundEffort2Fee |
Gets or sets the dispense fee for level of effort 2 |
decimal number |
None. |
| CompoundEffort3Fee |
Gets or sets the dispense fee for level of effort 3 |
decimal number |
None. |
| CompoundEffort4Fee |
Gets or sets the dispense fee for level of effort 4 |
decimal number |
None. |
| CompoundEffort5Fee |
Gets or sets the dispense fee for level of effort 5 |
decimal number |
None. |
| CompoundUseSubmittedDispenseFee |
Gets or sets the indicates whether to use the submitted dispense fee from the pharmacy for the compound |
boolean |
None. |
| CompoundUseUsualAndCustomary |
Gets or sets the indicates whether to use the submitted Usual and Customary price from the pharmacy for the compound |
boolean |
None. |
| CompoundUseGrossAmountDue |
Gets or sets the indicates whether to use the Gross Amount Due price from the pharmacy for the compound |
boolean |
None. |
| CompoundCoinsuranceUrl |
Gets or sets the link to the Coinsurance resource for compound drugs |
string |
None. |
| CompoundCoinsuranceNo |
Gets or sets the identifier for the Copay/Coinsurance used for compounds |
integer |
None. |
| CompoundOutOfPocketCoinsuranceUrl |
Gets or sets the link to the Coinsurance resource for compound drugs after out of pocket limits have been reached |
string |
None. |
| CompoundOutOfPocketCoinsuranceNo |
Gets or sets the identifier for the Copay/Coinsurance used for compounds after out of pocket limits have been reached |
integer |
None. |
| CompoundDrugPricingUrl |
Gets or sets the link to the Drug Pricing resource for compound drugs |
string |
None. |
| CompoundDrugPricingNo |
Gets or sets the identifier of the special drug pricing for a compound. |
integer |
None. |
| AltCompoundDrugPricingNo |
Gets or sets the identifier representing the Alternate compound pricing option (If two options are defined, then the lower pricing option will be used) |
integer |
None. |
| AltCompoundDrugPricingUrl |
Gets or sets the link to the Alt Drug Pricing resource for compound drugs |
string |
None. |
| UnknownDrugPricingUrl |
Gets or sets the link to the Drug Pricing resource for unknown/undefined drugs |
string |
None. |
| UnknownDrugPricingNo |
Gets or sets the identifier of the special drug pricing for an unknown/undefined drug. |
integer |
None. |
| UseNetworkCoinsurance |
Gets or sets whether to use Network Coinsurance if available |
boolean |
None. |
| UseNetworkIncentive |
Gets or sets whether to use Network Incentive if available |
boolean |
None. |
| UseNetworkDeductibleOptions |
Gets or set whether to use Network deductible options if available |
boolean |
None. |
| DURDrugDrugCheck |
Gets or sets whether to use Drug-Drug DUR (obsolete) |
boolean |
None. |
| DURDrugDrugLevelSeverity |
Gets or sets the least severe level of DUR the plan enforces (obsolete) |
string |
None. |
| DURDrugDrugMessage |
Gets or sets the message to send in the claim response when severity is exceeded (obsolete) |
string |
None. |
| DURDrugDrugActionTypeNo |
Gets or sets the action to take when severity level threshold is crossed (obsolete) |
integer |
None. |
| MMEActionTypeNo |
Gets or sets the action to take when threshold is exceeded |
integer |
None. |
| MMEThresholdCheck |
Gets or sets whether the system will determine if the patient is exceeding the daily dosage threshold for opioid medications |
boolean |
None. |
| MMEThreshold |
Gets or sets the daily dosage threshold for opioid medications |
integer |
None. |
| MMEResponseMessage |
Gets or sets the message to send in the claim response when MME Threshold is exceeded |
string |
None. |
| AllowFutureDateOfService |
Gets or sets whether the plan allows claims with future date of service |
boolean |
None. |
| DefaultPharmacyTier |
Gets or sets the default pharmacy tier value that will be saved on the claim audit if it isn't specified elsewhere during processing of a claim |
string |
None. |
| TemplateOverrideOptions |
Gets or sets whether the plan overrides the template options when deriving from a Group Template |
boolean |
None. |
| TemplateOverrideMessages |
Gets or sets whether the plan overrides the template messages when deriving from a Group Template |
boolean |
None. |
| TemplateOverridePrescriptionEdits |
Gets or sets whether the plan overrides the template prescription edits when deriving from a Group Template |
boolean |
None. |
| TemplateOverrideDUR |
Gets or sets whether the plan overrides the template DUR options when deriving from a Group Template |
boolean |
None. |
| TemplateOverrideCompoundPricing |
Gets or sets whether the plan overrides the template compound pricing options when deriving from a Group Template |
boolean |
None. |
| TemplateOverrideUnknownPricing |
Gets or sets whether the plan overrides the template unkown/undefined drug pricing options when deriving from a Group Template |
boolean |
None. |
| TemplateOverrideFormulary |
Gets or sets whether the plan overrides the template formulary options when deriving from a Group Template |
boolean |
None. |
| TemplateOverrideGlobalPricing |
Gets or sets whether the plan overrides the template Location/Global pricing when deriving from a Group Template |
boolean |
None. |
| ReturnMemberLookupMessages |
Gets or sets whether the eligibility messages are returned when using open enrollment and if the member was either found using an alternate lookup or was added to the system |
boolean |
None. |
| SubscribeToGlobalPricingACI |
Gets or sets whether the plan subscribes to Location/Global ACI pricing |
boolean |
None. |
| SubscribeToGlobalPricingAcqCost |
Gets or sets whether the plan subscribes to Location/Global acquisition pricing |
boolean |
None. |
| SubscribeToGlobalPricingCustomMAC |
Gets or sets whether the plan subscribes to Location/Global Custom MAC pricing |
boolean |
None. |
| SubscribeToGlobalPricingRefPrice |
Gets or sets whether the plan subscribes to Location/Global reference pricing |
boolean |
None. |
| RxExpireDays |
Gets or sets the number of days to indicate that a prescription is "expired." An Rx is expired if the date of service is later than the first fill for the Rx plus the RxExpireDays. |
integer |
None. |
| PrescriberGraceDays |
Gets or sets the Prescriber Grace Days to be used in conjuction with prescriber effective dates in rules. If a prescriber's effective date has expired, but the grace period has not been exceeded, the claim will continue processing. |
integer |
None. |
| EligibilityRejectMessage |
Get or sets the message for eligibility rejects |
string |
None. |
| PrescriptionWrittenMaxDays | integer |
None. |
|
| RejectClaimIfNoCustomPrice |
Gets or sets whether claims should reject if there is no custom pricing |
boolean |
None. |
| PlanTemplateNo |
Gets or sets the Plan Template from which this plan inherits |
integer |
None. |
| PlanTemplateUrl |
Gets or sets the link to the Plan Template resource for this plan |
string |
None. |
| PlanIncentiveLimitAmountPeriod |
Plan's Incentive Limit Amount for a member for a period |
decimal number |
None. |
| PlanIncentiveLimitAmountMonth |
Plan's Incentive Limit Amount for a member for a month |
decimal number |
None. |
| PlanIncentiveLimitMonthRollover |
Value indicating whether the Plan's Incentive Limit Amount should roll over to the next period |
boolean |
None. |
| Url |
Gets or sets the link representing a link back to the resource |
string |
None. |
| ID |
Gets or sets the identifier for the resource |
integer |
None. |
Response Formats
application/json, text/json, application/json-patch+json
{
"url": "sample string 34",
"id": 35,
"planContractsUrl": "sample string 1",
"deductiblesUrl": "sample string 2",
"maxOutOfPocketsUrl": "sample string 3",
"planBenefitLimitsUrl": "sample string 4",
"planIncentivesUrl": "sample string 5",
"appliedNetworksUrl": "sample string 6",
"appliedPharmacyHeadquarterExceptionsUrl": "sample string 7",
"planPricingGroupsUrl": "sample string 8",
"groupNo": 1,
"planName": "sample string 9",
"groupName": "sample string 10",
"description": "sample string 11",
"bin": "sample string 12",
"pcn": "sample string 13",
"validatePCN": true,
"effectiveStartDate": "2025-05-30T20:53:34.9506984-05:00",
"effectiveEndDate": "2025-05-30T20:53:34.9506984-05:00",
"basePerDiemUrl": "sample string 14",
"basePerDiemNo": 1,
"newStartDays": 1,
"maxClaimDays": 1,
"maxReversalDays": 1,
"defaultDrugTier": 64,
"enforceFormularyLimits": true,
"standardMessage": "sample string 15",
"approveMessage": "sample string 16",
"requiredOverrideMessage": "sample string 17",
"notCoveredMessage": "sample string 18",
"outOfPocketMessage": "sample string 19",
"helpDeskPhoneNumber": "sample string 20",
"unknownDispenseFee": 1.0,
"unknownUseSubmittedDispenseFee": true,
"unknownUseUsualAndCustomary": true,
"unknownUseGrossAmountDue": true,
"unknownCoinsuranceUrl": "sample string 21",
"unknownCoinsuranceNo": 1,
"unknownOutOfPocketCoinsuranceUrl": "sample string 22",
"unknownOutOfPocketCoinsuranceNo": 1,
"compoundPriceSubmittedDrugs": true,
"compoundRequireValidNDC": true,
"compoundMinimumDrugsToPrice": 64,
"compoundMaxDrugsToPrice": 64,
"compoundMinimumPrice": 1.0,
"compoundDefaultFee": 1.0,
"compoundEffort1Fee": 1.0,
"compoundEffort2Fee": 1.0,
"compoundEffort3Fee": 1.0,
"compoundEffort4Fee": 1.0,
"compoundEffort5Fee": 1.0,
"compoundUseSubmittedDispenseFee": true,
"compoundUseUsualAndCustomary": true,
"compoundUseGrossAmountDue": true,
"compoundCoinsuranceUrl": "sample string 23",
"compoundCoinsuranceNo": 1,
"compoundOutOfPocketCoinsuranceUrl": "sample string 24",
"compoundOutOfPocketCoinsuranceNo": 1,
"compoundDrugPricingUrl": "sample string 25",
"compoundDrugPricingNo": 1,
"altCompoundDrugPricingNo": 1,
"altCompoundDrugPricingUrl": "sample string 26",
"unknownDrugPricingUrl": "sample string 27",
"unknownDrugPricingNo": 1,
"useNetworkCoinsurance": true,
"useNetworkIncentive": true,
"useNetworkDeductibleOptions": true,
"durDrugDrugCheck": true,
"durDrugDrugLevelSeverity": "sample string 28",
"durDrugDrugMessage": "sample string 29",
"durDrugDrugActionTypeNo": 1,
"mmeActionTypeNo": 1,
"mmeThresholdCheck": true,
"mmeThreshold": 1,
"mmeResponseMessage": "sample string 30",
"allowFutureDateOfService": true,
"defaultPharmacyTier": "sample string 31",
"templateOverrideOptions": true,
"templateOverrideMessages": true,
"templateOverridePrescriptionEdits": true,
"templateOverrideDUR": true,
"templateOverrideCompoundPricing": true,
"templateOverrideUnknownPricing": true,
"templateOverrideFormulary": true,
"templateOverrideGlobalPricing": true,
"returnMemberLookupMessages": true,
"subscribeToGlobalPricingACI": true,
"subscribeToGlobalPricingAcqCost": true,
"subscribeToGlobalPricingCustomMAC": true,
"subscribeToGlobalPricingRefPrice": true,
"rxExpireDays": 1,
"prescriberGraceDays": 1,
"eligibilityRejectMessage": "sample string 32",
"prescriptionWrittenMaxDays": 1,
"rejectClaimIfNoCustomPrice": true,
"planTemplateNo": 1,
"planTemplateUrl": "sample string 33",
"planIncentiveLimitAmountPeriod": 1.0,
"planIncentiveLimitAmountMonth": 1.0,
"planIncentiveLimitMonthRollover": true
}