GroupPlanModel

Gets or sets the link to the Plan Contracts resource for the plan

Gets or sets the link to the Deductibles resource for the plan

Gets or sets the link to the Max Out of Pockets resource for the plan

Gets or sets the link to the Plan Benefit Limits resource for the plan

Gets or sets the link to the Plan Incentive resource for the plan

Gets or sets the link to the Applied Networks resource for the plan

Gets or sets the link to the Applied Pharmacy Headquarter Exceptions resource for the plan

Gets or sets the link to the Plan Pricing Groups resource for the plan

Gets or sets the identifier for the Group/Employer Group/Branch

Gets or sets the name given to represent the Plan

Gets or sets the alternative name given to the Group

Gets or sets the description given to represent the plan

Gets or sets the BIN used for claims processing

Gets or sets the PCN used for claims processing

Gets or sets whether the PCN should match when processing claims

Gets or sets the date the plan is effective

Gets or sets the date the plan is no longer effective. If not provided, the plan is active indefinitely

Gets or sets the link to the Base Per Diem resource for the plan

Gets or sets the identifier for the Base Per Diem used for the plan

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.

Gets or sets the maximum number of days the plan allows for submitting a claim based on the date of service

Gets or sets the maximum number days the plan allows for reversing a claim

Gets or sets the the default Tier captured if not specified on the formulary

Gets or sets the option to enforce formulary limits

Gets or sets the standard message in the claim header

Gets or sets the approve message in the claim header when claim is paid

Gets or sets the prior authorization message in the claim header when drug requires a PA

Gets or sets the not covered message in the claim header when drug is not covered

Gets or sets the out of pocket message in the claim header when out of pocket limit has been reached

Gets or sets the help desk phone number

Gets or sets the the catch-all dispense fee for the plan (obsolete)

Gets or sets whether to use the submitted dispense fee for unknown/undefined drugs (obsolete)

Gets or sets whether to use Usual and Customary for unknown/undefined drugs (obsolete)

Gets or sets whether to use Gross Amount Due for unknown/undefined drugs (obsolete)

Gets or sets the link to the Coinsurance resource for unkown or undefined drugs

Gets or sets the identifier for the Copay/Coinsurance used for unknown or undefined drugs

Gets or sets the link to the Coinsurance resource for unkown or undefined drugs after out of pocket limits have been reached

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

Gets or sets the whether the plan will price each drug of a compound (obsolete)

Gets or sets whether a valid NDC must be used in a compound claim (obsolete)

Gets or sets the minimum number of drugs to price in the compound (obsolete)

Gets or sets the maximum number of drugs to price in the compound (blank or null means all will be priced) (obsolete)

Gets or sets the minimum indgredient cost for the compound (obsolete)

Gets or sets the default dispense fee to be applied for a compound (level of effort 0) (obsolete)

Gets or sets the dispense fee for level of effort 1 (obsolete)

Gets or sets the dispense fee for level of effort 2 (obsolete)

Gets or sets the dispense fee for level of effort 3 (obsolete)

Gets or sets the dispense fee for level of effort 4 (obsolete)

Gets or sets the dispense fee for level of effort 5 (obsolete)

Gets or sets the indicates whether to use the submitted dispense fee from the pharmacy for the compound (obsolete)

Gets or sets the indicates whether to use the submitted Usual and Customary price from the pharmacy for the compound (obsolete)

Gets or sets the indicates whether to use the Gross Amount Due price from the pharmacy for the compound (obsolete)

Gets or sets the link to the Coinsurance resource for compound drugs

Gets or sets the identifier for the Copay/Coinsurance used for compounds

Gets or sets the link to the Coinsurance resource for compound drugs after out of pocket limits have been reached

Gets or sets the identifier for the Copay/Coinsurance used for compounds after out of pocket limits have been reached

Gets or sets the link to the Drug Pricing resource for compound drugs

Gets or sets the identifier of the special drug pricing for a compound.

Gets or sets the identifier representing the Alternate compound pricing option (If two options are defined, then the lower pricing option will be used)

Gets or sets the link to the Alt Drug Pricing resource for compound drugs

Gets or sets the link to the Drug Pricing resource for unknown/undefined drugs

Gets or sets the identifier of the special drug pricing for an unknown/undefined drug.

Gets or sets whether to use Network Coinsurance if available

Gets or sets whether to use Network Incentive if available

Gets or set whether to use Network deductible options if available

Gets or sets whether to use Drug-Drug DUR (obsolete)

Gets or sets the least severe level of DUR the plan enforces (obsolete)

Gets or sets the message to send in the claim response when severity is exceeded (obsolete)

Gets or sets the action to take when severity level threshold is crossed (obsolete)

Gets or sets the action to take when threshold is exceeded

Gets or sets whether the system will determine if the patient is exceeding the daily dosage threshold for opioid medications

Gets or sets the daily dosage threshold for opioid medications

Gets or sets the message to send in the claim response when MME Threshold is exceeded

Gets or sets whether the plan allows claims with future date of service

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

Gets or sets whether the plan overrides the template options when deriving from a Group Template

Gets or sets whether the plan overrides the template messages when deriving from a Group Template

Gets or sets whether the plan overrides the template prescription edits when deriving from a Group Template

Gets or sets whether the plan overrides the template DUR options when deriving from a Group Template

Gets or sets whether the plan overrides the template compound pricing options when deriving from a Group Template

Gets or sets whether the plan overrides the template unkown/undefined drug pricing options when deriving from a Group Template

Gets or sets whether the plan overrides the template formulary options when deriving from a Group Template

Gets or sets whether the plan overrides the template Location/Global pricing when deriving from a Group Template

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

Gets or sets whether the plan subscribes to Location/Global ACI pricing

Gets or sets whether the plan subscribes to Location/Global acquisition pricing

Gets or sets whether the plan subscribes to Location/Global Custom MAC pricing

Gets or sets whether the plan subscribes to Location/Global reference pricing

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.

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.

Get or sets the message for eligibility rejects

Gets or sets whether claims should reject if there is no custom pricing

Gets or sets the Plan Template from which this plan inherits

Gets or sets the link to the Plan Template resource for this plan

Plan's Incentive Limit Amount for a member for a period

Plan's Incentive Limit Amount for a member for a month

Value indicating whether the Plan's Incentive Limit Amount should roll over to the next period

Gets or sets the link representing a link back to the resource

Gets or sets the identifier for the resource