| Name | Description | Type | Additional information |
|---|---|---|---|
| BenefitPeriodsUrl |
Gets or sets the link to the Benefit Period resource for the plan contract |
string |
None. |
| OpenEnrollmentSubmissionClarificationCodesUrl |
Gets or sets the link to the Open Enrollment Submission Clarification Code resource for the plan contract |
string |
None. |
| GroupPlanNo |
Gets or sets the identifier for the Group Plan associated with this plan contract |
integer |
None. |
| FacilityBranchNo |
Gets or sets the seqno of the associated Facility Branch |
integer |
None. |
| ContractCode |
Gets or sets the contract code |
string |
None. |
| ContractName |
Gets or sets the contract name |
string |
None. |
| Description |
Gets or sets the the description |
string |
None. |
| OpenEnrollment |
Gets or sets whether open enrollment is enabled |
boolean |
None. |
| UseCustomCardholderID |
Gets or sets whether the contract uses a custom cardholder id |
boolean |
None. |
| AllowSecondaryPayer |
Gets or sets whether the contract allows secondary payer |
boolean |
None. |
| SecondaryPayerOnly |
Gets or sets whether the contract is secondary only |
boolean |
None. |
| PayClaimsRejectedByOtherPayer |
Gets or sets whether the contract pays other payer rejected claims |
boolean |
None. |
| OpenEnrollmentBackdateDays |
Gets or sets the number of days to backdate eligibility for open enrollment |
integer |
None. |
| DeductibleUrl |
Gets or sets the link to the periodic deductible resource |
string |
None. |
| DeductibleNo |
Gets or sets the periodic deductible identifier |
integer |
None. |
| MaxOutOfPocketUrl |
Gets or sets the link to the periodic max out of pocket resource |
string |
None. |
| MaxOutOfPocketNo |
Gets or sets the periodic max out of pocket identifier |
integer |
None. |
| PersonDeductibleIsMinimum |
Gets or sets whether the member deductible is required to be met for the family deductible |
boolean |
None. |
| PersonDeductibleIsCapped |
Gets or sets whether additional amounts paid by the member after deductible has been met is applied toward the family deductible the member's deductible (true = cap member deductible) |
boolean |
None. |
| EffectiveStartDate |
Gets or sets the effective start date |
date |
None. |
| EffectiveEndDate |
Gets or sets the effective end date |
date |
None. |
| HelpDeskPhoneNumber |
Gets or sets the help desk phone number (if set, overrides the plan's help desk phone number) |
string |
None. |
| StandardMessage |
Gets or sets the standard message in the claim header (if set, overrides the plan's standard message) |
string |
None. |
| ApproveMessage |
Gets or sets the approve message in the claim header when claim is paid (if set, overrides the plan's approve message) |
string |
None. |
| RequirePAMessage |
Gets or sets the prior authorization message in the claim header when drug requires a PA (if set, overrides the plan's require PA message) |
string |
None. |
| NotCoveredMessage |
Gets or sets the not covered message in the claim header when drug is not covered (if set, overrides the plan's not covered message) |
string |
None. |
| OutOfPocketMessage |
Gets or sets the out of pocket message in the claim header when out of pocket limit has been reached (if set, overrides the plan's out of pocket message) |
string |
None. |
| WaiveDeductibleAfterOOPMet |
Gets or sets whether remaining deductible amounts are waived after the member's OOP limit has been reached |
boolean |
None. |
| DependentsCovered |
Gets or sets whether dependents are covered |
boolean |
None. |
| MonthlyDeductibleUrl |
Gets or sets the link to the monthly deductible resource |
string |
None. |
| MonthlyDeductibleNo |
Gets or sets the monthly deductible identifier |
integer |
None. |
| MonthlyMaxOutOfPocketUrl |
Gets or sets the link to the monthly max out of pocket resource |
string |
None. |
| MonthlyMaxOutOfPocketNo |
Gets or sets the monthly max out of pocket identifier |
integer |
None. |
| PlanBenefitLimitMonthUrl |
Gets or sets the link to the monthly plan benefit limit resource |
string |
None. |
| PlanBenefitLimitMonthNo |
Gets or sets the monthly plan benefit limit identifier |
integer |
None. |
| PlanBenefitLimitPeriodUrl |
Gets or sets the link to the periodic plan benefit limit resource |
string |
None. |
| PlanBenefitLimitPeriodNo |
Gets or sets the periodic plan benefit limit identifier |
integer |
None. |
| PlanBenefitLimitLifeUrl |
Gets or sets the link to the lifetime plan benefit limit resource |
string |
None. |
| PlanBenefitLimitLifeNo |
Gets or sets the lifetime plan benefit limit identifier |
integer |
None. |
| PlanBenefitLimitRxOnlyMonthUrl |
Gets or sets the link to the Rx only monthly plan benefit limit resource |
string |
None. |
| PlanBenefitLimitRxOnlyMonthNo |
Gets or sets the Rx only monthly plan benefit limit identifier |
integer |
None. |
| PlanBenefitLimitRxOnlyPeriodUrl |
Gets or sets the link to the Rx only periodic plan benefit limit resource |
string |
None. |
| PlanBenefitLimitRxOnlyPeriodNo |
Gets or sets the Rx only periodic plan benefit limit identifier |
integer |
None. |
| PlanBenefitLimitRxOnlyLifeUrl |
Gets or sets the link to the Rx only lifetime plan benefit limit resource |
string |
None. |
| PlanBenefitLimitRxOnlyLifeNo |
Gets or sets the Rx only lifetime plan benefit limit identifier |
integer |
None. |
| ClaimUseCardholderID |
Get or sets whether to use the card holder ID to look up member when processing claim |
boolean |
None. |
| ClaimUsePatientID |
Get or sets whether to use the patient ID to look up member when processing claim |
boolean |
None. |
| ClaimUseAlternateID |
Get or sets whether to use the alternate ID to look up member when processing claim This field will be deprecated as of 03/30/2025. Use ClaimUseAlternateIDForMember and ClaimUseAlternateIDForCardholder instead |
boolean |
None. |
| ClaimUseAlternateIDForMember |
Get or sets whether to use the member alternate ID to look up member when processing claim |
boolean |
None. |
| ClaimUseAlternateIDForCardholder |
Get or sets whether to use the cardholder alternate ID to look up member when processing claim |
boolean |
None. |
| ClaimUseMemberInfo |
Get or sets whether to use the member name and date of birth to look up member when processing claim |
boolean |
None. |
| PlanIncentiveLimitAmountPeriod |
Get or sets the max plan incentive amount allowed for a month |
decimal number |
None. |
| PlanIncentiveLimitAmountMonth |
Get or sets the max plan incentive amount allowed for a month |
decimal number |
None. |
| PlanIncentiveLimitMonthRollover |
Get or sets whether plan incentive balances for a month rollover to the next month |
boolean |
None. |
| EligibilityRejectMessage |
Get or sets the message for eligibility rejects |
string |
None. |
| ApplyDeductibleToOOP |
Get or sets whether to apply deductible amounts to the OOP when processing claim |
boolean |
None. |
| DefaultBenefitCodeUrl |
Gets or sets the link to the default benefit code when processing claim |
string |
None. |
| DefaultBenefitCodeNo |
Gets or sets the default benefit code identifier |
integer |
None. |
| ClaimsStorePatientID |
Get or sets whether to use the internal member ID for the cardholder when processing claim |
boolean |
None. |
| BenefitCodesShareValuesForDeductible |
Get or sets whether deductible values are shared across all benefit codes |
boolean |
None. |
| BenefitCodesShareValuesForOutOfPocket |
Get or sets whether OOP values are shared across all benefit codes |
boolean |
None. |
| BenefitCodesShareValuesForPlanPaidAmt |
Get or sets whether plan paid amount values are shared across all benefit codes |
boolean |
None. |
| BenefitCodesShareValuesForPlanIncentive |
Get or sets whether plan incentive values are shared across all benefit codes |
boolean |
None. |
| ClaimReqMemberNameMatch |
Get or sets whether the member name has to match what is being submitted when processing claim |
boolean |
None. |
| IsAlternate |
Gets or sets the value indicating whether the plan contract is an alternate plan contract |
boolean |
None. |
| ClaimSend |
Gets or sets whether claim send is enabled |
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. |