{ "$schema": "http://json-schema.org/draft-07/schema#", "title": "Plan", "description": "Schema for Plan from CMS Marketplace API", "properties": { "id": { "description": "14-character HIOS plan ID", "type": "string" }, "name": { "description": "Name of the insurance plan", "type": "string" }, "benefits": { "items": { "$ref": "#/definitions/Benefit" }, "type": "array" }, "deductibles": { "items": { "$ref": "#/definitions/Deductible" }, "type": "array" }, "disease_mgmt_programs": { "items": { "$ref": "#/definitions/DiseaseMgmtProgramsEnum" }, "type": "array" }, "has_national_network": { "description": "if plan has a national network of providers", "type": "boolean" }, "quality_rating": { "$ref": "#/definitions/QualityRating" }, "insurance_market": { "$ref": "#/definitions/InsuranceMarketEnum" }, "issuer": { "$ref": "#/definitions/Issuer" }, "market": { "$ref": "#/definitions/MarketEnum" }, "max_age_child": { "description": "the maximum age a person is considered a child on their parents' plan", "format": "int32", "type": "number" }, "metal_level": { "$ref": "#/definitions/MetalLevelEnum" }, "moops": { "items": { "$ref": "#/definitions/MOOP" }, "type": "array" }, "premium": { "description": "monthly premium in US dollars, unsubsidized (i.e., no APTC applied)", "format": "float", "type": "number" }, "premium_w_credit": { "description": "monthly premium in US dollars, with APTC applied", "format": "float", "type": "number" }, "ehb_premium": { "description": "monthly premium in US dollars, for essential health benefits portion of total premium", "format": "float", "type": "number" }, "pediatric_ehb_premium": { "description": "monthly pediatric portion of the ehb premium in US dollars", "type": "number", "format": "float" }, "aptc_eligible_premium": { "description": "the portion of the premium that is eligible for APTC", "type": "number", "format": "float" }, "guaranteed_rate": { "description": "true if the premiums are guaranteed (versus estimated)", "type": "boolean" }, "simple_choice": { "description": "true if the plan is a Simple Choice plan", "type": "boolean" }, "product_division": { "$ref": "#/definitions/ProductDivisionEnum" }, "specialist_referral_required": { "type": "boolean" }, "state": { "description": "2-letter USPS state abbreviation", "type": "string" }, "type": { "$ref": "#/definitions/PlanTypeEnum" }, "benefits_url": { "type": "string" }, "brochure_url": { "type": "string" }, "formulary_url": { "type": "string" }, "network_url": { "type": "string" }, "hsa_eligible": { "description": "Is this plan eligible as an HSA?", "type": "boolean" }, "oopc": { "description": "out-of-pocket cost; calculated when age, gender and utilization_level are present, otherwise -1", "type": "number" }, "suppression_state": { "$ref": "#/definitions/SuppressionStatus" }, "tobacco_lookback": { "type": "integer" }, "certification": { "$ref": "#/definitions/CertificationStatus" }, "network_adequacy": { "description": "Network adequacy", "type": "object", "properties": { "scope": { "description": "The county for which the network adequacy is in scope", "type": "string" }, "networks": { "description": "Specialty networks and their network types", "type": "object" } } }, "sbcs": { "description": "Summary of benefits and costs", "type": "object", "properties": { "baby": { "description": "Typical yearly costs for having a healthy pregnancy and normal delivery for one person", "allOf": [ { "$ref": "#/definitions/SBCScenario" } ] }, "diabetes": { "description": "Typical yearly costs for managing type 2 diabetes for one person", "allOf": [ { "$ref": "#/definitions/SBCScenario" } ] }, "fracture": { "description": "Typical yearly costs for treating a simple fracture", "allOf": [ { "$ref": "#/definitions/SBCScenario" } ] } } }, "rx_3mo_mail_order": { "description": "3-month in-network mail order pharmacy benefit", "type": "boolean" }, "is_ineligible": { "description": "If the given enrollment group/household is ineligible for the plan by business rules, it will be flagged true", "type": "boolean" }, "covers_nonhyde_abortion": { "type": "boolean" }, "service_area_id": { "description": "6-character id representing the geographic area the plan accepts members from. The first two characters are the state's abbreviation.", "type": "string" } }, "type": "object" }