{
  "$schema": "https://json-schema.org/draft/2020-12/schema",
  "$id": "https://raw.githubusercontent.com/api-evangelist/independence-blue-cross/refs/heads/main/json-structure/independence-blue-cross-health-plan-structure.json",
  "title": "Independence Blue Cross Health Plan Structure",
  "description": "JSON Structure describing how Independence Blue Cross is organized for API consumers: parent holding company, underwriting carriers, lines of business, member populations covered by each FHIR surface, and the developer-portal contact surface.",
  "type": "object",
  "properties": {
    "provider": {
      "type": "object",
      "properties": {
        "id": {"type": "string", "const": "independence-blue-cross"},
        "name": {"type": "string", "const": "Independence Blue Cross"},
        "parent": {"type": "string", "const": "Independence Health Group, Inc."},
        "license": {"type": "string", "const": "Independent licensee of the Blue Cross Blue Shield Association"},
        "headquarters": {"type": "string", "const": "Philadelphia, Pennsylvania"},
        "founded": {"type": "string", "const": "more than 85 years (as of 2026)"},
        "membership_self": {"type": "string", "const": "approximately 3 million members"},
        "membership_group": {"type": "string", "const": "approximately 9 million covered lives across Independence Health Group"},
        "revenue_group_2025": {"type": "string", "const": "$36.3 billion (Independence Health Group consolidated, FY2025)"}
      }
    },
    "carriers": {
      "type": "array",
      "description": "Underwriting carrier brands publishing Transparency in Coverage files.",
      "items": {
        "type": "object",
        "properties": {
          "brand": {"type": "string"},
          "code": {"type": "string"},
          "tic_url": {"type": "string", "format": "uri"}
        }
      },
      "default": [
        {"brand": "Keystone Health Plan East", "code": "khpe", "tic_url": "https://www.ibx.com/cmstic/?brand=khpe"},
        {"brand": "QCC Insurance Company", "code": "qcc", "tic_url": "https://www.ibx.com/cmstic/?brand=qcc"},
        {"brand": "Independence Assurance Co, Inc.", "code": "iac", "tic_url": "https://www.ibx.com/cmstic/?brand=iac"}
      ]
    },
    "affiliates": {
      "type": "array",
      "items": {
        "type": "object",
        "properties": {
          "name": {"type": "string"},
          "role": {"type": "string"},
          "ownership": {"type": "string"}
        }
      },
      "default": [
        {"name": "AmeriHealth", "role": "Commercial health plans, TPA services", "ownership": "Independence Health Group subsidiary"},
        {"name": "AmeriHealth Administrators", "role": "National third-party administrator for self-funded plans", "ownership": "Independence Health Group subsidiary"},
        {"name": "AmeriHealth New Jersey (AmeriHealth Insurance Company of NJ)", "role": "Commercial payer for New Jersey (~209,000 members)", "ownership": "Independence Health Group subsidiary"},
        {"name": "AmeriHealth Caritas", "role": "Medicaid managed care, CHIP, D-SNP, LTSS, Marketplace in 13 states + DC", "ownership": "Independence Health Group 61.3% / Blue Cross Blue Shield of Michigan 38.7%"},
        {"name": "Tandigm Health", "role": "Value-based primary care enablement", "ownership": "Independence-affiliated"}
      ]
    },
    "service_area": {
      "type": "object",
      "properties": {
        "counties": {
          "type": "array",
          "items": {"type": "string"},
          "default": ["Bucks", "Chester", "Delaware", "Montgomery", "Philadelphia"]
        },
        "state": {"type": "string", "const": "Pennsylvania"}
      }
    },
    "lines_of_business": {
      "type": "array",
      "items": {"type": "string"},
      "default": [
        "Commercial (individual, group, large employer)",
        "Medicare Advantage (Keystone 65 HMO, Personal Choice 65 PPO)",
        "Children's Health Insurance Program (Keystone HMO CHIP)",
        "Dental (IBX Dental)",
        "Vision",
        "Behavioral Health",
        "Pharmacy Benefits"
      ]
    },
    "fhir_apis": {
      "type": "array",
      "items": {
        "type": "object",
        "properties": {
          "name": {"type": "string"},
          "base_url": {"type": "string"},
          "auth": {"type": "string"},
          "in_scope_population": {"type": "string"},
          "implementation_guide": {"type": "string"}
        }
      },
      "default": [
        {
          "name": "Patient Access FHIR API",
          "base_url": "https://eapics.ibx.com/patient/v1/fhir",
          "auth": "SMART on FHIR / OAuth 2.0 with PKCE",
          "in_scope_population": "Medicare Advantage + Keystone HMO CHIP members",
          "implementation_guide": "US Core 3.1.1 + CARIN BB + Da Vinci PDex"
        },
        {
          "name": "Provider Directory FHIR API",
          "base_url": "https://eapics.ibx.com/provider/v1/fhir",
          "auth": "None (public)",
          "in_scope_population": "All members and the public",
          "implementation_guide": "Da Vinci PDex Plan-Net"
        },
        {
          "name": "Drug Formulary FHIR API",
          "base_url": "https://eapics.ibx.com/formulary/v1/fhir",
          "auth": "None (public)",
          "in_scope_population": "All members and the public",
          "implementation_guide": "Da Vinci US Drug Formulary (USDF)"
        }
      ]
    },
    "developer_contacts": {
      "type": "object",
      "properties": {
        "portal": {"type": "string", "const": "https://devportal.ibx.com/"},
        "documentation": {"type": "string", "const": "https://devportal.ibx.com/documentation/"},
        "swagger": {"type": "string", "const": "https://www.ibx.com/scripts/custom/swagger/cmsSwagger.json"},
        "registration": {"type": "string", "const": "https://devportal.ibx.com/cmssignin/"},
        "support_email": {"type": "string", "const": "AppOnboardingSupport@ibx.com"},
        "terms": {"type": "string", "const": "https://www.ibx.com/htdocs/custom/tnc/Developer%20Portal%20TandC.pdf"}
      }
    }
  }
}