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Covered No Limit." } ], "code": "1", "inPlanNetworkIndicator": "Yes", "inPlanNetworkIndicatorCode": "Y", "name": "Active Coverage", "planCoverage": "Gold Plan", "serviceTypeCodes": [ "69" ], "serviceTypes": [ "Maternity" ] }, { "benefitPercent": "0.5", "code": "A", "coverageLevel": "Family", "coverageLevelCode": "FAM", "inPlanNetworkIndicator": "Yes", "inPlanNetworkIndicatorCode": "Y", "name": "Co-Insurance", "planCoverage": "Gold Plan", "serviceTypeCodes": [ "69" ], "serviceTypes": [ "Maternity" ], "timeQualifier": "Visit", "timeQualifierCode": "27" }, { "code": "I", "inPlanNetworkIndicator": "No", "inPlanNetworkIndicatorCode": "N", "name": "Non-Covered", "planCoverage": "Gold Plan", "serviceTypeCodes": [ "69" ], "serviceTypes": [ "Maternity" ] }, { "additionalInformation": [ { "description": "Covered No Limit." } ], "code": "1", "inPlanNetworkIndicator": "Yes", "inPlanNetworkIndicatorCode": "Y", "name": "Active Coverage", "planCoverage": "Gold Plan", "serviceTypeCodes": [ "86" ], "serviceTypes": [ "Emergency Services" ] }, { "benefitPercent": "0.5", "code": "A", "coverageLevel": "Family", "coverageLevelCode": "FAM", "inPlanNetworkIndicator": "Yes", "inPlanNetworkIndicatorCode": "Y", "name": "Co-Insurance", "planCoverage": "Gold Plan", "serviceTypeCodes": [ "86" ], "serviceTypes": [ "Emergency Services" ], "timeQualifier": "Visit", "timeQualifierCode": "27" }, { "additionalInformation": [ { "description": "Covered No Limit." } ], "code": "1", "inPlanNetworkIndicator": "No", "inPlanNetworkIndicatorCode": "N", "name": "Active Coverage", "planCoverage": "Gold Plan", "serviceTypeCodes": [ "86" ], "serviceTypes": [ "Emergency Services" ] }, { "benefitPercent": "0.5", "code": "A", "coverageLevel": "Family", "coverageLevelCode": "FAM", "inPlanNetworkIndicator": "No", "inPlanNetworkIndicatorCode": "N", "name": "Co-Insurance", "planCoverage": "Gold Plan", "serviceTypeCodes": [ "86" ], "serviceTypes": [ "Emergency Services" ], "timeQualifier": "Visit", "timeQualifierCode": "27" }, { "code": "1", "inPlanNetworkIndicator": "Yes", "inPlanNetworkIndicatorCode": "Y", "name": "Active Coverage", "planCoverage": "Gold Plan", "serviceTypeCodes": [ "88" ], "serviceTypes": [ "Pharmacy" ] }, { "additionalInformation": [ { "description": "per prescription" } ], "benefitAmount": "10", "code": "B", "coverageLevel": "Family", "coverageLevelCode": "FAM", "inPlanNetworkIndicator": "Yes", "inPlanNetworkIndicatorCode": "Y", "name": "Co-Payment", "planCoverage": "Gold Plan", "serviceTypeCodes": [ "88" ], "serviceTypes": [ "Pharmacy" ], "timeQualifier": "Visit", "timeQualifierCode": "27" }, { "code": "I", "inPlanNetworkIndicator": "No", "inPlanNetworkIndicatorCode": "N", "name": "Non-Covered", "planCoverage": "Gold Plan", "serviceTypeCodes": [ "88" ], "serviceTypes": [ "Pharmacy" ] }, { "additionalInformation": [ { "description": "PCP" } ], "code": "1", "inPlanNetworkIndicator": "Yes", "inPlanNetworkIndicatorCode": "Y", "name": "Active Coverage", "planCoverage": "Gold Plan", "serviceTypeCodes": [ "98" ], "serviceTypes": [ "Professional (Physician) Visit - Office" ] }, { "additionalInformation": [ { "description": "per visit" }, { "description": "PCP" } ], "benefitAmount": "15", "code": "B", "coverageLevel": "Family", "coverageLevelCode": "FAM", "inPlanNetworkIndicator": "Yes", "inPlanNetworkIndicatorCode": "Y", "name": "Co-Payment", "planCoverage": "Gold Plan", "serviceTypeCodes": [ "98" ], "serviceTypes": [ "Professional (Physician) Visit - Office" ], "timeQualifier": "Visit", "timeQualifierCode": "27" }, { "additionalInformation": [ { "description": "PCP" } ], "code": "I", "inPlanNetworkIndicator": "No", "inPlanNetworkIndicatorCode": "N", "name": "Non-Covered", "planCoverage": "Gold Plan", "serviceTypeCodes": [ "98" ], "serviceTypes": [ "Professional (Physician) Visit - Office" ] }, { "additionalInformation": [ { "description": "Specialist" }, { "description": "Covered No Limit." } ], "code": "1", "inPlanNetworkIndicator": "Yes", "inPlanNetworkIndicatorCode": "Y", "name": "Active Coverage", "planCoverage": "Gold Plan", "serviceTypeCodes": [ "98" ], "serviceTypes": [ "Professional (Physician) Visit - Office" ] }, { "additionalInformation": [ { "description": "per visit" }, { "description": "Specialist" } ], "benefitAmount": "30", "code": "B", "coverageLevel": "Family", "coverageLevelCode": "FAM", "inPlanNetworkIndicator": "Yes", "inPlanNetworkIndicatorCode": "Y", "name": "Co-Payment", "planCoverage": "Gold Plan", "serviceTypeCodes": [ "98" ], "serviceTypes": [ "Professional (Physician) Visit - Office" ], "timeQualifier": "Visit", "timeQualifierCode": "27" }, { "additionalInformation": [ { "description": "Specialist" } ], "code": "I", "inPlanNetworkIndicator": "No", "inPlanNetworkIndicatorCode": "N", "name": "Non-Covered", "planCoverage": "Gold Plan", "serviceTypeCodes": [ "98" ], "serviceTypes": [ "Professional (Physician) Visit - Office" ] }, { "additionalInformation": [ { "description": "Prior authorization may be required. 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