POST
/
insurance-discovery
/
check
/
v1
curl --request POST \
  --url https://healthcare.us.stedi.com/2024-04-01/insurance-discovery/check/v1 \
  --header 'Authorization: <api-key>' \
  --header 'Content-Type: application/json' \
  --data '{
  "provider": {
    "npi": "1999999984"
  },
  "subscriber": {
    "firstName": "John",
    "lastName": "Smith",
    "middleName": "Robert",
    "dateOfBirth": "19800101",
    "ssn": "123456789",
    "gender": "M",
    "address": {
      "address1": "123 Main St",
      "city": "Springfield",
      "state": "IL",
      "postalCode": "62701"
    }
  },
  "encounter": {
    "beginningDateOfService": "20240326",
    "endDateOfService": "20240326"
  }
}'
{
  "discoveryId": "12345678-abcd-4321-efgh-987654321abc",
  "items": [
    {
      "provider": {
        "providerName": "provider",
        "entityType": "Non-Person Entity",
        "npi": "1999999984"
      },
      "subscriber": {
        "memberId": "987654321000",
        "firstName": "John",
        "lastName": "Doe",
        "middleName": "Smith",
        "gender": "M",
        "dateOfBirth": "19900115",
        "groupNumber": "123456-78",
        "planNumber": "123456-EXMPL9876",
        "groupDescription": "Individual On-Exchange",
        "address": {
          "address1": "123 Main Street",
          "city": "ANYTOWN",
          "state": "CA",
          "postalCode": "12345"
        }
      },
      "payer": {
        "name": "EXAMPLE INSURANCE CO"
      },
      "planInformation": {
        "planNumber": "123456-EXMPL9876",
        "groupNumber": "123456-78",
        "groupDescription": "Individual On-Exchange"
      },
      "planDateInformation": {
        "planBegin": "20250101",
        "eligibilityBegin": "20250101",
        "service": "20250301"
      },
      "benefitsInformation": [
        {
          "inPlanNetworkIndicatorCode": "W",
          "benefitsRelatedEntities": [
            {
              "entityIdentifier": "Primary Care Provider",
              "entityIdentification": "XX",
              "entityName": "Dough",
              "entityIdentificationValue": "1234567890",
              "entityFirstname": "Jane",
              "entityType": "Person"
            }
          ],
          "additionalInformation": [
            {
              "description": "To determine if a prior authorization is required, please check the health plan's website."
            }
          ],
          "serviceTypeCodes": [
            "30"
          ],
          "serviceTypes": [
            "Health Benefit Plan Coverage"
          ],
          "inPlanNetworkIndicator": "Not Applicable",
          "name": "Active Coverage",
          "code": "1",
          "planCoverage": "Gold Plan"
        },
        {
          "serviceTypes": [
            "Medical Care"
          ],
          "name": "Active Coverage",
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicatorCode": "W",
          "serviceTypeCodes": [
            "1"
          ],
          "inPlanNetworkIndicator": "Not Applicable",
          "code": "1"
        },
        {
          "additionalInformation": [
            {
              "description": "Prior authorization may be required. Covered No Limit."
            }
          ],
          "inPlanNetworkIndicatorCode": "Y",
          "code": "1",
          "name": "Active Coverage",
          "serviceTypeCodes": [
            "4"
          ],
          "serviceTypes": [
            "Diagnostic X-Ray"
          ],
          "inPlanNetworkIndicator": "Yes",
          "planCoverage": "Gold Plan"
        },
        {
          "inPlanNetworkIndicator": "Yes",
          "code": "A",
          "serviceTypeCodes": [
            "4"
          ],
          "name": "Co-Insurance",
          "coverageLevel": "Family",
          "serviceTypes": [
            "Diagnostic X-Ray"
          ],
          "inPlanNetworkIndicatorCode": "Y",
          "benefitPercent": "0.5",
          "planCoverage": "Gold Plan",
          "timeQualifierCode": "27",
          "timeQualifier": "Visit",
          "coverageLevelCode": "FAM"
        },
        {
          "name": "Non-Covered",
          "serviceTypeCodes": [
            "4"
          ],
          "serviceTypes": [
            "Diagnostic X-Ray"
          ],
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No",
          "code": "I"
        },
        {
          "code": "1",
          "planCoverage": "Gold Plan",
          "serviceTypes": [
            "Diagnostic Lab"
          ],
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "name": "Active Coverage",
          "serviceTypeCodes": [
            "5"
          ]
        },
        {
          "code": "B",
          "name": "Co-Payment",
          "inPlanNetworkIndicator": "Yes",
          "planCoverage": "Gold Plan",
          "coverageLevelCode": "FAM",
          "benefitAmount": "20",
          "coverageLevel": "Family",
          "serviceTypeCodes": [
            "5"
          ],
          "serviceTypes": [
            "Diagnostic Lab"
          ],
          "timeQualifier": "Visit",
          "timeQualifierCode": "27",
          "inPlanNetworkIndicatorCode": "Y",
          "additionalInformation": [
            {
              "description": "per visit"
            }
          ]
        },
        {
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No",
          "serviceTypeCodes": [
            "5"
          ],
          "name": "Non-Covered",
          "code": "I",
          "planCoverage": "Gold Plan",
          "serviceTypes": [
            "Diagnostic Lab"
          ]
        },
        {
          "serviceTypeCodes": [
            "12"
          ],
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicator": "Yes",
          "serviceTypes": [
            "Durable Medical Equipment Purchase"
          ],
          "name": "Active Coverage",
          "inPlanNetworkIndicatorCode": "Y",
          "additionalInformation": [
            {
              "description": "Prior authorization may be required. Covered No Limit."
            }
          ],
          "code": "1"
        },
        {
          "serviceTypes": [
            "Durable Medical Equipment Purchase"
          ],
          "benefitPercent": "0.5",
          "inPlanNetworkIndicator": "Yes",
          "timeQualifierCode": "27",
          "coverageLevelCode": "FAM",
          "coverageLevel": "Family",
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicatorCode": "Y",
          "code": "A",
          "timeQualifier": "Visit",
          "name": "Co-Insurance",
          "serviceTypeCodes": [
            "12"
          ]
        },
        {
          "name": "Non-Covered",
          "serviceTypes": [
            "Durable Medical Equipment Purchase"
          ],
          "inPlanNetworkIndicatorCode": "N",
          "code": "I",
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicator": "No",
          "serviceTypeCodes": [
            "12"
          ]
        },
        {
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicator": "Yes",
          "serviceTypes": [
            "Ambulatory Service Center Facility"
          ],
          "code": "1",
          "inPlanNetworkIndicatorCode": "Y",
          "name": "Active Coverage",
          "serviceTypeCodes": [
            "13"
          ]
        },
        {
          "coverageLevel": "Family",
          "inPlanNetworkIndicator": "Yes",
          "benefitPercent": "0.5",
          "timeQualifier": "Visit",
          "serviceTypes": [
            "Ambulatory Service Center Facility"
          ],
          "code": "A",
          "coverageLevelCode": "FAM",
          "planCoverage": "Gold Plan",
          "serviceTypeCodes": [
            "13"
          ],
          "timeQualifierCode": "27",
          "name": "Co-Insurance",
          "inPlanNetworkIndicatorCode": "Y"
        },
        {
          "inPlanNetworkIndicator": "No",
          "code": "I",
          "name": "Non-Covered",
          "serviceTypeCodes": [
            "13"
          ],
          "serviceTypes": [
            "Ambulatory Service Center Facility"
          ],
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicatorCode": "N"
        },
        {
          "additionalInformation": [
            {
              "description": "Prior authorization may be required. Covered No Limit."
            }
          ],
          "inPlanNetworkIndicatorCode": "Y",
          "serviceTypeCodes": [
            "18"
          ],
          "name": "Active Coverage",
          "inPlanNetworkIndicator": "Yes",
          "code": "1",
          "planCoverage": "Gold Plan",
          "serviceTypes": [
            "Durable Medical Equipment Rental"
          ]
        },
        {
          "serviceTypes": [
            "Durable Medical Equipment Rental"
          ],
          "serviceTypeCodes": [
            "18"
          ],
          "planCoverage": "Gold Plan",
          "timeQualifier": "Visit",
          "name": "Co-Insurance",
          "coverageLevel": "Family",
          "inPlanNetworkIndicatorCode": "Y",
          "code": "A",
          "inPlanNetworkIndicator": "Yes",
          "benefitPercent": "0.5",
          "timeQualifierCode": "27",
          "coverageLevelCode": "FAM"
        },
        {
          "serviceTypeCodes": [
            "18"
          ],
          "serviceTypes": [
            "Durable Medical Equipment Rental"
          ],
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No",
          "code": "I",
          "name": "Non-Covered"
        },
        {
          "serviceTypeCodes": [
            "33"
          ],
          "serviceTypes": [
            "Chiropractic"
          ],
          "planCoverage": "Gold Plan",
          "additionalInformation": [
            {
              "description": "Limited to 26 visits per year (visits in excess of 26 require prior authorization)."
            }
          ],
          "inPlanNetworkIndicatorCode": "Y",
          "name": "Active Coverage",
          "inPlanNetworkIndicator": "Yes",
          "code": "1"
        },
        {
          "coverageLevel": "Family",
          "planCoverage": "Gold Plan",
          "timeQualifierCode": "27",
          "benefitPercent": "0.5",
          "inPlanNetworkIndicator": "Yes",
          "code": "A",
          "name": "Co-Insurance",
          "serviceTypes": [
            "Chiropractic"
          ],
          "serviceTypeCodes": [
            "33"
          ],
          "timeQualifier": "Visit",
          "inPlanNetworkIndicatorCode": "Y",
          "coverageLevelCode": "FAM"
        },
        {
          "planCoverage": "Gold Plan",
          "serviceTypes": [
            "Chiropractic"
          ],
          "inPlanNetworkIndicator": "No",
          "inPlanNetworkIndicatorCode": "N",
          "name": "Non-Covered",
          "code": "I",
          "serviceTypeCodes": [
            "33"
          ]
        },
        {
          "code": "1",
          "name": "Active Coverage",
          "serviceTypeCodes": [
            "48"
          ],
          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "Prior authorization may be required. Covered No Limit."
            }
          ],
          "serviceTypes": [
            "Hospital - Inpatient"
          ],
          "inPlanNetworkIndicatorCode": "Y",
          "planCoverage": "Gold Plan"
        },
        {
          "code": "A",
          "coverageLevel": "Family",
          "benefitPercent": "0.5",
          "timeQualifierCode": "27",
          "name": "Co-Insurance",
          "inPlanNetworkIndicator": "Yes",
          "coverageLevelCode": "FAM",
          "timeQualifier": "Visit",
          "inPlanNetworkIndicatorCode": "Y",
          "serviceTypes": [
            "Hospital - Inpatient"
          ],
          "planCoverage": "Gold Plan",
          "serviceTypeCodes": [
            "48"
          ]
        },
        {
          "serviceTypeCodes": [
            "48"
          ],
          "serviceTypes": [
            "Hospital - Inpatient"
          ],
          "code": "I",
          "name": "Non-Covered",
          "inPlanNetworkIndicatorCode": "N",
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicator": "No"
        },
        {
          "serviceTypes": [
            "Hospital - Outpatient"
          ],
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "Prior authorization may be required. Covered No Limit."
            }
          ],
          "code": "1",
          "planCoverage": "Gold Plan",
          "name": "Active Coverage",
          "serviceTypeCodes": [
            "50"
          ]
        },
        {
          "timeQualifier": "Visit",
          "coverageLevelCode": "FAM",
          "code": "A",
          "inPlanNetworkIndicatorCode": "Y",
          "name": "Co-Insurance",
          "serviceTypeCodes": [
            "50"
          ],
          "coverageLevel": "Family",
          "planCoverage": "Gold Plan",
          "benefitPercent": "0.5",
          "serviceTypes": [
            "Hospital - Outpatient"
          ],
          "inPlanNetworkIndicator": "Yes",
          "timeQualifierCode": "27"
        },
        {
          "serviceTypeCodes": [
            "50"
          ],
          "serviceTypes": [
            "Hospital - Outpatient"
          ],
          "planCoverage": "Gold Plan",
          "code": "I",
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No",
          "name": "Non-Covered"
        },
        {
          "inPlanNetworkIndicatorCode": "Y",
          "planCoverage": "Gold Plan",
          "serviceTypeCodes": [
            "51"
          ],
          "serviceTypes": [
            "Hospital - Emergency Accident"
          ],
          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "Covered No Limit."
            }
          ],
          "code": "1",
          "name": "Active Coverage"
        },
        {
          "timeQualifierCode": "27",
          "coverageLevel": "Family",
          "planCoverage": "Gold Plan",
          "name": "Co-Insurance",
          "serviceTypeCodes": [
            "51"
          ],
          "timeQualifier": "Visit",
          "serviceTypes": [
            "Hospital - Emergency Accident"
          ],
          "benefitPercent": "0.5",
          "code": "A",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "coverageLevelCode": "FAM"
        },
        {
          "planCoverage": "Gold Plan",
          "serviceTypes": [
            "Hospital - Emergency Accident"
          ],
          "code": "1",
          "additionalInformation": [
            {
              "description": "Covered No Limit."
            }
          ],
          "name": "Active Coverage",
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No",
          "serviceTypeCodes": [
            "51"
          ]
        },
        {
          "coverageLevel": "Family",
          "code": "A",
          "benefitPercent": "0.5",
          "serviceTypeCodes": [
            "51"
          ],
          "planCoverage": "Gold Plan",
          "timeQualifierCode": "27",
          "name": "Co-Insurance",
          "serviceTypes": [
            "Hospital - Emergency Accident"
          ],
          "coverageLevelCode": "FAM",
          "inPlanNetworkIndicator": "No",
          "timeQualifier": "Visit",
          "inPlanNetworkIndicatorCode": "N"
        },
        {
          "planCoverage": "Gold Plan",
          "name": "Active Coverage",
          "code": "1",
          "additionalInformation": [
            {
              "description": "Covered No Limit."
            }
          ],
          "serviceTypes": [
            "Hospital - Emergency Medical"
          ],
          "inPlanNetworkIndicatorCode": "Y",
          "serviceTypeCodes": [
            "52"
          ],
          "inPlanNetworkIndicator": "Yes"
        },
        {
          "inPlanNetworkIndicatorCode": "Y",
          "timeQualifier": "Visit",
          "benefitPercent": "0.5",
          "serviceTypes": [
            "Hospital - Emergency Medical"
          ],
          "code": "A",
          "serviceTypeCodes": [
            "52"
          ],
          "coverageLevelCode": "FAM",
          "planCoverage": "Gold Plan",
          "name": "Co-Insurance",
          "timeQualifierCode": "27",
          "coverageLevel": "Family",
          "inPlanNetworkIndicator": "Yes"
        },
        {
          "serviceTypes": [
            "Hospital - Emergency Medical"
          ],
          "serviceTypeCodes": [
            "52"
          ],
          "name": "Active Coverage",
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicator": "No",
          "additionalInformation": [
            {
              "description": "Covered No Limit."
            }
          ],
          "inPlanNetworkIndicatorCode": "N",
          "code": "1"
        },
        {
          "timeQualifierCode": "27",
          "timeQualifier": "Visit",
          "name": "Co-Insurance",
          "inPlanNetworkIndicator": "No",
          "inPlanNetworkIndicatorCode": "N",
          "coverageLevel": "Family",
          "coverageLevelCode": "FAM",
          "serviceTypeCodes": [
            "52"
          ],
          "serviceTypes": [
            "Hospital - Emergency Medical"
          ],
          "code": "A",
          "planCoverage": "Gold Plan",
          "benefitPercent": "0.5"
        },
        {
          "inPlanNetworkIndicator": "Yes",
          "name": "Active Coverage",
          "inPlanNetworkIndicatorCode": "Y",
          "planCoverage": "Gold Plan",
          "serviceTypeCodes": [
            "53"
          ],
          "code": "1",
          "serviceTypes": [
            "Hospital - Ambulatory Surgical"
          ]
        },
        {
          "timeQualifier": "Visit",
          "planCoverage": "Gold Plan",
          "serviceTypeCodes": [
            "53"
          ],
          "coverageLevelCode": "FAM",
          "benefitPercent": "0.5",
          "timeQualifierCode": "27",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "coverageLevel": "Family",
          "serviceTypes": [
            "Hospital - Ambulatory Surgical"
          ],
          "code": "A",
          "name": "Co-Insurance"
        },
        {
          "name": "Non-Covered",
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicator": "No",
          "inPlanNetworkIndicatorCode": "N",
          "serviceTypeCodes": [
            "53"
          ],
          "code": "I",
          "serviceTypes": [
            "Hospital - Ambulatory Surgical"
          ]
        },
        {
          "serviceTypeCodes": [
            "62"
          ],
          "name": "Active Coverage",
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicator": "Yes",
          "serviceTypes": [
            "MRI/CAT Scan"
          ],
          "inPlanNetworkIndicatorCode": "Y",
          "additionalInformation": [
            {
              "description": "Prior authorization may be required. Covered No Limit."
            }
          ],
          "code": "1"
        },
        {
          "timeQualifierCode": "27",
          "code": "A",
          "name": "Co-Insurance",
          "coverageLevelCode": "FAM",
          "coverageLevel": "Family",
          "planCoverage": "Gold Plan",
          "serviceTypes": [
            "MRI/CAT Scan"
          ],
          "serviceTypeCodes": [
            "62"
          ],
          "benefitPercent": "0.5",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "timeQualifier": "Visit"
        },
        {
          "serviceTypes": [
            "MRI/CAT Scan"
          ],
          "serviceTypeCodes": [
            "62"
          ],
          "code": "I",
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No",
          "name": "Non-Covered"
        },
        {
          "planCoverage": "Gold Plan",
          "name": "Active Coverage",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "code": "1",
          "serviceTypeCodes": [
            "65"
          ],
          "serviceTypes": [
            "Newborn Care"
          ],
          "additionalInformation": [
            {
              "description": "Prior authorization may be required. Covered No Limit."
            }
          ]
        },
        {
          "planCoverage": "Gold Plan",
          "serviceTypeCodes": [
            "65"
          ],
          "benefitPercent": "0.5",
          "timeQualifier": "Visit",
          "inPlanNetworkIndicatorCode": "Y",
          "coverageLevelCode": "FAM",
          "serviceTypes": [
            "Newborn Care"
          ],
          "coverageLevel": "Family",
          "code": "A",
          "inPlanNetworkIndicator": "Yes",
          "timeQualifierCode": "27",
          "name": "Co-Insurance"
        },
        {
          "name": "Non-Covered",
          "code": "I",
          "planCoverage": "Gold Plan",
          "serviceTypeCodes": [
            "65"
          ],
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No",
          "serviceTypes": [
            "Newborn Care"
          ]
        },
        {
          "planCoverage": "Gold Plan",
          "code": "1",
          "serviceTypes": [
            "Well Baby Care"
          ],
          "name": "Active Coverage",
          "inPlanNetworkIndicatorCode": "Y",
          "additionalInformation": [
            {
              "description": "Covered in accordance with ACA guidelines."
            }
          ],
          "inPlanNetworkIndicator": "Yes",
          "serviceTypeCodes": [
            "68"
          ]
        },
        {
          "code": "B",
          "serviceTypes": [
            "Well Baby Care"
          ],
          "benefitAmount": "0",
          "coverageLevel": "Family",
          "coverageLevelCode": "FAM",
          "timeQualifierCode": "27",
          "inPlanNetworkIndicatorCode": "Y",
          "serviceTypeCodes": [
            "68"
          ],
          "inPlanNetworkIndicator": "Yes",
          "planCoverage": "Gold Plan",
          "timeQualifier": "Visit",
          "name": "Co-Payment"
        },
        {
          "serviceTypeCodes": [
            "68"
          ],
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No",
          "name": "Non-Covered",
          "code": "I",
          "serviceTypes": [
            "Well Baby Care"
          ],
          "planCoverage": "Gold Plan"
        },
        {
          "serviceTypeCodes": [
            "69"
          ],
          "additionalInformation": [
            {
              "description": "Prior authorization may be required. Covered No Limit."
            }
          ],
          "inPlanNetworkIndicatorCode": "Y",
          "name": "Active Coverage",
          "code": "1",
          "serviceTypes": [
            "Maternity"
          ],
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicator": "Yes"
        },
        {
          "serviceTypeCodes": [
            "69"
          ],
          "benefitPercent": "0.5",
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicatorCode": "Y",
          "code": "A",
          "inPlanNetworkIndicator": "Yes",
          "coverageLevelCode": "FAM",
          "serviceTypes": [
            "Maternity"
          ],
          "timeQualifier": "Visit",
          "coverageLevel": "Family",
          "name": "Co-Insurance",
          "timeQualifierCode": "27"
        },
        {
          "serviceTypeCodes": [
            "69"
          ],
          "inPlanNetworkIndicatorCode": "N",
          "code": "I",
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicator": "No",
          "name": "Non-Covered",
          "serviceTypes": [
            "Maternity"
          ]
        },
        {
          "code": "1",
          "additionalInformation": [
            {
              "description": "Covered No Limit."
            }
          ],
          "inPlanNetworkIndicator": "Yes",
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicatorCode": "Y",
          "serviceTypeCodes": [
            "86"
          ],
          "name": "Active Coverage",
          "serviceTypes": [
            "Emergency Services"
          ]
        },
        {
          "benefitPercent": "0.5",
          "code": "A",
          "inPlanNetworkIndicatorCode": "Y",
          "serviceTypeCodes": [
            "86"
          ],
          "coverageLevel": "Family",
          "timeQualifierCode": "27",
          "serviceTypes": [
            "Emergency Services"
          ],
          "name": "Co-Insurance",
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicator": "Yes",
          "coverageLevelCode": "FAM",
          "timeQualifier": "Visit"
        },
        {
          "inPlanNetworkIndicator": "No",
          "code": "1",
          "name": "Active Coverage",
          "additionalInformation": [
            {
              "description": "Covered No Limit."
            }
          ],
          "planCoverage": "Gold Plan",
          "serviceTypeCodes": [
            "86"
          ],
          "inPlanNetworkIndicatorCode": "N",
          "serviceTypes": [
            "Emergency Services"
          ]
        },
        {
          "coverageLevelCode": "FAM",
          "coverageLevel": "Family",
          "code": "A",
          "serviceTypeCodes": [
            "86"
          ],
          "serviceTypes": [
            "Emergency Services"
          ],
          "timeQualifier": "Visit",
          "benefitPercent": "0.5",
          "inPlanNetworkIndicatorCode": "N",
          "timeQualifierCode": "27",
          "inPlanNetworkIndicator": "No",
          "name": "Co-Insurance",
          "planCoverage": "Gold Plan"
        },
        {
          "inPlanNetworkIndicatorCode": "Y",
          "name": "Active Coverage",
          "serviceTypes": [
            "Pharmacy"
          ],
          "inPlanNetworkIndicator": "Yes",
          "serviceTypeCodes": [
            "88"
          ],
          "code": "1",
          "planCoverage": "Gold Plan"
        },
        {
          "serviceTypeCodes": [
            "88"
          ],
          "coverageLevel": "Family",
          "name": "Co-Payment",
          "serviceTypes": [
            "Pharmacy"
          ],
          "planCoverage": "Gold Plan",
          "timeQualifier": "Visit",
          "timeQualifierCode": "27",
          "code": "B",
          "benefitAmount": "10",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "coverageLevelCode": "FAM",
          "additionalInformation": [
            {
              "description": "per prescription"
            }
          ]
        },
        {
          "inPlanNetworkIndicatorCode": "N",
          "name": "Non-Covered",
          "serviceTypeCodes": [
            "88"
          ],
          "inPlanNetworkIndicator": "No",
          "code": "I",
          "serviceTypes": [
            "Pharmacy"
          ],
          "planCoverage": "Gold Plan"
        },
        {
          "serviceTypes": [
            "Professional (Physician) Visit - Office"
          ],
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "code": "1",
          "serviceTypeCodes": [
            "98"
          ],
          "additionalInformation": [
            {
              "description": "PCP"
            }
          ],
          "name": "Active Coverage"
        },
        {
          "additionalInformation": [
            {
              "description": "per visit"
            },
            {
              "description": "PCP"
            }
          ],
          "inPlanNetworkIndicator": "Yes",
          "coverageLevel": "Family",
          "inPlanNetworkIndicatorCode": "Y",
          "coverageLevelCode": "FAM",
          "timeQualifierCode": "27",
          "serviceTypeCodes": [
            "98"
          ],
          "benefitAmount": "15",
          "serviceTypes": [
            "Professional (Physician) Visit - Office"
          ],
          "timeQualifier": "Visit",
          "name": "Co-Payment",
          "planCoverage": "Gold Plan",
          "code": "B"
        },
        {
          "code": "I",
          "serviceTypeCodes": [
            "98"
          ],
          "planCoverage": "Gold Plan",
          "name": "Non-Covered",
          "inPlanNetworkIndicatorCode": "N",
          "serviceTypes": [
            "Professional (Physician) Visit - Office"
          ],
          "inPlanNetworkIndicator": "No",
          "additionalInformation": [
            {
              "description": "PCP"
            }
          ]
        },
        {
          "inPlanNetworkIndicatorCode": "Y",
          "name": "Active Coverage",
          "planCoverage": "Gold Plan",
          "additionalInformation": [
            {
              "description": "Specialist"
            },
            {
              "description": "Covered No Limit."
            }
          ],
          "code": "1",
          "serviceTypes": [
            "Professional (Physician) Visit - Office"
          ],
          "inPlanNetworkIndicator": "Yes",
          "serviceTypeCodes": [
            "98"
          ]
        },
        {
          "planCoverage": "Gold Plan",
          "timeQualifier": "Visit",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "per visit"
            },
            {
              "description": "Specialist"
            }
          ],
          "benefitAmount": "30",
          "coverageLevel": "Family",
          "code": "B",
          "serviceTypes": [
            "Professional (Physician) Visit - Office"
          ],
          "timeQualifierCode": "27",
          "coverageLevelCode": "FAM",
          "name": "Co-Payment",
          "serviceTypeCodes": [
            "98"
          ]
        },
        {
          "additionalInformation": [
            {
              "description": "Specialist"
            }
          ],
          "serviceTypes": [
            "Professional (Physician) Visit - Office"
          ],
          "inPlanNetworkIndicator": "No",
          "serviceTypeCodes": [
            "98"
          ],
          "planCoverage": "Gold Plan",
          "code": "I",
          "name": "Non-Covered",
          "inPlanNetworkIndicatorCode": "N"
        },
        {
          "name": "Active Coverage",
          "inPlanNetworkIndicator": "Yes",
          "serviceTypeCodes": [
            "A4"
          ],
          "planCoverage": "Gold Plan",
          "code": "1",
          "serviceTypes": [
            "Psychiatric"
          ],
          "inPlanNetworkIndicatorCode": "Y",
          "additionalInformation": [
            {
              "description": "Prior authorization may be required. Covered No Limit. (Primary Care Provider (PCP) and other practitioner office visits do not require prior authorization.) Note| Services (excluding Emergency Room Care / Emergency Services) rendered by an out-of-network provider"
            }
          ]
        },
        {
          "coverageLevelCode": "FAM",
          "inPlanNetworkIndicator": "Yes",
          "coverageLevel": "Family",
          "serviceTypes": [
            "Psychiatric"
          ],
          "timeQualifierCode": "27",
          "name": "Co-Insurance",
          "serviceTypeCodes": [
            "A4"
          ],
          "benefitPercent": "0.5",
          "inPlanNetworkIndicatorCode": "Y",
          "planCoverage": "Gold Plan",
          "timeQualifier": "Visit",
          "code": "A"
        },
        {
          "serviceTypeCodes": [
            "A4"
          ],
          "name": "Non-Covered",
          "serviceTypes": [
            "Psychiatric"
          ],
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicatorCode": "N",
          "code": "I",
          "inPlanNetworkIndicator": "No"
        },
        {
          "name": "Active Coverage",
          "code": "1",
          "planCoverage": "Gold Plan",
          "serviceTypeCodes": [
            "A6"
          ],
          "serviceTypes": [
            "Psychotherapy"
          ],
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes"
        },
        {
          "timeQualifierCode": "27",
          "inPlanNetworkIndicatorCode": "Y",
          "benefitPercent": "0.5",
          "planCoverage": "Gold Plan",
          "timeQualifier": "Visit",
          "name": "Co-Insurance",
          "coverageLevelCode": "FAM",
          "serviceTypeCodes": [
            "A6"
          ],
          "serviceTypes": [
            "Psychotherapy"
          ],
          "inPlanNetworkIndicator": "Yes",
          "coverageLevel": "Family",
          "code": "A"
        },
        {
          "inPlanNetworkIndicator": "No",
          "inPlanNetworkIndicatorCode": "N",
          "code": "I",
          "planCoverage": "Gold Plan",
          "name": "Non-Covered",
          "serviceTypeCodes": [
            "A6"
          ],
          "serviceTypes": [
            "Psychotherapy"
          ]
        },
        {
          "planCoverage": "Gold Plan",
          "code": "1",
          "serviceTypes": [
            "Psychiatric - Inpatient"
          ],
          "inPlanNetworkIndicatorCode": "Y",
          "serviceTypeCodes": [
            "A7"
          ],
          "inPlanNetworkIndicator": "Yes",
          "name": "Active Coverage"
        },
        {
          "timeQualifier": "Visit",
          "coverageLevelCode": "FAM",
          "coverageLevel": "Family",
          "inPlanNetworkIndicator": "Yes",
          "inPlanNetworkIndicatorCode": "Y",
          "planCoverage": "Gold Plan",
          "serviceTypeCodes": [
            "A7"
          ],
          "timeQualifierCode": "27",
          "name": "Co-Insurance",
          "code": "A",
          "serviceTypes": [
            "Psychiatric - Inpatient"
          ],
          "benefitPercent": "0.5"
        },
        {
          "code": "I",
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicator": "No",
          "serviceTypeCodes": [
            "A7"
          ],
          "serviceTypes": [
            "Psychiatric - Inpatient"
          ],
          "name": "Non-Covered",
          "inPlanNetworkIndicatorCode": "N"
        },
        {
          "code": "1",
          "serviceTypes": [
            "Psychiatric - Outpatient"
          ],
          "planCoverage": "Gold Plan",
          "serviceTypeCodes": [
            "A8"
          ],
          "inPlanNetworkIndicator": "Yes",
          "name": "Active Coverage",
          "inPlanNetworkIndicatorCode": "Y"
        },
        {
          "timeQualifierCode": "27",
          "timeQualifier": "Visit",
          "inPlanNetworkIndicatorCode": "Y",
          "coverageLevel": "Family",
          "coverageLevelCode": "FAM",
          "serviceTypeCodes": [
            "A8"
          ],
          "benefitPercent": "0.5",
          "name": "Co-Insurance",
          "planCoverage": "Gold Plan",
          "code": "A",
          "inPlanNetworkIndicator": "Yes",
          "serviceTypes": [
            "Psychiatric - Outpatient"
          ]
        },
        {
          "serviceTypes": [
            "Psychiatric - Outpatient"
          ],
          "inPlanNetworkIndicator": "No",
          "name": "Non-Covered",
          "serviceTypeCodes": [
            "A8"
          ],
          "code": "I",
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicatorCode": "N"
        },
        {
          "inPlanNetworkIndicatorCode": "Y",
          "name": "Active Coverage",
          "serviceTypeCodes": [
            "AD"
          ],
          "serviceTypes": [
            "Occupational Therapy"
          ],
          "inPlanNetworkIndicator": "Yes",
          "planCoverage": "Gold Plan",
          "code": "1"
        },
        {
          "inPlanNetworkIndicator": "Yes",
          "serviceTypeCodes": [
            "AD"
          ],
          "planCoverage": "Gold Plan",
          "coverageLevel": "Family",
          "timeQualifierCode": "27",
          "serviceTypes": [
            "Occupational Therapy"
          ],
          "code": "A",
          "timeQualifier": "Visit",
          "coverageLevelCode": "FAM",
          "inPlanNetworkIndicatorCode": "Y",
          "benefitPercent": "0.5",
          "name": "Co-Insurance"
        },
        {
          "code": "I",
          "serviceTypeCodes": [
            "AD"
          ],
          "serviceTypes": [
            "Occupational Therapy"
          ],
          "name": "Non-Covered",
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No"
        },
        {
          "code": "1",
          "inPlanNetworkIndicator": "Yes",
          "serviceTypes": [
            "Speech Therapy"
          ],
          "serviceTypeCodes": [
            "AF"
          ],
          "planCoverage": "Gold Plan",
          "name": "Active Coverage",
          "inPlanNetworkIndicatorCode": "Y"
        },
        {
          "benefitPercent": "0.5",
          "inPlanNetworkIndicator": "Yes",
          "timeQualifierCode": "27",
          "coverageLevel": "Family",
          "serviceTypeCodes": [
            "AF"
          ],
          "coverageLevelCode": "FAM",
          "serviceTypes": [
            "Speech Therapy"
          ],
          "code": "A",
          "planCoverage": "Gold Plan",
          "name": "Co-Insurance",
          "timeQualifier": "Visit",
          "inPlanNetworkIndicatorCode": "Y"
        },
        {
          "planCoverage": "Gold Plan",
          "name": "Non-Covered",
          "code": "I",
          "serviceTypeCodes": [
            "AF"
          ],
          "serviceTypes": [
            "Speech Therapy"
          ],
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No"
        },
        {
          "serviceTypeCodes": [
            "AG"
          ],
          "additionalInformation": [
            {
              "description": "Prior authorization may be required. Limited to 150 days per year."
            }
          ],
          "inPlanNetworkIndicator": "Yes",
          "planCoverage": "Gold Plan",
          "code": "1",
          "name": "Active Coverage",
          "serviceTypes": [
            "Skilled Nursing Care"
          ],
          "inPlanNetworkIndicatorCode": "Y"
        },
        {
          "serviceTypeCodes": [
            "AG"
          ],
          "serviceTypes": [
            "Skilled Nursing Care"
          ],
          "planCoverage": "Gold Plan",
          "name": "Co-Insurance",
          "coverageLevelCode": "FAM",
          "code": "A",
          "coverageLevel": "Family",
          "benefitPercent": "0.5",
          "inPlanNetworkIndicator": "Yes",
          "timeQualifierCode": "27",
          "inPlanNetworkIndicatorCode": "Y",
          "timeQualifier": "Visit"
        },
        {
          "inPlanNetworkIndicatorCode": "N",
          "planCoverage": "Gold Plan",
          "serviceTypeCodes": [
            "AG"
          ],
          "serviceTypes": [
            "Skilled Nursing Care"
          ],
          "inPlanNetworkIndicator": "No",
          "name": "Non-Covered",
          "code": "I"
        },
        {
          "name": "Active Coverage",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "serviceTypes": [
            "Physician Visit - Office: Well"
          ],
          "serviceTypeCodes": [
            "BZ"
          ],
          "planCoverage": "Gold Plan",
          "additionalInformation": [
            {
              "description": "Covered in accordance with ACA guidelines."
            }
          ],
          "code": "1"
        },
        {
          "coverageLevelCode": "FAM",
          "inPlanNetworkIndicatorCode": "Y",
          "serviceTypeCodes": [
            "BZ"
          ],
          "inPlanNetworkIndicator": "Yes",
          "name": "Co-Payment",
          "coverageLevel": "Family",
          "timeQualifierCode": "27",
          "code": "B",
          "serviceTypes": [
            "Physician Visit - Office: Well"
          ],
          "planCoverage": "Gold Plan",
          "timeQualifier": "Visit",
          "benefitAmount": "0"
        },
        {
          "serviceTypes": [
            "Physician Visit - Office: Well"
          ],
          "code": "I",
          "serviceTypeCodes": [
            "BZ"
          ],
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicatorCode": "N",
          "name": "Non-Covered",
          "inPlanNetworkIndicator": "No"
        },
        {
          "code": "1",
          "inPlanNetworkIndicatorCode": "Y",
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicator": "Yes",
          "name": "Active Coverage",
          "serviceTypes": [
            "Mental Health"
          ],
          "additionalInformation": [
            {
              "description": "Prior authorization may be required. Covered No Limit."
            }
          ],
          "serviceTypeCodes": [
            "MH"
          ]
        },
        {
          "serviceTypeCodes": [
            "MH"
          ],
          "code": "A",
          "serviceTypes": [
            "Mental Health"
          ],
          "coverageLevel": "Family",
          "coverageLevelCode": "FAM",
          "planCoverage": "Gold Plan",
          "timeQualifier": "Visit",
          "benefitPercent": "0.5",
          "name": "Co-Insurance",
          "inPlanNetworkIndicator": "Yes",
          "inPlanNetworkIndicatorCode": "Y",
          "timeQualifierCode": "27"
        },
        {
          "inPlanNetworkIndicator": "No",
          "planCoverage": "Gold Plan",
          "serviceTypes": [
            "Mental Health"
          ],
          "name": "Non-Covered",
          "code": "I",
          "serviceTypeCodes": [
            "MH"
          ],
          "inPlanNetworkIndicatorCode": "N"
        },
        {
          "code": "1",
          "serviceTypes": [
            "Physical Therapy"
          ],
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "name": "Active Coverage",
          "serviceTypeCodes": [
            "PT"
          ]
        },
        {
          "additionalInformation": [
            {
              "description": "per visit"
            }
          ],
          "name": "Co-Payment",
          "timeQualifierCode": "27",
          "coverageLevel": "Family",
          "planCoverage": "Gold Plan",
          "coverageLevelCode": "FAM",
          "benefitAmount": "15",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "code": "B",
          "serviceTypeCodes": [
            "PT"
          ],
          "serviceTypes": [
            "Physical Therapy"
          ],
          "timeQualifier": "Visit"
        },
        {
          "serviceTypeCodes": [
            "PT"
          ],
          "name": "Non-Covered",
          "serviceTypes": [
            "Physical Therapy"
          ],
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicator": "No",
          "code": "I",
          "inPlanNetworkIndicatorCode": "N"
        },
        {
          "serviceTypeCodes": [
            "UC"
          ],
          "serviceTypes": [
            "Urgent Care"
          ],
          "inPlanNetworkIndicatorCode": "Y",
          "name": "Active Coverage",
          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "Covered No Limit."
            }
          ],
          "code": "1",
          "planCoverage": "Gold Plan"
        },
        {
          "serviceTypes": [
            "Urgent Care"
          ],
          "timeQualifierCode": "27",
          "serviceTypeCodes": [
            "UC"
          ],
          "coverageLevelCode": "FAM",
          "timeQualifier": "Visit",
          "benefitAmount": "10",
          "inPlanNetworkIndicatorCode": "Y",
          "name": "Co-Payment",
          "planCoverage": "Gold Plan",
          "coverageLevel": "Family",
          "additionalInformation": [
            {
              "description": "per visit"
            }
          ],
          "code": "B",
          "inPlanNetworkIndicator": "Yes"
        },
        {
          "name": "Active Coverage",
          "serviceTypeCodes": [
            "UC"
          ],
          "serviceTypes": [
            "Urgent Care"
          ],
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicatorCode": "N",
          "additionalInformation": [
            {
              "description": "Covered No Limit."
            }
          ],
          "inPlanNetworkIndicator": "No",
          "code": "1"
        },
        {
          "benefitAmount": "10",
          "inPlanNetworkIndicator": "No",
          "additionalInformation": [
            {
              "description": "per visit"
            }
          ],
          "code": "B",
          "inPlanNetworkIndicatorCode": "N",
          "timeQualifier": "Visit",
          "serviceTypeCodes": [
            "UC"
          ],
          "coverageLevelCode": "FAM",
          "planCoverage": "Gold Plan",
          "name": "Co-Payment",
          "serviceTypes": [
            "Urgent Care"
          ],
          "coverageLevel": "Family",
          "timeQualifierCode": "27"
        },
        {
          "name": "Deductible",
          "serviceTypeCodes": [
            "30"
          ],
          "timeQualifierCode": "23",
          "timeQualifier": "Calendar Year",
          "benefitAmount": "0",
          "code": "C",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "planCoverage": "Gold Plan",
          "coverageLevel": "Individual",
          "coverageLevelCode": "IND",
          "serviceTypes": [
            "Health Benefit Plan Coverage"
          ]
        },
        {
          "planCoverage": "Gold Plan",
          "serviceTypeCodes": [
            "30"
          ],
          "name": "Deductible",
          "code": "C",
          "timeQualifierCode": "29",
          "serviceTypes": [
            "Health Benefit Plan Coverage"
          ],
          "inPlanNetworkIndicator": "Yes",
          "coverageLevel": "Individual",
          "coverageLevelCode": "IND",
          "timeQualifier": "Remaining",
          "benefitAmount": "0",
          "inPlanNetworkIndicatorCode": "Y"
        },
        {
          "coverageLevelCode": "FAM",
          "name": "Deductible",
          "serviceTypes": [
            "Health Benefit Plan Coverage"
          ],
          "coverageLevel": "Family",
          "inPlanNetworkIndicatorCode": "Y",
          "timeQualifier": "Calendar Year",
          "benefitAmount": "0",
          "serviceTypeCodes": [
            "30"
          ],
          "code": "C",
          "inPlanNetworkIndicator": "Yes",
          "timeQualifierCode": "23",
          "planCoverage": "Gold Plan"
        },
        {
          "inPlanNetworkIndicatorCode": "Y",
          "serviceTypeCodes": [
            "30"
          ],
          "code": "C",
          "name": "Deductible",
          "timeQualifierCode": "29",
          "inPlanNetworkIndicator": "Yes",
          "serviceTypes": [
            "Health Benefit Plan Coverage"
          ],
          "planCoverage": "Gold Plan",
          "coverageLevelCode": "FAM",
          "timeQualifier": "Remaining",
          "coverageLevel": "Family",
          "benefitAmount": "0"
        },
        {
          "serviceTypeCodes": [
            "30"
          ],
          "name": "Deductible",
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicator": "No",
          "coverageLevelCode": "IND",
          "timeQualifierCode": "23",
          "timeQualifier": "Calendar Year",
          "coverageLevel": "Individual",
          "code": "C",
          "serviceTypes": [
            "Health Benefit Plan Coverage"
          ],
          "inPlanNetworkIndicatorCode": "N",
          "benefitAmount": "0"
        },
        {
          "timeQualifierCode": "29",
          "benefitAmount": "0",
          "name": "Deductible",
          "coverageLevel": "Individual",
          "planCoverage": "Gold Plan",
          "code": "C",
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No",
          "timeQualifier": "Remaining",
          "coverageLevelCode": "IND",
          "serviceTypeCodes": [
            "30"
          ],
          "serviceTypes": [
            "Health Benefit Plan Coverage"
          ]
        },
        {
          "benefitAmount": "0",
          "inPlanNetworkIndicatorCode": "N",
          "coverageLevelCode": "FAM",
          "code": "C",
          "serviceTypes": [
            "Health Benefit Plan Coverage"
          ],
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicator": "No",
          "timeQualifierCode": "23",
          "name": "Deductible",
          "serviceTypeCodes": [
            "30"
          ],
          "timeQualifier": "Calendar Year",
          "coverageLevel": "Family"
        },
        {
          "coverageLevel": "Family",
          "serviceTypeCodes": [
            "30"
          ],
          "timeQualifierCode": "29",
          "benefitAmount": "0",
          "inPlanNetworkIndicatorCode": "N",
          "serviceTypes": [
            "Health Benefit Plan Coverage"
          ],
          "name": "Deductible",
          "inPlanNetworkIndicator": "No",
          "coverageLevelCode": "FAM",
          "timeQualifier": "Remaining",
          "planCoverage": "Gold Plan",
          "code": "C"
        },
        {
          "coverageLevel": "Individual",
          "inPlanNetworkIndicator": "Yes",
          "benefitAmount": "3000",
          "name": "Out of Pocket (Stop Loss)",
          "serviceTypeCodes": [
            "30"
          ],
          "planCoverage": "Gold Plan",
          "timeQualifier": "Calendar Year",
          "code": "G",
          "timeQualifierCode": "23",
          "inPlanNetworkIndicatorCode": "Y",
          "serviceTypes": [
            "Health Benefit Plan Coverage"
          ],
          "coverageLevelCode": "IND"
        },
        {
          "code": "G",
          "coverageLevel": "Individual",
          "timeQualifier": "Remaining",
          "planCoverage": "Gold Plan",
          "name": "Out of Pocket (Stop Loss)",
          "timeQualifierCode": "29",
          "coverageLevelCode": "IND",
          "inPlanNetworkIndicator": "Yes",
          "inPlanNetworkIndicatorCode": "Y",
          "serviceTypeCodes": [
            "30"
          ],
          "benefitAmount": "2000",
          "serviceTypes": [
            "Health Benefit Plan Coverage"
          ]
        },
        {
          "serviceTypeCodes": [
            "30"
          ],
          "serviceTypes": [
            "Health Benefit Plan Coverage"
          ],
          "code": "G",
          "name": "Out of Pocket (Stop Loss)",
          "inPlanNetworkIndicatorCode": "Y",
          "timeQualifier": "Calendar Year",
          "timeQualifierCode": "23",
          "benefitAmount": "6000",
          "coverageLevelCode": "FAM",
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicator": "Yes",
          "coverageLevel": "Family"
        },
        {
          "code": "G",
          "coverageLevelCode": "FAM",
          "coverageLevel": "Family",
          "benefitAmount": "5000",
          "timeQualifierCode": "29",
          "inPlanNetworkIndicator": "Yes",
          "serviceTypes": [
            "Health Benefit Plan Coverage"
          ],
          "inPlanNetworkIndicatorCode": "Y",
          "name": "Out of Pocket (Stop Loss)",
          "planCoverage": "Gold Plan",
          "serviceTypeCodes": [
            "30"
          ],
          "timeQualifier": "Remaining"
        },
        {
          "coverageLevelCode": "IND",
          "benefitAmount": "0",
          "serviceTypeCodes": [
            "30"
          ],
          "timeQualifier": "Calendar Year",
          "planCoverage": "Gold Plan",
          "name": "Out of Pocket (Stop Loss)",
          "code": "G",
          "coverageLevel": "Individual",
          "serviceTypes": [
            "Health Benefit Plan Coverage"
          ],
          "timeQualifierCode": "23",
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No"
        },
        {
          "benefitAmount": "0",
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No",
          "code": "G",
          "coverageLevel": "Individual",
          "serviceTypeCodes": [
            "30"
          ],
          "timeQualifierCode": "29",
          "timeQualifier": "Remaining",
          "coverageLevelCode": "IND",
          "name": "Out of Pocket (Stop Loss)",
          "serviceTypes": [
            "Health Benefit Plan Coverage"
          ],
          "planCoverage": "Gold Plan"
        },
        {
          "code": "G",
          "inPlanNetworkIndicator": "No",
          "serviceTypes": [
            "Health Benefit Plan Coverage"
          ],
          "timeQualifierCode": "23",
          "inPlanNetworkIndicatorCode": "N",
          "benefitAmount": "0",
          "timeQualifier": "Calendar Year",
          "coverageLevel": "Family",
          "name": "Out of Pocket (Stop Loss)",
          "serviceTypeCodes": [
            "30"
          ],
          "coverageLevelCode": "FAM",
          "planCoverage": "Gold Plan"
        },
        {
          "benefitAmount": "0",
          "serviceTypes": [
            "Health Benefit Plan Coverage"
          ],
          "planCoverage": "Gold Plan",
          "name": "Out of Pocket (Stop Loss)",
          "inPlanNetworkIndicator": "No",
          "code": "G",
          "inPlanNetworkIndicatorCode": "N",
          "coverageLevel": "Family",
          "serviceTypeCodes": [
            "30"
          ],
          "timeQualifierCode": "29",
          "timeQualifier": "Remaining",
          "coverageLevelCode": "FAM"
        }
      ],
      "confidence": {
        "level": "REVIEW_NEEDED",
        "reason": "This record was identified as a low confidence match due to a DOB partial match"
      }
    }
  ],
  "meta": {
    "applicationMode": "production",
    "traceId": "1-abcdef12-123456789abcdef123456789"
  },
  "status": "COMPLETE"
}

This endpoint submits an insurance discovery check request for a patient. You can use an insurance discovery check to find a patient’s active coverage using only their demographic data.

You may need to perform an insurance discovery check when a patient provides outdated insurance details, doesn’t have their insurance card, or can’t provide insurance details in an urgent care situation. You may also want to use insurance discovery checks to simplify patient onboarding by reducing the amount of information new patients must provide to schedule an appointment.

  1. Call this endpoint with as much patient demographic information as possible to increase the chances of finding matching coverage. You’ll also need to include information like the provider’s NPI and the service date, similar to an eligibility check.
  2. Stedi determines if the patient has active coverage with one or more payers. This process involves demographic lookups to enrich partial patient details, comparisons across third-party data sources to determine member IDs, and submitting real-time eligibility checks to payers to detect coverage.
  3. When the insurance discovery check is complete, Stedi returns an array of potential active coverages along with subscriber details and benefits information.

You should always review the results to ensure the returned subscriber information for each active health plan matches the demographic information for the patient. Once you confirm matching coverage, you can use the benefits information to determine the patient’s eligibility for services. You generally shouldn’t need to perform a follow-up eligibility check since the insurance discovery response includes the same benefits information as a standard eligibility check.

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Limitations

Insurance discovery checks aren’t guaranteed to return a patient’s active health plans 100% of the time - especially when the request doesn’t include key demographic information like the patient’s address or Social Security Number (SSN). You should think of insurance discovery checks as a helpful backup when a patient can’t provide their insurance information, but not as a one-to-one replacement for standard eligibility checks.

In addition, you should be aware of the following limitations:

  • Insurance discovery checks are designed to identify active medical coverage for the patient. A payer may return dental coverage (service type code 35) as part of the results, but you shouldn’t rely on insurance discovery checks to identify dental coverage. There is no way to target dental payers directly, so we don’t recommend insurance discovery checks for dental-specific use cases.
  • The results can only return active coverage for the date of service range provided. For example, if a patient recently switched insurance plans and coverage for the previous plan has ended, the insurance discovery check will only return their new, active plan.

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Enrollment requirements

Before you can perform insurance discovery checks, you must complete transaction enrollment for Payer ID: DISCOVERY.

Medicaid Provider IDs aren’t required for transaction enrollment with Stedi, but they can enhance insurance discovery check results for certain payers. To add Medicaid Provider IDs to transaction enrollment requests, please email enrollments@stedi.com with a CSV file containing the NPI and Medicaid ID(s) for each provider. Learn more about Medicaid Provider IDs.

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Response

This endpoint can take up to 120 seconds to return a response, though it’s often faster.

The response can have one of two status values:

  • COMPLETE - Stedi has completed the insurance discovery search for the patient. If Stedi finds coverage for the patient, the items array will contain the results. If Stedi doesn’t find any coverage for the patient, the items array will be empty.
  • PENDING - Stedi is still processing the insurance discovery search for the patient. You can use the discoveryId in the response to retrieve the results asynchronously.

​
Retrieve results asynchronously

If the synchronous insurance discovery response indicates that the search is still PENDING, you can use the discoveryId to retrieve the complete results asynchronously from the Insurance Discovery Check Results endpoint.

Authorizations

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Authorization
string
header
required

A Stedi API Key for authentication.

Body

application/json

Response

200
application/json

InsuranceDiscoveryCheck 200 response

The response is of type object.