CarrierPlans
The CarrierPlans file contains information about health insurance carriers and the health plans that they offer.
This section contains the JSON schema specification and example JSON for the entire file; sections below describe attributes of nested objects.
Filename format
carrierplans_##.json
JSON schema
JSON schema for CarrierPlans file
{
"$schema": "https://json-schema.org/draft/2019-09/schema",
"$id": "https://defacto.health/insurances/carrierplans.schema.json",
"title": "Insurance carriers and health plans",
"description": "A collection of health insurance carriers and the health plans offered by them.",
"type": "object",
"properties":
{
"carrierPlans":
{
"type": "array",
"description": "All of the carriers and their insurance plans that Defacto Health has information for.",
"items":
{
"type": "object",
"properties":
{
"carrierId":
{
"type": "integer",
"description": "A Defacto Health generated identifier for the carrier, unique across all carriers.",
"exclusiveMinimum": 0
},
"carrierName":
{
"type": "string",
"description": "The name of the carrier (insurance company).",
"maxLength": 50
},
"plans":
{
"type": "array",
"description": "The different insurance plans offered by this carrier.",
"items":
{
"type": "object",
"properties":
{
"planId":
{
"description": "Defacto Health generated identifier for the health plan, unique across all plans across all carriers.",
"type": "integer",
"exclusiveMinimum": 0
},
"planName":
{
"description": "Name by which the insurance plan is known in the market.",
"type": "string",
"maxLength": 200
},
"lob":
{
"description": "Line of business (type of insurance product).",
"type": "string",
"maxLength": 10
},
"extPlanId":
{
"description": "Plan identifier assigned by an external entity.",
"type": "string",
"maxLength": 14
}
"extPlanIdType":
{
"description": "Type of external plan identifier.",
"type": "string",
"maxLength": 4
}
"research":
{
"type": "object",
"properties":
{
"extPlanIds":
{
"description": "Defacto Health researched identifiers for the health plan.",
"type": ["array", "null"]
},
"extPlanIdType":
{
"description": "Type of external plan identifiers researched by Defacto Health.",
"type": "string",
"maxLength": 4
},
"lob":
{
"description": "Defacto Health researched line of business for the health plan.",
"type": "string",
"maxLength": 10
}
}
}
},
"required":
[
"planId",
"planName"
]
}
}
},
"required": ["carrierId", "carrierName"]
}
}
}
}
Sample JSON
Sample JSON for CarrierPlans file
{
"carrierPlans": [
{
"carrierId": 10,
"carrierName": "United Healthcare",
"plans": [
{
"planId": 25,
"planName": "Peoples Health Patriot (PPO)"
"lob":"mediadv"
"extPlanId": "H4544001"
"extPlanIdType": "pbp"
},
{
"planId": 45,
"planName": "AARP Medicare Advantage (HMO)"
"lob":"medihmo"
"extPlanId": "H0543168"
"extPlanIdType": "pbp"
},
{
"planId": 52,
"planName": "UHC Gold Value+ ($5 Rx)"
"lob":"qhp"
"extPlanId": "69443TN0140001"
"extPlanIdType": "hios"
}
]
},
{
"carrierId": 20,
"carrierName": "Blue Cross and Blue Shield of Kansas City",
"plans": [
{
"planId": 457,
"planName": "Blue Medicare Advantage Spira Care (HMO)"
"research": {
"extPlanIds":
[
"H1352003"
]
"extPlanIdType": "pbp"
"lob":"medihmo"
}
},
{
"planId": 459,
"planName": "Blue Secure (HMO)"
"research": {
"extPlanIds":
[
"H1352004"
]
"extPlanIdType": "pbp"
"lob":"medihmo"
}
}
]
}
]
}
carrierPlans
All of the carriers and their insurance plans that Defacto Health has information for. The top-level carrierPlans object is an array of individual carrierPlan objects.
Attributes
| Attribute | Type | Description | Required | Constraints | Example |
|---|---|---|---|---|---|
| carrierPlans | array[carrierPlan] | An array of individual carrierPlan objects. |
yes |
carrierPlan
An object containing information about a health insurance carrier and the collection of health plans that it offers.
Attributes
Each carrierPlan object has the following attributes:
| Attribute | Type | Description | Required | Constraints | Example |
|---|---|---|---|---|---|
| carrierId | integer | Defacto Health generated identifier for the carrier, unique across all carriers. | yes | > 0 | 25 |
| carrierName | string | The name of the carrier (insurance company). | yes | maxLength: 50 | United Healthcare |
| plans | array[plan] | An array of the different insurance plans offered by this carrier. | no |
plan
An object containing information about an insurance plan.
Attributes
| Attribute | Type | Description | Required | Constraints | Example |
|---|---|---|---|---|---|
| planId | integer | Defacto Health generated identifier for the health plan, unique across all plans across all carriers. This identifier is persistent across data deliveries. | yes | > 0 | 25 |
| planName | string | Name by which the insurance plan is known in the market. | yes | maxLength: 200 | United Healthcare |
| lob | string | Line of business (type of insurance product) in the HL7 insurance product type value set. | no | maxLength: 10 | mediadv |
| extPlanId | string | Plan identifier assigned by an external entity. | no | maxLength: 14 | H3107801 |
| extPlanIdType | string | Type of external plan identifier | no | maxLength: 4 value in ['hios','pbp'] |
pbp |
| research | research | An object containing Defacto Health researched information about an insurance plan. | no |
research
An object containing Defacto Health researched information about an insurance plan.
Attributes
| Attribute | Type | Description | Required | Constraints | Example |
|---|---|---|---|---|---|
| lob | string | Researched line of business (type of insurance product) in the HL7 insurance product type value set. | no | maxLength: 4 | mediadv |
| extPlanIds | array[string] | Researched plan identifiers assigned by an external entity. Multiple plan identifiers may be included if they all match characteristics of the plan in carrier's dataset. | no | maxLength: 14 | ["H1278018", "H1278019"] |
| extPlanIdType | string | Type of external plan identifier | no | maxLength: 4 | pbp |