Plan

{
  "$schema": "http://json-schema.org/draft-07/schema#",
  "title": "Plan",
  "description": "Schema for Plan from CMS Marketplace API",
  "properties": {
    "id": {
      "description": "14-character HIOS plan ID",
      "type": "string"
    },
    "name": {
      "description": "Name of the insurance plan",
      "type": "string"
    },
    "benefits": {
      "items": {
        "$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"
}