Ribbon Health · Schema
getEligibility
JSON Schema for getEligibility response from Ribbon Health H1 API
HealthcareProvider DirectoryInsuranceClinical DataCare NavigationEligibilityPrice TransparencyProvider SearchHealth PlansDigital Health
Properties
| Name | Type | Description |
|---|---|---|
| parameters | object | |
| status | object | |
| request_id | string | A unique identifier for the given response which Ribbon can use to find it in our logs during support requests |
| plan_info | object | |
| deductible_detail | object | |
| out_of_pocket_detail | object | |
| primary_care_summary | object | |
| dme_summary | object | |
| oncology_summary | object | |
| vision_optometry_summary | object | |
| physical_therapy_summary | object | |
| specialist_office_summary | object | |
| mental_health_summary | object | |
| surgical_summary | object | |
| urgent_care_summary | object | |
| diagnostic_lab_summary | object | |
| asc_facility_summary | object | |
| chiropractic_summary | object | |
| mri_ct_scan_summary | object | |
| x_ray_summary | object | |
| speech_therapy_summary | object | |
| occupational_therapy_summary | object | |
| emergency_medical_summary | object | |
| wellness_or_routine_visit_summary | object | |
| podiatry_office_summary | object | |
| outpatient_professional_summary | object | |
| anesthesia_summary | object | |
| substance_abuse_professional_summary | object | |
| substance_abuse_in_patient_facility_summary | object | |
| substance_abuse_out_patient_facility_summary | object | |
| flu_vaccination_summary | object | |
| hospital_inpatient_summary | object | |
| pharmacy_summary | object | |
| hospital_outpatient_summary | object | |
| telemedicine_primary_care_summary | object | |
| telemedicine_specialist_summary | object | |
| telemedicine_urgent_care_summary | object | |
| telemedicine_physical_therapy_summary | object | |
| telemedicine_mental_health_summary | object | |
| psychotherapy_summary | object | |
| snf_summary | object | |
| snf_room_board_summary | object | |
| home_health_care_summary | object | |
| hospice_summary | object | |
| professional_physician_visit_inpatient_summary | object |
JSON Schema
{
"$schema": "http://json-schema.org/draft-07/schema#",
"title": "getEligibility",
"description": "JSON Schema for getEligibility response from Ribbon Health H1 API",
"required": [
"parameters",
"request_id",
"status"
],
"type": "object",
"properties": {
"parameters": {
"type": "object",
"properties": {
"member_id": {
"type": "string",
"description": "The member's identification number",
"example": "000000000-00"
},
"first_name": {
"type": "string",
"description": "The member's first name",
"example": "John"
},
"last_name": {
"type": "string",
"description": "The member's last name",
"example": "Doe"
},
"birth_date": {
"type": "string",
"description": "The member's birth date as an ISO-format date string",
"format": "date",
"example": "1980-12-31"
},
"insurance_partner": {
"type": "string",
"description": "The identifier for this insurance partner in the Ribbon API",
"example": "aetna_better_health_il"
}
}
},
"status": {
"type": "object",
"properties": {
"is_valid": {
"type": "boolean",
"description": "Whether the eligibility check was successful",
"example": true
},
"error": {
"type": "string",
"description": "If `is_valid` is `true`, an error code explaining what went wrong. When `is_valid` is `false`, this will be `null`.",
"nullable": true
}
}
},
"request_id": {
"type": "string",
"description": "A unique identifier for the given response which Ribbon can use to find it in our logs during support requests",
"example": "40610978"
},
"plan_info": {
"type": "object",
"properties": {
"insurance_partner": {
"type": "string",
"description": "The identifier for this insurance partner in the Ribbon API",
"example": "aetna_better_health_il"
},
"plan_name": {
"type": "string",
"description": "User-friendly display name for this insurance partner",
"example": "Aetna Better Health of Illinois"
},
"is_active": {
"type": "boolean",
"description": "Whether the member is actively covered by this plan",
"example": true
},
"plan_start_date": {
"type": "string",
"description": "The starting date for the member's coverage by this plan",
"format": "date",
"example": "2012-02-01"
},
"plan_end_date": {
"type": "string",
"description": "The ending date for the member's coverage by this plan",
"format": "date",
"nullable": true,
"example": "2024-01-01"
}
}
},
"deductible_detail": {
"type": "object",
"properties": {
"individual": {
"type": "object",
"properties": {
"in_network": {
"type": "object",
"properties": {
"spend": {
"type": "string",
"description": "The amount the member has paid towards in-network deductibles, in dollars",
"nullable": true,
"example": "16.43"
},
"maximum": {
"type": "string",
"description": "The maximum amount the member can pay towards in-network deductibles, in dollars",
"nullable": true,
"example": "3000"
},
"remaining": {
"type": "string",
"description": "The remaining amount the member can pay towards in-network deductibles, in dollars",
"example": "2983.57"
}
}
},
"out_of_network": {
"type": "object",
"properties": {
"spend": {
"type": "string",
"description": "The amount the member has paid towards out-of-network deductibles, in dollars",
"nullable": true,
"example": "16.43"
},
"maximum": {
"type": "string",
"description": "The maximum amount the member can pay towards out-of-network deductibles, in dollars",
"nullable": true,
"example": "6000"
},
"remaining": {
"type": "string",
"description": "The remaining amount the member can pay towards out-of-network deductibles, in dollars",
"nullable": true,
"example": "5983.57"
}
}
}
}
},
"family": {
"type": "object",
"properties": {
"in_network": {
"type": "object",
"properties": {
"spend": {
"type": "string",
"description": "The amount the member has paid towards in-network deductibles, in dollars",
"nullable": true,
"example": "16.43"
},
"maximum": {
"type": "string",
"description": "The maximum amount the member can pay towards in-network deductibles, in dollars",
"nullable": true,
"example": "6000"
},
"remaining": {
"type": "string",
"description": "The remaining amount the member can pay towards in-network deductibles, in dollars",
"nullable": true,
"example": "5983.57"
}
}
},
"out_of_network": {
"type": "object",
"properties": {
"spend": {
"type": "string",
"description": "The amount the member has paid towards out-of-network deductibles, in dollars",
"nullable": true,
"example": "16.43"
},
"maximum": {
"type": "string",
"description": "The maximum amount the member can pay towards out-of-network deductibles, in dollars",
"nullable": true,
"example": "6000"
},
"remaining": {
"type": "string",
"description": "The remaining amount the member can pay towards out-of-network deductibles, in dollars",
"nullable": true,
"example": "5983.57"
}
}
}
}
}
}
},
"out_of_pocket_detail": {
"type": "object",
"properties": {
"individual": {
"type": "object",
"properties": {
"in_network": {
"type": "object",
"properties": {
"spend": {
"type": "string",
"description": "The amount the member has paid towards their in-network out-of-pocket maximum, in dollars",
"nullable": true,
"example": "16.43"
},
"maximum": {
"type": "string",
"description": "The maximum amount the member can pay towards their in-network out-of-pocket maximum, in dollars",
"nullable": true,
"example": "3000"
},
"remaining": {
"type": "string",
"description": "The remaining amount the member can pay towards their in-network out-of-pocket maximum, in dollars",
"nullable": true,
"example": "2983.57"
}
}
},
"out_of_network": {
"type": "object",
"properties": {
"spend": {
"type": "string",
"description": "The amount the member has paid towards their out-of-network out-of-pocket maximum, in dollars",
"nullable": true,
"example": "16.43"
},
"maximum": {
"type": "string",
"description": "The maximum amount the member can pay towards their out-of-network out-of-pocket maximum, in dollars",
"nullable": true,
"example": "6000"
},
"remaining": {
"type": "string",
"description": "The remaining amount the member can pay towards their out-of-network out-of-pocket maximum, in dollars",
"nullable": true,
"example": "5983.57"
}
}
}
}
},
"family": {
"type": "object",
"properties": {
"in_network": {
"type": "object",
"properties": {
"spend": {
"type": "string",
"description": "The amount the member has paid towards their in-network out-of-pocket maximum, in dollars",
"nullable": true,
"example": "16.43"
},
"maximum": {
"type": "string",
"description": "The maximum amount the member can pay towards their in-network out-of-pocket maximum, in dollars",
"nullable": true,
"example": "3000"
},
"remaining": {
"type": "string",
"description": "The remaining amount the member can pay towards their in-network out-of-pocket maximum, in dollars",
"nullable": true,
"example": "2983.57"
}
}
},
"out_of_network": {
"type": "object",
"properties": {
"spend": {
"type": "string",
"description": "The amount the member has paid towards their out-of-network out-of-pocket maximum, in dollars",
"nullable": true,
"example": "16.43"
},
"maximum": {
"type": "string",
"description": "The maximum amount the member can pay towards their out-of-network out-of-pocket maximum, in dollars",
"nullable": true,
"example": "6000"
},
"remaining": {
"type": "string",
"description": "The remaining amount the member can pay towards their out-of-network out-of-pocket maximum, in dollars",
"nullable": true,
"example": "5983.57"
}
}
}
}
}
}
},
"primary_care_summary": {
"type": "object",
"properties": {
"in_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's in-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
},
"out_of_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's out-of-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
}
}
},
"dme_summary": {
"type": "object",
"properties": {
"in_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's in-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
},
"out_of_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's out-of-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
}
}
},
"oncology_summary": {
"type": "object",
"properties": {
"in_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's in-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
},
"out_of_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's out-of-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
}
}
},
"vision_optometry_summary": {
"type": "object",
"properties": {
"in_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's in-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
},
"out_of_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's out-of-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
}
}
},
"physical_therapy_summary": {
"type": "object",
"properties": {
"in_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's in-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
},
"out_of_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's out-of-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
}
}
},
"specialist_office_summary": {
"type": "object",
"properties": {
"in_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's in-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
},
"out_of_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's out-of-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
}
}
},
"mental_health_summary": {
"type": "object",
"properties": {
"in_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's in-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
},
"out_of_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's out-of-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
}
}
},
"surgical_summary": {
"type": "object",
"properties": {
"in_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's in-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
},
"out_of_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's out-of-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
}
}
},
"urgent_care_summary": {
"type": "object",
"properties": {
"in_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's in-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
},
"out_of_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's out-of-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
}
}
},
"diagnostic_lab_summary": {
"type": "object",
"properties": {
"in_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's in-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
},
"out_of_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's out-of-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
}
}
},
"asc_facility_summary": {
"type": "object",
"properties": {
"in_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's in-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
},
"out_of_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's out-of-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
}
}
},
"chiropractic_summary": {
"type": "object",
"properties": {
"in_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's in-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
},
"out_of_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's out-of-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
}
}
},
"mri_ct_scan_summary": {
"type": "object",
"properties": {
"in_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's in-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
},
"out_of_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's out-of-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
}
}
},
"x_ray_summary": {
"type": "object",
"properties": {
"in_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's in-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
},
"out_of_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's out-of-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
}
}
},
"speech_therapy_summary": {
"type": "object",
"properties": {
"in_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's in-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
},
"out_of_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's out-of-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
}
}
},
"occupational_therapy_summary": {
"type": "object",
"properties": {
"in_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's in-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
},
"out_of_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's out-of-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
}
}
},
"emergency_medical_summary": {
"type": "object",
"properties": {
"in_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's in-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
},
"out_of_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's out-of-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
}
}
},
"wellness_or_routine_visit_summary": {
"type": "object",
"properties": {
"in_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's in-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
},
"out_of_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's out-of-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
}
}
},
"podiatry_office_summary": {
"type": "object",
"properties": {
"in_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's in-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
},
"out_of_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's out-of-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
}
}
},
"outpatient_professional_summary": {
"type": "object",
"properties": {
"in_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's in-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
},
"out_of_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's out-of-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
}
}
},
"anesthesia_summary": {
"type": "object",
"properties": {
"in_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's in-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
},
"out_of_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's out-of-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
}
}
},
"substance_abuse_professional_summary": {
"type": "object",
"properties": {
"in_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's in-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
},
"out_of_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's out-of-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
"type": "string",
"nullable": true,
"example": "0.0"
}
}
}
}
},
"substance_abuse_in_patient_facility_summary": {
"type": "object",
"properties": {
"in_network": {
"type": "object",
"properties": {
"copay": {
"type": "string",
"description": "The amount of the member's in-network copay, in dollars",
"example": "30.0"
},
"coinsurance": {
# --- truncated at 32 KB (47 KB total) ---
# Full source: https://raw.githubusercontent.com/api-evangelist/ribbon-health/refs/heads/main/json-schema/geteligibility.json