Triple-S Management Health Plan Member

Schema for a Triple-S health plan member including coverage and eligibility information

Health InsuranceManaged CareMedicare AdvantagePuerto RicoBlue Cross Blue ShieldHealthcare

Properties

Name	Type	Description
memberId	string	Unique member identifier
name	object	Member name
dateOfBirth	string	Member date of birth
planType	string	Type of health plan
planId	string	Health plan identifier
groupNumber	string	Employer group number
effectiveDate	string	Coverage effective date
terminationDate	string	Coverage termination date
eligibilityStatus	string	Current eligibility status
primaryCareProvider	object	Assigned primary care provider
network	string	Provider network (BlueCross BlueShield, Puerto Rico, USVI)

View JSON Schema on GitHub

JSON Schema

{
  "$schema": "http://json-schema.org/draft-07/schema#",
  "$id": "https://api-evangelist.github.io/triple-s-management/json-schema/triple-s-management-member-schema.json",
  "title": "Triple-S Management Health Plan Member",
  "description": "Schema for a Triple-S health plan member including coverage and eligibility information",
  "type": "object",
  "required": ["memberId", "name", "planType"],
  "properties": {
    "memberId": {
      "type": "string",
      "description": "Unique member identifier"
    },
    "name": {
      "type": "object",
      "description": "Member name",
      "properties": {
        "first": { "type": "string" },
        "last": { "type": "string" },
        "middle": { "type": "string" }
      }
    },
    "dateOfBirth": {
      "type": "string",
      "format": "date",
      "description": "Member date of birth"
    },
    "planType": {
      "type": "string",
      "description": "Type of health plan",
      "enum": ["Commercial", "Medicare Advantage", "Government", "Life", "Property and Casualty"]
    },
    "planId": {
      "type": "string",
      "description": "Health plan identifier"
    },
    "groupNumber": {
      "type": "string",
      "description": "Employer group number"
    },
    "effectiveDate": {
      "type": "string",
      "format": "date",
      "description": "Coverage effective date"
    },
    "terminationDate": {
      "type": "string",
      "format": "date",
      "description": "Coverage termination date"
    },
    "eligibilityStatus": {
      "type": "string",
      "description": "Current eligibility status",
      "enum": ["Active", "Inactive", "Terminated", "Pending"]
    },
    "primaryCareProvider": {
      "type": "object",
      "description": "Assigned primary care provider",
      "properties": {
        "npi": { "type": "string", "description": "Provider NPI number" },
        "name": { "type": "string", "description": "Provider name" },
        "phone": { "type": "string", "description": "Provider phone number" }
      }
    },
    "network": {
      "type": "string",
      "description": "Provider network (BlueCross BlueShield, Puerto Rico, USVI)"
    }
  }
}