POST
/
insurance-discovery
/
check
/
v1
cURL
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"
}
Insurance discovery checks search for a patient’s active coverage using only their demographic data.
  1. Call this endpoint with as much patient demographic information as possible.
  2. Stedi searches for active coverage for the patient.
  3. The endpoint returns an array of potential active coverages along with subscriber details and benefits information.
We recommend using insurance discovery checks as a backup when eligibility checks fail or aren’t possible. Because of their limitations, you shouldn’t rely on them as your primary method for verifying patient coverage.
Visit Insurance discovery checks for a full how-to guide.

Authorizations

​
Authorization
string
header
required

A Stedi API Key for authentication.

Body

application/json

Response

InsuranceDiscoveryCheck 200 response

The response is of type object.