CoverageBenefit

Represents the benefits provided to a covered member by a purchaser’s plan.

Supported Calls

create(), delete(), describeLayout(), describeSObjects(), getDeleted(), getUpdated(), query(), retrieve(), search(), undelete(), update(), upsert()

Fields

Field Name	Details
BenefitNotes	Type textarea Properties Create, Nillable, Update Description Additional information about the benefits available to the member under this plan’s coverage.
BenefitPeriodEndDate	Type date Properties Create, Filter, Group, Nillable, Sort, Update Description Last day of the coverage benefit period.
BenefitPeriodStartDate	Type date Properties Create, Filter, Group, Nillable, Sort, Update Description First day of the coverage benefit period.
CareBenefitVerifyRequestId	Type reference Properties Create, Filter, Group, Nillable, Sort, Update Description The care benefit verify request associated with the coverage benefit. This field is a relationship field. This field is available in API version 61.0 and later with the Manage Pharmacy Benefits Verification permission set. Relationship Name CareBenefitVerifyRequest Relationship Type Lookup Refers To CareBenefitVerifyRequest
CoinsuranceNotes	Type textarea Properties Create, Nillable, Update Description Additional information about the contribution the member makes towards treatment.
CopayNotes	Type textarea Properties Create, Nillable, Update Description Additional information on the copayment amounts members contributes.
CoverageType	Type picklist Properties Create, Filter, Group, Nillable, Sort, Update Description General category of service covered. Possible values are: `Dental` `Medical` `Vision` `Home Health` - This picklist value is available for the Home Health feature in API version 59.0 and later. `Pharmacy` - This picklist value is available for the Pharmacy Benefits Verification feature in API version 63.0 and later. See Activate Picklist Value for Coverage Benefit to activate this value.
DeductibleNotes	Type textarea Properties Create, Nillable, Update Description Additional information about the member’s deductibles under this plan.
Disclaimer	Type string Properties Create, Filter, Group, Nillable, Sort, Update Description Overall plan benefit disclaimers.
EmergencyDepartmentCopay	Type currency Properties Create, Filter, Nillable, Sort, Update Description The amount the member contributes towards emergency treatment.
FamilyInNetworkDeductibleApplied	Type currency Properties Create, Filter, Nillable, Sort, Update Description The amount the member has paid for health care provided by the health plan’s preferred providers for all family members.
FamilyInNetworkDeductibleLimit	Type currency Properties Create, Filter, Nillable, Sort, Update Description The amount the member is required to pay for health care provided by the health plan’s preferred providers for all family members. When this amount is reached, the plan starts to contribute towards treatment.
FamilyInNetworkDeductibleRemaining	Type currency Properties Create, Filter, Nillable, Sort, Update Description The remaining amount the member still has to pay for health care provided by the health plan’s preferred providers for all family members. When this amount is reached, the plan starts to contribute towards treatment.
FamilyInNetworkOutofPocketApplied	Type currency Properties Create, Filter, Nillable, Sort, Update Description The amount of the member has paid in this coverage year for health care provided by the health plan’s preferred providers for all family members. It includes deductibles, copayments, and coinsurance, but excludes premiums.
FamilyInNetworkOutofPocketLimit	Type currency Properties Create, Filter, Nillable, Sort, Update Description The most the member pays during the coverage year for health care provided by the health plan’s preferred providers for all family members. It includes deductibles, copayments, and coinsurance, but excludes premiums.
FamilyInNetworkOutofPocketRemaining	Type currency Properties Create, Filter, Nillable, Sort, Update Description The remaining amount for the member to pay during this coverage year for care provided by the plan’s preferred providers for all family members. When this amount is reached, the plan starts to contribute towards treatment. It includes deductibles, copayments, and coinsurance, but excludes premiums.
FamilyOutofNetworkDeductibleApplied	Type currency Properties Create, Filter, Nillable, Sort, Update Description The amount the member has paid for health care provided by non-preferred providers for all family members.
FamilyOutofNetworkDeductibleLimit	Type currency Properties Create, Filter, Nillable, Sort, Update Description The total amount the member has to pay for health care provided by non-preferred providers for all family members. When this amount is reached, the plan starts to contribute towards treatment.
FamilyOutofNetworkDeductibleRemaining	Type currency Properties Create, Filter, Nillable, Sort, Update Description The amount the member still has to pay for health care provided by non-preferred providers for all family members. When this amount is reached, the plan starts to contribute towards treatment.
FamilyOutofNetworkOutofPocketApplied	Type currency Properties Create, Filter, Nillable, Sort, Update Description The amount of the member has paid in this coverage year for health care provided by non-preferred providers for all family members. It includes deductibles, copayments, and coinsurance, but excludes premiums.
FamilyOutofNetworkOutofPocketLimit	Type currency Properties Create, Filter, Nillable, Sort, Update Description The most the member pays during the coverage year for health care provided by non-preferred providers for all family members. It includes deductibles, copayments, and coinsurance, but excludes premiums.
FamilyOutofNetworkOutofPocketRemaining	Type currency Properties Create, Filter, Nillable, Sort, Update Description The remaining amount for the member to pay during this coverage period for health care provided by non-preferred providers for all family members. When this amount is reached, the plan starts to contribute towards treatment. It includes deductibles, copayments, and coinsurance, but excludes premiums.
FinalCoverageStatusCodeId	Type reference Properties Create, Filter, Group, Nillable, Sort, Update Description The code that's determined after considering the restrictions and other status types that apply to the coverage benefit. This field is a relationship field. This field is available in API version 61.0 and later with the Manage Pharmacy Benefits Verification permission set. Relationship Name FinalCoverageStatusCode Relationship Type Lookup Refers To CodeSet
IndividualInNetworkDeductibleApplied	Type currency Properties Create, Filter, Nillable, Sort, Update Description The amount the member has paid for health care provided by the health plan’s preferred providers to the most costly family member.
IndividualInNetworkDeductibleLimit	Type currency Properties Create, Filter, Nillable, Sort, Update Description The amount the member has to pay for health care provided by the plan’s preferred providers for any family member. When this amount is reached, the plan starts to contribute towards treatment.
IndividualInNetworkDeductibleRemaining	Type currency Properties Create, Filter, Nillable, Sort, Update Description The remaining amount the member has to pay for care during the coverage year provided by the plan’s preferred providers for any family member. When this amount is reached, the plan starts to contribute towards treatment.
IndividualInNetworkOutofPocketApplied	Type currency Properties Create, Filter, Nillable, Sort, Update Description The amount of the member has paid in this coverage year for health care provided by the plan’s preferred providers to any one family member. It includes deductibles, copayments, and coinsurance, but excludes premiums.
IndividualInNetworkOutofPocketLimit	Type currency Properties Create, Filter, Nillable, Sort, Update Description The most the member pays during the coverage year for health care provided by the health plan’s preferred providers for any family member. It includes deductibles, copayments, and coinsurance, but excludes premiums.
IndividualInNetworkOutofPocketRemaining	Type currency Properties Create, Filter, Nillable, Sort, Update Description The amount remaining for the member to pay during the coverage year for care provided by the plan’s preferred providers for any family member. It includes deductibles, copayments, and coinsurance, but excludes premiums.
IndividualOutofNetworkDeductibleApplied	Type currency Properties Create, Filter, Nillable, Sort, Update Description The amount the member has paid for health care provided by non-preferred providers to the most costly family member.
IndividualOutofNetworkDeductibleLimit	Type currency Properties Create, Filter, Nillable, Sort, Update Description The amount the member has to pay for health care provided by non-preferred providers to any one family member. When this amount is reached, the plan starts to contribute towards treatment.
IndividualOutofNetworkDeductibleRemain	Type currency Properties Create, Filter, Nillable, Sort, Update Description The remaining amount the member has to pay for health care during the coverage year provided by non-preferred providers to any family member. When this amount is reached, the plan starts to contribute towards treatment.
IndividualOutofNetworkOutofPocketApplied	Type currency Properties Create, Filter, Nillable, Sort, Update Description The amount of the member has paid in this coverage period for health care provided by non-preferred providers to any family members. It includes deductibles, copayments, and coinsurance, but excludes premiums.
IndividualOutofNetworkOutofPocketLimit	Type currency Properties Create, Filter, Nillable, Sort, Update Description The most the member pays during the coverage year for health care provided by non-preferred providers to any family member. It includes deductibles, copayments, and coinsurance, but excludes premiums.
IndividualOutofNetworkOutofPocketRemain	Type currency Properties Create, Filter, Nillable, Sort, Update Description The amount remaining for the member to pay during the coverage year for health care provided by non-preferred providers to any family member. It includes deductibles, copayments, and coinsurance, but excludes premiums.
InNetworkCoinsuranceAmount	Type currency Properties Create, Filter, Nillable, Sort, Update Description The amount the member contributes towards treatment undertaken by the health plan’s preferred providers.
InNetworkCoinsurancePercentage	Type percent Properties Create, Filter, Nillable, Sort, Update Description The percentage of treatment cost the member pays for treatment undertaken by the health plan’s preferred providers.
InNetworkLifetimeMaximum	Type currency Properties Create, Filter, Nillable, Sort, Update Description The amount the member has to pay during lifetime coverage under this plan after which the provider covers all costs for treatment provided by its preferred providers. It includes deductibles, copayments, and coinsurance, but excludes premiums.
IsActive	Type boolean Properties Create, Defaulted on create, Filter, Group, Sort, Update Description Specifies whether the coverage benefit is currently in force. The default value is 'false'.
LastReferencedDate	Type datetime Properties Filter, Nillable, Sort Description The timestamp for when the current user last viewed a record related to this record.
LastViewedDate	Type datetime Properties Filter, Nillable, Sort Description The timestamp for when the current user last viewed this record. If this value is null, it’s possible that this record was referenced (LastReferencedDate) and not viewed.
LifetimeMaximumNotes	Type textarea Properties Create, Nillable, Update Description Additional information on the lifetime maximum payments the member Will be expected to make.
MemberId	Type reference Properties Create, Filter, Group, Nillable, Sort, Update Description The ID of the member receiving these benefits.
MemberPlanId	Type reference Properties Create, Filter, Group, Sort Description The ID of the member plan receiving these benefits.
Name	Type string Properties Create, Filter, Group, Sort, Update Description Name of these coverage benefits.
OutcomeStatusCodeId	Type reference Properties Create, Filter, Group, Nillable, Sort, Update Description The outcome code set associated with the coverage benefit. This field is a relationship field. This field is available in API version 61.0 and later with the Manage Pharmacy Benefits Verification permission set. Relationship Name OutcomeStatusCode Relationship Type Lookup Refers To CodeSet
OutofNetworkCoinsuranceAmount	Type currency Properties Create, Filter, Nillable, Sort, Update Description The amount the member contributes towards treatment undertaken by non-preferred providers.
OutofNetworkCoinsurancPercentage	Type percent Properties Create, Filter, Nillable, Sort, Update Description The percentage of treatment cost the member pays for treatment undertaken by non-preferred providers.
OutofNetworkLifetimeMaximum	Type currency Properties Create, Filter, Nillable, Sort, Update Description The amount the member has to pay during lifetime coverage under this plan after which the plan provider covers all costs for treatment provided by its non-preferred providers. It includes deductibles, copayments, and coinsurance, but excludes premiums.
OutofPocketNotes	Type textarea Properties Create, Nillable, Update Description Additional information about the out-of-pocket payment the member makes.
OwnerId	Type reference Properties Create, Defaulted on create, Filter, Group, Sort, Update Description The ID of the user who owns this record.
PharmaCopayAmount	Type currency Properties Create, Filter, Nillable, Sort, Update Description The amount the member contributes towards the pharma products. This field is available in API version 62.0 and later with the Manage Financial Assistance Program permission set.

PrimaryCareCopay	Type currency Properties Create, Filter, Nillable, Sort, Update Description The amount the member contributes towards primary care treatment.
SourceSystem	Type string Properties Create, Filter, Group, Nillable, Sort, Update Description The name of the system this benefits record was obtained from.
SourceSystemIdentifier	Type string Properties Create, Filter, Group, Nillable, Sort, Update Description The ID of this benefits record on its source system.
SourceSystemModified	Type date Properties Create, Filter, Group, Nillable, Sort, Update Description The date on which these benefits were last changed on their source system.
SpecialistCopay	Type currency Properties Create, Filter, Nillable, Sort, Update Description The amount the member contributes towards specialist consultations.
StatusCodeId	Type reference Properties Create, Filter, Group, Nillable, Sort, Update Description The status code set associated with the coverage benefit. This field is a relationship field. This field is available in API version 61.0 and later with the Manage Pharmacy Benefits Verification permission set. Relationship Name StatusCode Relationship Type Lookup Refers To CodeSet
UrgentCareCopay	Type currency Properties Create, Filter, Nillable, Sort, Update Description The amount the member contributes towards urgent care.
VerificationDate	Type dateTime Properties Create, Filter, Nillable, Sort, Update Description Date on which the benefit was verified.

Associated Objects

This object has these associated objects. If the API version isn’t specified, they’re available in the same API versions as this object. Otherwise, they’re available in the specified API version and later.

CoverageBenefitChangeEvent (API version 59.0): Change events are available for the object.
CoverageBenefitFeed: Feed tracking is available for the object.
CoverageBenefitHistory: History is available for tracked fields of the object.
CoverageBenefitOwnerSharingRule: Sharing rules are available for the object.
CoverageBenefitShare: Sharing is available for the object.

Salesforce Health Cloud Developer Guide

CoverageBenefit

Supported Calls

Fields

Associated Objects