CoverageBenefitItem

Specific service covered by the insurance plan. This object is available in API version 53.0 and later.

Supported Calls

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

Fields

BenefitCategory

Type: string
Properties: Create, Filter, Group, Nillable, Sort, Update
Description: Name of the category this benefit is in.

CodeSetServiceTypeId

Type: reference
Properties: Create, Filter, Group, Nillable, Sort, Update
Description: ID of a Code Set Service Type in the Code Set object.

This is a relationship field.
Relationship Name: CodeSetServiceType
Relationship Type: Lookup
Refers To: CodeSet

CoverageBenefitId

Type: reference
Properties: Create, Filter, Group, Sort
Description: The ID of the covered benefit this item belongs to.

This is a relationship field.
Relationship Name: CoverageBenefit
Relationship Type: Lookup
Refers To: CoverageBenefit

CoverageLevel

Type: string
Properties: Create, Filter, Group, Nillable, Sort, Update
Description: Description of the level of coverage provided by this item.

DoesDeductibleApply

Type: boolean
Properties: Create, Defaulted on create, Filter, Group, Sort, Update
Description: Specifies whether the benefit item requires a prior expenditure by the patient.
Default value: false

FrequencyType

Type: picklist
Properties: Create, Filter, Group, Nillable, Restricted picklist, Sort, Update
Description: The frequency type of the coverage benefit item associated with the home healthcare visit.

This field is available in API version 66.0 and later with the Home Health add-on license.
Possible values:
- Daily
- Fortnightly
- Monthly
- Quarterly
- Weekly
- Yearly

InNetworkCoverage

Type: textarea
Properties: Create, Nillable, Update
Description: Description of the in network coverage provided by this item.

IsActive

Type: boolean
Properties: Create, Defaulted on create, Filter, Group, Sort, Update
Description: Specifies whether the benefit item is currently available.
Default value: false

IsInPlanNetwork

Type: boolean
Properties: Create, Defaulted on create, Filter, Group, Sort, Update
Description: Indicates whether the benefit is available only in-network (true) or both in-network and out-of-network (false).
Default value: false

IsPreauthorizationRequired

Type: boolean
Properties: Create, Defaulted on create, Filter, Group, Sort, Update
Description: Specifies whether the service must be approved before use.
Default value: 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.

MemberId

Type: reference
Properties: Create, Filter, Group, Nillable, Sort, Update
Description: The ID of the member receiving this benefit item.

This is a relationship field.
Relationship Name: Member
Relationship Type: Lookup
Refers To: Account

Name

Type: string
Properties: Create, Filter, Group, idLookup, Sort, Update
Description: Name of this coverage benefit item.

Notes

Type: textarea
Properties: Create, Nillable, Update
Description: Additional information about this coverage benefit item.

OutofNetworkCoverage

Type: textarea
Properties: Create, Nillable, Update
Description: Description of the coverage for non-preferred providers.

OwnerId

Type: reference
Properties: Create, Defaulted on create, Filter, Group, Sort, Update
Description: The ID of the user who owns this record.

This is a polymorphic relationship field.
Relationship Name: Owner
Relationship Type: Lookup
Refers To: Group, User

ServiceType

Type: string
Properties: Create, Filter, Group, Nillable, Sort, Update
Description: The type of service this plan benefit item provides.

LastReferencedDate

Type: dateTime
Properties: Filter, Nillable, Sort
Description: The timestamp indicating when the current user last viewed a related 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.

ServiceTypeCode

Type: string
Properties: Create, Filter, Group, Nillable, Sort, Update
Description: The code for the type of service this plan benefit item provides.

SourceSystem

Type: string
Properties: Create, Filter, Group, Nillable, Sort, Update
Description: The name of the system this coverage benefits item record came from.

SourceSystemIdentifier

Type: string
Properties: Create, Filter, Group, Nillable, Sort, Update
Description: The identifier of the CoverageBenefitItem in its source system.

SourceSystemModified

Type: dateTime
Properties: Create, Filter, Nillable, Sort, Update
Description: The ID of this coverage benefits item record on its source system.

SourceSystemModified

Type: dateTime
Properties: Create, Filter, Nillable, Sort, Update
Description: The date on which this coverage benefits item was last changed on the source system.

TimePeriod

Type: string
Properties: Create, Filter, Group, Nillable, Sort, Update
Description: A description of the period this plan benefit item covers.

Associated Objects

This object has the following 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.

CoverageBenefitItemChangeEvent (API version 59.0): Change events are available for the object.