CoverageBenefitItemLimit

Allows you to track details associated with a specific benefit as it relates to expenditures, limits, coverage levels, eligibility, and exclusion. 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

AllowedLimit

Type: string
Properties: Create, Filter, Group, Nillable, Sort, Update
Description: Maximum amount that will be paid for the service.

AllowedQuantity

Type: double
Properties: Create, Filter, Nillable, Sort, Update
Description: The maximum quantity allowed of the coverage benefit item.

This field is available in API Version 62.0 and later.

AllowedQuantityUnitId

Type: reference
Properties: Create, Filter, Group, Nillable, Sort, Update
Description: The unit of measure for the allowed quantity of the coverage benefit item.

This field is a relationship field.

This field is available in API Version 62.0 and later.
Relationship Name: AllowedQuantityUnit
Refers To: UnitOfMeasure

AppliedLimit

Type: string
Properties: Create, Filter, Group, Nillable, Sort, Update
Description: Specifies whether the benefit has been claimed.

AppliedQuantity

Type: double
Properties: Create, Filter, Nillable, Sort, Update
Description: The quantity of the coverage benefit item already used by the member.

This field is available in API Version 62.0 and later.

AppliedQuantityUnitId

Type: reference
Properties: Create, Filter, Group, Nillable, Sort, Update
Description: The unit of measure for the applied quantity of the coverage benefit item.

This field is a relationship field.

This field is available in API Version 62.0 and later.
Relationship Name: AppliedQuantityUnit
Refers To: UnitOfMeasure

CareLimitTypeId

Type: reference
Properties: Create, Filter, Group, Nillable, Sort, Update
Description: Specifies whether the limit is a required payment or excluded service.

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

CoverageBenefitItemId

Type: reference
Properties: Create, Filter, Group, Sort
Description: Specific service covered by the insurance plan.

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

CoverageLevel

Type: picklist
Properties: Create, Filter, Group, Nillable, Restricted picklist, Sort, Update
Description: Defines the persons eligible for the benefit item.
Possible values:
- EmployeeSpouse—Employee & Spouse
- Family
- Individual

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.

LimitNotes

Type: textarea
Properties: Create, Nillable, Update
Description: General information about the limit.

Name

Type: string
Properties: Create, Filter, Group, idLookup, Sort, Update
Description: The name of the coverage benefit item limit.

NetworkType

Type: picklist
Properties: Create, Filter, Group, Nillable, Restricted picklist, Sort, Update
Description: Specifies whether the benefit refers to in-network providers or out-of-network providers.

If the related CoverageBenefitItem record has an IsInPlanNetwork value of true, NetworkType is typically In. If the related record has an IsInPlanNetwork value of false, NetworkType can be any value.
Possible values:
- In—In-network providers
- NA—Not applicable
- Out—Out-of-network providers

PriorityOrder

Type: double
Properties: Create, Filter, Nillable, Sort, Update
Description: This limit’s position in the sequence for calculating limits.

TermType

Type: picklist
Properties: Create, Filter, Group, Nillable, Sort, Update
Description: Specifies the type of time period during which the benefit item is available.
Possible values:
- Calendar Year
- Day
- Month
- Year to Date

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.

CoverageBenefitItemLimitChangeEvent (API version 60.0): Change events are available for the object.
CoverageBenefitItemLimitHistory: History is available for tracked fields of the object.