PlanBenefit

Represents the standard benefits available under a plan that the purchaser offers to their members.

Supported Calls

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

Fields

BenefitNotes

Type: textarea
Properties: Create, Nillable, Update
Description: Additional information about the benefits available to members under this plan’s coverage.

CoinsuranceNotes

Type: textarea
Properties: Create, Nillable, Update
Description: Information about the contribution a member makes towards treatment.

CopayNotes

Type: textarea
Properties: Create, Nillable, Update
Description: Additional information on the copayment amounts that members contribute.

DeductibleNotes

Type: textarea
Properties: Create, Nillable, Update
Description: Additional information about a member’s deductibles.

DocumentLocation

Type: url
Properties: Create, Nillable, Update
Description: Hyperlink to internal or external resources.

EffectiveDate

Type: date
Properties: Create, Filter, Group, Nillable, Sort, Update
Description: The date on which these benefits are communicated to plan members.

EffectiveFrom

Type: date
Properties: Create, Filter, Group, Nillable, Sort, Update
Description: The date on which these benefits become effective.

EffectiveTo

Type: date
Properties: Create, Filter, Group, Nillable, Sort, Update
Description: The date on which these benefits ceased to be effective.

EmergencyDepartmentCopay

Type: currency
Properties: Create, Filter, Nillable, Sort, Update
Description: Patient’s portion of payment for using emergency department services.

FamilyInNetworkDeductible

Type: currency
Properties: Create, Filter, Nillable, Sort, Update
Description: The amount a member pays 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.

FamilyInNetworkOutofPocket

Type: currency
Properties: Create, Filter, Nillable, Sort, Update
Description: The most a member pays during a coverage year for health care provided by the health plan’s preferred providers for all family members. It includes deductibles, copayments, and coinsurance, but is in addition to premiums.

FamilyOutofNetworkDeductible

Type: currency
Properties: Create, Filter, Nillable, Sort, Update
Description: The amount a member pay for health care provided by non-preferred providers for all family members before this plan starts to contribute towards treatment.

FamilyOutofNetworkOutofPocket

Type: currency
Properties: Create, Filter, Nillable, Sort, Update
Description: The most a member pays during a coverage year for health care provided by non-preferred providers for all family members. It includes deductibles, copayments, and coinsurance, but is in addition to premiums.

FrequencyType

Type: picklist
Properties: Create, Filter, Group, Nillable, Restricted picklist, Sort, Update
Description: The frequency type of the plan benefit 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

IndividualInNetworkDeductible

Type: currency
Properties: Create, Filter, Nillable, Sort, Update
Description: The amount a member pays for health care provided by the health plan’s preferred providers to any one family member. When this amount is reached, the plan starts to contribute towards treatment.

IndividualInNetworkOutofPocket

Type: currency
Properties: Create, Filter, Nillable, Sort, Update
Description: The most a member pays during a coverage year for health care provided by the health plan’s preferred providers for any one family member. It includes deductibles, copayments, and coinsurance, but excludes premiums.

IndividualOutofNetworkDeductible

Type: currency
Properties: Create, Filter, Nillable, Sort, Update
Description: The amount a member pays for health care provided by non-preferred providers to any one family member before this plan starts to contribute towards treatment.

IndividualOutofNetworkOutofPocket

Type: currency
Properties: Create, Filter, Nillable, Sort, Update
Description: The most a member pays during a coverage year for health care provided by non-preferred providers for any one family member. It includes deductibles, copayments, and coinsurance, but excludes premiums.

InNetworkCoinsuranceAmount

Type: double
Properties: Create, Filter, Nillable, Sort, Update
Description: The amount a member contributes towards each treatment undertaken by the health plan’s preferred providers.

InNetworkCoinsurancePercentage

Type: double
Properties: Create, Filter, Nillable, Sort, Update
Description: The percentage of treatment cost the member pays for each treatment undertaken by the health plan’s preferred providers.

InNetworkLifetimeMaximum

Type: currency
Properties: Create, Filter, Nillable, Sort, Update
Description: The most a member pays during the lifetime membership on this plan for health care provided by the health plan’s preferred providers. It includes deductibles, copayments, and coinsurance, but excludes premiums.

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 about a member’s maximum lifetime payments.

Name

Type: string
Properties: Create, Filter, Group, Sort, Update
Description: Name of these plan coverage benefits.

OutofNetworkCoinsuranceAmount

Type: double
Properties: Create, Filter, Nillable, Sort, Update
Description: The amount a member contributes towards treatment undertaken by non-preferred providers.

OutofNetworkCoinsurancePercentage

Type: double
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 most a member pays during the lifetime membership on this plan for health care provided by 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 a member makes.

OwnerId

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

PrimaryCareCopay

Type: currency
Properties: Create, Filter, Nillable, Sort, Update
Description: The amount a member contributes towards primary care treatment.

PurchaserPlanId

Type: reference
Properties: Create, Filter, Group, Sort
Description: The ID of the purchaser plan offering these benefits.

SourceSystem

Type: string
Properties: Create, Filter, Group, Nillable, Sort, Update
Description: The name of the system this benefits record came 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 a member contributes towards specialist consultations.

Status

Type: picklist
Properties: Create, Filter, Group, Nillable, Sort, Update
Description: The status of these benefits. The default the picklist
Possible values:
- Active
- Inactive

TotalBenefitAmount

Type: currency
Properties: Create, Filter, Nillable, Sort, Update
Description: The total amount of the plan benefit associated with the home healthcare visit.

This field is available in API version 66.0 and later with the Home Health add-on license.

UrgentCareCopay

Type: currency
Properties: Create, Filter, Nillable, Sort, Update
Description: The amount a member contributes towards urgent care.

Associated Objects

This object has the following associated objects. Unless noted, they are available in the same API version as this object.

PlanBenefitChangeEvent (API version 60.0): Change events are available for the object.
PlanBenefitFeed: Feed tracking is available for the object.
PlanBenefitHistory: History is available for tracked fields of the object.
PlanBenefitOwnerSharingRule: Sharing rules are available for the object.
PlanBenefitShare: Sharing is available for the object.