STEDI LIVE ELIGIBILITY TEST — MOCK REQUESTS
Date: 2026-03-05
API Key: test_9gz3t4N.OT... (test key)

======================================================================
CASE: 1. Aetna subscriber-only — active coverage
======================================================================
STATUS: SUCCESS
RESULT:
{
  "status": "unknown",
  "eligible": true,
  "reference_id": "112233445",
  "plan_info": {
    "planInformation": {
      "planNumber": "1122334",
      "groupNumber": "111222333444555",
      "groupDescription": "New Jersey Plan"
    },
    "planDateInformation": {
      "planBegin": "20240401",
      "service": "20240917"
    },
    "benefitsInformation": [
      {
        "code": "W",
        "name": "Other Source of Data",
        "inPlanNetworkIndicatorCode": "W",
        "inPlanNetworkIndicator": "Not Applicable",
        "benefitsRelatedEntity": {
          "entityIdentifier": "Payer",
          "entityType": "Non-Person Entity",
          "entityName": "Aetna",
          "address": {
            "address1": "202 Main St",
            "city": "El Paso",
            "state": "TX",
            "postalCode": "79998"
          }
        },
        "benefitsRelatedEntities": [
          {
            "entityIdentifier": "Payer",
            "entityType": "Non-Person Entity",
            "entityName": "Aetna",
            "address": {
              "address1": "202 Main St",
              "city": "El Paso",
              "state": "TX",
              "postalCode": "79998"
            }
          }
        ]
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "insuranceTypeCode": "PR",
        "insuranceType": "Preferred Provider Organization (PPO)",
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "W",
        "inPlanNetworkIndicator": "Not Applicable"
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "timeQualifierCode": "25",
        "timeQualifier": "Contract",
        "benefitAmount": "500",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "benefitsDateInformation": {
          "planBegin": "20240401"
        }
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "timeQualifierCode": "29",
        "timeQualifier": "Remaining",
        "benefitAmount": "500",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "G",
        "name": "Out of Pocket (Stop Loss)",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "timeQualifierCode": "25",
        "timeQualifier": "Contract",
        "benefitAmount": "7000",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "G",
        "name": "Out of Pocket (Stop Loss)",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "timeQualifierCode": "29",
        "timeQualifier": "Remaining",
        "benefitAmount": "7000",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "timeQualifierCode": "25",
        "timeQualifier": "Contract",
        "benefitAmount": "1000",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No",
        "benefitsDateInformation": {
          "planBegin": "20240401"
        }
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "timeQualifierCode": "29",
        "timeQualifier": "Remaining",
        "benefitAmount": "1000",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "G",
        "name": "Out of Pocket (Stop Loss)",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "timeQualifierCode": "25",
        "timeQualifier": "Contract",
        "benefitAmount": "14000",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "G",
        "name": "Out of Pocket (Stop Loss)",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "timeQualifierCode": "29",
        "timeQualifier": "Remaining",
        "benefitAmount": "14000",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "1",
          "33",
          "47",
          "48",
          "50",
          "86",
          "98",
          "UC",
          "MH",
          "AL"
        ],
        "serviceTypes": [
          "Medical Care",
          "Chiropractic",
          "Hospital",
          "Hospital - Inpatient",
          "Hospital - Outpatient",
          "Emergency Services",
          "Professional (Physician) Visit - Office",
          "Urgent Care",
          "Mental Health",
          "Vision (Optometry)"
        ],
        "inPlanNetworkIndicatorCode": "W",
        "inPlanNetworkIndicator": "Not Applicable"
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "33",
          "86",
          "98",
          "MH",
          "UC"
        ],
        "serviceTypes": [
          "Chiropractic",
          "Emergency Services",
          "Professional (Physician) Visit - Office",
          "Mental Health",
          "Urgent Care"
        ],
        "benefitPercent": "0",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Chiropractic"
          },
          {
            "description": "Office Visits"
          },
          {
            "description": "Urgent Care"
          },
          {
            "description": "Walk in Clinic"
          },
          {
            "description": "Mental Health (outpatient)"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "86"
        ],
        "serviceTypes": [
          "Emergency Services"
        ],
        "benefitPercent": "0.2",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Emergency Room"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "48",
          "50",
          "MH"
        ],
        "serviceTypes": [
          "Hospital - Inpatient",
          "Hospital - Outpatient",
          "Mental Health"
        ],
        "benefitPercent": "0.2",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "IP Hospital Room and Board"
          },
          {
            "description": "IP Hospital Miscellaneous"
          },
          {
            "description": "OP Hospital Miscellaneous"
          },
          {
            "description": "Mental Health (inpatient)"
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "33"
        ],
        "serviceTypes": [
          "Chiropractic"
        ],
        "benefitAmount": "25",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Chiropractic"
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "98",
          "MH",
          "UC"
        ],
        "serviceTypes": [
          "Professional (Physician) Visit - Office",
          "Mental Health",
          "Urgent Care"
        ],
        "benefitAmount": "30",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Office Visits"
          },
          {
            "description": "Walk in Clinic"
          },
          {
            "description": "Mental Health (outpatient)"
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "86",
          "UC"
        ],
        "serviceTypes": [
          "Emergency Services",
          "Urgent Care"
        ],
        "benefitAmount": "40",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Urgent Care"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "33",
          "48",
          "50",
          "86",
          "98",
          "MH",
          "UC"
        ],
        "serviceTypes": [
          "Chiropractic",
          "Hospital - Inpatient",
          "Hospital - Outpatient",
          "Emergency Services",
          "Professional (Physician) Visit - Office",
          "Mental Health",
          "Urgent Care"
        ],
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No",
        "additionalInformation": [
          {
            "description": "Chiropractic"
          },
          {
            "description": "IP Hospital Room and Board"
          },
          {
            "description": "IP Hospital Miscellaneous"
          },
          {
            "description": "Office Visits"
          },
          {
            "description": "Urgent Care"
          },
          {
            "description": "Walk in Clinic"
          },
          {
            "description": "OP Hospital Miscellaneous"
          },
          {
            "description": "Mental Health (inpatient)"
          },
          {
            "description": "Mental Health (outpatient)"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "86"
        ],
        "serviceTypes": [
          "Emergency Services"
        ],
        "benefitPercent": "0.2",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No",
        "additionalInformation": [
          {
            "description": "Emergency Room"
          }
        ]
      }
    ],
    "planStatus": [
      {
        "statusCode": "1",
        "status": "Active Coverage",
        "planDetails": "Gold Plan",
        "serviceTypeCodes": [
          "30"
        ]
      },
      {
        "statusCode": "1",
        "status": "Active Coverage",
        "serviceTypeCodes": [
          "1",
          "33",
          "47",
          "48",
          "50",
          "86",
          "98",
          "UC",
          "MH",
          "AL"
        ]
      }
    ]
  },
  "raw_response": {
    "id": "ec_019cbdde-310e-73f0-8ecb-3a62c029aaae",
    "meta": {
      "senderId": "STEDI",
      "submitterId": "117151744",
      "applicationMode": "production",
      "traceId": "11112222333344445555666677",
      "outboundTraceId": "01KJYXWC8F3WRN5ZV2GE00E7Q4"
    },
    "controlNumber": "112233445",
    "reassociationKey": "112233445",
    "tradingPartnerServiceId": "60054",
    "provider": {
      "providerName": "MEDICAL PROVIDER",
      "entityIdentifier": "Provider",
      "entityType": "Non-Person Entity",
      "npi": "1999999984"
    },
    "subscriber": {
      "memberId": "AETNA12345",
      "firstName": "JANE",
      "lastName": "DOE",
      "gender": "F",
      "entityIdentifier": "Insured or Subscriber",
      "entityType": "Person",
      "dateOfBirth": "20040404",
      "groupNumber": "111222333444555",
      "planNumber": "1122334",
      "address": {
        "address1": "101 MAIN ST",
        "city": "TRENTON",
        "state": "NJ",
        "postalCode": "08601"
      }
    },
    "payer": {
      "entityIdentifier": "Payer",
      "entityType": "Non-Person Entity",
      "name": "AETNA INC",
      "payorIdentification": "953402799"
    },
    "planInformation": {
      "planNumber": "1122334",
      "groupNumber": "111222333444555",
      "groupDescription": "New Jersey Plan"
    },
    "planDateInformation": {
      "planBegin": "20240401",
      "service": "20240917"
    },
    "planStatus": [
      {
        "statusCode": "1",
        "status": "Active Coverage",
        "planDetails": "Gold Plan",
        "serviceTypeCodes": [
          "30"
        ]
      },
      {
        "statusCode": "1",
        "status": "Active Coverage",
        "serviceTypeCodes": [
          "1",
          "33",
          "47",
          "48",
          "50",
          "86",
          "98",
          "UC",
          "MH",
          "AL"
        ]
      }
    ],
    "benefitsInformation": [
      {
        "code": "W",
        "name": "Other Source of Data",
        "inPlanNetworkIndicatorCode": "W",
        "inPlanNetworkIndicator": "Not Applicable",
        "benefitsRelatedEntity": {
          "entityIdentifier": "Payer",
          "entityType": "Non-Person Entity",
          "entityName": "Aetna",
          "address": {
            "address1": "202 Main St",
            "city": "El Paso",
            "state": "TX",
            "postalCode": "79998"
          }
        },
        "benefitsRelatedEntities": [
          {
            "entityIdentifier": "Payer",
            "entityType": "Non-Person Entity",
            "entityName": "Aetna",
            "address": {
              "address1": "202 Main St",
              "city": "El Paso",
              "state": "TX",
              "postalCode": "79998"
            }
          }
        ]
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "insuranceTypeCode": "PR",
        "insuranceType": "Preferred Provider Organization (PPO)",
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "W",
        "inPlanNetworkIndicator": "Not Applicable"
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "timeQualifierCode": "25",
        "timeQualifier": "Contract",
        "benefitAmount": "500",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "benefitsDateInformation": {
          "planBegin": "20240401"
        }
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "timeQualifierCode": "29",
        "timeQualifier": "Remaining",
        "benefitAmount": "500",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "G",
        "name": "Out of Pocket (Stop Loss)",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "timeQualifierCode": "25",
        "timeQualifier": "Contract",
        "benefitAmount": "7000",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "G",
        "name": "Out of Pocket (Stop Loss)",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "timeQualifierCode": "29",
        "timeQualifier": "Remaining",
        "benefitAmount": "7000",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "timeQualifierCode": "25",
        "timeQualifier": "Contract",
        "benefitAmount": "1000",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No",
        "benefitsDateInformation": {
          "planBegin": "20240401"
        }
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "timeQualifierCode": "29",
        "timeQualifier": "Remaining",
        "benefitAmount": "1000",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "G",
        "name": "Out of Pocket (Stop Loss)",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "timeQualifierCode": "25",
        "timeQualifier": "Contract",
        "benefitAmount": "14000",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "G",
        "name": "Out of Pocket (Stop Loss)",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "timeQualifierCode": "29",
        "timeQualifier": "Remaining",
        "benefitAmount": "14000",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "1",
          "33",
          "47",
          "48",
          "50",
          "86",
          "98",
          "UC",
          "MH",
          "AL"
        ],
        "serviceTypes": [
          "Medical Care",
          "Chiropractic",
          "Hospital",
          "Hospital - Inpatient",
          "Hospital - Outpatient",
          "Emergency Services",
          "Professional (Physician) Visit - Office",
          "Urgent Care",
          "Mental Health",
          "Vision (Optometry)"
        ],
        "inPlanNetworkIndicatorCode": "W",
        "inPlanNetworkIndicator": "Not Applicable"
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "33",
          "86",
          "98",
          "MH",
          "UC"
        ],
        "serviceTypes": [
          "Chiropractic",
          "Emergency Services",
          "Professional (Physician) Visit - Office",
          "Mental Health",
          "Urgent Care"
        ],
        "benefitPercent": "0",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Chiropractic"
          },
          {
            "description": "Office Visits"
          },
          {
            "description": "Urgent Care"
          },
          {
            "description": "Walk in Clinic"
          },
          {
            "description": "Mental Health (outpatient)"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "86"
        ],
        "serviceTypes": [
          "Emergency Services"
        ],
        "benefitPercent": "0.2",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Emergency Room"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "48",
          "50",
          "MH"
        ],
        "serviceTypes": [
          "Hospital - Inpatient",
          "Hospital - Outpatient",
          "Mental Health"
        ],
        "benefitPercent": "0.2",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "IP Hospital Room and Board"
          },
          {
            "description": "IP Hospital Miscellaneous"
          },
          {
            "description": "OP Hospital Miscellaneous"
          },
          {
            "description": "Mental Health (inpatient)"
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "33"
        ],
        "serviceTypes": [
          "Chiropractic"
        ],
        "benefitAmount": "25",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Chiropractic"
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "98",
          "MH",
          "UC"
        ],
        "serviceTypes": [
          "Professional (Physician) Visit - Office",
          "Mental Health",
          "Urgent Care"
        ],
        "benefitAmount": "30",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Office Visits"
          },
          {
            "description": "Walk in Clinic"
          },
          {
            "description": "Mental Health (outpatient)"
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "86",
          "UC"
        ],
        "serviceTypes": [
          "Emergency Services",
          "Urgent Care"
        ],
        "benefitAmount": "40",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Urgent Care"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "33",
          "48",
          "50",
          "86",
          "98",
          "MH",
          "UC"
        ],
        "serviceTypes": [
          "Chiropractic",
          "Hospital - Inpatient",
          "Hospital - Outpatient",
          "Emergency Services",
          "Professional (Physician) Visit - Office",
          "Mental Health",
          "Urgent Care"
        ],
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No",
        "additionalInformation": [
          {
            "description": "Chiropractic"
          },
          {
            "description": "IP Hospital Room and Board"
          },
          {
            "description": "IP Hospital Miscellaneous"
          },
          {
            "description": "Office Visits"
          },
          {
            "description": "Urgent Care"
          },
          {
            "description": "Walk in Clinic"
          },
          {
            "description": "OP Hospital Miscellaneous"
          },
          {
            "description": "Mental Health (inpatient)"
          },
          {
            "description": "Mental Health (outpatient)"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "86"
        ],
        "serviceTypes": [
          "Emergency Services"
        ],
        "benefitPercent": "0.2",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No",
        "additionalInformation": [
          {
            "description": "Emergency Room"
          }
        ]
      }
    ],
    "errors": [],
    "x12": "",
    "eligibilitySearchId": "019cbdde-310e-73f0-8ecb-3a7e51ca99c4"
  },
  "errors": []
}

======================================================================
CASE: 2. Cigna subscriber — active coverage (Rolando Arrojo)
======================================================================
STATUS: SUCCESS
RESULT:
{
  "status": "unknown",
  "eligible": true,
  "reference_id": "123456789",
  "plan_info": {
    "planInformation": {
      "groupNumber": "00123874",
      "groupDescription": "ACME, Inc."
    },
    "planDateInformation": {
      "planBegin": "20240101",
      "planEnd": "20241231",
      "eligibilityBegin": "20230101"
    },
    "benefitsInformation": [
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "2"
        ],
        "serviceTypes": [
          "Surgical"
        ],
        "benefitPercent": "0",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Preventive Colonoscopy"
          },
          {
            "description": "Cardiac"
          }
        ],
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "11",
          "industry": "Office"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "11",
            "industry": "Office"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "2",
          "7"
        ],
        "serviceTypes": [
          "Surgical",
          "Anesthesia"
        ],
        "benefitPercent": "0",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Preventive Colonoscopy"
          }
        ],
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "22",
          "industry": "Outpatient Hospital"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "22",
            "industry": "Outpatient Hospital"
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "2"
        ],
        "serviceTypes": [
          "Surgical"
        ],
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "20",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Cardiac"
          }
        ],
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "11",
          "industry": "Office"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "11",
            "industry": "Office"
          }
        ]
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "82"
        ],
        "serviceTypes": [
          "Family Planning"
        ],
        "benefitAmount": "0",
        "authOrCertIndicator": "Y",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Includes services provided by Client Specific Network"
          },
          {
            "description": "Benefit also applies to convenience care"
          }
        ],
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "11",
          "industry": "Office"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "11",
            "industry": "Office"
          }
        ]
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "82"
        ],
        "serviceTypes": [
          "Family Planning"
        ],
        "benefitAmount": "0",
        "authOrCertIndicator": "Y",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Includes services provided by Client Specific Network"
          },
          {
            "description": "Benefit also applies to convenience care"
          }
        ],
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "22",
          "industry": "Outpatient Hospital"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "22",
            "industry": "Outpatient Hospital"
          }
        ]
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "82"
        ],
        "serviceTypes": [
          "Family Planning"
        ],
        "benefitAmount": "0",
        "authOrCertIndicator": "Y",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Includes services provided by Client Specific Network"
          },
          {
            "description": "Benefit also applies to convenience care"
          }
        ],
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "21",
          "industry": "Inpatient Hospital"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "21",
            "industry": "Inpatient Hospital"
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "82"
        ],
        "serviceTypes": [
          "Family Planning"
        ],
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "20",
        "authOrCertIndicator": "Y",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Services rendered thru Client Specific Network"
          },
          {
            "description": "Benefit also applies to convenience care"
          }
        ],
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "11",
          "industry": "Office"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "11",
            "industry": "Office"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "82"
        ],
        "serviceTypes": [
          "Family Planning"
        ],
        "benefitPercent": "0",
        "authOrCertIndicator": "Y",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Services rendered thru Client Specific Network"
          },
          {
            "description": "Benefit also applies to convenience care"
          }
        ],
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "11",
          "industry": "Office"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "11",
            "industry": "Office"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "82"
        ],
        "serviceTypes": [
          "Family Planning"
        ],
        "benefitPercent": "0",
        "authOrCertIndicator": "Y",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Services rendered thru Client Specific Network"
          },
          {
            "description": "Benefit also applies to convenience care"
          }
        ],
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "22",
          "industry": "Outpatient Hospital"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "22",
            "industry": "Outpatient Hospital"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "82"
        ],
        "serviceTypes": [
          "Family Planning"
        ],
        "benefitPercent": "0",
        "authOrCertIndicator": "Y",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Services rendered thru Client Specific Network"
          },
          {
            "description": "Benefit also applies to convenience care"
          }
        ],
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "21",
          "industry": "Inpatient Hospital"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "21",
            "industry": "Inpatient Hospital"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "82",
          "81"
        ],
        "serviceTypes": [
          "Family Planning",
          "Routine Physical"
        ],
        "benefitPercent": "0",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Services rendered thru Client Specific Network"
          },
          {
            "description": "Benefit also applies to convenience care"
          }
        ],
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "11",
          "industry": "Office"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "11",
            "industry": "Office"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "82",
          "81"
        ],
        "serviceTypes": [
          "Family Planning",
          "Routine Physical"
        ],
        "benefitPercent": "0",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Services rendered thru Client Specific Network"
          },
          {
            "description": "Benefit also applies to convenience care"
          }
        ],
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "22",
          "industry": "Outpatient Hospital"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "22",
            "industry": "Outpatient Hospital"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "82",
          "81"
        ],
        "serviceTypes": [
          "Family Planning",
          "Routine Physical"
        ],
        "benefitPercent": "0",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Services rendered thru Client Specific Network"
          },
          {
            "description": "Benefit also applies to convenience care"
          }
        ],
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "99",
          "industry": "Other Place of Service"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "99",
            "industry": "Other Place of Service"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "82",
          "81"
        ],
        "serviceTypes": [
          "Family Planning",
          "Routine Physical"
        ],
        "benefitPercent": "0",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Services rendered thru Client Specific Network"
          },
          {
            "description": "Benefit also applies to convenience care"
          }
        ],
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "49",
          "industry": "Independent Clinic"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "49",
            "industry": "Independent Clinic"
          }
        ]
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "82",
          "81"
        ],
        "serviceTypes": [
          "Family Planning",
          "Routine Physical"
        ],
        "benefitAmount": "0",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Includes services provided by Client Specific Network"
          },
          {
            "description": "Benefit also applies to convenience care"
          }
        ],
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "11",
          "industry": "Office"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "11",
            "industry": "Office"
          }
        ]
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "82",
          "81"
        ],
        "serviceTypes": [
          "Family Planning",
          "Routine Physical"
        ],
        "benefitAmount": "0",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Includes services provided by Client Specific Network"
          },
          {
            "description": "Benefit also applies to convenience care"
          }
        ],
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "22",
          "industry": "Outpatient Hospital"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "22",
            "industry": "Outpatient Hospital"
          }
        ]
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "82",
          "81"
        ],
        "serviceTypes": [
          "Family Planning",
          "Routine Physical"
        ],
        "benefitAmount": "0",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Includes services provided by Client Specific Network"
          },
          {
            "description": "Benefit also applies to convenience care"
          }
        ],
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "99",
          "industry": "Other Place of Service"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "99",
            "industry": "Other Place of Service"
          }
        ]
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "82",
          "81"
        ],
        "serviceTypes": [
          "Family Planning",
          "Routine Physical"
        ],
        "benefitAmount": "0",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Includes services provided by Client Specific Network"
          },
          {
            "description": "Benefit also applies to convenience care"
          }
        ],
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "49",
          "industry": "Independent Clinic"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "49",
            "industry": "Independent Clinic"
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "82"
        ],
        "serviceTypes": [
          "Family Planning"
        ],
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "20",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Services rendered thru Client Specific Network"
          },
          {
            "description": "Benefit also applies to convenience care"
          }
        ],
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "11",
          "industry": "Office"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "11",
            "industry": "Office"
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "82"
        ],
        "serviceTypes": [
          "Family Planning"
        ],
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "20",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Services rendered thru Client Specific Network"
          },
          {
            "description": "Benefit also applies to convenience care"
          }
        ],
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "99",
          "industry": "Other Place of Service"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "99",
            "industry": "Other Place of Service"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "82"
        ],
        "serviceTypes": [
          "Family Planning"
        ],
        "benefitPercent": "0",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Including Women's Contraceptive Surgery"
          },
          {
            "description": "Contraceptive Management PCP"
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        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
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        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
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        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "69"
        ],
        "serviceTypes": [
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        ],
        "benefitPercent": "0",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Ultrasound"
          }
        ],
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
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          "industryCode": "22",
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        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
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        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
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        "serviceTypeCodes": [
          "69"
        ],
        "serviceTypes": [
          "Maternity"
        ],
        "benefitPercent": "0",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
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          {
            "description": "Ultrasound Specialist"
          },
          {
            "description": "Lab Specialist"
          },
          {
            "description": "Ultrasound PCP"
          },
          {
            "description": "Gestational Diabetes Screening"
          },
          {
            "description": "Lab PCP"
          }
        ],
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
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        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
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        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
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        "serviceTypeCodes": [
          "69"
        ],
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        ],
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        "inPlanNetworkIndicator": "Yes",
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          {
            "description": "Gestational Diabetes Screening"
          }
        ],
        "eligibilityAdditionalInformation": {
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        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
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        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
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        "serviceTypeCodes": [
          "75"
        ],
        "serviceTypes": [
          "Prosthetic Device"
        ],
        "benefitPercent": "0.1",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Including Mastectomy Bra"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
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        "serviceTypeCodes": [
          "75"
        ],
        "serviceTypes": [
          "Prosthetic Device"
        ],
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        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No",
        "additionalInformation": [
          {
            "description": "Including Mastectomy Bra"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "81",
          "AD",
          "AE"
        ],
        "serviceTypes": [
          "Routine Physical",
          "Occupational Therapy",
          "Physical Medicine"
        ],
        "benefitPercent": "0",
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        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
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        "coverageLevel": "Individual",
        "serviceTypeCodes": [
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          "AD",
          "AE",
          "64"
        ],
        "serviceTypes": [
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          "Occupational Therapy",
          "Physical Medicine",
          "Acupuncture"
        ],
        "benefitPercent": "0",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "11",
          "industry": "Office"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "11",
            "industry": "Office"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "81",
          "AD",
          "AE"
        ],
        "serviceTypes": [
          "Routine Physical",
          "Occupational Therapy",
          "Physical Medicine"
        ],
        "benefitPercent": "0",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Included For Specific Services"
          }
        ],
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "99",
          "industry": "Other Place of Service"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "99",
            "industry": "Other Place of Service"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "81"
        ],
        "serviceTypes": [
          "Routine Physical"
        ],
        "benefitPercent": "0",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Pap Smear"
          },
          {
            "description": "PSA and Prostate Exam"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "17"
        ],
        "serviceTypes": [
          "Pre-Admission Testing"
        ],
        "benefitPercent": "0",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Lab PCP"
          },
          {
            "description": "X-Ray PCP"
          },
          {
            "description": "Lab Specialist"
          },
          {
            "description": "X-Ray Specialist"
          }
        ],
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "11",
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        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
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            "industry": "Office"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "80"
        ],
        "serviceTypes": [
          "Immunizations"
        ],
        "benefitPercent": "0",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "HPV"
          },
          {
            "description": "General"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "80",
          "76",
          "19",
          "BH",
          "UC"
        ],
        "serviceTypes": [
          "Immunizations",
          "Dialysis",
          "Pneumonia Vaccine",
          "Pediatric",
          "Urgent Care"
        ],
        "benefitPercent": "0",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Services rendered thru Client Specific Network"
          }
        ]
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "80",
          "76",
          "19",
          "BH",
          "UC"
        ],
        "serviceTypes": [
          "Immunizations",
          "Dialysis",
          "Pneumonia Vaccine",
          "Pediatric",
          "Urgent Care"
        ],
        "benefitAmount": "0",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Includes services provided by Client Specific Network"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "76"
        ],
        "serviceTypes": [
          "Dialysis"
        ],
        "benefitPercent": "0",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "PCP - Included For Specific Services"
          },
          {
            "description": "PCP"
          },
          {
            "description": "Specialist - Included For Specific Services"
          },
          {
            "description": "Specialist"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "BG"
        ],
        "serviceTypes": [
          "Cardiac Rehabilitation"
        ],
        "benefitPercent": "0",
        "authOrCertIndicator": "Y",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Specialist"
          },
          {
            "description": "Requires prior authorization after 36 visit(s)"
          },
          {
            "description": "PCP"
          }
        ],
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "11",
          "industry": "Office"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "11",
            "industry": "Office"
          }
        ]
      },
      {
        "code": "F",
        "name": "Limitations",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "A1"
        ],
        "serviceTypes": [
          "Professional (Physician) Visit - Nursing Home"
        ],
        "timeQualifierCode": "23",
        "timeQualifier": "Calendar Year",
        "quantityQualifierCode": "VS",
        "quantityQualifier": "Visits",
        "benefitQuantity": "100",
        "authOrCertIndicator": "Y",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Includes services provided by Client Specific Network"
          },
          {
            "description": "Combined Home Health Care and Professional (Physician) Visit (Nursing Home)"
          },
          {
            "description": "Amounts apply to both in-network and out-of-network"
          }
        ]
      },
      {
        "code": "CB",
        "name": "Coverage Basis",
        "serviceTypeCodes": [
          "A1",
          "AG"
        ],
        "serviceTypes": [
          "Professional (Physician) Visit - Nursing Home",
          "Skilled Nursing Care"
        ],
        "authOrCertIndicator": "Y",
        "inPlanNetworkIndicatorCode": "W",
        "inPlanNetworkIndicator": "Not Applicable"
      },
      {
        "code": "F",
        "name": "Limitations",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "A1"
        ],
        "serviceTypes": [
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        "timeQualifierCode": "23",
        "timeQualifier": "Calendar Year",
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        "authOrCertIndicator": "Y",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No",
        "additionalInformation": [
          {
            "description": "Amounts apply to both in-network and out-of-network"
          },
          {
            "description": "Combined Home Health Care and Professional (Physician) Visit (Nursing Home)"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "BR"
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        "serviceTypes": [
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        ],
        "benefitPercent": "0",
        "authOrCertIndicator": "Y",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Cataract Surgery"
          }
        ],
        "eligibilityAdditionalInformation": {
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          "codeListQualifier": "Mutually Defined",
          "industryCode": "11",
          "industry": "Office"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "11",
            "industry": "Office"
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        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
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        ],
        "serviceTypes": [
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        ],
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "20",
        "authOrCertIndicator": "Y",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Cataract Surgery"
          }
        ],
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "11",
          "industry": "Office"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "11",
            "industry": "Office"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "BR"
        ],
        "serviceTypes": [
          "Eye"
        ],
        "benefitPercent": "0",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Glaucoma Screening Specialist"
          },
          {
            "description": "Specialist"
          },
          {
            "description": "PCP"
          },
          {
            "description": "Glaucoma Screening PCP"
          }
        ],
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "11",
          "industry": "Office"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
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          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "73"
        ],
        "serviceTypes": [
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        ],
        "benefitPercent": "0",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "PCP"
          },
          {
            "description": "Pulmonary PCP"
          },
          {
            "description": "Specialist"
          },
          {
            "description": "Pulmonary Specialist"
          }
        ],
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
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          "industry": "Office"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
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          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "8",
          "7"
        ],
        "serviceTypes": [
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          "Anesthesia"
        ],
        "benefitPercent": "0",
        "authOrCertIndicator": "Y",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "General"
          }
        ],
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "11",
          "industry": "Office"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
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            "industry": "Office"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "7"
        ],
        "serviceTypes": [
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        ],
        "benefitPercent": "0",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Preventive Colonoscopy"
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        ],
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "11",
          "industry": "Office"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
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            "industry": "Office"
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "70",
          "AF"
        ],
        "serviceTypes": [
          "Transplants",
          "Speech Therapy"
        ],
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "20",
        "authOrCertIndicator": "Y",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "11",
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        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
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        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
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        "serviceTypeCodes": [
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          "97",
          "AF"
        ],
        "serviceTypes": [
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          "Anesthesiologist",
          "Speech Therapy"
        ],
        "benefitPercent": "0",
        "authOrCertIndicator": "Y",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
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        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
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            "industry": "Office"
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        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
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          "UC"
        ],
        "serviceTypes": [
          "Pneumonia Vaccine",
          "Urgent Care"
        ],
        "benefitPercent": "0",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "AD",
          "AE"
        ],
        "serviceTypes": [
          "Occupational Therapy",
          "Physical Medicine"
        ],
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "20",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Services rendered thru Client Specific Network"
          }
        ],
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "22",
          "industry": "Outpatient Hospital"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
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            "industry": "Outpatient Hospital"
          }
        ]
      },
      {
        "code": "B",
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        "benefitQuantity": "100",
        "authOrCertIndicator": "Y",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Includes services provided by Client Specific Network"
          },
          {
            "description": "Combined Home Health Care and Professional (Physician) Visit (Nursing Home)"
          },
          {
            "description": "Amounts apply to both in-network and out-of-network"
          }
        ]
      },
      {
        "code": "CB",
        "name": "Coverage Basis",
        "serviceTypeCodes": [
          "A1",
          "AG"
        ],
        "serviceTypes": [
          "Professional (Physician) Visit - Nursing Home",
          "Skilled Nursing Care"
        ],
        "authOrCertIndicator": "Y",
        "inPlanNetworkIndicatorCode": "W",
        "inPlanNetworkIndicator": "Not Applicable"
      },
      {
        "code": "F",
        "name": "Limitations",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "A1"
        ],
        "serviceTypes": [
          "Professional (Physician) Visit - Nursing Home"
        ],
        "timeQualifierCode": "23",
        "timeQualifier": "Calendar Year",
        "quantityQualifierCode": "VS",
        "quantityQualifier": "Visits",
        "benefitQuantity": "100",
        "authOrCertIndicator": "Y",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No",
        "additionalInformation": [
          {
            "description": "Amounts apply to both in-network and out-of-network"
          },
          {
            "description": "Combined Home Health Care and Professional (Physician) Visit (Nursing Home)"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "BR"
        ],
        "serviceTypes": [
          "Eye"
        ],
        "benefitPercent": "0",
        "authOrCertIndicator": "Y",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Cataract Surgery"
          }
        ],
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "11",
          "industry": "Office"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "11",
            "industry": "Office"
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "BR"
        ],
        "serviceTypes": [
          "Eye"
        ],
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "20",
        "authOrCertIndicator": "Y",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Cataract Surgery"
          }
        ],
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "11",
          "industry": "Office"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "11",
            "industry": "Office"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "BR"
        ],
        "serviceTypes": [
          "Eye"
        ],
        "benefitPercent": "0",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Glaucoma Screening Specialist"
          },
          {
            "description": "Specialist"
          },
          {
            "description": "PCP"
          },
          {
            "description": "Glaucoma Screening PCP"
          }
        ],
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "11",
          "industry": "Office"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "11",
            "industry": "Office"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "73"
        ],
        "serviceTypes": [
          "Diagnostic Medical"
        ],
        "benefitPercent": "0",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "PCP"
          },
          {
            "description": "Pulmonary PCP"
          },
          {
            "description": "Specialist"
          },
          {
            "description": "Pulmonary Specialist"
          }
        ],
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "11",
          "industry": "Office"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "11",
            "industry": "Office"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "8",
          "7"
        ],
        "serviceTypes": [
          "Surgical Assistance",
          "Anesthesia"
        ],
        "benefitPercent": "0",
        "authOrCertIndicator": "Y",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "General"
          }
        ],
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "11",
          "industry": "Office"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "11",
            "industry": "Office"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "7"
        ],
        "serviceTypes": [
          "Anesthesia"
        ],
        "benefitPercent": "0",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Preventive Colonoscopy"
          }
        ],
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "11",
          "industry": "Office"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "11",
            "industry": "Office"
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "70",
          "AF"
        ],
        "serviceTypes": [
          "Transplants",
          "Speech Therapy"
        ],
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "20",
        "authOrCertIndicator": "Y",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "11",
          "industry": "Office"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "11",
            "industry": "Office"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "70",
          "97",
          "AF"
        ],
        "serviceTypes": [
          "Transplants",
          "Anesthesiologist",
          "Speech Therapy"
        ],
        "benefitPercent": "0",
        "authOrCertIndicator": "Y",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "11",
          "industry": "Office"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "11",
            "industry": "Office"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "19",
          "UC"
        ],
        "serviceTypes": [
          "Pneumonia Vaccine",
          "Urgent Care"
        ],
        "benefitPercent": "0",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "AD",
          "AE"
        ],
        "serviceTypes": [
          "Occupational Therapy",
          "Physical Medicine"
        ],
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "20",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Services rendered thru Client Specific Network"
          }
        ],
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "22",
          "industry": "Outpatient Hospital"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "22",
            "industry": "Outpatient Hospital"
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "AD",
          "AE"
        ],
        "serviceTypes": [
          "Occupational Therapy",
          "Physical Medicine"
        ],
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "20",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "22",
          "industry": "Outpatient Hospital"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "22",
            "industry": "Outpatient Hospital"
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "AD",
          "AE",
          "64"
        ],
        "serviceTypes": [
          "Occupational Therapy",
          "Physical Medicine",
          "Acupuncture"
        ],
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "20",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "11",
          "industry": "Office"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "11",
            "industry": "Office"
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "UC"
        ],
        "serviceTypes": [
          "Urgent Care"
        ],
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "50",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "UC"
        ],
        "serviceTypes": [
          "Urgent Care"
        ],
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "50",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Services rendered thru Client Specific Network"
          }
        ]
      },
      {
        "code": "F",
        "name": "Limitations",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "AG"
        ],
        "serviceTypes": [
          "Skilled Nursing Care"
        ],
        "timeQualifierCode": "23",
        "timeQualifier": "Calendar Year",
        "quantityQualifierCode": "DY",
        "quantityQualifier": "Days",
        "benefitQuantity": "100",
        "authOrCertIndicator": "Y",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Includes services provided by Client Specific Network"
          },
          {
            "description": "Amounts apply to both in-network and out-of-network"
          }
        ]
      },
      {
        "code": "F",
        "name": "Limitations",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "AG"
        ],
        "serviceTypes": [
          "Skilled Nursing Care"
        ],
        "timeQualifierCode": "23",
        "timeQualifier": "Calendar Year",
        "quantityQualifierCode": "DY",
        "quantityQualifier": "Days",
        "benefitQuantity": "100",
        "authOrCertIndicator": "Y",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No",
        "additionalInformation": [
          {
            "description": "Amounts apply to both in-network and out-of-network"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "33"
        ],
        "serviceTypes": [
          "Chiropractic"
        ],
        "benefitPercent": "0",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Virtual Care Included For Specific Services"
          }
        ],
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "11",
          "industry": "Office"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "11",
            "industry": "Office"
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "33"
        ],
        "serviceTypes": [
          "Chiropractic"
        ],
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "20",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Virtual Care Included For Specific Services"
          }
        ],
        "eligibilityAdditionalInformation": {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "11",
          "industry": "Office"
        },
        "eligibilityAdditionalInformationList": [
          {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "11",
            "industry": "Office"
          }
        ]
      },
      {
        "code": "F",
        "name": "Limitations",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "33"
        ],
        "serviceTypes": [
          "Chiropractic"
        ],
        "timeQualifierCode": "23",
        "timeQualifier": "Calendar Year",
        "quantityQualifierCode": "VS",
        "quantityQualifier": "Visits",
        "benefitQuantity": "25",
        "authOrCertIndicator": "N",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Includes services provided by Client Specific Network"
          },
          {
            "description": "Amounts apply to both in-network and out-of-network"
          }
        ]
      },
      {
        "code": "F",
        "name": "Limitations",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "33"
        ],
        "serviceTypes": [
          "Chiropractic"
        ],
        "timeQualifierCode": "29",
        "timeQualifier": "Remaining",
        "quantityQualifierCode": "VS",
        "quantityQualifier": "Visits",
        "benefitQuantity": "25",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No",
        "additionalInformation": [
          {
            "description": "Virtual Care Included For Specific Services"
          },
          {
            "description": "Amounts apply to both in-network and out-of-network"
          }
        ]
      },
      {
        "code": "F",
        "name": "Limitations",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "64"
        ],
        "serviceTypes": [
          "Acupuncture"
        ],
        "timeQualifierCode": "29",
        "timeQualifier": "Remaining",
        "quantityQualifierCode": "VS",
        "quantityQualifier": "Visits",
        "benefitQuantity": "20",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No",
        "additionalInformation": [
          {
            "description": "Amounts apply to both in-network and out-of-network"
          }
        ]
      },
      {
        "code": "F",
        "name": "Limitations",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "64"
        ],
        "serviceTypes": [
          "Acupuncture"
        ],
        "timeQualifierCode": "29",
        "timeQualifier": "Remaining",
        "quantityQualifierCode": "VS",
        "quantityQualifier": "Visits",
        "benefitQuantity": "20",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Includes services provided by Client Specific Network"
          },
          {
            "description": "Amounts apply to both in-network and out-of-network"
          }
        ]
      }
    ],
    "errors": [],
    "eligibilitySearchId": "019cbdde-33d9-79d0-94f3-d74e054733ac"
  },
  "errors": []
}

======================================================================
CASE: 3. Ambetter subscriber — active coverage
======================================================================
STATUS: SUCCESS
RESULT:
{
  "status": "unknown",
  "eligible": true,
  "reference_id": "112233445",
  "plan_info": {
    "planInformation": {
      "planNumber": "11111AA2222222-33",
      "planDescription": "MO PLAN"
    },
    "planDateInformation": {
      "premiumPaidToDateEnd": "20241231",
      "planBegin": "20240101",
      "planEnd": "20241231",
      "dateOfLastUpdate": "20240917"
    },
    "benefitsInformation": [
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "W",
        "inPlanNetworkIndicator": "Not Applicable",
        "benefitsRelatedEntity": {
          "entityIdentifier": "Primary Care Provider",
          "entityType": "Person",
          "entityName": "Dough",
          "entityFirstname": "Jane",
          "entityIdentification": "XX",
          "entityIdentificationValue": "1234567890"
        },
        "benefitsRelatedEntities": [
          {
            "entityIdentifier": "Primary Care Provider",
            "entityType": "Person",
            "entityName": "Dough",
            "entityFirstname": "Jane",
            "entityIdentification": "XX",
            "entityIdentificationValue": "1234567890"
          }
        ],
        "additionalInformation": [
          {
            "description": "To determine if a prior authorization is required, please check the health plan's website."
          }
        ]
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "1"
        ],
        "serviceTypes": [
          "Medical Care"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "W",
        "inPlanNetworkIndicator": "Not Applicable"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "4"
        ],
        "serviceTypes": [
          "Diagnostic X-Ray"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Prior authorization may be required. Covered No Limit."
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "4"
        ],
        "serviceTypes": [
          "Diagnostic X-Ray"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "4"
        ],
        "serviceTypes": [
          "Diagnostic X-Ray"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "5"
        ],
        "serviceTypes": [
          "Diagnostic Lab"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "5"
        ],
        "serviceTypes": [
          "Diagnostic Lab"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "20",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "per visit"
          }
        ]
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "5"
        ],
        "serviceTypes": [
          "Diagnostic Lab"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "12"
        ],
        "serviceTypes": [
          "Durable Medical Equipment Purchase"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Prior authorization may be required. Covered No Limit."
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "12"
        ],
        "serviceTypes": [
          "Durable Medical Equipment Purchase"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "12"
        ],
        "serviceTypes": [
          "Durable Medical Equipment Purchase"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "13"
        ],
        "serviceTypes": [
          "Ambulatory Service Center Facility"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "13"
        ],
        "serviceTypes": [
          "Ambulatory Service Center Facility"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "13"
        ],
        "serviceTypes": [
          "Ambulatory Service Center Facility"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "18"
        ],
        "serviceTypes": [
          "Durable Medical Equipment Rental"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Prior authorization may be required. Covered No Limit."
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "18"
        ],
        "serviceTypes": [
          "Durable Medical Equipment Rental"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "18"
        ],
        "serviceTypes": [
          "Durable Medical Equipment Rental"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "33"
        ],
        "serviceTypes": [
          "Chiropractic"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Limited to 26 visits per year (visits in excess of 26 require prior authorization)."
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "33"
        ],
        "serviceTypes": [
          "Chiropractic"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "33"
        ],
        "serviceTypes": [
          "Chiropractic"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "V",
        "name": "Other Source of Data",
        "serviceTypeCodes": [
          "35"
        ],
        "serviceTypes": [
          "Dental Care"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "V",
        "name": "Other Source of Data",
        "serviceTypeCodes": [
          "35"
        ],
        "serviceTypes": [
          "Dental Care"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "48"
        ],
        "serviceTypes": [
          "Hospital - Inpatient"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Prior authorization may be required. Covered No Limit."
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "48"
        ],
        "serviceTypes": [
          "Hospital - Inpatient"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "48"
        ],
        "serviceTypes": [
          "Hospital - Inpatient"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "50"
        ],
        "serviceTypes": [
          "Hospital - Outpatient"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Prior authorization may be required. Covered No Limit."
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "50"
        ],
        "serviceTypes": [
          "Hospital - Outpatient"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "50"
        ],
        "serviceTypes": [
          "Hospital - Outpatient"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "51"
        ],
        "serviceTypes": [
          "Hospital - Emergency Accident"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Covered No Limit."
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "51"
        ],
        "serviceTypes": [
          "Hospital - Emergency Accident"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "51"
        ],
        "serviceTypes": [
          "Hospital - Emergency Accident"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No",
        "additionalInformation": [
          {
            "description": "Covered No Limit."
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "51"
        ],
        "serviceTypes": [
          "Hospital - Emergency Accident"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "52"
        ],
        "serviceTypes": [
          "Hospital - Emergency Medical"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Covered No Limit."
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "52"
        ],
        "serviceTypes": [
          "Hospital - Emergency Medical"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "52"
        ],
        "serviceTypes": [
          "Hospital - Emergency Medical"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No",
        "additionalInformation": [
          {
            "description": "Covered No Limit."
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "52"
        ],
        "serviceTypes": [
          "Hospital - Emergency Medical"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "53"
        ],
        "serviceTypes": [
          "Hospital - Ambulatory Surgical"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "53"
        ],
        "serviceTypes": [
          "Hospital - Ambulatory Surgical"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "53"
        ],
        "serviceTypes": [
          "Hospital - Ambulatory Surgical"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "62"
        ],
        "serviceTypes": [
          "MRI/CAT Scan"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Prior authorization may be required. Covered No Limit."
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "62"
        ],
        "serviceTypes": [
          "MRI/CAT Scan"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "62"
        ],
        "serviceTypes": [
          "MRI/CAT Scan"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "65"
        ],
        "serviceTypes": [
          "Newborn Care"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Prior authorization may be required. Covered No Limit."
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "65"
        ],
        "serviceTypes": [
          "Newborn Care"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "65"
        ],
        "serviceTypes": [
          "Newborn Care"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "68"
        ],
        "serviceTypes": [
          "Well Baby Care"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Covered in accordance with ACA guidelines."
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "68"
        ],
        "serviceTypes": [
          "Well Baby Care"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "0",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "68"
        ],
        "serviceTypes": [
          "Well Baby Care"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "69"
        ],
        "serviceTypes": [
          "Maternity"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Prior authorization may be required. Covered No Limit."
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "69"
        ],
        "serviceTypes": [
          "Maternity"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "69"
        ],
        "serviceTypes": [
          "Maternity"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "86"
        ],
        "serviceTypes": [
          "Emergency Services"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Covered No Limit."
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "86"
        ],
        "serviceTypes": [
          "Emergency Services"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "86"
        ],
        "serviceTypes": [
          "Emergency Services"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No",
        "additionalInformation": [
          {
            "description": "Covered No Limit."
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "86"
        ],
        "serviceTypes": [
          "Emergency Services"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "88"
        ],
        "serviceTypes": [
          "Pharmacy"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "88"
        ],
        "serviceTypes": [
          "Pharmacy"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "10",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "per prescription"
          }
        ]
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "88"
        ],
        "serviceTypes": [
          "Pharmacy"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "98"
        ],
        "serviceTypes": [
          "Professional (Physician) Visit - Office"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "PCP"
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "98"
        ],
        "serviceTypes": [
          "Professional (Physician) Visit - Office"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "15",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "per visit"
          },
          {
            "description": "PCP"
          }
        ]
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "98"
        ],
        "serviceTypes": [
          "Professional (Physician) Visit - Office"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No",
        "additionalInformation": [
          {
            "description": "PCP"
          }
        ]
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "98"
        ],
        "serviceTypes": [
          "Professional (Physician) Visit - Office"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Specialist"
          },
          {
            "description": "Covered No Limit."
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "98"
        ],
        "serviceTypes": [
          "Professional (Physician) Visit - Office"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "30",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "per visit"
          },
          {
            "description": "Specialist"
          }
        ]
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "98"
        ],
        "serviceTypes": [
          "Professional (Physician) Visit - Office"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No",
        "additionalInformation": [
          {
            "description": "Specialist"
          }
        ]
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "A4"
        ],
        "serviceTypes": [
          "Psychiatric"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "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"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "A4"
        ],
        "serviceTypes": [
          "Psychiatric"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "A4"
        ],
        "serviceTypes": [
          "Psychiatric"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "A6"
        ],
        "serviceTypes": [
          "Psychotherapy"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "A6"
        ],
        "serviceTypes": [
          "Psychotherapy"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "A6"
        ],
        "serviceTypes": [
          "Psychotherapy"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "A7"
        ],
        "serviceTypes": [
          "Psychiatric - Inpatient"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "A7"
        ],
        "serviceTypes": [
          "Psychiatric - Inpatient"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "A7"
        ],
        "serviceTypes": [
          "Psychiatric - Inpatient"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "A8"
        ],
        "serviceTypes": [
          "Psychiatric - Outpatient"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "A8"
        ],
        "serviceTypes": [
          "Psychiatric - Outpatient"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "A8"
        ],
        "serviceTypes": [
          "Psychiatric - Outpatient"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "AD"
        ],
        "serviceTypes": [
          "Occupational Therapy"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "AD"
        ],
        "serviceTypes": [
          "Occupational Therapy"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "AD"
        ],
        "serviceTypes": [
          "Occupational Therapy"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "AF"
        ],
        "serviceTypes": [
          "Speech Therapy"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "AF"
        ],
        "serviceTypes": [
          "Speech Therapy"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "AF"
        ],
        "serviceTypes": [
          "Speech Therapy"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "AG"
        ],
        "serviceTypes": [
          "Skilled Nursing Care"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Prior authorization may be required. Limited to 150 days per year."
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "AG"
        ],
        "serviceTypes": [
          "Skilled Nursing Care"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "AG"
        ],
        "serviceTypes": [
          "Skilled Nursing Care"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "V",
        "name": "Other Source of Data",
        "serviceTypeCodes": [
          "AL"
        ],
        "serviceTypes": [
          "Vision (Optometry)"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "V",
        "name": "Other Source of Data",
        "serviceTypeCodes": [
          "AL"
        ],
        "serviceTypes": [
          "Vision (Optometry)"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "BZ"
        ],
        "serviceTypes": [
          "Physician Visit - Office: Well"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Covered in accordance with ACA guidelines."
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "BZ"
        ],
        "serviceTypes": [
          "Physician Visit - Office: Well"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "0",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "BZ"
        ],
        "serviceTypes": [
          "Physician Visit - Office: Well"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "MH"
        ],
        "serviceTypes": [
          "Mental Health"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Prior authorization may be required. Covered No Limit."
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "MH"
        ],
        "serviceTypes": [
          "Mental Health"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "MH"
        ],
        "serviceTypes": [
          "Mental Health"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "PT"
        ],
        "serviceTypes": [
          "Physical Therapy"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "PT"
        ],
        "serviceTypes": [
          "Physical Therapy"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "15",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "per visit"
          }
        ]
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "PT"
        ],
        "serviceTypes": [
          "Physical Therapy"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "UC"
        ],
        "serviceTypes": [
          "Urgent Care"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Covered No Limit."
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "UC"
        ],
        "serviceTypes": [
          "Urgent Care"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "10",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "per visit"
          }
        ]
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "UC"
        ],
        "serviceTypes": [
          "Urgent Care"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No",
        "additionalInformation": [
          {
            "description": "Covered No Limit."
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "UC"
        ],
        "serviceTypes": [
          "Urgent Care"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "10",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No",
        "additionalInformation": [
          {
            "description": "per visit"
          }
        ]
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "23",
        "timeQualifier": "Calendar Year",
        "benefitAmount": "0",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "29",
        "timeQualifier": "Remaining",
        "benefitAmount": "0",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "23",
        "timeQualifier": "Calendar Year",
        "benefitAmount": "0",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "29",
        "timeQualifier": "Remaining",
        "benefitAmount": "0",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "23",
        "timeQualifier": "Calendar Year",
        "benefitAmount": "0",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "29",
        "timeQualifier": "Remaining",
        "benefitAmount": "0",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "23",
        "timeQualifier": "Calendar Year",
        "benefitAmount": "0",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "29",
        "timeQualifier": "Remaining",
        "benefitAmount": "0",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "G",
        "name": "Out of Pocket (Stop Loss)",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "23",
        "timeQualifier": "Calendar Year",
        "benefitAmount": "3000",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "G",
        "name": "Out of Pocket (Stop Loss)",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "29",
        "timeQualifier": "Remaining",
        "benefitAmount": "2000",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "G",
        "name": "Out of Pocket (Stop Loss)",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "23",
        "timeQualifier": "Calendar Year",
        "benefitAmount": "6000",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "G",
        "name": "Out of Pocket (Stop Loss)",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "29",
        "timeQualifier": "Remaining",
        "benefitAmount": "5000",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "G",
        "name": "Out of Pocket (Stop Loss)",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "23",
        "timeQualifier": "Calendar Year",
        "benefitAmount": "0",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "G",
        "name": "Out of Pocket (Stop Loss)",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "29",
        "timeQualifier": "Remaining",
        "benefitAmount": "0",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "G",
        "name": "Out of Pocket (Stop Loss)",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "23",
        "timeQualifier": "Calendar Year",
        "benefitAmount": "0",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "G",
        "name": "Out of Pocket (Stop Loss)",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "29",
        "timeQualifier": "Remaining",
        "benefitAmount": "0",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      }
    ],
    "planStatus": [
      {
        "statusCode": "1",
        "status": "Active Coverage",
        "planDetails": "Gold Plan",
        "serviceTypeCodes": [
          "30"
        ]
      },
      {
        "statusCode": "1",
        "status": "Active Coverage",
        "planDetails": "Gold Plan",
        "serviceTypeCodes": [
          "1"
        ]
      },
      {
        "statusCode": "1",
        "status": "Active Coverage",
        "planDetails": "Gold Plan",
        "serviceTypeCodes": [
          "4"
        ]
      },
      {
        "statusCode": "1",
        "status": "Active Coverage",
        "planDetails": "Gold Plan",
        "serviceTypeCodes": [
          "5"
        ]
      },
      {
        "statusCode": "1",
        "status": "Active Coverage",
        "planDetails": "Gold Plan",
        "serviceTypeCodes": [
          "12"
        ]
      },
      {
        "statusCode": "1",
        "status": "Active Coverage",
        "planDetails": "Gold Plan",
        "serviceTypeCodes": [
          "13"
        ]
      },
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      },
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        "statusCode": "1",
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        "serviceTypeCodes": [
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      },
      {
        "statusCode": "1",
        "status": "Active Coverage",
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        "serviceTypeCodes": [
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      },
      {
        "statusCode": "1",
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        "serviceTypeCodes": [
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        "serviceTypeCodes": [
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      },
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        "statusCode": "1",
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        "statusCode": "1",
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        "serviceTypeCodes": [
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      },
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        "statusCode": "1",
        "status": "Active Coverage",
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        "statusCode": "1",
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      },
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      },
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        "status": "Active Coverage",
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        "serviceTypeCodes": [
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      },
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        "status": "Active Coverage",
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        "serviceTypeCodes": [
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      }
    ],
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        "benefitsRelatedEntities": [
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        "code": "1",
        "name": "Active Coverage",
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        ],
        "serviceTypes": [
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        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Prior authorization may be required. Covered No Limit."
          }
        ]
      },
      {
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        "name": "Co-Insurance",
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        ],
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        "timeQualifierCode": "27",
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        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "4"
        ],
        "serviceTypes": [
          "Diagnostic X-Ray"
        ],
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      {
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        "name": "Active Coverage",
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        "serviceTypes": [
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        "serviceTypeCodes": [
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        ],
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        "benefitAmount": "20",
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        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "per visit"
          }
        ]
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "5"
        ],
        "serviceTypes": [
          "Diagnostic Lab"
        ],
        "planCoverage": "Gold Plan",
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        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
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        "serviceTypeCodes": [
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        ],
        "serviceTypes": [
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        "planCoverage": "Gold Plan",
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        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Prior authorization may be required. Covered No Limit."
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
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        ],
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        ],
        "planCoverage": "Gold Plan",
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        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "12"
        ],
        "serviceTypes": [
          "Durable Medical Equipment Purchase"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "13"
        ],
        "serviceTypes": [
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        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "13"
        ],
        "serviceTypes": [
          "Ambulatory Service Center Facility"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "13"
        ],
        "serviceTypes": [
          "Ambulatory Service Center Facility"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "18"
        ],
        "serviceTypes": [
          "Durable Medical Equipment Rental"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Prior authorization may be required. Covered No Limit."
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "18"
        ],
        "serviceTypes": [
          "Durable Medical Equipment Rental"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "18"
        ],
        "serviceTypes": [
          "Durable Medical Equipment Rental"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "33"
        ],
        "serviceTypes": [
          "Chiropractic"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Limited to 26 visits per year (visits in excess of 26 require prior authorization)."
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        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "33"
        ],
        "serviceTypes": [
          "Chiropractic"
        ],
        "planCoverage": "Gold Plan",
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        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "33"
        ],
        "serviceTypes": [
          "Chiropractic"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "V",
        "name": "Other Source of Data",
        "serviceTypeCodes": [
          "35"
        ],
        "serviceTypes": [
          "Dental Care"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "V",
        "name": "Other Source of Data",
        "serviceTypeCodes": [
          "35"
        ],
        "serviceTypes": [
          "Dental Care"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
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        ],
        "serviceTypes": [
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        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Prior authorization may be required. Covered No Limit."
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "48"
        ],
        "serviceTypes": [
          "Hospital - Inpatient"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "48"
        ],
        "serviceTypes": [
          "Hospital - Inpatient"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "50"
        ],
        "serviceTypes": [
          "Hospital - Outpatient"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Prior authorization may be required. Covered No Limit."
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "50"
        ],
        "serviceTypes": [
          "Hospital - Outpatient"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "50"
        ],
        "serviceTypes": [
          "Hospital - Outpatient"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "51"
        ],
        "serviceTypes": [
          "Hospital - Emergency Accident"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Covered No Limit."
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "51"
        ],
        "serviceTypes": [
          "Hospital - Emergency Accident"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "51"
        ],
        "serviceTypes": [
          "Hospital - Emergency Accident"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No",
        "additionalInformation": [
          {
            "description": "Covered No Limit."
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "51"
        ],
        "serviceTypes": [
          "Hospital - Emergency Accident"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "52"
        ],
        "serviceTypes": [
          "Hospital - Emergency Medical"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Covered No Limit."
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "52"
        ],
        "serviceTypes": [
          "Hospital - Emergency Medical"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "52"
        ],
        "serviceTypes": [
          "Hospital - Emergency Medical"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No",
        "additionalInformation": [
          {
            "description": "Covered No Limit."
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "52"
        ],
        "serviceTypes": [
          "Hospital - Emergency Medical"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "53"
        ],
        "serviceTypes": [
          "Hospital - Ambulatory Surgical"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "53"
        ],
        "serviceTypes": [
          "Hospital - Ambulatory Surgical"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "53"
        ],
        "serviceTypes": [
          "Hospital - Ambulatory Surgical"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "62"
        ],
        "serviceTypes": [
          "MRI/CAT Scan"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Prior authorization may be required. Covered No Limit."
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "62"
        ],
        "serviceTypes": [
          "MRI/CAT Scan"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "62"
        ],
        "serviceTypes": [
          "MRI/CAT Scan"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "65"
        ],
        "serviceTypes": [
          "Newborn Care"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Prior authorization may be required. Covered No Limit."
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "65"
        ],
        "serviceTypes": [
          "Newborn Care"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "65"
        ],
        "serviceTypes": [
          "Newborn Care"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "68"
        ],
        "serviceTypes": [
          "Well Baby Care"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Covered in accordance with ACA guidelines."
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "68"
        ],
        "serviceTypes": [
          "Well Baby Care"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "0",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "68"
        ],
        "serviceTypes": [
          "Well Baby Care"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "69"
        ],
        "serviceTypes": [
          "Maternity"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Prior authorization may be required. Covered No Limit."
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "69"
        ],
        "serviceTypes": [
          "Maternity"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "69"
        ],
        "serviceTypes": [
          "Maternity"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "86"
        ],
        "serviceTypes": [
          "Emergency Services"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Covered No Limit."
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "86"
        ],
        "serviceTypes": [
          "Emergency Services"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "86"
        ],
        "serviceTypes": [
          "Emergency Services"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No",
        "additionalInformation": [
          {
            "description": "Covered No Limit."
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "86"
        ],
        "serviceTypes": [
          "Emergency Services"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "88"
        ],
        "serviceTypes": [
          "Pharmacy"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "88"
        ],
        "serviceTypes": [
          "Pharmacy"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "10",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "per prescription"
          }
        ]
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "88"
        ],
        "serviceTypes": [
          "Pharmacy"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "98"
        ],
        "serviceTypes": [
          "Professional (Physician) Visit - Office"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "PCP"
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "98"
        ],
        "serviceTypes": [
          "Professional (Physician) Visit - Office"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "15",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "per visit"
          },
          {
            "description": "PCP"
          }
        ]
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "98"
        ],
        "serviceTypes": [
          "Professional (Physician) Visit - Office"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No",
        "additionalInformation": [
          {
            "description": "PCP"
          }
        ]
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "98"
        ],
        "serviceTypes": [
          "Professional (Physician) Visit - Office"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Specialist"
          },
          {
            "description": "Covered No Limit."
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "98"
        ],
        "serviceTypes": [
          "Professional (Physician) Visit - Office"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "30",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "per visit"
          },
          {
            "description": "Specialist"
          }
        ]
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "98"
        ],
        "serviceTypes": [
          "Professional (Physician) Visit - Office"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No",
        "additionalInformation": [
          {
            "description": "Specialist"
          }
        ]
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "A4"
        ],
        "serviceTypes": [
          "Psychiatric"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "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"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "A4"
        ],
        "serviceTypes": [
          "Psychiatric"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "A4"
        ],
        "serviceTypes": [
          "Psychiatric"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "A6"
        ],
        "serviceTypes": [
          "Psychotherapy"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "A6"
        ],
        "serviceTypes": [
          "Psychotherapy"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "A6"
        ],
        "serviceTypes": [
          "Psychotherapy"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "A7"
        ],
        "serviceTypes": [
          "Psychiatric - Inpatient"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "A7"
        ],
        "serviceTypes": [
          "Psychiatric - Inpatient"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "A7"
        ],
        "serviceTypes": [
          "Psychiatric - Inpatient"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "A8"
        ],
        "serviceTypes": [
          "Psychiatric - Outpatient"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "A8"
        ],
        "serviceTypes": [
          "Psychiatric - Outpatient"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "A8"
        ],
        "serviceTypes": [
          "Psychiatric - Outpatient"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "AD"
        ],
        "serviceTypes": [
          "Occupational Therapy"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "AD"
        ],
        "serviceTypes": [
          "Occupational Therapy"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "AD"
        ],
        "serviceTypes": [
          "Occupational Therapy"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "AF"
        ],
        "serviceTypes": [
          "Speech Therapy"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "AF"
        ],
        "serviceTypes": [
          "Speech Therapy"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "AF"
        ],
        "serviceTypes": [
          "Speech Therapy"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "AG"
        ],
        "serviceTypes": [
          "Skilled Nursing Care"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Prior authorization may be required. Limited to 150 days per year."
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "AG"
        ],
        "serviceTypes": [
          "Skilled Nursing Care"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "AG"
        ],
        "serviceTypes": [
          "Skilled Nursing Care"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "V",
        "name": "Other Source of Data",
        "serviceTypeCodes": [
          "AL"
        ],
        "serviceTypes": [
          "Vision (Optometry)"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "V",
        "name": "Other Source of Data",
        "serviceTypeCodes": [
          "AL"
        ],
        "serviceTypes": [
          "Vision (Optometry)"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "BZ"
        ],
        "serviceTypes": [
          "Physician Visit - Office: Well"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Covered in accordance with ACA guidelines."
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "BZ"
        ],
        "serviceTypes": [
          "Physician Visit - Office: Well"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "0",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "BZ"
        ],
        "serviceTypes": [
          "Physician Visit - Office: Well"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "MH"
        ],
        "serviceTypes": [
          "Mental Health"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Prior authorization may be required. Covered No Limit."
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "MH"
        ],
        "serviceTypes": [
          "Mental Health"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "MH"
        ],
        "serviceTypes": [
          "Mental Health"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "PT"
        ],
        "serviceTypes": [
          "Physical Therapy"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "PT"
        ],
        "serviceTypes": [
          "Physical Therapy"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "15",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "per visit"
          }
        ]
      },
      {
        "code": "I",
        "name": "Non-Covered",
        "serviceTypeCodes": [
          "PT"
        ],
        "serviceTypes": [
          "Physical Therapy"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "UC"
        ],
        "serviceTypes": [
          "Urgent Care"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Covered No Limit."
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "UC"
        ],
        "serviceTypes": [
          "Urgent Care"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "10",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "per visit"
          }
        ]
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "UC"
        ],
        "serviceTypes": [
          "Urgent Care"
        ],
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No",
        "additionalInformation": [
          {
            "description": "Covered No Limit."
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "UC"
        ],
        "serviceTypes": [
          "Urgent Care"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "10",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No",
        "additionalInformation": [
          {
            "description": "per visit"
          }
        ]
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "23",
        "timeQualifier": "Calendar Year",
        "benefitAmount": "0",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "29",
        "timeQualifier": "Remaining",
        "benefitAmount": "0",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "23",
        "timeQualifier": "Calendar Year",
        "benefitAmount": "0",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "29",
        "timeQualifier": "Remaining",
        "benefitAmount": "0",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "23",
        "timeQualifier": "Calendar Year",
        "benefitAmount": "0",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "29",
        "timeQualifier": "Remaining",
        "benefitAmount": "0",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "23",
        "timeQualifier": "Calendar Year",
        "benefitAmount": "0",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "29",
        "timeQualifier": "Remaining",
        "benefitAmount": "0",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "G",
        "name": "Out of Pocket (Stop Loss)",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "23",
        "timeQualifier": "Calendar Year",
        "benefitAmount": "3000",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "G",
        "name": "Out of Pocket (Stop Loss)",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "29",
        "timeQualifier": "Remaining",
        "benefitAmount": "2000",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "G",
        "name": "Out of Pocket (Stop Loss)",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "23",
        "timeQualifier": "Calendar Year",
        "benefitAmount": "6000",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "G",
        "name": "Out of Pocket (Stop Loss)",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "29",
        "timeQualifier": "Remaining",
        "benefitAmount": "5000",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "G",
        "name": "Out of Pocket (Stop Loss)",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "23",
        "timeQualifier": "Calendar Year",
        "benefitAmount": "0",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "G",
        "name": "Out of Pocket (Stop Loss)",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "29",
        "timeQualifier": "Remaining",
        "benefitAmount": "0",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "G",
        "name": "Out of Pocket (Stop Loss)",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "23",
        "timeQualifier": "Calendar Year",
        "benefitAmount": "0",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "G",
        "name": "Out of Pocket (Stop Loss)",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "planCoverage": "Gold Plan",
        "timeQualifierCode": "29",
        "timeQualifier": "Remaining",
        "benefitAmount": "0",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      }
    ],
    "errors": [],
    "x12": "",
    "eligibilitySearchId": "019cbdde-38e0-79f2-8ccc-526592d2d49b"
  },
  "errors": []
}

======================================================================
CASE: 4. UHC subscriber — active coverage (Jane Doe)
======================================================================
STATUS: SUCCESS
RESULT:
{
  "status": "unknown",
  "eligible": true,
  "reference_id": "112233445",
  "plan_info": {
    "planInformation": {
      "groupNumber": "111222"
    },
    "planDateInformation": {
      "planBegin": "20240101"
    },
    "benefitsInformation": [
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "insuranceTypeCode": "C1",
        "insuranceType": "Commercial",
        "planCoverage": "Gold Plan HMO",
        "authOrCertIndicator": "Y",
        "inPlanNetworkIndicatorCode": "W",
        "inPlanNetworkIndicator": "Not Applicable",
        "benefitsRelatedEntity": {
          "entityIdentifier": "Payer",
          "entityType": "Non-Person Entity",
          "entityName": "UNITEDHEALTHCARE",
          "entityIdentification": "PI",
          "entityIdentificationValue": "87726"
        },
        "benefitsRelatedEntities": [
          {
            "entityIdentifier": "Payer",
            "entityType": "Non-Person Entity",
            "entityName": "UNITEDHEALTHCARE",
            "entityIdentification": "PI",
            "entityIdentificationValue": "87726"
          }
        ],
        "additionalInformation": [
          {
            "description": "PCP TO SUBMIT A SPECIALIST REFERRAL"
          }
        ]
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "timeQualifierCode": "29",
        "timeQualifier": "Remaining",
        "benefitAmount": "0",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "G",
        "name": "Out of Pocket (Stop Loss)",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "insuranceTypeCode": "C1",
        "insuranceType": "Commercial",
        "timeQualifierCode": "23",
        "timeQualifier": "Calendar Year",
        "benefitAmount": "3000",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "timeQualifierCode": "29",
        "timeQualifier": "Remaining",
        "benefitAmount": "0",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "G",
        "name": "Out of Pocket (Stop Loss)",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "insuranceTypeCode": "C1",
        "insuranceType": "Commercial",
        "timeQualifierCode": "24",
        "timeQualifier": "Year to Date",
        "benefitAmount": "925",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "G",
        "name": "Out of Pocket (Stop Loss)",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "insuranceTypeCode": "C1",
        "insuranceType": "Commercial",
        "timeQualifierCode": "23",
        "timeQualifier": "Calendar Year",
        "benefitAmount": "1500",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "G",
        "name": "Out of Pocket (Stop Loss)",
        "coverageLevelCode": "FAM",
        "coverageLevel": "Family",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "insuranceTypeCode": "C1",
        "insuranceType": "Commercial",
        "timeQualifierCode": "29",
        "timeQualifier": "Remaining",
        "benefitAmount": "2200",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "G",
        "name": "Out of Pocket (Stop Loss)",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "insuranceTypeCode": "C1",
        "insuranceType": "Commercial",
        "timeQualifierCode": "24",
        "timeQualifier": "Year to Date",
        "benefitAmount": "650",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "G",
        "name": "Out of Pocket (Stop Loss)",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "insuranceTypeCode": "C1",
        "insuranceType": "Commercial",
        "timeQualifierCode": "29",
        "timeQualifier": "Remaining",
        "benefitAmount": "850",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "L",
        "name": "Primary Care Provider",
        "inPlanNetworkIndicatorCode": "W",
        "inPlanNetworkIndicator": "Not Applicable",
        "benefitsRelatedEntity": {
          "entityIdentifier": "Primary Care Provider",
          "entityType": "Person",
          "entityName": "DOUGH",
          "entityFirstname": "JOHN",
          "entityMiddlename": "L",
          "entityIdentification": "XX",
          "entityIdentificationValue": "3334445556",
          "address": {
            "address1": "202 MAIN ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postalCode": "94203"
          }
        },
        "benefitsRelatedEntities": [
          {
            "entityIdentifier": "Primary Care Provider",
            "entityType": "Person",
            "entityName": "DOUGH",
            "entityFirstname": "JOHN",
            "entityMiddlename": "L",
            "entityIdentification": "XX",
            "entityIdentificationValue": "3334445556",
            "address": {
              "address1": "202 MAIN ST",
              "city": "SACRAMENTO",
              "state": "CA",
              "postalCode": "94203"
            }
          }
        ]
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "PT"
        ],
        "serviceTypes": [
          "Physical Therapy"
        ],
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "REHABILITATIVE"
          }
        ]
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "PT"
        ],
        "serviceTypes": [
          "Physical Therapy"
        ],
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "HABILITATIVE"
          }
        ]
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "33"
        ],
        "serviceTypes": [
          "Chiropractic"
        ],
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "VARIED BENEFIT.REFER TO PLAN EVIDENCE OF COVERAGE FOR BENEFITS AND LIMITATIONS"
          }
        ]
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "96"
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          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "insuranceTypeCode": "C1",
        "insuranceType": "Commercial",
        "timeQualifierCode": "29",
        "timeQualifier": "Remaining",
        "benefitAmount": "850",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "L",
        "name": "Primary Care Provider",
        "inPlanNetworkIndicatorCode": "W",
        "inPlanNetworkIndicator": "Not Applicable",
        "benefitsRelatedEntity": {
          "entityIdentifier": "Primary Care Provider",
          "entityType": "Person",
          "entityName": "DOUGH",
          "entityFirstname": "JOHN",
          "entityMiddlename": "L",
          "entityIdentification": "XX",
          "entityIdentificationValue": "3334445556",
          "address": {
            "address1": "202 MAIN ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postalCode": "94203"
          }
        },
        "benefitsRelatedEntities": [
          {
            "entityIdentifier": "Primary Care Provider",
            "entityType": "Person",
            "entityName": "DOUGH",
            "entityFirstname": "JOHN",
            "entityMiddlename": "L",
            "entityIdentification": "XX",
            "entityIdentificationValue": "3334445556",
            "address": {
              "address1": "202 MAIN ST",
              "city": "SACRAMENTO",
              "state": "CA",
              "postalCode": "94203"
            }
          }
        ]
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "PT"
        ],
        "serviceTypes": [
          "Physical Therapy"
        ],
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "REHABILITATIVE"
          }
        ]
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "PT"
        ],
        "serviceTypes": [
          "Physical Therapy"
        ],
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "HABILITATIVE"
          }
        ]
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "33"
        ],
        "serviceTypes": [
          "Chiropractic"
        ],
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "VARIED BENEFIT.REFER TO PLAN EVIDENCE OF COVERAGE FOR BENEFITS AND LIMITATIONS"
          }
        ]
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "96"
        ],
        "serviceTypes": [
          "Professional (Physician)"
        ],
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "SPECIALIST"
          },
          {
            "description": "OUTPATIENT MATERNITY"
          }
        ]
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "86"
        ],
        "serviceTypes": [
          "Emergency Services"
        ],
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "COPAY WAIVED IF ADMITTED"
          }
        ]
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "BZ"
        ],
        "serviceTypes": [
          "Physician Visit - Office: Well"
        ],
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "OUTPATIENT PERIODIC HEALTH EVALUATION"
          }
        ]
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "1",
          "AL",
          "48",
          "35",
          "47",
          "50",
          "MH",
          "BZ",
          "BY",
          "UC"
        ],
        "serviceTypes": [
          "Medical Care",
          "Vision (Optometry)",
          "Hospital - Inpatient",
          "Dental Care",
          "Hospital",
          "Hospital - Outpatient",
          "Mental Health",
          "Physician Visit - Office: Well",
          "Physician Visit - Office: Sick",
          "Urgent Care"
        ],
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": [
          "96"
        ],
        "serviceTypes": [
          "Professional (Physician)"
        ],
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "SPECIALIST"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "BZ"
        ],
        "serviceTypes": [
          "Physician Visit - Office: Well"
        ],
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "OUTPATIENT PERIODIC HEALTH EVALUATION"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "UC",
          "48",
          "BZ",
          "BY",
          "50"
        ],
        "serviceTypes": [
          "Urgent Care",
          "Hospital - Inpatient",
          "Physician Visit - Office: Well",
          "Physician Visit - Office: Sick",
          "Hospital - Outpatient"
        ],
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "PT"
        ],
        "serviceTypes": [
          "Physical Therapy"
        ],
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "REHABILITATIVE"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "33"
        ],
        "serviceTypes": [
          "Chiropractic"
        ],
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "VARIED BENEFIT.REFER TO PLAN EVIDENCE OF COVERAGE FOR BENEFITS AND LIMITATIONS"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "96"
        ],
        "serviceTypes": [
          "Professional (Physician)"
        ],
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "SPECIALIST"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "PT"
        ],
        "serviceTypes": [
          "Physical Therapy"
        ],
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "HABILITATIVE"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "86"
        ],
        "serviceTypes": [
          "Emergency Services"
        ],
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "COPAY WAIVED IF ADMITTED"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "96"
        ],
        "serviceTypes": [
          "Professional (Physician)"
        ],
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitPercent": "0",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "SPECIALIST"
          },
          {
            "description": "OUTPATIENT MATERNITY"
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "96"
        ],
        "serviceTypes": [
          "Professional (Physician)"
        ],
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "15",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "SPECIALIST"
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "96"
        ],
        "serviceTypes": [
          "Professional (Physician)"
        ],
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "0",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "SPECIALIST"
          },
          {
            "description": "OUTPATIENT MATERNITY"
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "PT"
        ],
        "serviceTypes": [
          "Physical Therapy"
        ],
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "15",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "HABILITATIVE"
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "BZ"
        ],
        "serviceTypes": [
          "Physician Visit - Office: Well"
        ],
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "0",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "OUTPATIENT PERIODIC HEALTH EVALUATION"
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "BY",
          "BZ",
          "UC"
        ],
        "serviceTypes": [
          "Physician Visit - Office: Sick",
          "Physician Visit - Office: Well",
          "Urgent Care"
        ],
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "15",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "48",
          "50"
        ],
        "serviceTypes": [
          "Hospital - Inpatient",
          "Hospital - Outpatient"
        ],
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "0",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "33"
        ],
        "serviceTypes": [
          "Chiropractic"
        ],
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "15",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "VARIED BENEFIT.REFER TO PLAN EVIDENCE OF COVERAGE FOR BENEFITS AND LIMITATIONS"
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "86"
        ],
        "serviceTypes": [
          "Emergency Services"
        ],
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "50",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "COPAY WAIVED IF ADMITTED"
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "PT"
        ],
        "serviceTypes": [
          "Physical Therapy"
        ],
        "timeQualifierCode": "27",
        "timeQualifier": "Visit",
        "benefitAmount": "15",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "REHABILITATIVE"
          }
        ]
      },
      {
        "code": "U",
        "name": "Contact Following Entity for Eligibility or Benefit Information",
        "serviceTypeCodes": [
          "88"
        ],
        "serviceTypes": [
          "Pharmacy"
        ],
        "inPlanNetworkIndicatorCode": "W",
        "inPlanNetworkIndicator": "Not Applicable",
        "benefitsRelatedEntity": {
          "entityIdentifier": "Vendor",
          "entityType": "Non-Person Entity",
          "entityName": "OPTUMRX",
          "contactInformation": {
            "contacts": [
              {
                "communicationMode": "Uniform Resource Locator (URL)",
                "communicationNumber": "PROFESSIONALS.OPTUMRX.COM"
              }
            ]
          }
        },
        "benefitsRelatedEntities": [
          {
            "entityIdentifier": "Vendor",
            "entityType": "Non-Person Entity",
            "entityName": "OPTUMRX",
            "contactInformation": {
              "contacts": [
                {
                  "communicationMode": "Uniform Resource Locator (URL)",
                  "communicationNumber": "PROFESSIONALS.OPTUMRX.COM"
                }
              ]
            }
          }
        ]
      },
      {
        "code": "X",
        "name": "Health Care Facility",
        "inPlanNetworkIndicatorCode": "W",
        "inPlanNetworkIndicator": "Not Applicable",
        "benefitsRelatedEntity": {
          "entityIdentifier": "Facility",
          "entityType": "Non-Person Entity",
          "entityName": "DIRECTED BY PRIMARY MD"
        },
        "benefitsRelatedEntities": [
          {
            "entityIdentifier": "Facility",
            "entityType": "Non-Person Entity",
            "entityName": "DIRECTED BY PRIMARY MD"
          }
        ]
      },
      {
        "code": "N",
        "name": "Services Restricted to Following Provider",
        "inPlanNetworkIndicatorCode": "W",
        "inPlanNetworkIndicator": "Not Applicable",
        "benefitsRelatedEntity": {
          "entityIdentifier": "Contracted Service Provider",
          "entityType": "Non-Person Entity",
          "entityName": "MEDICAL FACILITY SACRAMENTO",
          "address": {
            "address1": "202 MAIN ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postalCode": "94203"
          }
        },
        "benefitsRelatedEntities": [
          {
            "entityIdentifier": "Contracted Service Provider",
            "entityType": "Non-Person Entity",
            "entityName": "MEDICAL FACILITY SACRAMENTO",
            "address": {
              "address1": "202 MAIN ST",
              "city": "SACRAMENTO",
              "state": "CA",
              "postalCode": "94203"
            }
          }
        ]
      }
    ],
    "errors": [],
    "x12": "",
    "eligibilitySearchId": "019cbdde-3ece-7493-a62f-9c85dcfcbbbc"
  },
  "errors": []
}

======================================================================
CASE: 5. UHC subscriber — INACTIVE coverage
======================================================================
STATUS: SUCCESS
RESULT:
{
  "status": "unknown",
  "eligible": false,
  "reference_id": "112233445",
  "plan_info": {
    "benefitsInformation": [
      {
        "code": "6",
        "name": "Inactive",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "inPlanNetworkIndicatorCode": "W",
        "inPlanNetworkIndicator": "Not Applicable"
      },
      {
        "code": "X",
        "name": "Health Care Facility",
        "inPlanNetworkIndicatorCode": "W",
        "inPlanNetworkIndicator": "Not Applicable",
        "benefitsRelatedEntity": {
          "entityIdentifier": "Provider",
          "entityType": "Non-Person Entity",
          "entityName": "MEDICAL PROVIDER",
          "entityIdentification": "XX",
          "entityIdentificationValue": "0001112223"
        },
        "benefitsRelatedEntities": [
          {
            "entityIdentifier": "Provider",
            "entityType": "Non-Person Entity",
            "entityName": "MEDICAL PROVIDER",
            "entityIdentification": "XX",
            "entityIdentificationValue": "0001112223"
          }
        ]
      }
    ],
    "planStatus": [
      {
        "statusCode": "6",
        "status": "Inactive",
        "serviceTypeCodes": [
          "30"
        ]
      }
    ]
  },
  "raw_response": {
    "id": "ec_019cbdde-42c5-7e72-9f6c-424e51920ca3",
    "meta": {
      "senderId": "STEDI",
      "submitterId": "117151744",
      "applicationMode": "production",
      "traceId": "11112222333344445555666677",
      "outboundTraceId": "01KJYXWGP660S574Q115Q2G3R2"
    },
    "controlNumber": "112233445",
    "reassociationKey": "112233445",
    "tradingPartnerServiceId": "87726",
    "provider": {
      "providerName": "MEDICAL PROVIDER",
      "entityIdentifier": "Provider",
      "entityType": "Non-Person Entity",
      "npi": "1999999984"
    },
    "subscriber": {
      "memberId": "UHCINACTIVE",
      "firstName": "JANE",
      "lastName": "DOE",
      "gender": "F",
      "entityIdentifier": "Insured or Subscriber",
      "entityType": "Person",
      "dateOfBirth": "19700101",
      "address": {
        "address1": "101 MAIN ST",
        "city": "SACRAMENTO",
        "state": "CA",
        "postalCode": "94203"
      }
    },
    "payer": {
      "entityIdentifier": "Payer",
      "entityType": "Non-Person Entity",
      "name": "UNITEDHEALTHCARE",
      "payorIdentification": "87726",
      "contactInformation": {
        "contacts": [
          {
            "communicationMode": "Uniform Resource Locator (URL)",
            "communicationNumber": "WWW.UHCPROVIDER.COM"
          }
        ]
      }
    },
    "planStatus": [
      {
        "statusCode": "6",
        "status": "Inactive",
        "serviceTypeCodes": [
          "30"
        ]
      }
    ],
    "benefitsInformation": [
      {
        "code": "6",
        "name": "Inactive",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "inPlanNetworkIndicatorCode": "W",
        "inPlanNetworkIndicator": "Not Applicable"
      },
      {
        "code": "X",
        "name": "Health Care Facility",
        "inPlanNetworkIndicatorCode": "W",
        "inPlanNetworkIndicator": "Not Applicable",
        "benefitsRelatedEntity": {
          "entityIdentifier": "Provider",
          "entityType": "Non-Person Entity",
          "entityName": "MEDICAL PROVIDER",
          "entityIdentification": "XX",
          "entityIdentificationValue": "0001112223"
        },
        "benefitsRelatedEntities": [
          {
            "entityIdentifier": "Provider",
            "entityType": "Non-Person Entity",
            "entityName": "MEDICAL PROVIDER",
            "entityIdentification": "XX",
            "entityIdentificationValue": "0001112223"
          }
        ]
      }
    ],
    "errors": [],
    "x12": "",
    "eligibilitySearchId": "019cbdde-42c6-7433-95fd-e5b4f01fb51e"
  },
  "errors": []
}

======================================================================
CASE: 6. Aetna with externalPatientId tracking
======================================================================
STATUS: SUCCESS
RESULT:
{
  "status": "unknown",
  "eligible": true,
  "reference_id": "112233445",
  "plan_info": {
    "planInformation": {
      "planNumber": "1122334",
      "groupNumber": "111222333444555",
      "groupDescription": "New Jersey Plan"
    },
    "planDateInformation": {
      "planBegin": "20240401",
      "service": "20240917"
    },
    "benefitsInformation": [
      {
        "code": "W",
        "name": "Other Source of Data",
        "inPlanNetworkIndicatorCode": "W",
        "inPlanNetworkIndicator": "Not Applicable",
        "benefitsRelatedEntity": {
          "entityIdentifier": "Payer",
          "entityType": "Non-Person Entity",
          "entityName": "Aetna",
          "address": {
            "address1": "202 Main St",
            "city": "El Paso",
            "state": "TX",
            "postalCode": "79998"
          }
        },
        "benefitsRelatedEntities": [
          {
            "entityIdentifier": "Payer",
            "entityType": "Non-Person Entity",
            "entityName": "Aetna",
            "address": {
              "address1": "202 Main St",
              "city": "El Paso",
              "state": "TX",
              "postalCode": "79998"
            }
          }
        ]
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "insuranceTypeCode": "PR",
        "insuranceType": "Preferred Provider Organization (PPO)",
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "W",
        "inPlanNetworkIndicator": "Not Applicable"
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "timeQualifierCode": "25",
        "timeQualifier": "Contract",
        "benefitAmount": "500",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "benefitsDateInformation": {
          "planBegin": "20240401"
        }
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "IND",
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  },
  "errors": []
}

======================================================================
CASE: 7. Aetna with submitterTransactionIdentifier
======================================================================
STATUS: SUCCESS
RESULT:
{
  "status": "unknown",
  "eligible": true,
  "reference_id": "112233445",
  "plan_info": {
    "planInformation": {
      "planNumber": "1122334",
      "groupNumber": "111222333444555",
      "groupDescription": "New Jersey Plan"
    },
    "planDateInformation": {
      "planBegin": "20240401",
      "service": "20240917"
    },
    "benefitsInformation": [
      {
        "code": "W",
        "name": "Other Source of Data",
        "inPlanNetworkIndicatorCode": "W",
        "inPlanNetworkIndicator": "Not Applicable",
        "benefitsRelatedEntity": {
          "entityIdentifier": "Payer",
          "entityType": "Non-Person Entity",
          "entityName": "Aetna",
          "address": {
            "address1": "202 Main St",
            "city": "El Paso",
            "state": "TX",
            "postalCode": "79998"
          }
        },
        "benefitsRelatedEntities": [
          {
            "entityIdentifier": "Payer",
            "entityType": "Non-Person Entity",
            "entityName": "Aetna",
            "address": {
              "address1": "202 Main St",
              "city": "El Paso",
              "state": "TX",
              "postalCode": "79998"
            }
          }
        ]
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "insuranceTypeCode": "PR",
        "insuranceType": "Preferred Provider Organization (PPO)",
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "W",
        "inPlanNetworkIndicator": "Not Applicable"
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "timeQualifierCode": "25",
        "timeQualifier": "Contract",
        "benefitAmount": "500",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "benefitsDateInformation": {
          "planBegin": "20240401"
        }
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "timeQualifierCode": "29",
        "timeQualifier": "Remaining",
        "benefitAmount": "500",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "G",
        "name": "Out of Pocket (Stop Loss)",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "timeQualifierCode": "25",
        "timeQualifier": "Contract",
        "benefitAmount": "7000",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "G",
        "name": "Out of Pocket (Stop Loss)",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "timeQualifierCode": "29",
        "timeQualifier": "Remaining",
        "benefitAmount": "7000",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "timeQualifierCode": "25",
        "timeQualifier": "Contract",
        "benefitAmount": "1000",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No",
        "benefitsDateInformation": {
          "planBegin": "20240401"
        }
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "timeQualifierCode": "29",
        "timeQualifier": "Remaining",
        "benefitAmount": "1000",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "G",
        "name": "Out of Pocket (Stop Loss)",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "timeQualifierCode": "25",
        "timeQualifier": "Contract",
        "benefitAmount": "14000",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "G",
        "name": "Out of Pocket (Stop Loss)",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "timeQualifierCode": "29",
        "timeQualifier": "Remaining",
        "benefitAmount": "14000",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "1",
          "33",
          "47",
          "48",
          "50",
          "86",
          "98",
          "UC",
          "MH",
          "AL"
        ],
        "serviceTypes": [
          "Medical Care",
          "Chiropractic",
          "Hospital",
          "Hospital - Inpatient",
          "Hospital - Outpatient",
          "Emergency Services",
          "Professional (Physician) Visit - Office",
          "Urgent Care",
          "Mental Health",
          "Vision (Optometry)"
        ],
        "inPlanNetworkIndicatorCode": "W",
        "inPlanNetworkIndicator": "Not Applicable"
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "33",
          "86",
          "98",
          "MH",
          "UC"
        ],
        "serviceTypes": [
          "Chiropractic",
          "Emergency Services",
          "Professional (Physician) Visit - Office",
          "Mental Health",
          "Urgent Care"
        ],
        "benefitPercent": "0",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Chiropractic"
          },
          {
            "description": "Office Visits"
          },
          {
            "description": "Urgent Care"
          },
          {
            "description": "Walk in Clinic"
          },
          {
            "description": "Mental Health (outpatient)"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "86"
        ],
        "serviceTypes": [
          "Emergency Services"
        ],
        "benefitPercent": "0.2",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Emergency Room"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "48",
          "50",
          "MH"
        ],
        "serviceTypes": [
          "Hospital - Inpatient",
          "Hospital - Outpatient",
          "Mental Health"
        ],
        "benefitPercent": "0.2",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "IP Hospital Room and Board"
          },
          {
            "description": "IP Hospital Miscellaneous"
          },
          {
            "description": "OP Hospital Miscellaneous"
          },
          {
            "description": "Mental Health (inpatient)"
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "33"
        ],
        "serviceTypes": [
          "Chiropractic"
        ],
        "benefitAmount": "25",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Chiropractic"
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "98",
          "MH",
          "UC"
        ],
        "serviceTypes": [
          "Professional (Physician) Visit - Office",
          "Mental Health",
          "Urgent Care"
        ],
        "benefitAmount": "30",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Office Visits"
          },
          {
            "description": "Walk in Clinic"
          },
          {
            "description": "Mental Health (outpatient)"
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "86",
          "UC"
        ],
        "serviceTypes": [
          "Emergency Services",
          "Urgent Care"
        ],
        "benefitAmount": "40",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Urgent Care"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "33",
          "48",
          "50",
          "86",
          "98",
          "MH",
          "UC"
        ],
        "serviceTypes": [
          "Chiropractic",
          "Hospital - Inpatient",
          "Hospital - Outpatient",
          "Emergency Services",
          "Professional (Physician) Visit - Office",
          "Mental Health",
          "Urgent Care"
        ],
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No",
        "additionalInformation": [
          {
            "description": "Chiropractic"
          },
          {
            "description": "IP Hospital Room and Board"
          },
          {
            "description": "IP Hospital Miscellaneous"
          },
          {
            "description": "Office Visits"
          },
          {
            "description": "Urgent Care"
          },
          {
            "description": "Walk in Clinic"
          },
          {
            "description": "OP Hospital Miscellaneous"
          },
          {
            "description": "Mental Health (inpatient)"
          },
          {
            "description": "Mental Health (outpatient)"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "86"
        ],
        "serviceTypes": [
          "Emergency Services"
        ],
        "benefitPercent": "0.2",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No",
        "additionalInformation": [
          {
            "description": "Emergency Room"
          }
        ]
      }
    ],
    "planStatus": [
      {
        "statusCode": "1",
        "status": "Active Coverage",
        "planDetails": "Gold Plan",
        "serviceTypeCodes": [
          "30"
        ]
      },
      {
        "statusCode": "1",
        "status": "Active Coverage",
        "serviceTypeCodes": [
          "1",
          "33",
          "47",
          "48",
          "50",
          "86",
          "98",
          "UC",
          "MH",
          "AL"
        ]
      }
    ]
  },
  "raw_response": {
    "id": "ec_019cbdde-48a7-7df3-a60b-6970dbf71c81",
    "meta": {
      "senderId": "STEDI",
      "submitterId": "117151744",
      "applicationMode": "production",
      "traceId": "11112222333344445555666677",
      "outboundTraceId": "01KJYXWJ58KAMFXT4W940REWVX"
    },
    "controlNumber": "112233445",
    "reassociationKey": "112233445",
    "tradingPartnerServiceId": "60054",
    "provider": {
      "providerName": "MEDICAL PROVIDER",
      "entityIdentifier": "Provider",
      "entityType": "Non-Person Entity",
      "npi": "1999999984"
    },
    "subscriber": {
      "memberId": "AETNA12345",
      "firstName": "JANE",
      "lastName": "DOE",
      "gender": "F",
      "entityIdentifier": "Insured or Subscriber",
      "entityType": "Person",
      "dateOfBirth": "20040404",
      "groupNumber": "111222333444555",
      "planNumber": "1122334",
      "address": {
        "address1": "101 MAIN ST",
        "city": "TRENTON",
        "state": "NJ",
        "postalCode": "08601"
      }
    },
    "payer": {
      "entityIdentifier": "Payer",
      "entityType": "Non-Person Entity",
      "name": "AETNA INC",
      "payorIdentification": "953402799"
    },
    "planInformation": {
      "planNumber": "1122334",
      "groupNumber": "111222333444555",
      "groupDescription": "New Jersey Plan"
    },
    "planDateInformation": {
      "planBegin": "20240401",
      "service": "20240917"
    },
    "planStatus": [
      {
        "statusCode": "1",
        "status": "Active Coverage",
        "planDetails": "Gold Plan",
        "serviceTypeCodes": [
          "30"
        ]
      },
      {
        "statusCode": "1",
        "status": "Active Coverage",
        "serviceTypeCodes": [
          "1",
          "33",
          "47",
          "48",
          "50",
          "86",
          "98",
          "UC",
          "MH",
          "AL"
        ]
      }
    ],
    "benefitsInformation": [
      {
        "code": "W",
        "name": "Other Source of Data",
        "inPlanNetworkIndicatorCode": "W",
        "inPlanNetworkIndicator": "Not Applicable",
        "benefitsRelatedEntity": {
          "entityIdentifier": "Payer",
          "entityType": "Non-Person Entity",
          "entityName": "Aetna",
          "address": {
            "address1": "202 Main St",
            "city": "El Paso",
            "state": "TX",
            "postalCode": "79998"
          }
        },
        "benefitsRelatedEntities": [
          {
            "entityIdentifier": "Payer",
            "entityType": "Non-Person Entity",
            "entityName": "Aetna",
            "address": {
              "address1": "202 Main St",
              "city": "El Paso",
              "state": "TX",
              "postalCode": "79998"
            }
          }
        ]
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "insuranceTypeCode": "PR",
        "insuranceType": "Preferred Provider Organization (PPO)",
        "planCoverage": "Gold Plan",
        "inPlanNetworkIndicatorCode": "W",
        "inPlanNetworkIndicator": "Not Applicable"
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "timeQualifierCode": "25",
        "timeQualifier": "Contract",
        "benefitAmount": "500",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "benefitsDateInformation": {
          "planBegin": "20240401"
        }
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "timeQualifierCode": "29",
        "timeQualifier": "Remaining",
        "benefitAmount": "500",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "G",
        "name": "Out of Pocket (Stop Loss)",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "timeQualifierCode": "25",
        "timeQualifier": "Contract",
        "benefitAmount": "7000",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "G",
        "name": "Out of Pocket (Stop Loss)",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "timeQualifierCode": "29",
        "timeQualifier": "Remaining",
        "benefitAmount": "7000",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes"
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "timeQualifierCode": "25",
        "timeQualifier": "Contract",
        "benefitAmount": "1000",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No",
        "benefitsDateInformation": {
          "planBegin": "20240401"
        }
      },
      {
        "code": "C",
        "name": "Deductible",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "timeQualifierCode": "29",
        "timeQualifier": "Remaining",
        "benefitAmount": "1000",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "G",
        "name": "Out of Pocket (Stop Loss)",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "timeQualifierCode": "25",
        "timeQualifier": "Contract",
        "benefitAmount": "14000",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "G",
        "name": "Out of Pocket (Stop Loss)",
        "coverageLevelCode": "IND",
        "coverageLevel": "Individual",
        "serviceTypeCodes": [
          "30"
        ],
        "serviceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "timeQualifierCode": "29",
        "timeQualifier": "Remaining",
        "benefitAmount": "14000",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No"
      },
      {
        "code": "1",
        "name": "Active Coverage",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "1",
          "33",
          "47",
          "48",
          "50",
          "86",
          "98",
          "UC",
          "MH",
          "AL"
        ],
        "serviceTypes": [
          "Medical Care",
          "Chiropractic",
          "Hospital",
          "Hospital - Inpatient",
          "Hospital - Outpatient",
          "Emergency Services",
          "Professional (Physician) Visit - Office",
          "Urgent Care",
          "Mental Health",
          "Vision (Optometry)"
        ],
        "inPlanNetworkIndicatorCode": "W",
        "inPlanNetworkIndicator": "Not Applicable"
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "33",
          "86",
          "98",
          "MH",
          "UC"
        ],
        "serviceTypes": [
          "Chiropractic",
          "Emergency Services",
          "Professional (Physician) Visit - Office",
          "Mental Health",
          "Urgent Care"
        ],
        "benefitPercent": "0",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Chiropractic"
          },
          {
            "description": "Office Visits"
          },
          {
            "description": "Urgent Care"
          },
          {
            "description": "Walk in Clinic"
          },
          {
            "description": "Mental Health (outpatient)"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "86"
        ],
        "serviceTypes": [
          "Emergency Services"
        ],
        "benefitPercent": "0.2",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Emergency Room"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "48",
          "50",
          "MH"
        ],
        "serviceTypes": [
          "Hospital - Inpatient",
          "Hospital - Outpatient",
          "Mental Health"
        ],
        "benefitPercent": "0.2",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "IP Hospital Room and Board"
          },
          {
            "description": "IP Hospital Miscellaneous"
          },
          {
            "description": "OP Hospital Miscellaneous"
          },
          {
            "description": "Mental Health (inpatient)"
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "33"
        ],
        "serviceTypes": [
          "Chiropractic"
        ],
        "benefitAmount": "25",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Chiropractic"
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "98",
          "MH",
          "UC"
        ],
        "serviceTypes": [
          "Professional (Physician) Visit - Office",
          "Mental Health",
          "Urgent Care"
        ],
        "benefitAmount": "30",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Office Visits"
          },
          {
            "description": "Walk in Clinic"
          },
          {
            "description": "Mental Health (outpatient)"
          }
        ]
      },
      {
        "code": "B",
        "name": "Co-Payment",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "86",
          "UC"
        ],
        "serviceTypes": [
          "Emergency Services",
          "Urgent Care"
        ],
        "benefitAmount": "40",
        "inPlanNetworkIndicatorCode": "Y",
        "inPlanNetworkIndicator": "Yes",
        "additionalInformation": [
          {
            "description": "Urgent Care"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "33",
          "48",
          "50",
          "86",
          "98",
          "MH",
          "UC"
        ],
        "serviceTypes": [
          "Chiropractic",
          "Hospital - Inpatient",
          "Hospital - Outpatient",
          "Emergency Services",
          "Professional (Physician) Visit - Office",
          "Mental Health",
          "Urgent Care"
        ],
        "benefitPercent": "0.5",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No",
        "additionalInformation": [
          {
            "description": "Chiropractic"
          },
          {
            "description": "IP Hospital Room and Board"
          },
          {
            "description": "IP Hospital Miscellaneous"
          },
          {
            "description": "Office Visits"
          },
          {
            "description": "Urgent Care"
          },
          {
            "description": "Walk in Clinic"
          },
          {
            "description": "OP Hospital Miscellaneous"
          },
          {
            "description": "Mental Health (inpatient)"
          },
          {
            "description": "Mental Health (outpatient)"
          }
        ]
      },
      {
        "code": "A",
        "name": "Co-Insurance",
        "coverageLevelCode": "EMP",
        "coverageLevel": "Employee Only",
        "serviceTypeCodes": [
          "86"
        ],
        "serviceTypes": [
          "Emergency Services"
        ],
        "benefitPercent": "0.2",
        "inPlanNetworkIndicatorCode": "N",
        "inPlanNetworkIndicator": "No",
        "additionalInformation": [
          {
            "description": "Emergency Room"
          }
        ]
      }
    ],
    "errors": [],
    "x12": "",
    "eligibilitySearchId": "019cbdde-48a7-7df3-a60b-698a0ec12f51"
  },
  "errors": []
}

======================================================================
CASE: 8. AAA Error 72 — Invalid/Missing Subscriber ID (mock)
======================================================================
STATUS: SUCCESS
RESULT:
{
  "status": "unknown",
  "eligible": null,
  "reference_id": "123456789",
  "plan_info": {},
  "raw_response": {
    "id": "ec_019cbdde-4bfb-7361-85fc-68fdd3291192",
    "meta": {
      "senderId": "STEDI",
      "submitterId": "117151744",
      "applicationMode": "production",
      "traceId": "11112222333344445555666677",
      "outboundTraceId": "01KJYXWJZW34XF43H3JCY2MD29"
    },
    "controlNumber": "123456789",
    "reassociationKey": "123456789",
    "tradingPartnerServiceId": "87726",
    "provider": {
      "providerName": "MEDICAL PROVIDER",
      "entityIdentifier": "Provider",
      "entityType": "Non-Person Entity",
      "npi": "1999999984"
    },
    "subscriber": {
      "memberId": "UHCAAA72",
      "firstName": "JOHN",
      "lastName": "DOE",
      "entityIdentifier": "Insured or Subscriber",
      "entityType": "Person",
      "dateOfBirth": "19900101",
      "aaaErrors": [
        {
          "field": "AAA",
          "code": "72",
          "description": "Invalid/Missing Subscriber/Insured ID",
          "followupAction": "Please Correct and Resubmit",
          "location": "Loop 2100C",
          "possibleResolutions": "- Subscriber member ID was incorrect in the request.\n- Request does not meet the payer requirements for subscriber ID.\n- There is another unidentified error in the request data."
        }
      ]
    },
    "payer": {
      "entityIdentifier": "Payer",
      "entityType": "Non-Person Entity",
      "name": "UNITEDHEALTHCARE",
      "payorIdentification": "87726",
      "contactInformation": {
        "contacts": [
          {
            "communicationMode": "Uniform Resource Locator (URL)",
            "communicationNumber": "WWW.UHCPROVIDER.COM"
          }
        ]
      }
    },
    "errors": [
      {
        "field": "AAA",
        "code": "72",
        "description": "Invalid/Missing Subscriber/Insured ID",
        "followupAction": "Please Correct and Resubmit",
        "location": "Loop 2100C",
        "possibleResolutions": "- Subscriber member ID was incorrect in the request.\n- Request does not meet the payer requirements for subscriber ID.\n- There is another unidentified error in the request data."
      }
    ],
    "x12": "",
    "eligibilitySearchId": "019cbdde-4bfc-7022-a43a-b06631d51a67"
  },
  "errors": [
    "72: Invalid/Missing Subscriber/Insured ID"
  ]
}