{"created_at":"2013-11-13T18:41:12-05:00","eligible_id":"1384386069946030110675","demographics":{"subscriber":{"last_name":"FRANKLIN","first_name":"BEN","member_id":"AETNA1234","group_id":"047653201500945","group_name":"FREEDOM GROUP INC.","dob":"1757-05-23","gender":"M","address":{"street_line_1":"323 REASON ROAD","street_line_2":null,"city":"HILLSBORO","state":"TX","zip":"76645"}},"dependent":{}},"insurance":{"name":"AETNA INC","id":"00002","payer_type":"PR","payer_type_label":"Payer","contacts":[],"service_providers":{"physicians":[{"eligibility_code":"L","eligibility_code_label":"Primary Care Provider","insurance_type":"PS","insurance_type_label":"Point of Service (POS)","primary_care":true,"restricted":null,"contact_details":[],"dates":[],"comments":["PCP SELECTION NOT REQUIRED"]}]}},"plan":{"type":"30","coverage_status":"1","coverage_status_label":"Active Coverage","coverage_basis":[],"plan_number":"0476532","plan_name":"HSA Aetna Choice POS II","plan_type":"PS","plan_type_label":"Point of Service (POS)","group_name":"TRIUMPH GROUP INC.","dates":[{"date_type":"plan_begin","date_value":"2011-07-01"},{"date_type":"service","date_value":"2013-11-13"},{"date_type":"eligibility_begin","date_value":"2011-07-01"}],"comments":[],"exclusions":{"noncovered":[],"pre_existing_condition":{"waiting_period":[]}},"financials":{"deductible":{"remainings":{"in_network":[{"amount":"4238.35","level":"FAMILY","insurance_type":null,"insurance_type_label":null,"pos":null,"pos_label":null,"authorization_required":null,"description":null,"contact_details":[],"dates":[],"comments":["INT MED AND RX"]}],"out_network":[]},"spent":{"in_network":[],"out_network":[]},"totals":{"in_network":[{"amount":"4350","time_period":"25","time_period_label":"contract","level":"FAMILY","insurance_type":null,"insurance_type_label":null,"pos":null,"pos_label":null,"authorization_required":null,"description":null,"contact_details":[],"dates":[{"date_type":"eligibilty","date_value":"2013-07-01"}],"comments":["INT MED AND RX,DED INCLUDED IN OOP,Visit or Evaluation by Chiropractor,Manipulation by Chiropractor,Emergency use of Emergency Room,Outpatient Surgery Facility,Outpatient Medical Ancillary,Ambulatory Medical Ancillary,Medical Ancillary,Inpatient Xray and Lab","Room and Board,Intensive Care Room and Board,Non Emergency use of Emergency Room,Emergency Room Physician,Urgent Care,Non Urgent Services at an Urgent Care Facility,GYN Visit,Specialist Visit or Evaluation,Primary Care Visit or Evaluation,Physician Xray and Lab","Xray and Lab,Outpatient Xray and Lab"]}],"out_network":[]}},"stop_loss":{"remainings":{"in_network":[{"amount":"4862.15","level":"FAMILY","insurance_type":null,"insurance_type_label":null,"pos":null,"pos_label":null,"authorization_required":null,"description":null,"contact_details":[],"dates":[],"comments":[]}],"out_network":[{"amount":"9237.15","level":"FAMILY","insurance_type":null,"insurance_type_label":null,"pos":null,"pos_label":null,"authorization_required":null,"description":null,"contact_details":[],"dates":[],"comments":[]}]},"spent":{"in_network":[],"out_network":[]},"totals":{"in_network":[{"amount":"4975","time_period":null,"time_period_label":null,"level":"FAMILY","insurance_type":null,"insurance_type_label":null,"pos":null,"pos_label":null,"authorization_required":null,"description":null,"contact_details":[],"dates":[],"comments":["In-Network Providers"]}],"out_network":[{"amount":"9350","time_period":null,"time_period_label":null,"level":"FAMILY","insurance_type":null,"insurance_type_label":null,"pos":null,"pos_label":null,"authorization_required":null,"description":null,"contact_details":[],"dates":[],"comments":[]}]}},"coinsurance":{"percents":{"in_network":[],"out_network":[]}},"copayment":{"amounts":{"in_network":[],"out_network":[]}},"cost_containment":{"remainings":{"in_network":[],"out_network":[]},"spent":{"in_network":[],"out_network":[]},"totals":{"in_network":[],"out_network":[]}},"spend_down":{"remainings":{"in_network":[],"out_network":[]},"spent":{"in_network":[],"out_network":[]},"totals":{"in_network":[],"out_network":[]}},"limitations":{"amounts":[{"amount":null,"time_period":null,"time_period_label":null,"level":"Employee and Spouse","network":"IN","insurance_type":null,"insurance_type_label":null,"pos":null,"pos_label":null,"authorization_required":null,"description":null,"contact_details":[],"dates":[],"comments":["Plan Requires PreCert"]},{"amount":null,"time_period":null,"time_period_label":null,"level":"Employee and Spouse","network":"IN","insurance_type":null,"insurance_type_label":null,"pos":null,"pos_label":null,"authorization_required":null,"description":null,"contact_details":[],"dates":[],"comments":["Self Funded"]},{"amount":null,"time_period":"32","time_period_label":"lifetime","level":"Employee and Spouse","network":"IN","insurance_type":null,"insurance_type_label":null,"pos":null,"pos_label":null,"authorization_required":null,"description":null,"contact_details":[],"dates":[],"comments":["Unlimited Lifetime Benefits"]}]},"disclaimer":[],"other_sources":{"amounts":[{"amount":null,"time_period":null,"time_period_label":null,"level":"INDIVIDUAL","network":"IN","insurance_type":null,"insurance_type_label":null,"pos":null,"pos_label":null,"authorization_required":null,"description":null,"contact_details":[{"entity_code":"PR","entity_code_label":"Payer","last_name":"Aetna","first_name":null,"identification_type":null,"identification_code":null,"contacts":[],"address":{"street_line_1":"PO Box 14079","street_line_2":null,"city":"Lexington","state":"KY","zip":"40512"}}],"dates":[],"comments":[]}]}},"benefit_details":{"benefit_description":{"amounts":[]},"managed_care":{"amounts":[]},"unlimited":{"amounts":[]}},"additional_insurance_policies":[]},"services":[{"type":"47","type_label":"Hospital","coverage_status":"1","coverage_status_label":"Active Coverage","coverage_basis":[],"facility":{"amounts":[]},"noncovered":[],"benefit_details":{"benefit_description":{"amounts":[]},"managed_care":{"amounts":[]},"unlimited":{"amounts":[]}},"financials":{"deductible":{"remainings":{"in_network":[],"out_network":[]},"spent":{"in_network":[],"out_network":[]},"totals":{"in_network":[],"out_network":[]}},"stop_loss":{"remainings":{"in_network":[],"out_network":[]},"spent":{"in_network":[],"out_network":[]},"totals":{"in_network":[],"out_network":[]}},"coinsurance":{"percents":{"in_network":[],"out_network":[]}},"copayment":{"amounts":{"in_network":[],"out_network":[]}},"cost_containment":{"remainings":{"in_network":[],"out_network":[]},"spent":{"in_network":[],"out_network":[]},"totals":{"in_network":[],"out_network":[]}},"spend_down":{"remainings":{"in_network":[],"out_network":[]},"spent":{"in_network":[],"out_network":[]},"totals":{"in_network":[],"out_network":[]}},"limitations":{"amounts":[]},"disclaimer":[],"other_sources":{"amounts":[]}},"visits":{"amounts":{"in_network":[],"out_network":[]}},"additional_insurance_policies":[{"insurance_type":null,"insurance_type_label":null,"coverage_description":null,"reference":[],"contact_details":[],"dates":[],"comments":[]}]},{"type":"48","type_label":"Hospital - Inpatient","coverage_status":"1","coverage_status_label":"Active Coverage","coverage_basis":[],"facility":{"amounts":[]},"noncovered":[],"benefit_details":{"benefit_description":{"amounts":[]},"managed_care":{"amounts":[]},"unlimited":{"amounts":[]}},"financials":{"deductible":{"remainings":{"in_network":[],"out_network":[]},"spent":{"in_network":[],"out_network":[]},"totals":{"in_network":[],"out_network":[]}},"stop_loss":{"remainings":{"in_network":[],"out_network":[]},"spent":{"in_network":[],"out_network":[]},"totals":{"in_network":[],"out_network":[]}},"coinsurance":{"percents":{"in_network":[{"percent":"10","time_period":null,"time_period_label":null,"level":"Employee and Spouse","insurance_type":null,"insurance_type_label":null,"pos":null,"pos_label":null,"authorization_required":null,"description":null,"contact_details":[],"dates":[],"comments":["In-Network Providers","Medical Ancillary,COINS APPLIES TO OUT OF POCKET","Inpatient Xray and Lab,COINS APPLIES TO OUT OF POCKET","Room and Board,COINS APPLIES TO OUT OF POCKET","Intensive Care Room and Board,COINS APPLIES TO OUT OF POCKET"]}],"out_network":[{"percent":"30","time_period":null,"time_period_label":null,"level":"Employee and Spouse","insurance_type":null,"insurance_type_label":null,"pos":null,"pos_label":null,"authorization_required":null,"description":null,"contact_details":[],"dates":[],"comments":["Medical Ancillary,COINS APPLIES TO OUT OF POCKET","Inpatient Xray and Lab,COINS APPLIES TO OUT OF POCKET","Room and Board,COINS APPLIES TO OUT OF POCKET","Intensive Care Room and Board,COINS APPLIES TO OUT OF POCKET"]}]}},"copayment":{"amounts":{"in_network":[{"amount":"0","time_period":null,"time_period_label":null,"level":"Employee and Spouse","insurance_type":null,"insurance_type_label":null,"pos":null,"pos_label":null,"authorization_required":null,"description":null,"contact_details":[],"dates":[],"comments":["Room and Board"]}],"out_network":[]}},"cost_containment":{"remainings":{"in_network":[],"out_network":[]},"spent":{"in_network":[],"out_network":[]},"totals":{"in_network":[],"out_network":[]}},"spend_down":{"remainings":{"in_network":[],"out_network":[]},"spent":{"in_network":[],"out_network":[]},"totals":{"in_network":[],"out_network":[]}},"limitations":{"amounts":[{"amount":null,"time_period":null,"time_period_label":null,"level":"Employee and Spouse","network":"IN","insurance_type":null,"insurance_type_label":null,"pos":null,"pos_label":null,"authorization_required":null,"description":null,"contact_details":[],"dates":[],"comments":["Plan includes NAP"]}]},"disclaimer":[],"other_sources":{"amounts":[]}},"visits":{"amounts":{"in_network":[],"out_network":[]}},"additional_insurance_policies":[{"insurance_type":null,"insurance_type_label":null,"coverage_description":null,"reference":[],"contact_details":[],"dates":[],"comments":[]}]},{"type":"50","type_label":"Hospital - Outpatient","coverage_status":"1","coverage_status_label":"Active Coverage","coverage_basis":[],"facility":{"amounts":[]},"noncovered":[],"benefit_details":{"benefit_description":{"amounts":[]},"managed_care":{"amounts":[]},"unlimited":{"amounts":[]}},"financials":{"deductible":{"remainings":{"in_network":[],"out_network":[]},"spent":{"in_network":[],"out_network":[]},"totals":{"in_network":[],"out_network":[]}},"stop_loss":{"remainings":{"in_network":[],"out_network":[]},"spent":{"in_network":[],"out_network":[]},"totals":{"in_network":[],"out_network":[]}},"coinsurance":{"percents":{"in_network":[{"percent":"10","time_period":null,"time_period_label":null,"level":"Employee and Spouse","insurance_type":null,"insurance_type_label":null,"pos":null,"pos_label":null,"authorization_required":null,"description":null,"contact_details":[],"dates":[],"comments":["In-Network Providers","COINS APPLIES TO OUT OF POCKET"]}],"out_network":[{"percent":"30","time_period":null,"time_period_label":null,"level":"Employee and Spouse","insurance_type":null,"insurance_type_label":null,"pos":null,"pos_label":null,"authorization_required":null,"description":null,"contact_details":[],"dates":[],"comments":["COINS APPLIES TO OUT OF POCKET"]}]}},"copayment":{"amounts":{"in_network":[{"amount":"0","time_period":null,"time_period_label":null,"level":"Employee and Spouse","insurance_type":null,"insurance_type_label":null,"pos":null,"pos_label":null,"authorization_required":null,"description":null,"contact_details":[],"dates":[],"comments":["In-Network Providers","Outpatient Medical Ancillary"]},{"amount":"0","time_period":null,"time_period_label":null,"level":"Employee and Spouse","insurance_type":null,"insurance_type_label":null,"pos":null,"pos_label":null,"authorization_required":true,"description":null,"contact_details":[],"dates":[],"comments":["Outpatient Surgery Facility","Medical Ancillary"]}],"out_network":[]}},"cost_containment":{"remainings":{"in_network":[],"out_network":[]},"spent":{"in_network":[],"out_network":[]},"totals":{"in_network":[],"out_network":[]}},"spend_down":{"remainings":{"in_network":[],"out_network":[]},"spent":{"in_network":[],"out_network":[]},"totals":{"in_network":[],"out_network":[]}},"limitations":{"amounts":[{"amount":null,"time_period":null,"time_period_label":null,"level":"Employee and Spouse","network":"IN","insurance_type":null,"insurance_type_label":null,"pos":null,"pos_label":null,"authorization_required":null,"description":null,"contact_details":[],"dates":[],"comments":["Plan includes NAP"]}]},"disclaimer":[],"other_sources":{"amounts":[]}},"visits":{"amounts":{"in_network":[],"out_network":[]}},"additional_insurance_policies":[{"insurance_type":null,"insurance_type_label":null,"coverage_description":null,"reference":[],"contact_details":[],"dates":[],"comments":[]}]},{"type":"51","type_label":"Hospital - Emergency Accident","coverage_status":"11","coverage_status_label":"Generic inquiry provided no information for this service type. Retry by including service_type_code=51 for an explicit inquiry for this service type."},{"type":"52","type_label":"Hospital - Emergency Medical","coverage_status":"11","coverage_status_label":"Generic inquiry provided no information for this service type. Retry by including service_type_code=52 for an explicit inquiry for this service type."},{"type":"53","type_label":"Hospital - Ambulatory Surgical","coverage_status":"11","coverage_status_label":"Generic inquiry provided no information for this service type. Retry by including service_type_code=53 for an explicit inquiry for this service type."},{"type":"96","type_label":"Professional (Physician)","coverage_status":"11","coverage_status_label":"Generic inquiry provided no information for this service type. Retry by including service_type_code=96 for an explicit inquiry for this service type."},{"type":"98","type_label":"Professional (Physician) Visit - Office","coverage_status":"1","coverage_status_label":"Active Coverage","coverage_basis":[],"facility":{"amounts":[]},"noncovered":[],"benefit_details":{"benefit_description":{"amounts":[]},"managed_care":{"amounts":[]},"unlimited":{"amounts":[]}},"financials":{"deductible":{"remainings":{"in_network":[],"out_network":[]},"spent":{"in_network":[],"out_network":[]},"totals":{"in_network":[],"out_network":[]}},"stop_loss":{"remainings":{"in_network":[],"out_network":[]},"spent":{"in_network":[],"out_network":[]},"totals":{"in_network":[],"out_network":[]}},"coinsurance":{"percents":{"in_network":[{"percent":"10","time_period":null,"time_period_label":null,"level":"Employee and Spouse","insurance_type":null,"insurance_type_label":null,"pos":null,"pos_label":null,"authorization_required":null,"description":null,"contact_details":[],"dates":[],"comments":["In-Network Providers","GYN Visit,COINS APPLIES TO OUT OF POCKET","Specialist Visit or Evaluation,COINS APPLIES TO OUT OF POCKET","Primary Care Visit or Evaluation,COINS APPLIES TO OUT OF POCKET"]}],"out_network":[{"percent":"30","time_period":null,"time_period_label":null,"level":"Employee and Spouse","insurance_type":null,"insurance_type_label":null,"pos":null,"pos_label":null,"authorization_required":null,"description":null,"contact_details":[],"dates":[],"comments":["GYN Visit,COINS APPLIES TO OUT OF POCKET","Specialist Visit or Evaluation,COINS APPLIES TO OUT OF POCKET","Primary Care Visit or Evaluation,COINS APPLIES TO OUT OF POCKET"]}]}},"copayment":{"amounts":{"in_network":[{"amount":"0","time_period":null,"time_period_label":null,"level":"Employee and Spouse","insurance_type":null,"insurance_type_label":null,"pos":null,"pos_label":null,"authorization_required":true,"description":null,"contact_details":[],"dates":[],"comments":["GYN Visit","Specialist Visit or Evaluation","Primary Care Visit or Evaluation"]}],"out_network":[]}},"cost_containment":{"remainings":{"in_network":[],"out_network":[]},"spent":{"in_network":[],"out_network":[]},"totals":{"in_network":[],"out_network":[]}},"spend_down":{"remainings":{"in_network":[],"out_network":[]},"spent":{"in_network":[],"out_network":[]},"totals":{"in_network":[],"out_network":[]}},"limitations":{"amounts":[{"amount":null,"time_period":null,"time_period_label":null,"level":"Employee and Spouse","network":"IN","insurance_type":null,"insurance_type_label":null,"pos":null,"pos_label":null,"authorization_required":null,"description":null,"contact_details":[],"dates":[],"comments":["Plan includes NAP"]}]},"disclaimer":[],"other_sources":{"amounts":[]}},"visits":{"amounts":{"in_network":[],"out_network":[]}},"additional_insurance_policies":[{"insurance_type":null,"insurance_type_label":null,"coverage_description":null,"reference":[],"contact_details":[],"dates":[],"comments":[]}]},{"type":"99","type_label":"Professional (Physician) Visit - Inpatient","coverage_status":"11","coverage_status_label":"Generic inquiry provided no information for this service type. Retry by including service_type_code=99 for an explicit inquiry for this service type."},{"type":"A0","type_label":"Professional (Physician) Visit - Outpatient","coverage_status":"11","coverage_status_label":"Generic inquiry provided no information for this service type. Retry by including service_type_code=A0 for an explicit inquiry for this service type."},{"type":"A1","type_label":"Professional (Physician) Visit - Nursing Home","coverage_status":"11","coverage_status_label":"Generic inquiry provided no information for this service type. Retry by including service_type_code=A1 for an explicit inquiry for this service type."},{"type":"A3","type_label":"Professional (Physician) Visit - Home","coverage_status":"11","coverage_status_label":"Generic inquiry provided no information for this service type. Retry by including service_type_code=A3 for an explicit inquiry for this service type."},{"type":"BZ","type_label":"Physician Visit - Well","coverage_status":"11","coverage_status_label":"Generic inquiry provided no information for this service type. Retry by including service_type_code=BZ for an explicit inquiry for this service type."},{"type":"BY","type_label":"Physician Visit - Sick","coverage_status":"11","coverage_status_label":"Generic inquiry provided no information for this service type. Retry by including service_type_code=BY for an explicit inquiry for this service type."},{"type":"UC","type_label":"Urgent Care","coverage_status":"1","coverage_status_label":"Active Coverage","coverage_basis":[],"facility":{"amounts":[]},"noncovered":[],"benefit_details":{"benefit_description":{"amounts":[]},"managed_care":{"amounts":[]},"unlimited":{"amounts":[]}},"financials":{"deductible":{"remainings":{"in_network":[],"out_network":[]},"spent":{"in_network":[],"out_network":[]},"totals":{"in_network":[],"out_network":[]}},"stop_loss":{"remainings":{"in_network":[],"out_network":[]},"spent":{"in_network":[],"out_network":[]},"totals":{"in_network":[],"out_network":[]}},"coinsurance":{"percents":{"in_network":[{"percent":"10","time_period":null,"time_period_label":null,"level":"Employee and Spouse","insurance_type":null,"insurance_type_label":null,"pos":null,"pos_label":null,"authorization_required":null,"description":null,"contact_details":[],"dates":[],"comments":["In-Network Providers","COINS APPLIES TO OUT OF POCKET"]}],"out_network":[{"percent":"30","time_period":null,"time_period_label":null,"level":"Employee and Spouse","insurance_type":null,"insurance_type_label":null,"pos":null,"pos_label":null,"authorization_required":null,"description":null,"contact_details":[],"dates":[],"comments":["COINS APPLIES TO OUT OF POCKET"]}]}},"copayment":{"amounts":{"in_network":[{"amount":"0","time_period":null,"time_period_label":null,"level":"Employee and Spouse","insurance_type":null,"insurance_type_label":null,"pos":null,"pos_label":null,"authorization_required":true,"description":null,"contact_details":[],"dates":[],"comments":[]}],"out_network":[]}},"cost_containment":{"remainings":{"in_network":[],"out_network":[]},"spent":{"in_network":[],"out_network":[]},"totals":{"in_network":[],"out_network":[]}},"spend_down":{"remainings":{"in_network":[],"out_network":[]},"spent":{"in_network":[],"out_network":[]},"totals":{"in_network":[],"out_network":[]}},"limitations":{"amounts":[{"amount":null,"time_period":null,"time_period_label":null,"level":"Employee and Spouse","network":"IN","insurance_type":null,"insurance_type_label":null,"pos":null,"pos_label":null,"authorization_required":null,"description":null,"contact_details":[],"dates":[],"comments":["Plan includes NAP"]}]},"disclaimer":[],"other_sources":{"amounts":[]}},"visits":{"amounts":{"in_network":[],"out_network":[]}},"additional_insurance_policies":[{"insurance_type":null,"insurance_type_label":null,"coverage_description":null,"reference":[],"contact_details":[],"dates":[],"comments":[]}]}]}