Compliance Overview
The Benefit Plan Standard provides a unified schema for representing health benefit plan data.
Compliance ensures that all implementers—carriers, brokers, TPAs, and developers—adhere to the same structure, vocabulary, and behavior.
Why Compliance Matters
- Ensures consistency across carriers
- Enables automated ingestion pipelines
- Prevents ambiguous or conflicting data
- Improves downstream analytics and plan comparison
- Supports interoperability between vendors and systems
What “Compliance” Means
To be considered compliant with the Benefit Plan Standard, an implementation must:
- Produce a valid JSON matching the official schema.
- Use approved field definitions and vocabulary.
- Follow crosswalk mapping rules.
- Respect module requirements (e.g., Medical Core module is mandatory).
- Include required metadata fields.
- Pass the validation suite.
Compliance Levels
Level 1 — Structural Compliance
Your JSON passes schema validation with no errors.
Level 2 — Semantic Compliance
Values are correctly interpreted using the schema vocabulary and crosswalk rules.
Level 3 — Full Carrier Compliance
Your entire plan portfolio is normalized, validated, and consistent.
How to Become Compliant
- Read the core specification
- Use the example JSON plans
- Normalize plan data using the crosswalk
- Run the validation suite
- Submit for certification (optional)