Examples

This page showcases example normalized plan files and explains how to interpret them. Every example is a real plan. 8 are read from the Summary of Benefits and Coverage the carrier published and verified value by value against it; 2 Medicare Advantage plans are read from the CMS Summary of Benefits; 5 are imported from the CMS Marketplace public use files and 5 Medicare Advantage plans from the CMS Plan Benefit Package (PBP) files, with no PDF involved. All 20 live in the examples/ directory of the schema repository, and the 10 read from a document have their source PDFs in examples/sources/:

File	Plan	Type	Market
aetna_example.json	Aetna FL PPO 1500 80/50	PPO	Large group
aetna_ppo5000_example.json	Aetna FL PPO 5000 80/50	PPO	Large group
ambetter_example.json	Health Net of CA Silver 94 Ambetter	HMO	Individual
bluecross_example.json	Florida Blue BlueOptions 505	PPO	Individual
cigna_example.json	Bowdoin College Open Access Plus	OAP	Large group
gatorcare_example.json	Florida Blue BlueOptions 03768 Prime	EPO	Self-funded
kaiser_example.json	Kaiser Permanente Gold 80	HMO	Individual
united_example.json	UHC Choice Plus HSA Gold 1700-4	POS	Small group
humana_example.json	Humana Gold Plus H1036-025	HMO	Medicare Advantage
scan_example.json	SCAN Classic, Los Angeles County	HMO	Medicare Advantage
avmed-avmed-entrust-gold-125.puf.json	AvMed Entrust Gold 125, from the public files	HMO	Individual
blue-cross-and-blue-shield-of-louisiana-blue-max-copay-50-50.puf.json	Blue Cross and Blue Shield of Louisiana Blue Max Copay 50/50, from the public files	PPO	Individual
florida-blue-blueoptions-gold-1505.puf.json	Florida Blue BlueOptions Gold 1505, from the public files	EPO	Individual
unitedhealthcare-uhc-bronze-essential.puf.json	UnitedHealthcare UHC Bronze Essential, from the public files	HMO	Individual
unitedhealthcare-uhc-gold-standard.puf.json	UnitedHealthcare UHC Gold Standard, from the public files	HMO	Individual
unitedhealthcare-aarp-medicare-advantage-from-uhc-fl-0021.pbp.json	AARP Medicare Advantage from UHC FL-0021, from the PBP files	PPO	Medicare Advantage
humana-humana-gold-plus-h1036-068.pbp.json	Humana Gold Plus H1036-068, from the PBP files	HMO	Medicare Advantage
aetna-medicare-aetna-medicare-select-extra.pbp.json	Aetna Medicare Select Extra, from the PBP files	HMO-POS	Medicare Advantage
upmc-for-life-upmc-for-life-ppo-rx-choice.pbp.json	UPMC for Life PPO Rx Choice, from the PBP files	PPO	Medicare Advantage
scan-health-plan-scan-costco-medicare-advantage.pbp.json	SCAN Costco Medicare Advantage, from the PBP files	HMO	Medicare Advantage

The full table, with plan years, schema versions and benefit counts, is on the Examples page under Specification; the public-file examples are explained on CMS Marketplace public files and CMS Medicare Advantage PBP files.

The first 8 are commercial and marketplace plans built from the SBC. The 7 Medicare Advantage plans come from other CMS documents: 2 from the Summary of Benefits and 5 from the PBP files. Medicaid is not part of this set yet.

All 20 validate against the Benefit Plan Standard schema 1.2.0 draft: from the Benefit Plan Standard schema repository, node scripts/validate.js --schema schema/v1.2.0/benefit-plan.schema.json examples/*.json prints 20 PASS. Without --schema, scripts/validate.js checks against Benefit Plan Standard schema 1.1.0, the latest final release, which only the 8 SBC examples declare; the Marketplace importer and the Medicare Advantage importer write 1.2.0 documents.

Example: Blue Cross PPO

examples/bluecross_example.json is a good first read. It shows how deductibles, copays, coinsurance and network tiers fit together in one JSON object.

• Two tiers, IN and OUT, each with its own cost shares
• Separate in-network and out-of-network deductibles and out-of-pocket maximums, at both the individual and family level
• 31 benefit entries, each carrying a source reference back to the page of the SBC it came from

Example: Kaiser Permanente HMO

examples/kaiser_example.json shows a closed-network plan.

• One tier, IN, and no out-of-network accumulators, because the plan has no out-of-network benefit
• The same benefit categories as the PPO examples, so the two can be compared field for field

Example: GatorCare EPO

examples/gatorcare_example.json is a self-funded employer plan administered under a carrier's document.

• Market is self_funded, which is how the standard records a plan the employer funds and a carrier administers
• IN and OUT tiers with a single set of plan-wide accumulators

How to Explore Examples

To inspect any example plan:

1. Clone the schema repository: git clone https://github.com/Benefit-Plan-Standard/benefit-plan-schema, or browse the examples/ directory directly on GitHub.
2. Open one of the JSON files in the examples/ directory.
3. Compare the fields to the Field Definitions to understand their meaning.
4. Validate the JSON using a schema validator (see Installation & Usage).

As more carriers and lines of business are normalized, new examples will be added.