Examples
This page showcases example normalized plan files and explains how to interpret them. These examples correspond to real carrier plans that have been converted into the Benefit Plan Standard.
Example: Blue Cross PPO
You can view a normalized Blue Cross plan in the schema repository under examples/bluecross_example.json. It illustrates how deductibles, copays, coinsurance, network tiers, and limits are represented in a single JSON object.
Key features:
- Multiple tiers (
IN,OUT) with different cost shares - Separate plan‑wide deductible and OOP maximum
- Limit objects for rehabilitation services (e.g., 25 visits per year)
- Conditions for prior authorization on certain imaging services
- Source references pointing back to the SBC
Example: Humana Medicare Advantage
The examples/humana_example.json file shows how a Medicare Advantage plan is encoded:
- Many services have $0 copay because MA plans typically cover preventive services fully
- A pharmacy deductible applies only to tiers 3–5
- Worldwide emergency coverage is captured with a separate tier and MOOP exclusion flag
- Supplemental benefits such as hearing and vision are represented as additional benefit items
Example: UnitedHealthcare HMO
In examples/united_example.json you’ll find a commercial HMO plan with:
- Flat copays for physician visits and urgent care
- Tier‑specific deductibles for in‑network and out‑of‑network providers
- Combined annual visit caps for therapies
- Conditions requiring referrals for specialist visits
How to Explore Examples
To inspect any example plan:
- Clone the schema repository:
git clone https://github.com/Benefit-Plan-Standard/benefit-plan-schema - Open one of the JSON files in the
examples/directory. - Compare the fields to the Field Definitions to understand their meaning.
- Validate the JSON using a schema validator (see Installation & Usage).
These examples serve as a practical guide for developers and analysts. As more carriers are normalized, new examples will be added.