vericred_client 0.0.9 → 0.0.11
Sign up to get free protection for your applications and to get access to all the features.
- checksums.yaml +4 -4
- data/README.md +116 -13
- data/docs/Base.md +1 -1
- data/docs/Drug.md +1 -0
- data/docs/DrugCoverage.md +2 -1
- data/docs/DrugCoverageResponse.md +1 -1
- data/docs/DrugCoveragesApi.md +69 -0
- data/docs/DrugPackage.md +1 -0
- data/docs/DrugPackagesApi.md +66 -0
- data/docs/DrugSearchResponse.md +1 -1
- data/docs/DrugsApi.md +0 -61
- data/docs/Formulary.md +9 -0
- data/docs/FormularyDrugPackageResponse.md +10 -0
- data/docs/FormularyResponse.md +9 -0
- data/docs/Network.md +1 -1
- data/docs/NetworkDetails.md +10 -0
- data/docs/NetworkDetailsResponse.md +8 -0
- data/docs/NetworkSearchResponse.md +1 -1
- data/docs/NetworkSize.md +10 -0
- data/docs/NetworkSizesApi.md +124 -0
- data/docs/NetworksApi.md +55 -0
- data/docs/Plan.md +6 -4
- data/docs/PlanSearchResponse.md +2 -2
- data/docs/PlanSearchResponseMeta.md +9 -0
- data/docs/PlanSearchResult.md +6 -4
- data/docs/PlansApi.md +12 -10
- data/docs/Provider.md +1 -6
- data/docs/ProviderDetails.md +31 -0
- data/docs/ProviderGeocode.md +10 -0
- data/docs/ProvidersApi.md +61 -7
- data/docs/ProvidersGeocodeResponse.md +9 -0
- data/docs/ProvidersSearchResponse.md +1 -1
- data/docs/RequestPlanFindApplicant.md +2 -0
- data/docs/RequestPlanFindDrugPackage.md +1 -0
- data/docs/RequestProvidersSearch.md +5 -2
- data/docs/StateNetworkSizeRequest.md +9 -0
- data/docs/StateNetworkSizeResponse.md +9 -0
- data/docs/ZipCountiesApi.md +56 -1
- data/lib/vericred_client.rb +103 -2
- data/lib/vericred_client/api/drug_coverages_api.rb +295 -0
- data/lib/vericred_client/api/drug_packages_api.rb +289 -0
- data/lib/vericred_client/api/drugs_api.rb +88 -68
- data/lib/vericred_client/api/network_sizes_api.rb +348 -0
- data/lib/vericred_client/api/networks_api.rb +145 -1
- data/lib/vericred_client/api/plans_api.rb +108 -15
- data/lib/vericred_client/api/providers_api.rb +155 -9
- data/lib/vericred_client/api/zip_counties_api.rb +148 -4
- data/lib/vericred_client/api_client.rb +110 -21
- data/lib/vericred_client/api_error.rb +88 -1
- data/lib/vericred_client/configuration.rb +88 -1
- data/lib/vericred_client/models/applicant.rb +90 -3
- data/lib/vericred_client/models/base.rb +91 -4
- data/lib/vericred_client/models/carrier.rb +90 -3
- data/lib/vericred_client/models/carrier_subsidiary.rb +90 -3
- data/lib/vericred_client/models/county.rb +90 -3
- data/lib/vericred_client/models/county_bulk.rb +90 -3
- data/lib/vericred_client/models/drug.rb +101 -4
- data/lib/vericred_client/models/drug_coverage.rb +111 -14
- data/lib/vericred_client/models/drug_coverage_response.rb +91 -4
- data/lib/vericred_client/models/drug_package.rb +104 -7
- data/lib/vericred_client/models/drug_search_response.rb +91 -4
- data/lib/vericred_client/models/formulary.rb +404 -0
- data/lib/vericred_client/models/formulary_drug_package_response.rb +414 -0
- data/lib/vericred_client/models/formulary_response.rb +406 -0
- data/lib/vericred_client/models/meta.rb +90 -3
- data/lib/vericred_client/models/network.rb +91 -4
- data/lib/vericred_client/models/network_details.rb +416 -0
- data/lib/vericred_client/models/{pricing.rb → network_details_response.rb} +99 -112
- data/lib/vericred_client/models/network_search_response.rb +91 -4
- data/lib/vericred_client/models/network_size.rb +414 -0
- data/lib/vericred_client/models/plan.rb +115 -8
- data/lib/vericred_client/models/plan_county.rb +90 -3
- data/lib/vericred_client/models/plan_county_bulk.rb +90 -3
- data/lib/vericred_client/models/plan_search_response.rb +93 -6
- data/lib/vericred_client/models/plan_search_response_meta.rb +404 -0
- data/lib/vericred_client/models/plan_search_result.rb +115 -8
- data/lib/vericred_client/models/plan_show_response.rb +90 -3
- data/lib/vericred_client/models/provider.rb +101 -66
- data/lib/vericred_client/models/provider_details.rb +628 -0
- data/lib/vericred_client/models/provider_geocode.rb +414 -0
- data/lib/vericred_client/models/provider_show_response.rb +90 -3
- data/lib/vericred_client/models/providers_geocode_response.rb +406 -0
- data/lib/vericred_client/models/providers_search_response.rb +91 -4
- data/lib/vericred_client/models/rating_area.rb +90 -3
- data/lib/vericred_client/models/request_plan_find.rb +90 -3
- data/lib/vericred_client/models/request_plan_find_applicant.rb +114 -7
- data/lib/vericred_client/models/request_plan_find_drug_package.rb +104 -7
- data/lib/vericred_client/models/request_plan_find_provider.rb +90 -3
- data/lib/vericred_client/models/request_providers_search.rb +143 -26
- data/lib/vericred_client/models/service_area.rb +90 -3
- data/lib/vericred_client/models/service_area_zip_county.rb +90 -3
- data/lib/vericred_client/models/state.rb +90 -3
- data/lib/vericred_client/models/state_network_size_request.rb +408 -0
- data/lib/vericred_client/models/state_network_size_response.rb +406 -0
- data/lib/vericred_client/models/zip_code.rb +90 -3
- data/lib/vericred_client/models/zip_counties_response.rb +90 -3
- data/lib/vericred_client/models/zip_county.rb +90 -3
- data/lib/vericred_client/models/zip_county_bulk.rb +90 -3
- data/lib/vericred_client/models/zip_county_response.rb +90 -3
- data/lib/vericred_client/version.rb +89 -2
- data/spec/api/drug_coverages_api_spec.rb +254 -0
- data/spec/api/drug_packages_api_spec.rb +253 -0
- data/spec/api/drugs_api_spec.rb +88 -15
- data/spec/api/network_sizes_api_spec.rb +266 -0
- data/spec/api/networks_api_spec.rb +100 -1
- data/spec/api/plans_api_spec.rb +92 -4
- data/spec/api/providers_api_spec.rb +102 -3
- data/spec/api/zip_counties_api_spec.rb +101 -2
- data/spec/api_client_spec.rb +91 -25
- data/spec/configuration_spec.rb +88 -1
- data/spec/models/applicant_spec.rb +88 -1
- data/spec/models/base_spec.rb +88 -1
- data/spec/models/carrier_spec.rb +88 -1
- data/spec/models/carrier_subsidiary_spec.rb +88 -1
- data/spec/models/county_bulk_spec.rb +88 -1
- data/spec/models/county_spec.rb +88 -1
- data/spec/models/drug_coverage_response_spec.rb +88 -1
- data/spec/models/drug_coverage_spec.rb +95 -2
- data/spec/models/drug_package_spec.rb +94 -1
- data/spec/models/drug_search_response_spec.rb +88 -1
- data/spec/models/drug_spec.rb +94 -1
- data/spec/models/formulary_drug_package_response_spec.rb +259 -0
- data/spec/models/formulary_response_spec.rb +253 -0
- data/spec/models/formulary_spec.rb +253 -0
- data/spec/models/meta_spec.rb +88 -1
- data/spec/models/network_details_response_spec.rb +247 -0
- data/spec/models/network_details_spec.rb +259 -0
- data/spec/models/network_search_response_spec.rb +88 -1
- data/spec/models/network_size_spec.rb +259 -0
- data/spec/models/network_spec.rb +88 -1
- data/spec/models/plan_county_bulk_spec.rb +88 -1
- data/spec/models/plan_county_spec.rb +88 -1
- data/spec/models/plan_search_response_meta_spec.rb +253 -0
- data/spec/models/plan_search_response_spec.rb +88 -1
- data/spec/models/plan_search_result_spec.rb +100 -1
- data/spec/models/plan_show_response_spec.rb +88 -1
- data/spec/models/plan_spec.rb +100 -1
- data/spec/models/provider_details_spec.rb +385 -0
- data/spec/models/provider_geocode_spec.rb +259 -0
- data/spec/models/provider_show_response_spec.rb +88 -1
- data/spec/models/provider_spec.rb +94 -37
- data/spec/models/providers_geocode_response_spec.rb +253 -0
- data/spec/models/providers_search_response_spec.rb +88 -1
- data/spec/models/rating_area_spec.rb +88 -1
- data/spec/models/request_plan_find_applicant_spec.rb +100 -1
- data/spec/models/request_plan_find_drug_package_spec.rb +94 -1
- data/spec/models/request_plan_find_provider_spec.rb +88 -1
- data/spec/models/request_plan_find_spec.rb +88 -1
- data/spec/models/request_providers_search_spec.rb +109 -4
- data/spec/models/service_area_spec.rb +88 -1
- data/spec/models/service_area_zip_county_spec.rb +88 -1
- data/spec/models/state_network_size_request_spec.rb +253 -0
- data/spec/models/state_network_size_response_spec.rb +253 -0
- data/spec/models/state_spec.rb +88 -1
- data/spec/models/zip_code_spec.rb +88 -1
- data/spec/models/zip_counties_response_spec.rb +88 -1
- data/spec/models/zip_county_bulk_spec.rb +88 -1
- data/spec/models/zip_county_response_spec.rb +88 -1
- data/spec/models/zip_county_spec.rb +88 -1
- data/spec/spec_helper.rb +88 -1
- data/vericred_client.gemspec +90 -2
- metadata +66 -16
- data/docs/Pricing.md +0 -18
- data/spec/models/pricing_spec.rb +0 -220
@@ -6,13 +6,20 @@ accepts.
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## Getting Started
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Visit our [Developer Portal](https://vericred.
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Visit our [Developer Portal](https://developers.vericred.com) to
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create an account.
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Once you have created an account, you can create one Application for
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Production and another for our Sandbox (select the appropriate Plan when
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you create the Application).
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## SDKs
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Our API follows standard REST conventions, so you can use any HTTP client
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to integrate with us. You will likely find it easier to use one of our
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[autogenerated SDKs](https://github.com/vericred/?query=vericred-),
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which we make available for several common programming languages.
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## Authentication
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To authenticate, pass the API Key you created in the Developer Portal as
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}
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```
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## Benefits summary format
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Benefit cost-share strings are formatted to capture:
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* Network tiers
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* Compound or conditional cost-share
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* Limits on the cost-share
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* Benefit-specific maximum out-of-pocket costs
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**Example #1**
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As an example, we would represent [this Summary of Benefits & Coverage](https://s3.amazonaws.com/vericred-data/SBC/2017/33602TX0780032.pdf) as:
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* **Hospital stay facility fees**:
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- Network Provider: `$400 copay/admit plus 20% coinsurance`
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- Out-of-Network Provider: `$1,500 copay/admit plus 50% coinsurance`
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- Vericred's format for this benefit: `In-Network: $400 before deductible then 20% after deductible / Out-of-Network: $1,500 before deductible then 50% after deductible`
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* **Rehabilitation services:**
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- Network Provider: `20% coinsurance`
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- Out-of-Network Provider: `50% coinsurance`
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- Limitations & Exceptions: `35 visit maximum per benefit period combined with Chiropractic care.`
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- Vericred's format for this benefit: `In-Network: 20% after deductible / Out-of-Network: 50% after deductible | limit: 35 visit(s) per Benefit Period`
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**Example #2**
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In [this other Summary of Benefits & Coverage](https://s3.amazonaws.com/vericred-data/SBC/2017/40733CA0110568.pdf), the **specialty_drugs** cost-share has a maximum out-of-pocket for in-network pharmacies.
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* **Specialty drugs:**
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- Network Provider: `40% coinsurance up to a $500 maximum for up to a 30 day supply`
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- Out-of-Network Provider `Not covered`
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- Vericred's format for this benefit: `In-Network: 40% after deductible, up to $500 per script / Out-of-Network: 100%`
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**BNF**
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Here's a description of the benefits summary string, represented as a context-free grammar:
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```
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root ::= coverage
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coverage ::= (simple_coverage | tiered_coverage) (space pipe space coverage_limitation)?
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tiered_coverage ::= tier (space slash space tier)*
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tier ::= tier_name colon space (tier_coverage | not_applicable)
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tier_coverage ::= simple_coverage (space (then | or | and) space simple_coverage)* tier_limitation?
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simple_coverage ::= (pre_coverage_limitation space)? coverage_amount (space post_coverage_limitation)? (comma? space coverage_condition)?
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coverage_limitation ::= "limit" colon space (((simple_coverage | simple_limitation) (semicolon space see_carrier_documentation)?) | see_carrier_documentation | waived_if_admitted)
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waived_if_admitted ::= ("copay" space)? "waived if admitted"
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simple_limitation ::= pre_coverage_limitation space "copay applies"
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tier_name ::= "In-Network-Tier-2" | "Out-of-Network" | "In-Network"
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tier_limitation ::= comma space "up to" space (currency | (integer space time_unit plural?)) (space post_coverage_limitation)?
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coverage_amount ::= currency | unlimited | included | unknown | percentage | (digits space (treatment_unit | time_unit) plural?)
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pre_coverage_limitation ::= first space digits space time_unit plural?
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post_coverage_limitation ::= (((then space currency) | "per condition") space)? "per" space (treatment_unit | (integer space time_unit) | time_unit) plural?
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coverage_condition ::= ("before deductible" | "after deductible" | "penalty" | allowance | "in-state" | "out-of-state") (space allowance)?
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allowance ::= upto_allowance | after_allowance
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upto_allowance ::= "up to" space (currency space)? "allowance"
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after_allowance ::= "after" space (currency space)? "allowance"
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see_carrier_documentation ::= "see carrier documentation for more information"
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unknown ::= "unknown"
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unlimited ::= /[uU]nlimited/
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included ::= /[iI]ncluded in [mM]edical/
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time_unit ::= /[hH]our/ | (((/[cC]alendar/ | /[cC]ontract/) space)? /[yY]ear/) | /[mM]onth/ | /[dD]ay/ | /[wW]eek/ | /[vV]isit/ | /[lL]ifetime/ | ((((/[bB]enefit/ plural?) | /[eE]ligibility/) space)? /[pP]eriod/)
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treatment_unit ::= /[pP]erson/ | /[gG]roup/ | /[cC]ondition/ | /[sS]cript/ | /[vV]isit/ | /[eE]xam/ | /[iI]tem/ | /[sS]tay/ | /[tT]reatment/ | /[aA]dmission/ | /[eE]pisode/
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comma ::= ","
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colon ::= ":"
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semicolon ::= ";"
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pipe ::= "|"
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slash ::= "/"
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plural ::= "(s)" | "s"
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then ::= "then" | ("," space) | space
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or ::= "or"
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and ::= "and"
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not_applicable ::= "Not Applicable" | "N/A" | "NA"
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first ::= "first"
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currency ::= "$" number
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percentage ::= number "%"
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number ::= float | integer
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float ::= digits "." digits
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integer ::= /[0-9]/+ (comma_int | under_int)*
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comma_int ::= ("," /[0-9]/*3) !"_"
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under_int ::= ("_" /[0-9]/*3) !","
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digits ::= /[0-9]/+ ("_" /[0-9]/+)*
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space ::= /[ \t]/+
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```
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OpenAPI spec version: 1.0.0
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data/spec/models/county_spec.rb
CHANGED
@@ -6,13 +6,20 @@ accepts.
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## Getting Started
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Visit our [Developer Portal](https://vericred.
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Visit our [Developer Portal](https://developers.vericred.com) to
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create an account.
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11
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Once you have created an account, you can create one Application for
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13
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Production and another for our Sandbox (select the appropriate Plan when
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14
14
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you create the Application).
|
15
15
|
|
16
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+
## SDKs
|
17
|
+
|
18
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+
Our API follows standard REST conventions, so you can use any HTTP client
|
19
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+
to integrate with us. You will likely find it easier to use one of our
|
20
|
+
[autogenerated SDKs](https://github.com/vericred/?query=vericred-),
|
21
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+
which we make available for several common programming languages.
|
22
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+
|
16
23
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## Authentication
|
17
24
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|
18
25
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To authenticate, pass the API Key you created in the Developer Portal as
|
@@ -108,6 +115,86 @@ The response would be
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108
115
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}
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109
116
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```
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110
117
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|
118
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## Benefits summary format
|
119
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+
Benefit cost-share strings are formatted to capture:
|
120
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+
* Network tiers
|
121
|
+
* Compound or conditional cost-share
|
122
|
+
* Limits on the cost-share
|
123
|
+
* Benefit-specific maximum out-of-pocket costs
|
124
|
+
|
125
|
+
**Example #1**
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126
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As an example, we would represent [this Summary of Benefits & Coverage](https://s3.amazonaws.com/vericred-data/SBC/2017/33602TX0780032.pdf) as:
|
127
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+
|
128
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* **Hospital stay facility fees**:
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129
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- Network Provider: `$400 copay/admit plus 20% coinsurance`
|
130
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+
- Out-of-Network Provider: `$1,500 copay/admit plus 50% coinsurance`
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131
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- Vericred's format for this benefit: `In-Network: $400 before deductible then 20% after deductible / Out-of-Network: $1,500 before deductible then 50% after deductible`
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132
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+
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133
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* **Rehabilitation services:**
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- Network Provider: `20% coinsurance`
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- Out-of-Network Provider: `50% coinsurance`
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- Limitations & Exceptions: `35 visit maximum per benefit period combined with Chiropractic care.`
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- Vericred's format for this benefit: `In-Network: 20% after deductible / Out-of-Network: 50% after deductible | limit: 35 visit(s) per Benefit Period`
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**Example #2**
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In [this other Summary of Benefits & Coverage](https://s3.amazonaws.com/vericred-data/SBC/2017/40733CA0110568.pdf), the **specialty_drugs** cost-share has a maximum out-of-pocket for in-network pharmacies.
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* **Specialty drugs:**
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- Network Provider: `40% coinsurance up to a $500 maximum for up to a 30 day supply`
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- Out-of-Network Provider `Not covered`
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- Vericred's format for this benefit: `In-Network: 40% after deductible, up to $500 per script / Out-of-Network: 100%`
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**BNF**
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Here's a description of the benefits summary string, represented as a context-free grammar:
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```
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root ::= coverage
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coverage ::= (simple_coverage | tiered_coverage) (space pipe space coverage_limitation)?
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tiered_coverage ::= tier (space slash space tier)*
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tier ::= tier_name colon space (tier_coverage | not_applicable)
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coverage_limitation ::= "limit" colon space (((simple_coverage | simple_limitation) (semicolon space see_carrier_documentation)?) | see_carrier_documentation | waived_if_admitted)
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coverage_condition ::= ("before deductible" | "after deductible" | "penalty" | allowance | "in-state" | "out-of-state") (space allowance)?
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treatment_unit ::= /[pP]erson/ | /[gG]roup/ | /[cC]ondition/ | /[sS]cript/ | /[vV]isit/ | /[eE]xam/ | /[iI]tem/ | /[sS]tay/ | /[tT]reatment/ | /[aA]dmission/ | /[eE]pisode/
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comma ::= ","
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then ::= "then" | ("," space) | space
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or ::= "or"
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not_applicable ::= "Not Applicable" | "N/A" | "NA"
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first ::= "first"
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currency ::= "$" number
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percentage ::= number "%"
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number ::= float | integer
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float ::= digits "." digits
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comma_int ::= ("," /[0-9]/*3) !"_"
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- Vericred's format for this benefit: `In-Network: $400 before deductible then 20% after deductible / Out-of-Network: $1,500 before deductible then 50% after deductible`
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**Example #2**
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In [this other Summary of Benefits & Coverage](https://s3.amazonaws.com/vericred-data/SBC/2017/40733CA0110568.pdf), the **specialty_drugs** cost-share has a maximum out-of-pocket for in-network pharmacies.
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root ::= coverage
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tier ::= tier_name colon space (tier_coverage | not_applicable)
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tier_coverage ::= simple_coverage (space (then | or | and) space simple_coverage)* tier_limitation?
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simple_coverage ::= (pre_coverage_limitation space)? coverage_amount (space post_coverage_limitation)? (comma? space coverage_condition)?
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coverage_limitation ::= "limit" colon space (((simple_coverage | simple_limitation) (semicolon space see_carrier_documentation)?) | see_carrier_documentation | waived_if_admitted)
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waived_if_admitted ::= ("copay" space)? "waived if admitted"
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simple_limitation ::= pre_coverage_limitation space "copay applies"
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tier_name ::= "In-Network-Tier-2" | "Out-of-Network" | "In-Network"
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tier_limitation ::= comma space "up to" space (currency | (integer space time_unit plural?)) (space post_coverage_limitation)?
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coverage_amount ::= currency | unlimited | included | unknown | percentage | (digits space (treatment_unit | time_unit) plural?)
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pre_coverage_limitation ::= first space digits space time_unit plural?
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post_coverage_limitation ::= (((then space currency) | "per condition") space)? "per" space (treatment_unit | (integer space time_unit) | time_unit) plural?
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coverage_condition ::= ("before deductible" | "after deductible" | "penalty" | allowance | "in-state" | "out-of-state") (space allowance)?
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allowance ::= upto_allowance | after_allowance
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upto_allowance ::= "up to" space (currency space)? "allowance"
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after_allowance ::= "after" space (currency space)? "allowance"
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see_carrier_documentation ::= "see carrier documentation for more information"
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unknown ::= "unknown"
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unlimited ::= /[uU]nlimited/
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included ::= /[iI]ncluded in [mM]edical/
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time_unit ::= /[hH]our/ | (((/[cC]alendar/ | /[cC]ontract/) space)? /[yY]ear/) | /[mM]onth/ | /[dD]ay/ | /[wW]eek/ | /[vV]isit/ | /[lL]ifetime/ | ((((/[bB]enefit/ plural?) | /[eE]ligibility/) space)? /[pP]eriod/)
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treatment_unit ::= /[pP]erson/ | /[gG]roup/ | /[cC]ondition/ | /[sS]cript/ | /[vV]isit/ | /[eE]xam/ | /[iI]tem/ | /[sS]tay/ | /[tT]reatment/ | /[aA]dmission/ | /[eE]pisode/
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comma ::= ","
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colon ::= ":"
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semicolon ::= ";"
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pipe ::= "|"
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slash ::= "/"
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plural ::= "(s)" | "s"
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then ::= "then" | ("," space) | space
|
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or ::= "or"
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and ::= "and"
|
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not_applicable ::= "Not Applicable" | "N/A" | "NA"
|
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first ::= "first"
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currency ::= "$" number
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percentage ::= number "%"
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number ::= float | integer
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float ::= digits "." digits
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integer ::= /[0-9]/+ (comma_int | under_int)*
|
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comma_int ::= ("," /[0-9]/*3) !"_"
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under_int ::= ("_" /[0-9]/*3) !","
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digits ::= /[0-9]/+ ("_" /[0-9]/+)*
|
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space ::= /[ \t]/+
|
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```
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OpenAPI spec version: 1.0.0
|
@@ -6,13 +6,20 @@ accepts.
|
|
6
6
|
|
7
7
|
## Getting Started
|
8
8
|
|
9
|
-
Visit our [Developer Portal](https://vericred.
|
9
|
+
Visit our [Developer Portal](https://developers.vericred.com) to
|
10
10
|
create an account.
|
11
11
|
|
12
12
|
Once you have created an account, you can create one Application for
|
13
13
|
Production and another for our Sandbox (select the appropriate Plan when
|
14
14
|
you create the Application).
|
15
15
|
|
16
|
+
## SDKs
|
17
|
+
|
18
|
+
Our API follows standard REST conventions, so you can use any HTTP client
|
19
|
+
to integrate with us. You will likely find it easier to use one of our
|
20
|
+
[autogenerated SDKs](https://github.com/vericred/?query=vericred-),
|
21
|
+
which we make available for several common programming languages.
|
22
|
+
|
16
23
|
## Authentication
|
17
24
|
|
18
25
|
To authenticate, pass the API Key you created in the Developer Portal as
|
@@ -108,6 +115,86 @@ The response would be
|
|
108
115
|
}
|
109
116
|
```
|
110
117
|
|
118
|
+
## Benefits summary format
|
119
|
+
Benefit cost-share strings are formatted to capture:
|
120
|
+
* Network tiers
|
121
|
+
* Compound or conditional cost-share
|
122
|
+
* Limits on the cost-share
|
123
|
+
* Benefit-specific maximum out-of-pocket costs
|
124
|
+
|
125
|
+
**Example #1**
|
126
|
+
As an example, we would represent [this Summary of Benefits & Coverage](https://s3.amazonaws.com/vericred-data/SBC/2017/33602TX0780032.pdf) as:
|
127
|
+
|
128
|
+
* **Hospital stay facility fees**:
|
129
|
+
- Network Provider: `$400 copay/admit plus 20% coinsurance`
|
130
|
+
- Out-of-Network Provider: `$1,500 copay/admit plus 50% coinsurance`
|
131
|
+
- Vericred's format for this benefit: `In-Network: $400 before deductible then 20% after deductible / Out-of-Network: $1,500 before deductible then 50% after deductible`
|
132
|
+
|
133
|
+
* **Rehabilitation services:**
|
134
|
+
- Network Provider: `20% coinsurance`
|
135
|
+
- Out-of-Network Provider: `50% coinsurance`
|
136
|
+
- Limitations & Exceptions: `35 visit maximum per benefit period combined with Chiropractic care.`
|
137
|
+
- Vericred's format for this benefit: `In-Network: 20% after deductible / Out-of-Network: 50% after deductible | limit: 35 visit(s) per Benefit Period`
|
138
|
+
|
139
|
+
**Example #2**
|
140
|
+
In [this other Summary of Benefits & Coverage](https://s3.amazonaws.com/vericred-data/SBC/2017/40733CA0110568.pdf), the **specialty_drugs** cost-share has a maximum out-of-pocket for in-network pharmacies.
|
141
|
+
* **Specialty drugs:**
|
142
|
+
- Network Provider: `40% coinsurance up to a $500 maximum for up to a 30 day supply`
|
143
|
+
- Out-of-Network Provider `Not covered`
|
144
|
+
- Vericred's format for this benefit: `In-Network: 40% after deductible, up to $500 per script / Out-of-Network: 100%`
|
145
|
+
|
146
|
+
**BNF**
|
147
|
+
|
148
|
+
Here's a description of the benefits summary string, represented as a context-free grammar:
|
149
|
+
|
150
|
+
```
|
151
|
+
root ::= coverage
|
152
|
+
|
153
|
+
coverage ::= (simple_coverage | tiered_coverage) (space pipe space coverage_limitation)?
|
154
|
+
tiered_coverage ::= tier (space slash space tier)*
|
155
|
+
tier ::= tier_name colon space (tier_coverage | not_applicable)
|
156
|
+
tier_coverage ::= simple_coverage (space (then | or | and) space simple_coverage)* tier_limitation?
|
157
|
+
simple_coverage ::= (pre_coverage_limitation space)? coverage_amount (space post_coverage_limitation)? (comma? space coverage_condition)?
|
158
|
+
coverage_limitation ::= "limit" colon space (((simple_coverage | simple_limitation) (semicolon space see_carrier_documentation)?) | see_carrier_documentation | waived_if_admitted)
|
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|
+
waived_if_admitted ::= ("copay" space)? "waived if admitted"
|
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|
+
simple_limitation ::= pre_coverage_limitation space "copay applies"
|
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|
+
tier_name ::= "In-Network-Tier-2" | "Out-of-Network" | "In-Network"
|
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|
+
tier_limitation ::= comma space "up to" space (currency | (integer space time_unit plural?)) (space post_coverage_limitation)?
|
163
|
+
coverage_amount ::= currency | unlimited | included | unknown | percentage | (digits space (treatment_unit | time_unit) plural?)
|
164
|
+
pre_coverage_limitation ::= first space digits space time_unit plural?
|
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|
+
post_coverage_limitation ::= (((then space currency) | "per condition") space)? "per" space (treatment_unit | (integer space time_unit) | time_unit) plural?
|
166
|
+
coverage_condition ::= ("before deductible" | "after deductible" | "penalty" | allowance | "in-state" | "out-of-state") (space allowance)?
|
167
|
+
allowance ::= upto_allowance | after_allowance
|
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|
+
upto_allowance ::= "up to" space (currency space)? "allowance"
|
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|
+
after_allowance ::= "after" space (currency space)? "allowance"
|
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|
+
see_carrier_documentation ::= "see carrier documentation for more information"
|
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|
+
unknown ::= "unknown"
|
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|
+
unlimited ::= /[uU]nlimited/
|
173
|
+
included ::= /[iI]ncluded in [mM]edical/
|
174
|
+
time_unit ::= /[hH]our/ | (((/[cC]alendar/ | /[cC]ontract/) space)? /[yY]ear/) | /[mM]onth/ | /[dD]ay/ | /[wW]eek/ | /[vV]isit/ | /[lL]ifetime/ | ((((/[bB]enefit/ plural?) | /[eE]ligibility/) space)? /[pP]eriod/)
|
175
|
+
treatment_unit ::= /[pP]erson/ | /[gG]roup/ | /[cC]ondition/ | /[sS]cript/ | /[vV]isit/ | /[eE]xam/ | /[iI]tem/ | /[sS]tay/ | /[tT]reatment/ | /[aA]dmission/ | /[eE]pisode/
|
176
|
+
comma ::= ","
|
177
|
+
colon ::= ":"
|
178
|
+
semicolon ::= ";"
|
179
|
+
pipe ::= "|"
|
180
|
+
slash ::= "/"
|
181
|
+
plural ::= "(s)" | "s"
|
182
|
+
then ::= "then" | ("," space) | space
|
183
|
+
or ::= "or"
|
184
|
+
and ::= "and"
|
185
|
+
not_applicable ::= "Not Applicable" | "N/A" | "NA"
|
186
|
+
first ::= "first"
|
187
|
+
currency ::= "$" number
|
188
|
+
percentage ::= number "%"
|
189
|
+
number ::= float | integer
|
190
|
+
float ::= digits "." digits
|
191
|
+
integer ::= /[0-9]/+ (comma_int | under_int)*
|
192
|
+
comma_int ::= ("," /[0-9]/*3) !"_"
|
193
|
+
under_int ::= ("_" /[0-9]/*3) !","
|
194
|
+
digits ::= /[0-9]/+ ("_" /[0-9]/+)*
|
195
|
+
space ::= /[ \t]/+
|
196
|
+
```
|
197
|
+
|
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|
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|
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|
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describe 'test attribute "
|
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describe 'test attribute "med_id"' do
|
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|
it 'should work' do
|
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|
# assertion here. ref: https://www.relishapp.com/rspec/rspec-expectations/docs/built-in-matchers
|
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|
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|
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|
|
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|
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|
187
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|
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|
188
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|
|
276
|
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describe 'test attribute "tier"' do
|
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it 'should work' do
|
278
|
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# assertion here. ref: https://www.relishapp.com/rspec/rspec-expectations/docs/built-in-matchers
|
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|
+
end
|
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end
|
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+
|
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|
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|
190
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|