Documentation Index
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Overview
The Health Insurance Card model extracts and structures information from US health insurance cards, including member information, prescription details, plan information, and Medicare/Medicaid data. The model handles various card formats and insurance types.
Model Details
- Model ID:
HEALTH_INSURANCE
- Supported Locales:
en-US
- Version: GA
- Release Date: November 30, 2024
Schema Structure
Root Level Fields
| Field | Type | Description |
|---|
Insurer | string? | Health insurance provider name |
Member | Member? | Member information |
Dependents | Dependent[] | Array of dependents |
IdNumber | IdNumber? | Identification number information |
GroupNumber | string? | Insurance Group Number |
PrescriptionInfo | PrescriptionInfo? | Prescription information |
Pbm | string? | Pharmacy Benefit Manager |
EffectiveDate | string? | Plan effective date |
Copays | Copay[] | Array of copay benefits |
Payer | Payer? | Payer information |
Plan | Plan? | Plan information |
MedicareMedicaidInfo | MedicareMedicaidInfo? | Medicare/Medicaid information |
Member Fields
| Field | Type | Description |
|---|
Name | string? | Member name |
BirthDate | string? | Member date of birth |
Employer | string? | Member employer |
Gender | string? | Member gender |
IdNumberSuffix | string? | Identification Number Suffix |
Dependent Fields
| Field | Type | Description |
|---|
Name | string? | Dependent name |
ID Number Fields
| Field | Type | Description |
|---|
Prefix | string? | ID number prefix |
Number | string? | ID number |
| Field | Type | Description |
|---|
Issuer | string? | ANSI issuer identification number |
RxBIN | string? | Prescription issued BIN number |
RxPCN | string? | Prescription processor control number |
RxGrp | string? | Prescription group number |
RxId | string? | Prescription identification number |
RxPlan | string? | Prescription Plan number |
Copay Fields
| Field | Type | Description |
|---|
Benefit | string? | Co-Pay Benefit name |
Amount | number? | Co-Pay required amount |
Plan Fields
| Field | Type | Description |
|---|
Number | string? | Plan number |
Name | string? | Plan name |
Type | string? | Plan type |
Type Definitions
import type {
Member,
Dependent,
IdNumber,
PrescriptionInfo,
Copay,
Payer,
Plan,
MedicareMedicaidInfo,
HealthInsuranceCard,
HealthInsuranceCardResponse,
StrictHealthInsuranceCardResponse
} from '@your-package/models';
Validation Rules
Basic Validation
- All fields are optional by default
- Dependents and Copays default to empty arrays if not specified
Strict Validation
The following fields are required in strict mode:
- Insurer
- Member.Name
- Member.BirthDate
- IdNumber.Number
- Plan.Name
- Plan.Type
Example Usage
import { validateHealthInsuranceCard, healthInsuranceCardUtils } from '@your-package/models';
// Example health insurance card data
const cardData = {
Insurer: "PREMERA BLUE CROSS",
Member: {
Name: "ANGEL BROWN",
BirthDate: "1958-01-06",
Gender: "M"
},
IdNumber: {
Prefix: "ABC",
Number: "123456789"
},
GroupNumber: "1000000",
Plan: {
Name: "HEALTH SAVINGS PLAN",
Type: "PPO"
}
};
// Validate the card
const validatedCard = validateHealthInsuranceCard(cardData);
// Access validated data through result property
const memberId = healthInsuranceCardUtils.getFullMemberId(validatedCard.result);
Date Handling
The model accepts dates in multiple formats:
- ISO 8601 datetime strings
- YYYY-MM-DD format
- MM/DD/YYYY format
- MM-DD-YYYY format
All dates are converted to ISO format during validation.
Best Practices
- Always validate cards before processing:
const card = validateHealthInsuranceCard(cardData);
- Use full member ID for lookups:
const memberId = healthInsuranceCardUtils.getFullMemberId(card);
- Format copay amounts consistently:
const formattedCopay = healthInsuranceCardUtils.formatCopayAmount(copay.amount);
- Check card validity:
if (!healthInsuranceCardUtils.isCardValid(card)) {
// Handle invalid card
}
-
Handle prescription information carefully as it may be on a separate card
-
Preserve original ID numbers and group numbers as strings
