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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.

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Model Details

  • Model ID: HEALTH_INSURANCE
  • Supported Locales: en-US
  • Version: GA
  • Release Date: November 30, 2024

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Schema Structure

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Root Level Fields

FieldTypeDescription
Insurerstring?Health insurance provider name
MemberMember?Member information
DependentsDependent[]Array of dependents
IdNumberIdNumber?Identification number information
GroupNumberstring?Insurance Group Number
PrescriptionInfoPrescriptionInfo?Prescription information
Pbmstring?Pharmacy Benefit Manager
EffectiveDatestring?Plan effective date
CopaysCopay[]Array of copay benefits
PayerPayer?Payer information
PlanPlan?Plan information
MedicareMedicaidInfoMedicareMedicaidInfo?Medicare/Medicaid information

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Member Fields

FieldTypeDescription
Namestring?Member name
BirthDatestring?Member date of birth
Employerstring?Member employer
Genderstring?Member gender
IdNumberSuffixstring?Identification Number Suffix

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Dependent Fields

FieldTypeDescription
Namestring?Dependent name

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ID Number Fields

FieldTypeDescription
Prefixstring?ID number prefix
Numberstring?ID number

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Prescription Information Fields

FieldTypeDescription
Issuerstring?ANSI issuer identification number
RxBINstring?Prescription issued BIN number
RxPCNstring?Prescription processor control number
RxGrpstring?Prescription group number
RxIdstring?Prescription identification number
RxPlanstring?Prescription Plan number

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Copay Fields

FieldTypeDescription
Benefitstring?Co-Pay Benefit name
Amountnumber?Co-Pay required amount

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Plan Fields

FieldTypeDescription
Numberstring?Plan number
Namestring?Plan name
Typestring?Plan type

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Type Definitions

import type {
  Member,
  Dependent,
  IdNumber,
  PrescriptionInfo,
  Copay,
  Payer,
  Plan,
  MedicareMedicaidInfo,
  HealthInsuranceCard,
  HealthInsuranceCardResponse,
  StrictHealthInsuranceCardResponse
} from '@your-package/models';

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Validation Rules

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Basic Validation

  • All fields are optional by default
  • Dependents and Copays default to empty arrays if not specified

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Strict Validation

The following fields are required in strict mode:

  • Insurer
  • Member.Name
  • Member.BirthDate
  • IdNumber.Number
  • Plan.Name
  • Plan.Type

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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);

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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.

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Best Practices

  1. Always validate cards before processing:
const card = validateHealthInsuranceCard(cardData);
  1. Use full member ID for lookups:
const memberId = healthInsuranceCardUtils.getFullMemberId(card);
  1. Format copay amounts consistently:
const formattedCopay = healthInsuranceCardUtils.formatCopayAmount(copay.amount);
  1. Check card validity:
if (!healthInsuranceCardUtils.isCardValid(card)) {
  // Handle invalid card
}

  1. Handle prescription information carefully as it may be on a separate card

  2. Preserve original ID numbers and group numbers as strings