--- schema_version: "1" id: 43e37aee343b58c4fae03ad39c33c358ea28d998c9ae861034b13f1bd9b847a2 title: CoverageBenefit collection: legacydeveloper version: current locale: en-us portal_url: https://docs.salesforce.com/legacydeveloper/current/en-us/health_cloud_object_reference/sforce_api_objects_coveragebenefit.md canonical_url: https://developer.salesforce.com/docs/atlas.en-us.health_cloud_object_reference.meta/health_cloud_object_reference/sforce_api_objects_coveragebenefit.htm source_site: developer.salesforce.com content_type: documentation content_hash: df2d0abe7773ced96fa636615e79418e2164a62c8f3d973020c70ebc1bcd6055 description: Represents the benefits provided to a covered member by a purchaser’s plan. --- # CoverageBenefit Represents the benefits provided to a covered member by a purchaser’s plan. ## Supported Calls create(),  delete(),  describeLayout(),  describeSObjects(),  getDeleted(),  getUpdated(),  query(),  retrieve(),  search(),  undelete(),  update(),  upsert() ## Fields ### BenefitNotes - **Type**: textarea - **Properties**: Create, Nillable, Update - **Description**: Additional information about the benefits available to the member under this plan’s coverage. ### BenefitPeriodEndDate - **Type**: date - **Properties**: Create, Filter, Group, Nillable, Sort, Update - **Description**: Last day of the coverage benefit period. ### BenefitPeriodStartDate - **Type**: date - **Properties**: Create, Filter, Group, Nillable, Sort, Update - **Description**: First day of the coverage benefit period. ### CareBenefitVerifyRequestId - **Type**: reference - **Properties**: Create, Filter, Group, Nillable, Sort, Update - **Description**: The care benefit verify request associated with the coverage benefit. This field is a relationship field. This field is available in API version 61.0 and later with the Manage Pharmacy Benefits Verification permission set. - **Relationship Name**: CareBenefitVerifyRequest - **Relationship Type**: Lookup - **Refers To**: CareBenefitVerifyRequest ### CoinsuranceNotes - **Type**: textarea - **Properties**: Create, Nillable, Update - **Description**: Additional information about the contribution the member makes towards treatment. ### CopayNotes - **Type**: textarea - **Properties**: Create, Nillable, Update - **Description**: Additional information on the copayment amounts members contributes. ### CoverageType - **Type**: picklist - **Properties**: Create, Filter, Group, Nillable, Sort, Update - **Description**: General category of service covered. - **Possible values**: - Dental - Medical - Vision - Home Health - This picklist value is available for the Home Health feature in API version 59.0 and later. - Pharmacy - This picklist value is available for the Pharmacy Benefits Verification feature in API version 63.0 and later. See [Activate Picklist Value for Coverage Benefit](https://help.salesforce.com/s/articleView?id=ind.lsc_admin_pharmacy_benefits_verification_configure_picklist_field.htm&type=5&language=en_US) to activate this value. ### DeductibleNotes - **Type**: textarea - **Properties**: Create, Nillable, Update - **Description**: Additional information about the member’s deductibles under this plan. ### Disclaimer - **Type**: string - **Properties**: Create, Filter, Group, Nillable, Sort, Update - **Description**: Overall plan benefit disclaimers. ### EmergencyDepartmentCopay - **Type**: currency - **Properties**: Create, Filter, Nillable, Sort, Update - **Description**: The amount the member contributes towards emergency treatment. ### FamilyInNetworkDeductibleApplied - **Type**: currency - **Properties**: Create, Filter, Nillable, Sort, Update - **Description**: The amount the member has paid for health care provided by the health plan’s preferred providers for all family members. ### FamilyInNetworkDeductibleLimit - **Type**: currency - **Properties**: Create, Filter, Nillable, Sort, Update - **Description**: The amount the member is required to pay for health care provided by the health plan’s preferred providers for all family members. When this amount is reached, the plan starts to contribute towards treatment. ### FamilyInNetworkDeductibleRemaining - **Type**: currency - **Properties**: Create, Filter, Nillable, Sort, Update - **Description**: The remaining amount the member still has to pay for health care provided by the health plan’s preferred providers for all family members. When this amount is reached, the plan starts to contribute towards treatment. ### FamilyInNetworkOutofPocketApplied - **Type**: currency - **Properties**: Create, Filter, Nillable, Sort, Update - **Description**: The amount of the member has paid in this coverage year for health care provided by the health plan’s preferred providers for all family members. It includes deductibles, copayments, and coinsurance, but excludes premiums. ### FamilyInNetworkOutofPocketLimit - **Type**: currency - **Properties**: Create, Filter, Nillable, Sort, Update - **Description**: The most the member pays during the coverage year for health care provided by the health plan’s preferred providers for all family members. It includes deductibles, copayments, and coinsurance, but excludes premiums. ### FamilyInNetworkOutofPocketRemaining - **Type**: currency - **Properties**: Create, Filter, Nillable, Sort, Update - **Description**: The remaining amount for the member to pay during this coverage year for care provided by the plan’s preferred providers for all family members. When this amount is reached, the plan starts to contribute towards treatment. It includes deductibles, copayments, and coinsurance, but excludes premiums. ### FamilyOutofNetworkDeductibleApplied - **Type**: currency - **Properties**: Create, Filter, Nillable, Sort, Update - **Description**: The amount the member has paid for health care provided by non-preferred providers for all family members. ### FamilyOutofNetworkDeductibleLimit - **Type**: currency - **Properties**: Create, Filter, Nillable, Sort, Update - **Description**: The total amount the member has to pay for health care provided by non-preferred providers for all family members. When this amount is reached, the plan starts to contribute towards treatment. ### FamilyOutofNetworkDeductibleRemaining - **Type**: currency - **Properties**: Create, Filter, Nillable, Sort, Update - **Description**: The amount the member still has to pay for health care provided by non-preferred providers for all family members. When this amount is reached, the plan starts to contribute towards treatment. ### FamilyOutofNetworkOutofPocketApplied - **Type**: currency - **Properties**: Create, Filter, Nillable, Sort, Update - **Description**: The amount of the member has paid in this coverage year for health care provided by non-preferred providers for all family members. It includes deductibles, copayments, and coinsurance, but excludes premiums. ### FamilyOutofNetworkOutofPocketLimit - **Type**: currency - **Properties**: Create, Filter, Nillable, Sort, Update - **Description**: The most the member pays during the coverage year for health care provided by non-preferred providers for all family members. It includes deductibles, copayments, and coinsurance, but excludes premiums. ### FamilyOutofNetworkOutofPocketRemaining - **Type**: currency - **Properties**: Create, Filter, Nillable, Sort, Update - **Description**: The remaining amount for the member to pay during this coverage period for health care provided by non-preferred providers for all family members. When this amount is reached, the plan starts to contribute towards treatment. It includes deductibles, copayments, and coinsurance, but excludes premiums. ### FinalCoverageStatusCodeId - **Type**: reference - **Properties**: Create, Filter, Group, Nillable, Sort, Update - **Description**: The code that's determined after considering the restrictions and other status types that apply to the coverage benefit. This field is a relationship field. This field is available in API version 61.0 and later with the Manage Pharmacy Benefits Verification permission set. - **Relationship Name**: FinalCoverageStatusCode - **Relationship Type**: Lookup - **Refers To**: CodeSet ### FrequencyType - **Type**: picklist - **Properties**: Create, Filter, Group, Nillable, Restricted picklist, Sort, Update - **Description**: The frequency type of the coverage benefit associated with the home healthcare visit. This field is available in API version 66.0 and later with the Home Health add-on license. - **Possible values**: - Daily - Fortnightly - Monthly - Quarterly - Weekly - Yearly ### IndividualInNetworkDeductibleApplied - **Type**: currency - **Properties**: Create, Filter, Nillable, Sort, Update - **Description**: The amount the member has paid for health care provided by the health plan’s preferred providers to the most costly family member. ### IndividualInNetworkDeductibleLimit - **Type**: currency - **Properties**: Create, Filter, Nillable, Sort, Update - **Description**: The amount the member has to pay for health care provided by the plan’s preferred providers for any family member. When this amount is reached, the plan starts to contribute towards treatment. ### IndividualInNetworkDeductibleRemaining - **Type**: currency - **Properties**: Create, Filter, Nillable, Sort, Update - **Description**: The remaining amount the member has to pay for care during the coverage year provided by the plan’s preferred providers for any family member. When this amount is reached, the plan starts to contribute towards treatment. ### IndividualInNetworkOutofPocketApplied - **Type**: currency - **Properties**: Create, Filter, Nillable, Sort, Update - **Description**: The amount of the member has paid in this coverage year for health care provided by the plan’s preferred providers to any one family member. It includes deductibles, copayments, and coinsurance, but excludes premiums. ### IndividualInNetworkOutofPocketLimit - **Type**: currency - **Properties**: Create, Filter, Nillable, Sort, Update - **Description**: The most the member pays during the coverage year for health care provided by the health plan’s preferred providers for any family member. It includes deductibles, copayments, and coinsurance, but excludes premiums. ### IndividualInNetworkOutofPocketRemaining - **Type**: currency - **Properties**: Create, Filter, Nillable, Sort, Update - **Description**: The amount remaining for the member to pay during the coverage year for care provided by the plan’s preferred providers for any family member. It includes deductibles, copayments, and coinsurance, but excludes premiums. ### IndividualOutofNetworkDeductibleApplied - **Type**: currency - **Properties**: Create, Filter, Nillable, Sort, Update - **Description**: The amount the member has paid for health care provided by non-preferred providers to the most costly family member. ### IndividualOutofNetworkDeductibleLimit - **Type**: currency - **Properties**: Create, Filter, Nillable, Sort, Update - **Description**: The amount the member has to pay for health care provided by non-preferred providers to any one family member. When this amount is reached, the plan starts to contribute towards treatment. ### IndividualOutofNetworkDeductibleRemain - **Type**: currency - **Properties**: Create, Filter, Nillable, Sort, Update - **Description**: The remaining amount the member has to pay for health care during the coverage year provided by non-preferred providers to any family member. When this amount is reached, the plan starts to contribute towards treatment. ### IndividualOutofNetworkOutofPocketApplied - **Type**: currency - **Properties**: Create, Filter, Nillable, Sort, Update - **Description**: The amount of the member has paid in this coverage period for health care provided by non-preferred providers to any family members. It includes deductibles, copayments, and coinsurance, but excludes premiums. ### IndividualOutofNetworkOutofPocketLimit - **Type**: currency - **Properties**: Create, Filter, Nillable, Sort, Update - **Description**: The most the member pays during the coverage year for health care provided by non-preferred providers to any family member. It includes deductibles, copayments, and coinsurance, but excludes premiums. ### IndividualOutofNetworkOutofPocketRemain - **Type**: currency - **Properties**: Create, Filter, Nillable, Sort, Update - **Description**: The amount remaining for the member to pay during the coverage year for health care provided by non-preferred providers to any family member. It includes deductibles, copayments, and coinsurance, but excludes premiums. ### InNetworkCoinsuranceAmount - **Type**: currency - **Properties**: Create, Filter, Nillable, Sort, Update - **Description**: The amount the member contributes towards treatment undertaken by the health plan’s preferred providers. ### InNetworkCoinsurancePercentage - **Type**: percent - **Properties**: Create, Filter, Nillable, Sort, Update - **Description**: The percentage of treatment cost the member pays for treatment undertaken by the health plan’s preferred providers. ### InNetworkLifetimeMaximum - **Type**: currency - **Properties**: Create, Filter, Nillable, Sort, Update - **Description**: The amount the member has to pay during lifetime coverage under this plan after which the provider covers all costs for treatment provided by its preferred providers. It includes deductibles, copayments, and coinsurance, but excludes premiums. ### IsActive - **Type**: boolean - **Properties**: Create, Defaulted on create, Filter, Group, Sort, Update - **Description**: Specifies whether the coverage benefit is currently in force. - **Default value**: false ### LastReferencedDate - **Type**: datetime - **Properties**: Filter, Nillable, Sort - **Description**: The timestamp for when the current user last viewed a record related to this record. ### LastViewedDate - **Type**: datetime - **Properties**: Filter, Nillable, Sort - **Description**: The timestamp for when the current user last viewed this record. If this value is null, it’s possible that this record was referenced (LastReferencedDate) and not viewed. ### LifetimeMaximumNotes - **Type**: textarea - **Properties**: Create, Nillable, Update - **Description**: Additional information on the lifetime maximum payments the member Will be expected to make. ### MemberId - **Type**: reference - **Properties**: Create, Filter, Group, Nillable, Sort, Update - **Description**: The ID of the member receiving these benefits. ### MemberPlanId - **Type**: reference - **Properties**: Create, Filter, Group, Sort - **Description**: The ID of the member plan receiving these benefits. ### Name - **Type**: string - **Properties**: Create, Filter, Group, Sort, Update - **Description**: Name of these coverage benefits. ### OutcomeStatusCodeId - **Type**: reference - **Properties**: Create, Filter, Group, Nillable, Sort, Update - **Description**: The outcome code set associated with the coverage benefit. This field is a relationship field. This field is available in API version 61.0 and later with the Manage Pharmacy Benefits Verification permission set. - **Relationship Name**: OutcomeStatusCode - **Relationship Type**: Lookup - **Refers To**: CodeSet ### OutofNetworkCoinsuranceAmount - **Type**: currency - **Properties**: Create, Filter, Nillable, Sort, Update - **Description**: The amount the member contributes towards treatment undertaken by non-preferred providers. ### OutofNetworkCoinsurancPercentage - **Type**: percent - **Properties**: Create, Filter, Nillable, Sort, Update - **Description**: The percentage of treatment cost the member pays for treatment undertaken by non-preferred providers. ### OutofNetworkLifetimeMaximum - **Type**: currency - **Properties**: Create, Filter, Nillable, Sort, Update - **Description**: The amount the member has to pay during lifetime coverage under this plan after which the plan provider covers all costs for treatment provided by its non-preferred providers. It includes deductibles, copayments, and coinsurance, but excludes premiums. ### OutofPocketNotes - **Type**: textarea - **Properties**: Create, Nillable, Update - **Description**: Additional information about the out-of-pocket payment the member makes. ### OwnerId - **Type**: reference - **Properties**: Create, Defaulted on create, Filter, Group, Sort, Update - **Description**: The ID of the user who owns this record. ### PharmaCopayAmount - **Type**: currency - **Properties**: Create, Filter, Nillable, Sort, Update - **Description**: The amount the member contributes towards the pharma products. This field is available in API version 62.0 and later with the Manage Financial Assistance Program permission set. ### PrimaryCareCopay - **Type**: currency - **Properties**: Create, Filter, Nillable, Sort, Update - **Description**: The amount the member contributes towards primary care treatment. ### SourceSystem - **Type**: string - **Properties**: Create, Filter, Group, Nillable, Sort, Update - **Description**: The name of the system this benefits record was obtained from. ### SourceSystemIdentifier - **Type**: string - **Properties**: Create, Filter, Group, Nillable, Sort, Update - **Description**: The ID of this benefits record on its source system. ### SourceSystemModified - **Type**: date - **Properties**: Create, Filter, Group, Nillable, Sort, Update - **Description**: The date on which these benefits were last changed on their source system. ### SpecialistCopay - **Type**: currency - **Properties**: Create, Filter, Nillable, Sort, Update - **Description**: The amount the member contributes towards specialist consultations. ### StatusCodeId - **Type**: reference - **Properties**: Create, Filter, Group, Nillable, Sort, Update - **Description**: The status code set associated with the coverage benefit. This field is a relationship field. This field is available in API version 61.0 and later with the Manage Pharmacy Benefits Verification permission set. - **Relationship Name**: StatusCode - **Relationship Type**: Lookup - **Refers To**: CodeSet ### TotalBenefitAmount - **Type**: currency - **Properties**: Create, Filter, Nillable, Sort, Update - **Description**: The total amount of the coverage benefit associated with the home healthcare visit. This field is available in API version 66.0 and later with the Home Health add-on license. ### UrgentCareCopay - **Type**: currency - **Properties**: Create, Filter, Nillable, Sort, Update - **Description**: The amount the member contributes towards urgent care. ### VerificationDate - **Type**: dateTime - **Properties**: Create, Filter, Nillable, Sort, Update - **Description**: Date on which the benefit was verified. ## Associated Objects This object has these associated objects. If the API version isn’t specified, they’re available in the same API versions as this object. Otherwise, they’re available in the specified API version and later. [CoverageBenefitChangeEvent](https://developer.salesforce.com/docs/atlas.en-us.health_cloud_object_reference.meta/health_cloud_object_reference/sforce_api_associated_objects_change_event.htm "A StandardObjectNameChangeEvent object is available for each object that supports Change Data Capture. You can subscribe to a stream of change events using Change Data Capture to receive data tied to record changes in Salesforce. Changes include record creation, updates to an existing record, deletion of a record, and undeletion of a record. A change event isn’t a Salesforce object—it doesn’t support CRUD operations or queries. It’s included in the object reference so you can discover which Salesforce objects support change events.") (API version 59.0) Change events are available for the object. [CoverageBenefitFeed](https://developer.salesforce.com/docs/atlas.en-us.health_cloud_object_reference.meta/health_cloud_object_reference/sforce_api_associated_objects_feed.htm "StandardObjectNameFeed is the model for all feed objects associated with standard objects. These objects represent the posts and feed-tracked changes of a standard object.") Feed tracking is available for the object. [CoverageBenefitHistory](https://developer.salesforce.com/docs/atlas.en-us.health_cloud_object_reference.meta/health_cloud_object_reference/sforce_api_associated_objects_history.htm "StandardObjectNameHistory is the model for all history objects associated with standard objects. These objects represent the history of changes to the values in the fields of a standard object.") History is available for tracked fields of the object. [CoverageBenefitOwnerSharingRule](https://developer.salesforce.com/docs/atlas.en-us.health_cloud_object_reference.meta/health_cloud_object_reference/sforce_api_associated_objects_ownersharingrule.htm "StandardObjectNameOwnerSharingRule is the model for all owner sharing rule objects associated with standard objects. These objects represent a rule for sharing a standard object with users other than the owner.") Sharing rules are available for the object. [CoverageBenefitShare](https://developer.salesforce.com/docs/atlas.en-us.health_cloud_object_reference.meta/health_cloud_object_reference/sforce_api_associated_objects_share.htm "StandardObjectNameShare is the model for all share objects associated with standard objects. These objects represent a sharing entry on the standard object.") Sharing is available for the object.