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CoverageBenefitItem

Specific service covered by the insurance plan. This object is available in API version 53.0 and later.

Supported Calls

create(), delete(), describeLayout(), describeSObjects(), getDeleted(), getUpdated(), query(), retrieve(), search(), undelete(), update(), upsert()

Fields

BenefitCategory

  • Type: string
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Name of the category this benefit is in.

CodeSetServiceTypeId

  • Type: reference
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: ID of a Code Set Service Type in the Code Set object.

    This is a relationship field.

  • Relationship Name: CodeSetServiceType
  • Relationship Type: Lookup
  • Refers To: CodeSet

CoverageBenefitId

  • Type: reference
  • Properties: Create, Filter, Group, Sort
  • Description: The ID of the covered benefit this item belongs to.

    This is a relationship field.

  • Relationship Name: CoverageBenefit
  • Relationship Type: Lookup
  • Refers To: CoverageBenefit

CoverageLevel

  • Type: string
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Description of the level of coverage provided by this item.

DoesDeductibleApply

  • Type: boolean
  • Properties: Create, Defaulted on create, Filter, Group, Sort, Update
  • Description: Specifies whether the benefit item requires a prior expenditure by the patient.
  • Default value: false

FrequencyType

  • Type: picklist
  • Properties: Create, Filter, Group, Nillable, Restricted picklist, Sort, Update
  • Description: The frequency type of the coverage benefit item 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

InNetworkCoverage

  • Type: textarea
  • Properties: Create, Nillable, Update
  • Description: Description of the in network coverage provided by this item.

IsActive

  • Type: boolean
  • Properties: Create, Defaulted on create, Filter, Group, Sort, Update
  • Description: Specifies whether the benefit item is currently available.
  • Default value: false

IsInPlanNetwork

  • Type: boolean
  • Properties: Create, Defaulted on create, Filter, Group, Sort, Update
  • Description: Indicates whether the benefit is available only in-network (true) or both in-network and out-of-network (false).
  • Default value: false

IsPreauthorizationRequired

  • Type: boolean
  • Properties: Create, Defaulted on create, Filter, Group, Sort, Update
  • Description: Specifies whether the service must be approved before use.
  • 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.

MemberId

  • Type: reference
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: The ID of the member receiving this benefit item.

    This is a relationship field.

  • Relationship Name: Member
  • Relationship Type: Lookup
  • Refers To: Account

Name

  • Type: string
  • Properties: Create, Filter, Group, idLookup, Sort, Update
  • Description: Name of this coverage benefit item.

Notes

  • Type: textarea
  • Properties: Create, Nillable, Update
  • Description: Additional information about this coverage benefit item.

OutofNetworkCoverage

  • Type: textarea
  • Properties: Create, Nillable, Update
  • Description: Description of the coverage for non-preferred providers.

OwnerId

  • Type: reference
  • Properties: Create, Defaulted on create, Filter, Group, Sort, Update
  • Description: The ID of the user who owns this record.

    This is a polymorphic relationship field.

  • Relationship Name: Owner
  • Relationship Type: Lookup
  • Refers To: Group, User

ServiceType

  • Type: string
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: The type of service this plan benefit item provides.

LastReferencedDate

  • Type: dateTime
  • Properties: Filter, Nillable, Sort
  • Description: The timestamp indicating when the current user last viewed a related 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.

ServiceTypeCode

  • Type: string
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: The code for the type of service this plan benefit item provides.

SourceSystem

  • Type: string
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: The name of the system this coverage benefits item record came from.

SourceSystemIdentifier

  • Type: string
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: The identifier of the CoverageBenefitItem in its source system.

SourceSystemModified

  • Type: dateTime
  • Properties: Create, Filter, Nillable, Sort, Update
  • Description: The ID of this coverage benefits item record on its source system.

SourceSystemModified

  • Type: dateTime
  • Properties: Create, Filter, Nillable, Sort, Update
  • Description: The date on which this coverage benefits item was last changed on the source system.

TimePeriod

  • Type: string
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: A description of the period this plan benefit item covers.

Associated Objects

This object has the following 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.

CoverageBenefitItemChangeEvent (API version 59.0)
Change events are available for the object.