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- {
- "type": "PP",
- "code": "XX12345",
- "principal_schedule": "a",
- "phic_status": "O",
- "pec": [
- {
- "pec_code": "PEC-DREADED-P",
- "member_type": "P",
- "member_category": "E",
- "is_same_effective_as_account": true,
- "inner_limit_value": "99",
- "inner_limit_type": "PC",
- "duration": 6,
- "disease_category": "D"
- },
- {
- "pec_code": "PECPS002",
- "member_type": "P",
- "member_category": "E",
- "is_same_effective_as_account": true,
- "inner_limit_value": "99",
- "inner_limit_type": "PC",
- "duration": 6,
- "disease_category": "ND"
- }
- ],
- "name": "ff",
- "max_no_dependents": "12",
- "loa_validity": 365,
- "outer_limits": [
- {
- "limit_type": "MBL",
- "limit_amount": "1005678.00",
- "is_shared_dependents": true,
- "extension_limit": "12345.00",
- "coverage_codes": [
- "IP"
- ]
- }
- ],
- "sonny_medina_amount": 1000,
- "is_sonny_medina": true,
- "is_reimbursement": false,
- "is_no_outright_denial": false,
- "is_loa_facilitated": true,
- "hoed": [
- {
- "dependent_hierarchy": [
- {
- "hierarchy": 1,
- "dependent": "PR"
- },
- {
- "hierarchy": 2,
- "dependent": "SL"
- }
- ],
- "civil_status": [
- "S"
- ]
- },
- {
- "dependent_hierarchy": [
- {
- "hierarchy": 1,
- "dependent": "SL"
- },
- {
- "hierarchy": 2,
- "dependent": "PR"
- }
- ],
- "civil_status": [
- "M"
- ]
- }
- ],
- "grace_principal_value": 365,
- "grace_principal_type": "D",
- "grace_dependent_value": 365,
- "grace_dependent_type": "D",
- "exclusion_codes": [],
- "description": "Maxicare Plus Group",
- "dependent_schedule": "a",
- "default_effective_date": "DR",
- "coverages": [
- {
- "specific_facility_codes": [],
- "rs_member_pays_handling": [
- "AO"
- ],
- "room_upgrade": 366,
- "room_category": "",
- "risk_share_specific": [
- {
- "rs_member_pays_handling": [
- "AO"
- ],
- "risk_share_value": "100",
- "risk_share_type": "CP",
- "facility_code": "880000000006035"
- }
- ],
- "risk_share_all_value": "10",
- "risk_share_all_type": "CI",
- "member_pays_handling": [],
- "is_room_category": false,
- "is_risk_share_all_coverage": false,
- "is_facility_all_coverage": false,
- "is_days": true,
- "is_amount": false,
- "incremental_cost": "10",
- "funding_arrangement": "FR",
- "facility_type": "ALL",
- "facility_group_codes": [],
- "excluded_facility_codes": [],
- "days_value": "15",
- "days_type": "C",
- "coverage_code": "IP",
- "amount_value": "",
- "amount_type": ""
- },
- {
- "coverage_code": "M",
- "covered_enrollees": [
- "MFP",
- "SFP",
- "MFD",
- "AFD"
- ],
- "waiting_period_type": "M",
- "waiting_period_value": "12",
- "waiting_period_event": "DH",
- "philhealth": "R",
- "is_charge_to_ip_limit": false
- }
- ],
- "classification": "C",
- "charge_type": [
- {
- "professional_fee": "99.02",
- "hospital_bill_value": "1.23",
- "hospital_bill_type": "PC",
- "facility": "AF",
- "cost_type": "AC"
- }
- ],
- "benefits": [
- {
- "limit_value": "1000.00",
- "limit_type": "PS",
- "benefit_code": "TestIan4",
- "coverage_codes": [
- "IP"
- ]
- },
- {
- "limit_value": "1000.00",
- "limit_type": "PS",
- "benefit_code": "TestIan4",
- "coverage_codes": [
- "IP"
- ]
- },
- {
- "limit_value": "1000.00",
- "limit_type": "PS",
- "benefit_code": "E.7-IP",
- "coverage_codes": [
- "IP"
- ]
- },
- {
- "limit_value": "1000.00",
- "limit_type": "PS",
- "benefit_code": "C.58-IP",
- "coverage_codes": [
- "IP"
- ]
- },
- {
- "limit_value": "1000.00",
- "limit_type": "PS",
- "benefit_code": "C.53-IP",
- "coverage_codes": [
- "IP"
- ]
- },
- {
- "limit_value": "1000.00",
- "limit_type": "PS",
- "benefit_code": "C.54-IP",
- "coverage_codes": [
- "IP"
- ]
- },
- {
- "limit_value": "1000.00",
- "limit_type": "PS",
- "benefit_code": "C.62-IP",
- "coverage_codes": [
- "IP"
- ]
- },
- {
- "limit_value": "1000.00",
- "limit_type": "PS",
- "benefit_code": "C.65-IP",
- "coverage_codes": [
- "IP"
- ]
- },
- {
- "limit_value": "1000.00",
- "limit_type": "PS",
- "benefit_code": "C.66-IP",
- "coverage_codes": [
- "IP"
- ]
- },
- {
- "limit_value": "1000.00",
- "limit_type": "PS",
- "benefit_code": "C.70-IP",
- "coverage_codes": [
- "IP"
- ]
- },
- {
- "limit_value": "1000.00",
- "limit_type": "PS",
- "benefit_code": "C.7-IP",
- "coverage_codes": [
- "IP"
- ]
- },
- {
- "limit_value": "1000.00",
- "limit_type": "PS",
- "benefit_code": "C.72-IP",
- "coverage_codes": [
- "IP"
- ]
- },
- {
- "limit_value": "1000.00",
- "limit_type": "PS",
- "benefit_code": "BN-00002",
- "coverage_codes": [
- "M"
- ]
- }
- ],
- "application_of_limit": "lt",
- "applicability": "P",
- "age_eligibility": [
- {
- "min_age": "1",
- "min_age_type": "Y",
- "member_type": "P",
- "max_age": "99"
- }
- ],
- "upper_limits": [
- {
- "coverage_codes": [
- "ACU",
- "IP"
- ],
- "limit_type": "MBL",
- "limit_amount": "50",
- "is_shared_dependents": true,
- "benefits": [
- {
- "limit_value": "1000.00",
- "limit_type": "PS",
- "benefit_code": "TestIan4",
- "coverage_codes": [
- "IP"
- ]
- },
- {
- "limit_value": "1000.00",
- "limit_type": "PS",
- "benefit_code": "TestIan4",
- "coverage_codes": [
- "IP"
- ]
- },
- {
- "limit_value": "1000.00",
- "limit_type": "PS",
- "benefit_code": "E.7-IP",
- "coverage_codes": [
- "IP"
- ]
- }
- ]
- }
- ]
- }
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