Insurance Coverage Structure

{
  "$schema": "https://json-structure.org/meta/core/v0/#",
  "$id": "https://raw.githubusercontent.com/api-evangelist/abortion-policy-api/refs/heads/main/json-structure/insurance-coverage-structure.json",
  "name": "InsuranceCoverage",
  "description": "Abortion insurance coverage restrictions covering Medicaid, private insurance, and ACA exchange plans for a US state.",
  "type": "object",
  "properties": {
    "requires_coverage": {
      "type": "boolean",
      "description": "If true, state requires private health plans to cover abortion.",
      "example": false
    },
    "private_coverage_no_restrictions": {
      "type": "boolean",
      "description": "If true, private insurance may cover abortion without restrictions.",
      "example": true
    },
    "private_exception_life": {
      "type": "boolean",
      "description": "If true, private insurance coverage allowed when abortion is necessary to save pregnant person's life.",
      "example": true
    },
    "private_exception_health": {
      "type": "string",
      "nullable": true,
      "description": "Private insurance coverage allowed for serious health conditions described by this field.",
      "example": "Major Bodily Function"
    },
    "private_exception_fetal": {
      "type": "string",
      "nullable": true,
      "description": "Private insurance coverage allowed for described fetal anomaly types.",
      "example": "Lethal fetal anomaly"
    },
    "private_exception_rape_or_incest": {
      "type": "boolean",
      "description": "If true, private insurance coverage allowed in cases of rape or incest.",
      "example": true
    },
    "exchange_coverage_no_restrictions": {
      "type": "boolean",
      "description": "If true, state has not restricted abortion coverage in ACA exchange plans.",
      "example": true
    },
    "exchange_exception_life": {
      "type": "boolean",
      "description": "If true, exchange plan coverage allowed when abortion is necessary to save pregnant person's life.",
      "example": true
    },
    "exchange_exception_health": {
      "type": "string",
      "nullable": true,
      "description": "Exchange plan coverage allowed for health conditions described by this field.",
      "example": "Physical"
    },
    "exchange_exception_fetal": {
      "type": "string",
      "nullable": true,
      "description": "Exchange plan coverage allowed for described fetal anomaly types.",
      "example": "Lethal fetal anomaly"
    },
    "exchange_exception_rape_or_incest": {
      "type": "boolean",
      "description": "If true, exchange plan coverage allowed in cases of rape or incest.",
      "example": true
    },
    "exchange_forbids_coverage": {
      "type": "boolean",
      "description": "If true, state prohibits all exchange insurance coverage for abortion.",
      "example": false
    },
    "medicaid_coverage_provider_patient_decision": {
      "type": "boolean",
      "description": "If true, state uses Medicaid funds for medically necessary abortion determined by patient/provider.",
      "example": true
    },
    "medicaid_exception_life": {
      "type": "boolean",
      "description": "If true, Medicaid covers abortion necessary to save pregnant person's life (required by Hyde Amendment).",
      "example": true
    },
    "medicaid_exception_health": {
      "type": "string",
      "nullable": true,
      "description": "Medicaid coverage for health conditions described by this field.",
      "example": "Physical"
    },
    "medicaid_exception_fetal": {
      "type": "string",
      "nullable": true,
      "description": "Medicaid coverage for described fetal anomaly types.",
      "example": "Serious fetal anomaly"
    },
    "medicaid_exception_rape_or_incest": {
      "type": "boolean",
      "description": "If true, Medicaid covers abortion in cases of rape or incest (required by Hyde Amendment).",
      "example": true
    },
    "Last Updated": {
      "type": "string",
      "description": "Date this policy record was last updated.",
      "example": "2025-01-15"
    }
  }
}