Independence Blue Cross Health Plan Structure is a JSON Structure definition published by Independence Blue Cross, describing 7 properties. It conforms to the https://json-schema.org/draft/2020-12/schema meta-schema.
{
"$schema": "https://json-schema.org/draft/2020-12/schema",
"$id": "https://raw.githubusercontent.com/api-evangelist/independence-blue-cross/refs/heads/main/json-structure/independence-blue-cross-health-plan-structure.json",
"title": "Independence Blue Cross Health Plan Structure",
"description": "JSON Structure describing how Independence Blue Cross is organized for API consumers: parent holding company, underwriting carriers, lines of business, member populations covered by each FHIR surface, and the developer-portal contact surface.",
"type": "object",
"properties": {
"provider": {
"type": "object",
"properties": {
"id": {"type": "string", "const": "independence-blue-cross"},
"name": {"type": "string", "const": "Independence Blue Cross"},
"parent": {"type": "string", "const": "Independence Health Group, Inc."},
"license": {"type": "string", "const": "Independent licensee of the Blue Cross Blue Shield Association"},
"headquarters": {"type": "string", "const": "Philadelphia, Pennsylvania"},
"founded": {"type": "string", "const": "more than 85 years (as of 2026)"},
"membership_self": {"type": "string", "const": "approximately 3 million members"},
"membership_group": {"type": "string", "const": "approximately 9 million covered lives across Independence Health Group"},
"revenue_group_2025": {"type": "string", "const": "$36.3 billion (Independence Health Group consolidated, FY2025)"}
}
},
"carriers": {
"type": "array",
"description": "Underwriting carrier brands publishing Transparency in Coverage files.",
"items": {
"type": "object",
"properties": {
"brand": {"type": "string"},
"code": {"type": "string"},
"tic_url": {"type": "string", "format": "uri"}
}
},
"default": [
{"brand": "Keystone Health Plan East", "code": "khpe", "tic_url": "https://www.ibx.com/cmstic/?brand=khpe"},
{"brand": "QCC Insurance Company", "code": "qcc", "tic_url": "https://www.ibx.com/cmstic/?brand=qcc"},
{"brand": "Independence Assurance Co, Inc.", "code": "iac", "tic_url": "https://www.ibx.com/cmstic/?brand=iac"}
]
},
"affiliates": {
"type": "array",
"items": {
"type": "object",
"properties": {
"name": {"type": "string"},
"role": {"type": "string"},
"ownership": {"type": "string"}
}
},
"default": [
{"name": "AmeriHealth", "role": "Commercial health plans, TPA services", "ownership": "Independence Health Group subsidiary"},
{"name": "AmeriHealth Administrators", "role": "National third-party administrator for self-funded plans", "ownership": "Independence Health Group subsidiary"},
{"name": "AmeriHealth New Jersey (AmeriHealth Insurance Company of NJ)", "role": "Commercial payer for New Jersey (~209,000 members)", "ownership": "Independence Health Group subsidiary"},
{"name": "AmeriHealth Caritas", "role": "Medicaid managed care, CHIP, D-SNP, LTSS, Marketplace in 13 states + DC", "ownership": "Independence Health Group 61.3% / Blue Cross Blue Shield of Michigan 38.7%"},
{"name": "Tandigm Health", "role": "Value-based primary care enablement", "ownership": "Independence-affiliated"}
]
},
"service_area": {
"type": "object",
"properties": {
"counties": {
"type": "array",
"items": {"type": "string"},
"default": ["Bucks", "Chester", "Delaware", "Montgomery", "Philadelphia"]
},
"state": {"type": "string", "const": "Pennsylvania"}
}
},
"lines_of_business": {
"type": "array",
"items": {"type": "string"},
"default": [
"Commercial (individual, group, large employer)",
"Medicare Advantage (Keystone 65 HMO, Personal Choice 65 PPO)",
"Children's Health Insurance Program (Keystone HMO CHIP)",
"Dental (IBX Dental)",
"Vision",
"Behavioral Health",
"Pharmacy Benefits"
]
},
"fhir_apis": {
"type": "array",
"items": {
"type": "object",
"properties": {
"name": {"type": "string"},
"base_url": {"type": "string"},
"auth": {"type": "string"},
"in_scope_population": {"type": "string"},
"implementation_guide": {"type": "string"}
}
},
"default": [
{
"name": "Patient Access FHIR API",
"base_url": "https://eapics.ibx.com/patient/v1/fhir",
"auth": "SMART on FHIR / OAuth 2.0 with PKCE",
"in_scope_population": "Medicare Advantage + Keystone HMO CHIP members",
"implementation_guide": "US Core 3.1.1 + CARIN BB + Da Vinci PDex"
},
{
"name": "Provider Directory FHIR API",
"base_url": "https://eapics.ibx.com/provider/v1/fhir",
"auth": "None (public)",
"in_scope_population": "All members and the public",
"implementation_guide": "Da Vinci PDex Plan-Net"
},
{
"name": "Drug Formulary FHIR API",
"base_url": "https://eapics.ibx.com/formulary/v1/fhir",
"auth": "None (public)",
"in_scope_population": "All members and the public",
"implementation_guide": "Da Vinci US Drug Formulary (USDF)"
}
]
},
"developer_contacts": {
"type": "object",
"properties": {
"portal": {"type": "string", "const": "https://devportal.ibx.com/"},
"documentation": {"type": "string", "const": "https://devportal.ibx.com/documentation/"},
"swagger": {"type": "string", "const": "https://www.ibx.com/scripts/custom/swagger/cmsSwagger.json"},
"registration": {"type": "string", "const": "https://devportal.ibx.com/cmssignin/"},
"support_email": {"type": "string", "const": "AppOnboardingSupport@ibx.com"},
"terms": {"type": "string", "const": "https://www.ibx.com/htdocs/custom/tnc/Developer%20Portal%20TandC.pdf"}
}
}
}
}