{ "result": { "member": { "name": "Charlie Smith", "date_of_birth": "2013-03-04", "plan": "Gold PPO", "member_id": "CS-001-2024" }, "medical_plan": { "name": "Gold PPO", "deductible": 1500, "deductible_met": 850, "out_of_pocket_max": 6000, "out_of_pocket_met": 1200, "coinsurance": "20%", "primary_care_copay": 25, "specialist_copay": 50, "emergency_room_copay": 250 }, "pharmacy_plan": { "tier_1_copay": 10, "tier_2_copay": 30, "tier_3_copay": 60, "tier_4_coinsurance": "30%", "mail_order_available": true }, "mental_health": { "covered_visits_per_year": 20, "visits_used": 4, "telehealth": true, "in_network_providers": "https://taller-wox.fitlabs.dev/docs/mental-health-providers" }, "wellness": { "gym_reimbursement_annual": 300, "gym_reimbursement_used": 150, "annual_checkup_covered": true, "preventive_care_100_percent": true, "flu_shot_covered": true }, "tax_documents": { "form_1095_available": true, "form_1095_url": "https://taller-wox.fitlabs.dev/docs/1095-2025.pdf", "instructions": "Tu formulario 1095 está disponible en el portal del afiliado bajo Documentos > Impuestos. Si no lo puedes acceder, llama al 1-800-FIT-CARE." }, "overdue_procedures": [ { "procedure": "Annual Physical Exam", "last_date": "2024-05-15", "recommended_frequency_months": 12, "due_since_months": 12, "priority": "high" }, { "procedure": "Dental Cleaning", "last_date": "2025-01-10", "recommended_frequency_months": 6, "due_since_months": 10, "priority": "medium" }, { "procedure": "Vision Exam", "last_date": "2023-08-22", "recommended_frequency_months": 24, "due_since_months": 8, "priority": "medium" }, { "procedure": "Blood Test - Cholesterol Panel", "last_date": "2024-11-04", "recommended_frequency_months": 12, "due_since_months": 6, "priority": "low" } ] } }