The Benefit Plan Standard (BPS) is a unified, open, machine-readable schema for representing U.S. health insurance benefit plan information across carriers.
It provides:

• A canonical JSON schema for health plan normalization
• Standard terminology and field definitions
• Carrier crosswalk tables
• Compliance & validation guidance (schema-level only)
• Extensible modules (pharmacy, behavioral health, dental/vision, supplemental)
• A structure designed for interoperability, analytics, and automation

Goal:
A single, consistent representation of health plan benefits — independent of carrier formatting, terminology, or document structure.

Documentation site containing:

• Specification overview
• Field definitions
• Versioning & governance
• Crosswalk tables
• Compliance guidelines
• Examples
• Roadmap

📘 Live Documentation: https://benefitplanstandard.org
Repo: https://github.com/Benefit-Plan-Standard/benefit-plan-docs

The official JSON Schema for the Benefit Plan Standard (v1.0.0), including:

• Core schema
• Modules
• Example normalized plans
• Versioning rules
• Schema change process

Repo: https://github.com/Benefit-Plan-Standard/benefit-plan-schema

This GitHub organization maintains the open, vendor-neutral artifacts of the standard:

• 📄 JSON Schema (v1.0.0 + future modules)
• 🧭 Carrier crosswalk mappings
• 📚 Documentation & governance
• ✔ Compliance expectations relevant to the schema
• 🗺 Roadmap for the evolution of the standard

These resources enable:

• Carriers
• Brokers & TPAs
• Health tech vendors
• Researchers
• Regulators

…to align around a shared, interoperable model.

To maintain neutrality, this organization does not include:

• PDF/SBC/EOC ingestion pipelines
• AI extraction tooling
• Proprietary validation logic
• Confidence scoring engines
• Carrier-specific rule packs
• Commercial APIs
• Customer dashboards or authentication systems

These are not part of the open standard and remain private.

A separate project — HealthPlanAPI.com — implements ingestion and validation pipelines using the standard.
It is an implementer, not the owner of this organization or standard.

This preserves neutrality while demonstrating real-world adoption.

Carriers describe plans differently — cost-sharing, accumulators, network tiers, benefits, and conditions vary wildly.
This fragmentation makes it difficult to:

• Compare health plans
• Build transparency tools
• Automate underwriting
• Train ML/AI models
• Normalize data across carriers
• Streamline broker and TPA workflows

The Benefit Plan Standard addresses this by creating a stable, unified representation — similar to how:

• FHIR standardized clinical data
• EDI standardized claims
• HL7 standardized healthcare messaging

BPS is the foundation for interoperable benefit plan data.

The standard follows a transparent governance model:

• Public roadmap
• Structured versioning
• RFC process for changes
• Backwards-compatibility rules
• Industry collaboration
• Community participation

Governance documentation:
https://benefitplanstandard.org/docs/governance/governance-overview

We welcome participation from:

• Carriers
• Brokers / TPAs
• Healthcare technology vendors
• Data engineers & architects
• Researchers
• Standards organizations

Discussion Board:
https://github.com/Benefit-Plan-Standard/benefit-plan-docs/discussions

Issues (schema):
https://github.com/Benefit-Plan-Standard/benefit-plan-schema/issues

Contribution guidelines:
https://benefitplanstandard.org/docs/compliance/compliance-overview

• v1.1.0 modules:
  • Pharmacy
  • Behavioral Health
  • Supplemental Benefits
• Expanded carrier crosswalks
• Improved consistency rules
• More examples + test plans
• Schema refinement

Full Roadmap:
https://benefitplanstandard.org/docs/specification/roadmap-v1.1

HealthPlanAPI.com
A commercial implementation of the standard providing ingestion, validation, and API distribution of normalized benefit plans.

It operates separately and does not influence the neutrality of the open standard.

📧 contact@benefitplanstandard.org
🔗 https://benefitplanstandard.org