PCS provides a series of APIs to integrate PCS with external systems. These APIs are detailed below.

The sales team can view a Pega PCS plan catalog that is made available by using the Plan catalog REST service API. All plans that satisfy the request criteria are included in the API response.

The returned plans include details such as the following:

• PlanID
• Planname
• Effective dates
• Status
• Line of business
• Category
• Marketsegment

Other APIs are also available to provide robust data from PCS:

• GetPlan details – Used to inquire about the details of a single plan from PCS.
• Custom Plan Request - Used to request changes to plans or additions of new plans in the PCS application. All requests are routed to a custom work queue for approval. The plan lifecycle is followed after approval has been obtained.
• Plan Cost Share Range API returns values for ranges of cost shares in response to a request for a custom health insurance plan. This provides a smooth integration between PCS and your sales system, for example Sales Automation for Healthcare (SAHC). A sales broker or representative can select a plan in SAHC and then receive the range of cost shares from the product template that is configured in PCS, including the network cost shares and the cost shares for the default benefit in each benefit category.

For example, a sales representative sells a custom PPO plan to U+Health. The representative finds the closest matching plan in SAHC and requests the ranges for a copayment for an office visit. The range of values that is returned might be from $0 to $50. The salesperson can set the copayment for the office visit to any value within that range.

You can extract summary data for product templates, products, and plans and review and compare the data without having to access each entity separately. In the Summary data report, you get the the details that you enter during the first step of entity creation and high-level entity cost share

information. You can also extract cost share data and its pattern for inheritance including copayments, coinsurance, deductible, annual maximum, lifetime maximum, and out-of-pocket values for products and plans and view this information in the cost shares report.

For more information, see the Pega Product Composer for Healthcare Implementation Guide on the Pega Product Composer for Healthcare product page.

PCS gives you the ability to extract complex plan and benefit data from the application into a standard flattened structure. You can use this structure in downstream data such as claims adjudication or as input to a System for Electronic Rate and Form Filing (SERFF) file. This means that there are instances of each benefit for every plan and a dedicated benefit for each variation. You can generate a flattened structure for an individual plan or all plans in the system.

You can also automate the extracting of plan data from the application into a standard flattened structure without any manual intervention. When you configure the PCS parameters, the approval and selection process is automated, and all plans are updated and flattened. For more information about configuring automatic flattening of data, see the Pega Product Composer for Healthcare Implementation Guide on the Pega Product Composer for Healthcare product page.