Details of a Health Insurance product/plan provided by an organization.

Identifier for the product/plan that is used to identify it across multiple disparate systems.

Whether the organization's record is still in active use.

Need a flag to indicate a record is no longer to be used and should generally be hidden for the user in the UI.

The type of product/plan.

Official name of the product/plan (as designated by the owner).

If the name of the product/plan changes, consider putting the old name in the alias column so that it can still be located through searches.

A list of alternate names that the product/plan is known as, or was known as in the past.

Over time products/plans go through many changes and can be known by different names.

For searching knowing previous names that the product/plan was known by can be very useful.

There are no dates associated with the alias/historic names, as this is not intended to track when names were used, but to assist in searching so that older names can still result in identifying the product/plan.

The period of time that the product is available.

Owner of the product/plan (typically a payer).

Administrator of the product/plan (e.g. self-insured employer plan administered by a TPA).

An address for the organization.

May need to keep track of the organization's addresses for contacting, billing or reporting requirements.

Organization may have multiple addresses with different uses or applicable periods. The use code home is not to be used.

The geographic region in which this product/plan is available.

Contact for the product/plan for a certain purpose.

Need to keep track of assigned contact points within bigger organization.

Where multiple contacts for the same purpose are provided there is a standard extension that can be used to determine which one is the preferred contact to use.

Indicates a purpose for which the contact can be reached.

Need to distinguish between multiple contact persons.

A name associated with the contact.

Need to be able to track the person by name.

A contact detail (e.g. a telephone number or an email address) by which the party may be contacted.

People have (primary) ways to contact them in some way such as phone, email.

Visiting or postal addresses for the contact.

May need to keep track of a contact party's address for contacting, billing or reporting requirements.

Details about the coverage offered by the insurance product.

Type of coverage (Medical; Dental; Mental Health; Substance Abuse; Vision; Drug; Short Term; Long Term Care; Hospice; Home Health).

Specific benefits under this type of coverage.

Type of benefit (primary care; speciality care; inpatient; outpatient).

Specific benefit and related value.

Coded Details of the specific benefit (days; visits).

Value of the specific benefit.

Details about an insurance plan.

Type of plan (Platinum; Gold; Silver; Bronze; High Deductable; Low Deductable).

Additional descriptive content about the plan.

Plan premium.

List of the costs associated with plan benefits.

General category of benefit (Medical; Dental; Vision; Drug; Mental Health; Substance Abuse; Hospice, Home Health).

List of the specific benefits under this category of benefit.

Type of specific benefit (preventative; primary care office visit; speciality office visit; hospitalization; emergency room; urgent care).

List of the costs associated with a specific benefit.

Type of cost (copay; individual cap; family cap; coinsurance; deductible).

Whether the cost applies to in-network or out-of-network providers (in-network; out-of-network; other).

Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA).

The actual cost value.

Technical endpoints providing access to services operated for the organization.

Organizations have multiple systems that provide various services and need to be able to define the technical connection details for how to connect to them, and for what purpose.