R4 Ballot #1 (Mixed Normative/Trial use)

This page is part of the FHIR Specification (v3.3.0: R4 Ballot 2). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions

8.33 Resource ProductPlan - Content

Patient Administration Work GroupMaturity Level: 0 Draft Compartments: Not linked to any defined compartments

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

8.33.1 Scope and Usage

A product is a discrete package of health insurance coverage benefits that are offered under a particular network type. A given payer’s products typically differ by network type and/or coverage benefits. A plan pairs the health insurance coverage benefits under a product with the particular cost sharing structure offered to a consumer. A given product may comprise multiple plans.

ProductPlan describes a health insurance offering comprised of a list of covered benefits (i.e. the product), costs associated with those benefits (i.e. the plan), and additional information about the offering, such as who it is owned and administered by, a coverage area, contact information, etc.

8.33.2 Boundaries and Relationships

TBD.

8.33.3 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. ProductPlan IDDomainResourceDetails of a Health Insurance product/plan provided by an organization
+ The organization SHALL at least have a name or an id, and possibly more than one
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier ΣI0..*IdentifierIdentifies this product/plan across multiple systems
... status ?!Σ0..1codedraft | active | retired | unknown
PublicationStatus (Required)
... type Σ0..*CodeableConceptKind of product/plan
ProductPlanType (Example)
... name ΣI0..1stringOfficial name
... alias 0..*stringA list of alternate names that the product/plan is known as, or was known as in the past
... period 0..1PeriodThe time period the product/plan is available
... ownedBy Σ0..1Reference(Organization)Owner of the product/plan
... administeredBy Σ0..1Reference(Organization)Administrator of the product/plan
... address I0..*AddressAn address for the organization
+ An address of an organization can never be of use 'home'
... coverageArea Σ0..1Reference(Location)The geographic region in which this product/plan is available
... contact 0..*BackboneElementContact for the product/plan for a certain purpose
.... purpose 0..1CodeableConceptThe type of contact
ContactEntityType (Extensible)
.... name 0..1HumanNameA name associated with the contact
.... telecom 0..*ContactPointContact details (telephone, email, etc.) for a contact
.... address 0..1AddressVisiting or postal addresses for the contact
... coverage 0..*BackboneElementDetails about the coverage offered by the insurance product
.... type 1..1CodeableConceptType of coverage
.... benefit 1..*BackboneElementSpecific benefits under this type of coverage
..... type 1..1CodeableConceptType of benefit
..... item 1..*BackboneElementSpecific benefit and related value
...... code 1..1CodeableConceptCoded Details of the specific benefit (days; visits)
...... benefitValue 0..1QuantityValue of the specific benefit
... plan 0..*BackboneElementDetails about an insurance plan
.... type 0..1CodeableConceptType of plan
.... description 0..1stringAdditional descriptive content about the plan
.... premium 0..1MoneyPlan premium
.... category 0..*BackboneElementList of the costs associated with plan benefits
..... code 0..1CodeableConceptGeneral category of benefit (Medical; Dental; Vision; Drug; Mental Health; Substance Abuse; Hospice, Home Health)
..... benefit 0..*BackboneElementList of the specific benefits under this category of benefit
...... type 1..1CodeableConceptType of specific benefit (preventative; primary care office visit; speciality office visit; hospitalization; emergency room; urgent care)
...... cost 0..*BackboneElementList of the costs associated with a specific benefit
....... type 1..1CodeableConceptType of cost (copay; individual cap; family cap; coinsurance; deductible)
....... applicability 0..*CodingWhether the cost applies to in-network or out-of-network providers (in-network; out-of-network; other)
....... qualifiers 0..*stringAdditional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA)
....... value 0..1QuantityThe actual cost value
... endpoint 0..*Reference(Endpoint)Technical endpoints providing access to services operated for the organization

doco Documentation for this format

UML Diagram (Legend)

ProductPlan (DomainResource)Identifier for the product/plan that is used to identify it across multiple disparate systemsidentifier : Identifier [0..*]Whether the organization's record is still in active use (this element modifies the meaning of other elements)status : code [0..1] « The lifecycle status of an artifact. (Strength=Required)PublicationStatus! »The type of product/plantype : CodeableConcept [0..*] « Used to categorize the product/plan (Strength=Example)ProductPlanType?? »Official name of the product/plan (as designated by the owner)name : string [0..1]A list of alternate names that the product/plan is known as, or was known as in the pastalias : string [0..*]The period of time that the product is availableperiod : Period [0..1]Owner of the product/plan (typically a payer)ownedBy : Reference [0..1] « Organization »Administrator of the product/plan (e.g. self-insured employer plan administered by a TPA)administeredBy : Reference [0..1] « Organization »An address for the organizationaddress : Address [0..*]The geographic region in which this product/plan is availablecoverageArea : Reference [0..1] « Location »Technical endpoints providing access to services operated for the organizationendpoint : Reference [0..*] « Endpoint »ContactIndicates a purpose for which the contact can be reachedpurpose : CodeableConcept [0..1] « The purpose for which you would contact a contact party (Strength=Extensible)ContactEntityType+ »A name associated with the contactname : HumanName [0..1]A contact detail (e.g. a telephone number or an email address) by which the party may be contactedtelecom : ContactPoint [0..*]Visiting or postal addresses for the contactaddress : Address [0..1]CoverageType of coverage (Medical; Dental; Mental Health; Substance Abuse; Vision; Drug; Short Term; Long Term Care; Hospice; Home Health)type : CodeableConcept [1..1]BenefitType of benefit (primary care; speciality care; inpatient; outpatient)type : CodeableConcept [1..1]ItemCoded Details of the specific benefit (days; visits)code : CodeableConcept [1..1]Value of the specific benefitbenefitValue : Quantity [0..1]PlanType of plan (Platinum; Gold; Silver; Bronze; High Deductable; Low Deductable)type : CodeableConcept [0..1]Additional descriptive content about the plandescription : string [0..1]Plan premiumpremium : Money [0..1]CategoryGeneral category of benefit (Medical; Dental; Vision; Drug; Mental Health; Substance Abuse; Hospice, Home Health)code : CodeableConcept [0..1]BenefitType of specific benefit (preventative; primary care office visit; speciality office visit; hospitalization; emergency room; urgent care)type : CodeableConcept [1..1]CostType of cost (copay; individual cap; family cap; coinsurance; deductible)type : CodeableConcept [1..1]Whether the cost applies to in-network or out-of-network providers (in-network; out-of-network; other)applicability : Coding [0..*]Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA)qualifiers : string [0..*]The actual cost valuevalue : Quantity [0..1]Contact for the product/plan for a certain purposecontact[0..*]Specific benefit and related valueitem[1..*]Specific benefits under this type of coveragebenefit[1..*]Details about the coverage offered by the insurance productcoverage[0..*]List of the costs associated with a specific benefitcost[0..*]List of the specific benefits under this category of benefitbenefit[0..*]List of the costs associated with plan benefitscategory[0..*]Details about an insurance planplan[0..*]

XML Template

<ProductPlan xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- ?? 0..* Identifier Identifies this product/plan  across multiple systems --></identifier>
 <status value="[code]"/><!-- 0..1 draft | active | retired | unknown -->
 <type><!-- 0..* CodeableConcept Kind of product/plan --></type>
 <name value="[string]"/><!-- ?? 0..1 Official name -->
 <alias value="[string]"/><!-- 0..* A list of alternate names that the product/plan is known as, or was known as in the past -->
 <period><!-- 0..1 Period The time period the product/plan is available --></period>
 <ownedBy><!-- 0..1 Reference(Organization) Owner of the product/plan --></ownedBy>
 <administeredBy><!-- 0..1 Reference(Organization) Administrator of the product/plan --></administeredBy>
 <address><!-- ?? 0..* Address An address for the organization --></address>
 <coverageArea><!-- 0..1 Reference(Location) The geographic region in which this product/plan is available --></coverageArea>
 <contact>  <!-- 0..* Contact for the product/plan for a certain purpose -->
  <purpose><!-- 0..1 CodeableConcept The type of contact --></purpose>
  <name><!-- 0..1 HumanName A name associated with the contact --></name>
  <telecom><!-- 0..* ContactPoint Contact details (telephone, email, etc.)  for a contact --></telecom>
  <address><!-- 0..1 Address Visiting or postal addresses for the contact --></address>
 </contact>
 <coverage>  <!-- 0..* Details about the coverage offered by the insurance product -->
  <type><!-- 1..1 CodeableConcept Type of coverage --></type>
  <benefit>  <!-- 1..* Specific benefits under this type of coverage -->
   <type><!-- 1..1 CodeableConcept Type of benefit --></type>
   <item>  <!-- 1..* Specific benefit and related value -->
    <code><!-- 1..1 CodeableConcept Coded Details of the specific benefit (days; visits) --></code>
    <benefitValue><!-- 0..1 Quantity Value of the specific benefit --></benefitValue>
   </item>
  </benefit>
 </coverage>
 <plan>  <!-- 0..* Details about an insurance plan -->
  <type><!-- 0..1 CodeableConcept Type of plan --></type>
  <description value="[string]"/><!-- 0..1 Additional descriptive content about the plan -->
  <premium><!-- 0..1 Money Plan premium --></premium>
  <category>  <!-- 0..* List of the costs associated with plan benefits -->
   <code><!-- 0..1 CodeableConcept General category of benefit (Medical; Dental; Vision; Drug; Mental Health; Substance Abuse; Hospice, Home Health) --></code>
   <benefit>  <!-- 0..* List of the specific benefits under this category of benefit -->
    <type><!-- 1..1 CodeableConcept Type of specific benefit (preventative; primary care office visit; speciality office visit; hospitalization; emergency room; urgent care) --></type>
    <cost>  <!-- 0..* List of the costs associated with a specific benefit -->
     <type><!-- 1..1 CodeableConcept Type of cost (copay; individual cap; family cap; coinsurance; deductible) --></type>
     <applicability><!-- 0..* Coding Whether the cost applies to in-network or out-of-network providers (in-network; out-of-network; other) --></applicability>
     <qualifiers value="[string]"/><!-- 0..* Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA) -->
     <value><!-- 0..1 Quantity The actual cost value --></value>
    </cost>
   </benefit>
  </category>
 </plan>
 <endpoint><!-- 0..* Reference(Endpoint) Technical endpoints providing access to services operated for the organization --></endpoint>
</ProductPlan>

JSON Template

{doco
  "resourceType" : "ProductPlan",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // C? Identifies this product/plan  across multiple systems
  "status" : "<code>", // draft | active | retired | unknown
  "type" : [{ CodeableConcept }], // Kind of product/plan
  "name" : "<string>", // C? Official name
  "alias" : ["<string>"], // A list of alternate names that the product/plan is known as, or was known as in the past
  "period" : { Period }, // The time period the product/plan is available
  "ownedBy" : { Reference(Organization) }, // Owner of the product/plan
  "administeredBy" : { Reference(Organization) }, // Administrator of the product/plan
  "address" : [{ Address }], // C? An address for the organization
  "coverageArea" : { Reference(Location) }, // The geographic region in which this product/plan is available
  "contact" : [{ // Contact for the product/plan for a certain purpose
    "purpose" : { CodeableConcept }, // The type of contact
    "name" : { HumanName }, // A name associated with the contact
    "telecom" : [{ ContactPoint }], // Contact details (telephone, email, etc.)  for a contact
    "address" : { Address } // Visiting or postal addresses for the contact
  }],
  "coverage" : [{ // Details about the coverage offered by the insurance product
    "type" : { CodeableConcept }, // R!  Type of coverage
    "benefit" : [{ // R!  Specific benefits under this type of coverage
      "type" : { CodeableConcept }, // R!  Type of benefit
      "item" : [{ // R!  Specific benefit and related value
        "code" : { CodeableConcept }, // R!  Coded Details of the specific benefit (days; visits)
        "benefitValue" : { Quantity } // Value of the specific benefit
      }]
    }]
  }],
  "plan" : [{ // Details about an insurance plan
    "type" : { CodeableConcept }, // Type of plan
    "description" : "<string>", // Additional descriptive content about the plan
    "premium" : { Money }, // Plan premium
    "category" : [{ // List of the costs associated with plan benefits
      "code" : { CodeableConcept }, // General category of benefit (Medical; Dental; Vision; Drug; Mental Health; Substance Abuse; Hospice, Home Health)
      "benefit" : [{ // List of the specific benefits under this category of benefit
        "type" : { CodeableConcept }, // R!  Type of specific benefit (preventative; primary care office visit; speciality office visit; hospitalization; emergency room; urgent care)
        "cost" : [{ // List of the costs associated with a specific benefit
          "type" : { CodeableConcept }, // R!  Type of cost (copay; individual cap; family cap; coinsurance; deductible)
          "applicability" : [{ Coding }], // Whether the cost applies to in-network or out-of-network providers (in-network; out-of-network; other)
          "qualifiers" : ["<string>"], // Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA)
          "value" : { Quantity } // The actual cost value
        }]
      }]
    }]
  }],
  "endpoint" : [{ Reference(Endpoint) }] // Technical endpoints providing access to services operated for the organization
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:ProductPlan;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:ProductPlan.identifier [ Identifier ], ... ; # 0..* Identifies this product/plan  across multiple systems
  fhir:ProductPlan.status [ code ]; # 0..1 draft | active | retired | unknown
  fhir:ProductPlan.type [ CodeableConcept ], ... ; # 0..* Kind of product/plan
  fhir:ProductPlan.name [ string ]; # 0..1 Official name
  fhir:ProductPlan.alias [ string ], ... ; # 0..* A list of alternate names that the product/plan is known as, or was known as in the past
  fhir:ProductPlan.period [ Period ]; # 0..1 The time period the product/plan is available
  fhir:ProductPlan.ownedBy [ Reference(Organization) ]; # 0..1 Owner of the product/plan
  fhir:ProductPlan.administeredBy [ Reference(Organization) ]; # 0..1 Administrator of the product/plan
  fhir:ProductPlan.address [ Address ], ... ; # 0..* An address for the organization
  fhir:ProductPlan.coverageArea [ Reference(Location) ]; # 0..1 The geographic region in which this product/plan is available
  fhir:ProductPlan.contact [ # 0..* Contact for the product/plan for a certain purpose
    fhir:ProductPlan.contact.purpose [ CodeableConcept ]; # 0..1 The type of contact
    fhir:ProductPlan.contact.name [ HumanName ]; # 0..1 A name associated with the contact
    fhir:ProductPlan.contact.telecom [ ContactPoint ], ... ; # 0..* Contact details (telephone, email, etc.)  for a contact
    fhir:ProductPlan.contact.address [ Address ]; # 0..1 Visiting or postal addresses for the contact
  ], ...;
  fhir:ProductPlan.coverage [ # 0..* Details about the coverage offered by the insurance product
    fhir:ProductPlan.coverage.type [ CodeableConcept ]; # 1..1 Type of coverage
    fhir:ProductPlan.coverage.benefit [ # 1..* Specific benefits under this type of coverage
      fhir:ProductPlan.coverage.benefit.type [ CodeableConcept ]; # 1..1 Type of benefit
      fhir:ProductPlan.coverage.benefit.item [ # 1..* Specific benefit and related value
        fhir:ProductPlan.coverage.benefit.item.code [ CodeableConcept ]; # 1..1 Coded Details of the specific benefit (days; visits)
        fhir:ProductPlan.coverage.benefit.item.benefitValue [ Quantity ]; # 0..1 Value of the specific benefit
      ], ...;
    ], ...;
  ], ...;
  fhir:ProductPlan.plan [ # 0..* Details about an insurance plan
    fhir:ProductPlan.plan.type [ CodeableConcept ]; # 0..1 Type of plan
    fhir:ProductPlan.plan.description [ string ]; # 0..1 Additional descriptive content about the plan
    fhir:ProductPlan.plan.premium [ Money ]; # 0..1 Plan premium
    fhir:ProductPlan.plan.category [ # 0..* List of the costs associated with plan benefits
      fhir:ProductPlan.plan.category.code [ CodeableConcept ]; # 0..1 General category of benefit (Medical; Dental; Vision; Drug; Mental Health; Substance Abuse; Hospice, Home Health)
      fhir:ProductPlan.plan.category.benefit [ # 0..* List of the specific benefits under this category of benefit
        fhir:ProductPlan.plan.category.benefit.type [ CodeableConcept ]; # 1..1 Type of specific benefit (preventative; primary care office visit; speciality office visit; hospitalization; emergency room; urgent care)
        fhir:ProductPlan.plan.category.benefit.cost [ # 0..* List of the costs associated with a specific benefit
          fhir:ProductPlan.plan.category.benefit.cost.type [ CodeableConcept ]; # 1..1 Type of cost (copay; individual cap; family cap; coinsurance; deductible)
          fhir:ProductPlan.plan.category.benefit.cost.applicability [ Coding ], ... ; # 0..* Whether the cost applies to in-network or out-of-network providers (in-network; out-of-network; other)
          fhir:ProductPlan.plan.category.benefit.cost.qualifiers [ string ], ... ; # 0..* Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA)
          fhir:ProductPlan.plan.category.benefit.cost.value [ Quantity ]; # 0..1 The actual cost value
        ], ...;
      ], ...;
    ], ...;
  ], ...;
  fhir:ProductPlan.endpoint [ Reference(Endpoint) ], ... ; # 0..* Technical endpoints providing access to services operated for the organization
]

Changes since R3

This resource did not exist in Release 2

This analysis is available as XML or JSON.

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. ProductPlan IDDomainResourceDetails of a Health Insurance product/plan provided by an organization
+ The organization SHALL at least have a name or an id, and possibly more than one
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier ΣI0..*IdentifierIdentifies this product/plan across multiple systems
... status ?!Σ0..1codedraft | active | retired | unknown
PublicationStatus (Required)
... type Σ0..*CodeableConceptKind of product/plan
ProductPlanType (Example)
... name ΣI0..1stringOfficial name
... alias 0..*stringA list of alternate names that the product/plan is known as, or was known as in the past
... period 0..1PeriodThe time period the product/plan is available
... ownedBy Σ0..1Reference(Organization)Owner of the product/plan
... administeredBy Σ0..1Reference(Organization)Administrator of the product/plan
... address I0..*AddressAn address for the organization
+ An address of an organization can never be of use 'home'
... coverageArea Σ0..1Reference(Location)The geographic region in which this product/plan is available
... contact 0..*BackboneElementContact for the product/plan for a certain purpose
.... purpose 0..1CodeableConceptThe type of contact
ContactEntityType (Extensible)
.... name 0..1HumanNameA name associated with the contact
.... telecom 0..*ContactPointContact details (telephone, email, etc.) for a contact
.... address 0..1AddressVisiting or postal addresses for the contact
... coverage 0..*BackboneElementDetails about the coverage offered by the insurance product
.... type 1..1CodeableConceptType of coverage
.... benefit 1..*BackboneElementSpecific benefits under this type of coverage
..... type 1..1CodeableConceptType of benefit
..... item 1..*BackboneElementSpecific benefit and related value
...... code 1..1CodeableConceptCoded Details of the specific benefit (days; visits)
...... benefitValue 0..1QuantityValue of the specific benefit
... plan 0..*BackboneElementDetails about an insurance plan
.... type 0..1CodeableConceptType of plan
.... description 0..1stringAdditional descriptive content about the plan
.... premium 0..1MoneyPlan premium
.... category 0..*BackboneElementList of the costs associated with plan benefits
..... code 0..1CodeableConceptGeneral category of benefit (Medical; Dental; Vision; Drug; Mental Health; Substance Abuse; Hospice, Home Health)
..... benefit 0..*BackboneElementList of the specific benefits under this category of benefit
...... type 1..1CodeableConceptType of specific benefit (preventative; primary care office visit; speciality office visit; hospitalization; emergency room; urgent care)
...... cost 0..*BackboneElementList of the costs associated with a specific benefit
....... type 1..1CodeableConceptType of cost (copay; individual cap; family cap; coinsurance; deductible)
....... applicability 0..*CodingWhether the cost applies to in-network or out-of-network providers (in-network; out-of-network; other)
....... qualifiers 0..*stringAdditional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA)
....... value 0..1QuantityThe actual cost value
... endpoint 0..*Reference(Endpoint)Technical endpoints providing access to services operated for the organization

doco Documentation for this format

UML Diagram (Legend)

ProductPlan (DomainResource)Identifier for the product/plan that is used to identify it across multiple disparate systemsidentifier : Identifier [0..*]Whether the organization's record is still in active use (this element modifies the meaning of other elements)status : code [0..1] « The lifecycle status of an artifact. (Strength=Required)PublicationStatus! »The type of product/plantype : CodeableConcept [0..*] « Used to categorize the product/plan (Strength=Example)ProductPlanType?? »Official name of the product/plan (as designated by the owner)name : string [0..1]A list of alternate names that the product/plan is known as, or was known as in the pastalias : string [0..*]The period of time that the product is availableperiod : Period [0..1]Owner of the product/plan (typically a payer)ownedBy : Reference [0..1] « Organization »Administrator of the product/plan (e.g. self-insured employer plan administered by a TPA)administeredBy : Reference [0..1] « Organization »An address for the organizationaddress : Address [0..*]The geographic region in which this product/plan is availablecoverageArea : Reference [0..1] « Location »Technical endpoints providing access to services operated for the organizationendpoint : Reference [0..*] « Endpoint »ContactIndicates a purpose for which the contact can be reachedpurpose : CodeableConcept [0..1] « The purpose for which you would contact a contact party (Strength=Extensible)ContactEntityType+ »A name associated with the contactname : HumanName [0..1]A contact detail (e.g. a telephone number or an email address) by which the party may be contactedtelecom : ContactPoint [0..*]Visiting or postal addresses for the contactaddress : Address [0..1]CoverageType of coverage (Medical; Dental; Mental Health; Substance Abuse; Vision; Drug; Short Term; Long Term Care; Hospice; Home Health)type : CodeableConcept [1..1]BenefitType of benefit (primary care; speciality care; inpatient; outpatient)type : CodeableConcept [1..1]ItemCoded Details of the specific benefit (days; visits)code : CodeableConcept [1..1]Value of the specific benefitbenefitValue : Quantity [0..1]PlanType of plan (Platinum; Gold; Silver; Bronze; High Deductable; Low Deductable)type : CodeableConcept [0..1]Additional descriptive content about the plandescription : string [0..1]Plan premiumpremium : Money [0..1]CategoryGeneral category of benefit (Medical; Dental; Vision; Drug; Mental Health; Substance Abuse; Hospice, Home Health)code : CodeableConcept [0..1]BenefitType of specific benefit (preventative; primary care office visit; speciality office visit; hospitalization; emergency room; urgent care)type : CodeableConcept [1..1]CostType of cost (copay; individual cap; family cap; coinsurance; deductible)type : CodeableConcept [1..1]Whether the cost applies to in-network or out-of-network providers (in-network; out-of-network; other)applicability : Coding [0..*]Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA)qualifiers : string [0..*]The actual cost valuevalue : Quantity [0..1]Contact for the product/plan for a certain purposecontact[0..*]Specific benefit and related valueitem[1..*]Specific benefits under this type of coveragebenefit[1..*]Details about the coverage offered by the insurance productcoverage[0..*]List of the costs associated with a specific benefitcost[0..*]List of the specific benefits under this category of benefitbenefit[0..*]List of the costs associated with plan benefitscategory[0..*]Details about an insurance planplan[0..*]

XML Template

<ProductPlan xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- ?? 0..* Identifier Identifies this product/plan  across multiple systems --></identifier>
 <status value="[code]"/><!-- 0..1 draft | active | retired | unknown -->
 <type><!-- 0..* CodeableConcept Kind of product/plan --></type>
 <name value="[string]"/><!-- ?? 0..1 Official name -->
 <alias value="[string]"/><!-- 0..* A list of alternate names that the product/plan is known as, or was known as in the past -->
 <period><!-- 0..1 Period The time period the product/plan is available --></period>
 <ownedBy><!-- 0..1 Reference(Organization) Owner of the product/plan --></ownedBy>
 <administeredBy><!-- 0..1 Reference(Organization) Administrator of the product/plan --></administeredBy>
 <address><!-- ?? 0..* Address An address for the organization --></address>
 <coverageArea><!-- 0..1 Reference(Location) The geographic region in which this product/plan is available --></coverageArea>
 <contact>  <!-- 0..* Contact for the product/plan for a certain purpose -->
  <purpose><!-- 0..1 CodeableConcept The type of contact --></purpose>
  <name><!-- 0..1 HumanName A name associated with the contact --></name>
  <telecom><!-- 0..* ContactPoint Contact details (telephone, email, etc.)  for a contact --></telecom>
  <address><!-- 0..1 Address Visiting or postal addresses for the contact --></address>
 </contact>
 <coverage>  <!-- 0..* Details about the coverage offered by the insurance product -->
  <type><!-- 1..1 CodeableConcept Type of coverage --></type>
  <benefit>  <!-- 1..* Specific benefits under this type of coverage -->
   <type><!-- 1..1 CodeableConcept Type of benefit --></type>
   <item>  <!-- 1..* Specific benefit and related value -->
    <code><!-- 1..1 CodeableConcept Coded Details of the specific benefit (days; visits) --></code>
    <benefitValue><!-- 0..1 Quantity Value of the specific benefit --></benefitValue>
   </item>
  </benefit>
 </coverage>
 <plan>  <!-- 0..* Details about an insurance plan -->
  <type><!-- 0..1 CodeableConcept Type of plan --></type>
  <description value="[string]"/><!-- 0..1 Additional descriptive content about the plan -->
  <premium><!-- 0..1 Money Plan premium --></premium>
  <category>  <!-- 0..* List of the costs associated with plan benefits -->
   <code><!-- 0..1 CodeableConcept General category of benefit (Medical; Dental; Vision; Drug; Mental Health; Substance Abuse; Hospice, Home Health) --></code>
   <benefit>  <!-- 0..* List of the specific benefits under this category of benefit -->
    <type><!-- 1..1 CodeableConcept Type of specific benefit (preventative; primary care office visit; speciality office visit; hospitalization; emergency room; urgent care) --></type>
    <cost>  <!-- 0..* List of the costs associated with a specific benefit -->
     <type><!-- 1..1 CodeableConcept Type of cost (copay; individual cap; family cap; coinsurance; deductible) --></type>
     <applicability><!-- 0..* Coding Whether the cost applies to in-network or out-of-network providers (in-network; out-of-network; other) --></applicability>
     <qualifiers value="[string]"/><!-- 0..* Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA) -->
     <value><!-- 0..1 Quantity The actual cost value --></value>
    </cost>
   </benefit>
  </category>
 </plan>
 <endpoint><!-- 0..* Reference(Endpoint) Technical endpoints providing access to services operated for the organization --></endpoint>
</ProductPlan>

JSON Template

{doco
  "resourceType" : "ProductPlan",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // C? Identifies this product/plan  across multiple systems
  "status" : "<code>", // draft | active | retired | unknown
  "type" : [{ CodeableConcept }], // Kind of product/plan
  "name" : "<string>", // C? Official name
  "alias" : ["<string>"], // A list of alternate names that the product/plan is known as, or was known as in the past
  "period" : { Period }, // The time period the product/plan is available
  "ownedBy" : { Reference(Organization) }, // Owner of the product/plan
  "administeredBy" : { Reference(Organization) }, // Administrator of the product/plan
  "address" : [{ Address }], // C? An address for the organization
  "coverageArea" : { Reference(Location) }, // The geographic region in which this product/plan is available
  "contact" : [{ // Contact for the product/plan for a certain purpose
    "purpose" : { CodeableConcept }, // The type of contact
    "name" : { HumanName }, // A name associated with the contact
    "telecom" : [{ ContactPoint }], // Contact details (telephone, email, etc.)  for a contact
    "address" : { Address } // Visiting or postal addresses for the contact
  }],
  "coverage" : [{ // Details about the coverage offered by the insurance product
    "type" : { CodeableConcept }, // R!  Type of coverage
    "benefit" : [{ // R!  Specific benefits under this type of coverage
      "type" : { CodeableConcept }, // R!  Type of benefit
      "item" : [{ // R!  Specific benefit and related value
        "code" : { CodeableConcept }, // R!  Coded Details of the specific benefit (days; visits)
        "benefitValue" : { Quantity } // Value of the specific benefit
      }]
    }]
  }],
  "plan" : [{ // Details about an insurance plan
    "type" : { CodeableConcept }, // Type of plan
    "description" : "<string>", // Additional descriptive content about the plan
    "premium" : { Money }, // Plan premium
    "category" : [{ // List of the costs associated with plan benefits
      "code" : { CodeableConcept }, // General category of benefit (Medical; Dental; Vision; Drug; Mental Health; Substance Abuse; Hospice, Home Health)
      "benefit" : [{ // List of the specific benefits under this category of benefit
        "type" : { CodeableConcept }, // R!  Type of specific benefit (preventative; primary care office visit; speciality office visit; hospitalization; emergency room; urgent care)
        "cost" : [{ // List of the costs associated with a specific benefit
          "type" : { CodeableConcept }, // R!  Type of cost (copay; individual cap; family cap; coinsurance; deductible)
          "applicability" : [{ Coding }], // Whether the cost applies to in-network or out-of-network providers (in-network; out-of-network; other)
          "qualifiers" : ["<string>"], // Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA)
          "value" : { Quantity } // The actual cost value
        }]
      }]
    }]
  }],
  "endpoint" : [{ Reference(Endpoint) }] // Technical endpoints providing access to services operated for the organization
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:ProductPlan;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:ProductPlan.identifier [ Identifier ], ... ; # 0..* Identifies this product/plan  across multiple systems
  fhir:ProductPlan.status [ code ]; # 0..1 draft | active | retired | unknown
  fhir:ProductPlan.type [ CodeableConcept ], ... ; # 0..* Kind of product/plan
  fhir:ProductPlan.name [ string ]; # 0..1 Official name
  fhir:ProductPlan.alias [ string ], ... ; # 0..* A list of alternate names that the product/plan is known as, or was known as in the past
  fhir:ProductPlan.period [ Period ]; # 0..1 The time period the product/plan is available
  fhir:ProductPlan.ownedBy [ Reference(Organization) ]; # 0..1 Owner of the product/plan
  fhir:ProductPlan.administeredBy [ Reference(Organization) ]; # 0..1 Administrator of the product/plan
  fhir:ProductPlan.address [ Address ], ... ; # 0..* An address for the organization
  fhir:ProductPlan.coverageArea [ Reference(Location) ]; # 0..1 The geographic region in which this product/plan is available
  fhir:ProductPlan.contact [ # 0..* Contact for the product/plan for a certain purpose
    fhir:ProductPlan.contact.purpose [ CodeableConcept ]; # 0..1 The type of contact
    fhir:ProductPlan.contact.name [ HumanName ]; # 0..1 A name associated with the contact
    fhir:ProductPlan.contact.telecom [ ContactPoint ], ... ; # 0..* Contact details (telephone, email, etc.)  for a contact
    fhir:ProductPlan.contact.address [ Address ]; # 0..1 Visiting or postal addresses for the contact
  ], ...;
  fhir:ProductPlan.coverage [ # 0..* Details about the coverage offered by the insurance product
    fhir:ProductPlan.coverage.type [ CodeableConcept ]; # 1..1 Type of coverage
    fhir:ProductPlan.coverage.benefit [ # 1..* Specific benefits under this type of coverage
      fhir:ProductPlan.coverage.benefit.type [ CodeableConcept ]; # 1..1 Type of benefit
      fhir:ProductPlan.coverage.benefit.item [ # 1..* Specific benefit and related value
        fhir:ProductPlan.coverage.benefit.item.code [ CodeableConcept ]; # 1..1 Coded Details of the specific benefit (days; visits)
        fhir:ProductPlan.coverage.benefit.item.benefitValue [ Quantity ]; # 0..1 Value of the specific benefit
      ], ...;
    ], ...;
  ], ...;
  fhir:ProductPlan.plan [ # 0..* Details about an insurance plan
    fhir:ProductPlan.plan.type [ CodeableConcept ]; # 0..1 Type of plan
    fhir:ProductPlan.plan.description [ string ]; # 0..1 Additional descriptive content about the plan
    fhir:ProductPlan.plan.premium [ Money ]; # 0..1 Plan premium
    fhir:ProductPlan.plan.category [ # 0..* List of the costs associated with plan benefits
      fhir:ProductPlan.plan.category.code [ CodeableConcept ]; # 0..1 General category of benefit (Medical; Dental; Vision; Drug; Mental Health; Substance Abuse; Hospice, Home Health)
      fhir:ProductPlan.plan.category.benefit [ # 0..* List of the specific benefits under this category of benefit
        fhir:ProductPlan.plan.category.benefit.type [ CodeableConcept ]; # 1..1 Type of specific benefit (preventative; primary care office visit; speciality office visit; hospitalization; emergency room; urgent care)
        fhir:ProductPlan.plan.category.benefit.cost [ # 0..* List of the costs associated with a specific benefit
          fhir:ProductPlan.plan.category.benefit.cost.type [ CodeableConcept ]; # 1..1 Type of cost (copay; individual cap; family cap; coinsurance; deductible)
          fhir:ProductPlan.plan.category.benefit.cost.applicability [ Coding ], ... ; # 0..* Whether the cost applies to in-network or out-of-network providers (in-network; out-of-network; other)
          fhir:ProductPlan.plan.category.benefit.cost.qualifiers [ string ], ... ; # 0..* Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA)
          fhir:ProductPlan.plan.category.benefit.cost.value [ Quantity ]; # 0..1 The actual cost value
        ], ...;
      ], ...;
    ], ...;
  ], ...;
  fhir:ProductPlan.endpoint [ Reference(Endpoint) ], ... ; # 0..* Technical endpoints providing access to services operated for the organization
]

Changes since DSTU2

This resource did not exist in Release 2

This analysis is available as XML or JSON.

 

Alternate definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions & the dependency analysis

8.33.3.1 Terminology Bindings

PathDefinitionTypeReference
ProductPlan.status The lifecycle status of an artifact.RequiredPublicationStatus
ProductPlan.type Used to categorize the product/planExampleProductPlanType
ProductPlan.contact.purpose The purpose for which you would contact a contact partyExtensibleContactEntityType

8.33.3.2 Constraints

  • ppn-1: The organization SHALL at least have a name or an id, and possibly more than one (expression : (identifier.count() + name.count()) > 0)
  • ppn-2: On ProductPlan.address: An address of an organization can never be of use 'home' (expression on ProductPlan.address: where(use = 'home').empty())

8.33.4 Notes:

8.33.5 Search Parameters

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

NameTypeDescriptionExpressionIn Common
addressstringA server defined search that may match any of the string fields in the Address, including line, city, district, state, country, postalCode, and/or textProductPlan.address
address-citystringA city specified in an addressProductPlan.address.city
address-countrystringA country specified in an addressProductPlan.address.country
address-postalcodestringA postal code specified in an addressProductPlan.address.postalCode
address-statestringA state specified in an addressProductPlan.address.state
address-usetokenA use code specified in an addressProductPlan.address.use
administered-byreferenceAdministrator of the product/planProductPlan.administeredBy
(Organization)
endpointreferenceTechnical endpoints providing access to services operated for the organizationProductPlan.endpoint
(Endpoint)
identifiertokenAny identifier for the organization (not the accreditation issuer's identifier)ProductPlan.identifier
namestringA portion of the organization's name or aliasname | alias
owned-byreferenceAn organization of which this organization forms a partProductPlan.ownedBy
(Organization)
phoneticstringA portion of the organization's name using some kind of phonetic matching algorithmProductPlan.name
statustokenIs the Organization record activeProductPlan.status
typetokenA code for the type of organizationProductPlan.type