This page is part of the FHIR Specification (v4.4.0: R5 Preview #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 . Page versions: R5 R4B R4
Patient Administration Work Group | Maturity Level: 0 | Trial Use | Security Category: Business | Compartments: Not linked to any defined compartments |
Details of a Health Insurance product/plan provided by an organization.
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.
InsurancePlan 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.
This resource is referenced by UsageContext.
This resource does not implement any patterns.
Structure
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
InsurancePlan | TU | DomainResource | Details of a Health Insurance product/plan provided by an organization + Rule: The organization SHALL at least have a name or an idendtifier, and possibly more than one Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension | |
identifier | ΣI | 0..* | Identifier | Business Identifier for Product |
status | ?!Σ | 0..1 | code | draft | active | retired | unknown PublicationStatus (Required) |
type | Σ | 0..* | CodeableConcept | Kind of product Insurance plan type (Example) |
name | ΣI | 0..1 | string | Official name |
alias | 0..* | string | Alternate names | |
period | 0..1 | Period | When the product is available | |
ownedBy | Σ | 0..1 | Reference(Organization) | Plan issuer |
administeredBy | Σ | 0..1 | Reference(Organization) | Product administrator |
coverageArea | Σ | 0..* | Reference(Location) | Where product applies |
contact | 0..* | BackboneElement | Contact for the product | |
purpose | 0..1 | CodeableConcept | The type of contact Contact entity type (Extensible) | |
name | 0..1 | HumanName | A name associated with the contact | |
telecom | 0..* | ContactPoint | Contact details (telephone, email, etc.) for a contact | |
address | 0..1 | Address | Visiting or postal addresses for the contact | |
endpoint | 0..* | Reference(Endpoint) | Technical endpoint | |
network | 0..* | Reference(Organization) | What networks are Included | |
coverage | 0..* | BackboneElement | Coverage details | |
type | 1..1 | CodeableConcept | Type of coverage | |
network | 0..* | Reference(Organization) | What networks provide coverage | |
benefit | 1..* | BackboneElement | List of benefits | |
type | 1..1 | CodeableConcept | Type of benefit | |
requirement | 0..1 | string | Referral requirements | |
limit | 0..* | BackboneElement | Benefit limits | |
value | 0..1 | Quantity | Maximum value allowed | |
code | 0..1 | CodeableConcept | Benefit limit details | |
plan | 0..* | BackboneElement | Plan details | |
identifier | Σ | 0..* | Identifier | Business Identifier for Product |
type | 0..1 | CodeableConcept | Type of plan | |
coverageArea | Σ | 0..* | Reference(Location) | Where product applies |
network | 0..* | Reference(Organization) | What networks provide coverage | |
generalCost | 0..* | BackboneElement | Overall costs | |
type | 0..1 | CodeableConcept | Type of cost | |
groupSize | 0..1 | positiveInt | Number of enrollees | |
cost | 0..1 | Money | Cost value | |
comment | 0..1 | string | Additional cost information | |
specificCost | 0..* | BackboneElement | Specific costs | |
category | 1..1 | CodeableConcept | General category of benefit | |
benefit | 0..* | BackboneElement | Benefits list | |
type | 1..1 | CodeableConcept | Type of specific benefit | |
cost | 0..* | BackboneElement | List of the costs | |
type | 1..1 | CodeableConcept | Type of cost | |
applicability | 0..1 | CodeableConcept | in-network | out-of-network | other Benefit cost applicability (Required) | |
qualifiers | 0..* | CodeableConcept | Additional information about the cost | |
value | 0..1 | Quantity | The actual cost value | |
Documentation for this format |
UML Diagram (Legend)
XML Template
<InsurancePlan xmlns="http://hl7.org/fhir"> <!-- from Resource: id, meta, implicitRules, and language --> <!-- from DomainResource: text, contained, extension, and modifierExtension --> <identifier><!-- 0..* Identifier Business Identifier for Product --></identifier> <status value="[code]"/><!-- 0..1 draft | active | retired | unknown --> <type><!-- 0..* CodeableConcept Kind of product --></type> <name value="[string]"/><!-- 0..1 Official name --> <alias value="[string]"/><!-- 0..* Alternate names --> <period><!-- 0..1 Period When the product is available --></period> <ownedBy><!-- 0..1 Reference(Organization) Plan issuer --></ownedBy> <administeredBy><!-- 0..1 Reference(Organization) Product administrator --></administeredBy> <coverageArea><!-- 0..* Reference(Location) Where product applies --></coverageArea> <contact> <!-- 0..* Contact for the product --> <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> <endpoint><!-- 0..* Reference(Endpoint) Technical endpoint --></endpoint> <network><!-- 0..* Reference(Organization) What networks are Included --></network> <coverage> <!-- 0..* Coverage details --> <type><!-- 1..1 CodeableConcept Type of coverage --></type> <network><!-- 0..* Reference(Organization) What networks provide coverage --></network> <benefit> <!-- 1..* List of benefits --> <type><!-- 1..1 CodeableConcept Type of benefit --></type> <requirement value="[string]"/><!-- 0..1 Referral requirements --> <limit> <!-- 0..* Benefit limits --> <value><!-- 0..1 Quantity Maximum value allowed --></value> <code><!-- 0..1 CodeableConcept Benefit limit details --></code> </limit> </benefit> </coverage> <plan> <!-- 0..* Plan details --> <identifier><!-- 0..* Identifier Business Identifier for Product --></identifier> <type><!-- 0..1 CodeableConcept Type of plan --></type> <coverageArea><!-- 0..* Reference(Location) Where product applies --></coverageArea> <network><!-- 0..* Reference(Organization) What networks provide coverage --></network> <generalCost> <!-- 0..* Overall costs --> <type><!-- 0..1 CodeableConcept Type of cost --></type> <groupSize value="[positiveInt]"/><!-- 0..1 Number of enrollees --> <cost><!-- 0..1 Money Cost value --></cost> <comment value="[string]"/><!-- 0..1 Additional cost information --> </generalCost> <specificCost> <!-- 0..* Specific costs --> <category><!-- 1..1 CodeableConcept General category of benefit --></category> <benefit> <!-- 0..* Benefits list --> <type><!-- 1..1 CodeableConcept Type of specific benefit --></type> <cost> <!-- 0..* List of the costs --> <type><!-- 1..1 CodeableConcept Type of cost --></type> <applicability><!-- 0..1 CodeableConcept in-network | out-of-network | other --></applicability> <qualifiers><!-- 0..* CodeableConcept Additional information about the cost --></qualifiers> <value><!-- 0..1 Quantity The actual cost value --></value> </cost> </benefit> </specificCost> </plan> </InsurancePlan>
JSON Template
{ "resourceType" : "InsurancePlan", // from Resource: id, meta, implicitRules, and language // from DomainResource: text, contained, extension, and modifierExtension "identifier" : [{ Identifier }], // C? Business Identifier for Product "status" : "<code>", // draft | active | retired | unknown "type" : [{ CodeableConcept }], // Kind of product "name" : "<string>", // C? Official name "alias" : ["<string>"], // Alternate names "period" : { Period }, // When the product is available "ownedBy" : { Reference(Organization) }, // Plan issuer "administeredBy" : { Reference(Organization) }, // Product administrator "coverageArea" : [{ Reference(Location) }], // Where product applies "contact" : [{ // Contact for the product "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 }], "endpoint" : [{ Reference(Endpoint) }], // Technical endpoint "network" : [{ Reference(Organization) }], // What networks are Included "coverage" : [{ // Coverage details "type" : { CodeableConcept }, // R! Type of coverage "network" : [{ Reference(Organization) }], // What networks provide coverage "benefit" : [{ // R! List of benefits "type" : { CodeableConcept }, // R! Type of benefit "requirement" : "<string>", // Referral requirements "limit" : [{ // Benefit limits "value" : { Quantity }, // Maximum value allowed "code" : { CodeableConcept } // Benefit limit details }] }] }], "plan" : [{ // Plan details "identifier" : [{ Identifier }], // Business Identifier for Product "type" : { CodeableConcept }, // Type of plan "coverageArea" : [{ Reference(Location) }], // Where product applies "network" : [{ Reference(Organization) }], // What networks provide coverage "generalCost" : [{ // Overall costs "type" : { CodeableConcept }, // Type of cost "groupSize" : "<positiveInt>", // Number of enrollees "cost" : { Money }, // Cost value "comment" : "<string>" // Additional cost information }], "specificCost" : [{ // Specific costs "category" : { CodeableConcept }, // R! General category of benefit "benefit" : [{ // Benefits list "type" : { CodeableConcept }, // R! Type of specific benefit "cost" : [{ // List of the costs "type" : { CodeableConcept }, // R! Type of cost "applicability" : { CodeableConcept }, // in-network | out-of-network | other "qualifiers" : [{ CodeableConcept }], // Additional information about the cost "value" : { Quantity } // The actual cost value }] }] }] }] }
Turtle Template
@prefix fhir: <http://hl7.org/fhir/> . [ a fhir:InsurancePlan; 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:InsurancePlan.identifier [ Identifier ], ... ; # 0..* Business Identifier for Product fhir:InsurancePlan.status [ code ]; # 0..1 draft | active | retired | unknown fhir:InsurancePlan.type [ CodeableConcept ], ... ; # 0..* Kind of product fhir:InsurancePlan.name [ string ]; # 0..1 Official name fhir:InsurancePlan.alias [ string ], ... ; # 0..* Alternate names fhir:InsurancePlan.period [ Period ]; # 0..1 When the product is available fhir:InsurancePlan.ownedBy [ Reference(Organization) ]; # 0..1 Plan issuer fhir:InsurancePlan.administeredBy [ Reference(Organization) ]; # 0..1 Product administrator fhir:InsurancePlan.coverageArea [ Reference(Location) ], ... ; # 0..* Where product applies fhir:InsurancePlan.contact [ # 0..* Contact for the product fhir:InsurancePlan.contact.purpose [ CodeableConcept ]; # 0..1 The type of contact fhir:InsurancePlan.contact.name [ HumanName ]; # 0..1 A name associated with the contact fhir:InsurancePlan.contact.telecom [ ContactPoint ], ... ; # 0..* Contact details (telephone, email, etc.) for a contact fhir:InsurancePlan.contact.address [ Address ]; # 0..1 Visiting or postal addresses for the contact ], ...; fhir:InsurancePlan.endpoint [ Reference(Endpoint) ], ... ; # 0..* Technical endpoint fhir:InsurancePlan.network [ Reference(Organization) ], ... ; # 0..* What networks are Included fhir:InsurancePlan.coverage [ # 0..* Coverage details fhir:InsurancePlan.coverage.type [ CodeableConcept ]; # 1..1 Type of coverage fhir:InsurancePlan.coverage.network [ Reference(Organization) ], ... ; # 0..* What networks provide coverage fhir:InsurancePlan.coverage.benefit [ # 1..* List of benefits fhir:InsurancePlan.coverage.benefit.type [ CodeableConcept ]; # 1..1 Type of benefit fhir:InsurancePlan.coverage.benefit.requirement [ string ]; # 0..1 Referral requirements fhir:InsurancePlan.coverage.benefit.limit [ # 0..* Benefit limits fhir:InsurancePlan.coverage.benefit.limit.value [ Quantity ]; # 0..1 Maximum value allowed fhir:InsurancePlan.coverage.benefit.limit.code [ CodeableConcept ]; # 0..1 Benefit limit details ], ...; ], ...; ], ...; fhir:InsurancePlan.plan [ # 0..* Plan details fhir:InsurancePlan.plan.identifier [ Identifier ], ... ; # 0..* Business Identifier for Product fhir:InsurancePlan.plan.type [ CodeableConcept ]; # 0..1 Type of plan fhir:InsurancePlan.plan.coverageArea [ Reference(Location) ], ... ; # 0..* Where product applies fhir:InsurancePlan.plan.network [ Reference(Organization) ], ... ; # 0..* What networks provide coverage fhir:InsurancePlan.plan.generalCost [ # 0..* Overall costs fhir:InsurancePlan.plan.generalCost.type [ CodeableConcept ]; # 0..1 Type of cost fhir:InsurancePlan.plan.generalCost.groupSize [ positiveInt ]; # 0..1 Number of enrollees fhir:InsurancePlan.plan.generalCost.cost [ Money ]; # 0..1 Cost value fhir:InsurancePlan.plan.generalCost.comment [ string ]; # 0..1 Additional cost information ], ...; fhir:InsurancePlan.plan.specificCost [ # 0..* Specific costs fhir:InsurancePlan.plan.specificCost.category [ CodeableConcept ]; # 1..1 General category of benefit fhir:InsurancePlan.plan.specificCost.benefit [ # 0..* Benefits list fhir:InsurancePlan.plan.specificCost.benefit.type [ CodeableConcept ]; # 1..1 Type of specific benefit fhir:InsurancePlan.plan.specificCost.benefit.cost [ # 0..* List of the costs fhir:InsurancePlan.plan.specificCost.benefit.cost.type [ CodeableConcept ]; # 1..1 Type of cost fhir:InsurancePlan.plan.specificCost.benefit.cost.applicability [ CodeableConcept ]; # 0..1 in-network | out-of-network | other fhir:InsurancePlan.plan.specificCost.benefit.cost.qualifiers [ CodeableConcept ], ... ; # 0..* Additional information about the cost fhir:InsurancePlan.plan.specificCost.benefit.cost.value [ Quantity ]; # 0..1 The actual cost value ], ...; ], ...; ], ...; ], ...; ]
Changes since R3
InsurancePlan | |
InsurancePlan.status |
|
InsurancePlan.plan.specificCost.benefit.cost.applicability |
|
See the Full Difference for further information
Structure
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
InsurancePlan | TU | DomainResource | Details of a Health Insurance product/plan provided by an organization + Rule: The organization SHALL at least have a name or an idendtifier, and possibly more than one Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension | |
identifier | ΣI | 0..* | Identifier | Business Identifier for Product |
status | ?!Σ | 0..1 | code | draft | active | retired | unknown PublicationStatus (Required) |
type | Σ | 0..* | CodeableConcept | Kind of product Insurance plan type (Example) |
name | ΣI | 0..1 | string | Official name |
alias | 0..* | string | Alternate names | |
period | 0..1 | Period | When the product is available | |
ownedBy | Σ | 0..1 | Reference(Organization) | Plan issuer |
administeredBy | Σ | 0..1 | Reference(Organization) | Product administrator |
coverageArea | Σ | 0..* | Reference(Location) | Where product applies |
contact | 0..* | BackboneElement | Contact for the product | |
purpose | 0..1 | CodeableConcept | The type of contact Contact entity type (Extensible) | |
name | 0..1 | HumanName | A name associated with the contact | |
telecom | 0..* | ContactPoint | Contact details (telephone, email, etc.) for a contact | |
address | 0..1 | Address | Visiting or postal addresses for the contact | |
endpoint | 0..* | Reference(Endpoint) | Technical endpoint | |
network | 0..* | Reference(Organization) | What networks are Included | |
coverage | 0..* | BackboneElement | Coverage details | |
type | 1..1 | CodeableConcept | Type of coverage | |
network | 0..* | Reference(Organization) | What networks provide coverage | |
benefit | 1..* | BackboneElement | List of benefits | |
type | 1..1 | CodeableConcept | Type of benefit | |
requirement | 0..1 | string | Referral requirements | |
limit | 0..* | BackboneElement | Benefit limits | |
value | 0..1 | Quantity | Maximum value allowed | |
code | 0..1 | CodeableConcept | Benefit limit details | |
plan | 0..* | BackboneElement | Plan details | |
identifier | Σ | 0..* | Identifier | Business Identifier for Product |
type | 0..1 | CodeableConcept | Type of plan | |
coverageArea | Σ | 0..* | Reference(Location) | Where product applies |
network | 0..* | Reference(Organization) | What networks provide coverage | |
generalCost | 0..* | BackboneElement | Overall costs | |
type | 0..1 | CodeableConcept | Type of cost | |
groupSize | 0..1 | positiveInt | Number of enrollees | |
cost | 0..1 | Money | Cost value | |
comment | 0..1 | string | Additional cost information | |
specificCost | 0..* | BackboneElement | Specific costs | |
category | 1..1 | CodeableConcept | General category of benefit | |
benefit | 0..* | BackboneElement | Benefits list | |
type | 1..1 | CodeableConcept | Type of specific benefit | |
cost | 0..* | BackboneElement | List of the costs | |
type | 1..1 | CodeableConcept | Type of cost | |
applicability | 0..1 | CodeableConcept | in-network | out-of-network | other Benefit cost applicability (Required) | |
qualifiers | 0..* | CodeableConcept | Additional information about the cost | |
value | 0..1 | Quantity | The actual cost value | |
Documentation for this format |
XML Template
<InsurancePlan xmlns="http://hl7.org/fhir"> <!-- from Resource: id, meta, implicitRules, and language --> <!-- from DomainResource: text, contained, extension, and modifierExtension --> <identifier><!-- 0..* Identifier Business Identifier for Product --></identifier> <status value="[code]"/><!-- 0..1 draft | active | retired | unknown --> <type><!-- 0..* CodeableConcept Kind of product --></type> <name value="[string]"/><!-- 0..1 Official name --> <alias value="[string]"/><!-- 0..* Alternate names --> <period><!-- 0..1 Period When the product is available --></period> <ownedBy><!-- 0..1 Reference(Organization) Plan issuer --></ownedBy> <administeredBy><!-- 0..1 Reference(Organization) Product administrator --></administeredBy> <coverageArea><!-- 0..* Reference(Location) Where product applies --></coverageArea> <contact> <!-- 0..* Contact for the product --> <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> <endpoint><!-- 0..* Reference(Endpoint) Technical endpoint --></endpoint> <network><!-- 0..* Reference(Organization) What networks are Included --></network> <coverage> <!-- 0..* Coverage details --> <type><!-- 1..1 CodeableConcept Type of coverage --></type> <network><!-- 0..* Reference(Organization) What networks provide coverage --></network> <benefit> <!-- 1..* List of benefits --> <type><!-- 1..1 CodeableConcept Type of benefit --></type> <requirement value="[string]"/><!-- 0..1 Referral requirements --> <limit> <!-- 0..* Benefit limits --> <value><!-- 0..1 Quantity Maximum value allowed --></value> <code><!-- 0..1 CodeableConcept Benefit limit details --></code> </limit> </benefit> </coverage> <plan> <!-- 0..* Plan details --> <identifier><!-- 0..* Identifier Business Identifier for Product --></identifier> <type><!-- 0..1 CodeableConcept Type of plan --></type> <coverageArea><!-- 0..* Reference(Location) Where product applies --></coverageArea> <network><!-- 0..* Reference(Organization) What networks provide coverage --></network> <generalCost> <!-- 0..* Overall costs --> <type><!-- 0..1 CodeableConcept Type of cost --></type> <groupSize value="[positiveInt]"/><!-- 0..1 Number of enrollees --> <cost><!-- 0..1 Money Cost value --></cost> <comment value="[string]"/><!-- 0..1 Additional cost information --> </generalCost> <specificCost> <!-- 0..* Specific costs --> <category><!-- 1..1 CodeableConcept General category of benefit --></category> <benefit> <!-- 0..* Benefits list --> <type><!-- 1..1 CodeableConcept Type of specific benefit --></type> <cost> <!-- 0..* List of the costs --> <type><!-- 1..1 CodeableConcept Type of cost --></type> <applicability><!-- 0..1 CodeableConcept in-network | out-of-network | other --></applicability> <qualifiers><!-- 0..* CodeableConcept Additional information about the cost --></qualifiers> <value><!-- 0..1 Quantity The actual cost value --></value> </cost> </benefit> </specificCost> </plan> </InsurancePlan>
JSON Template
{ "resourceType" : "InsurancePlan", // from Resource: id, meta, implicitRules, and language // from DomainResource: text, contained, extension, and modifierExtension "identifier" : [{ Identifier }], // C? Business Identifier for Product "status" : "<code>", // draft | active | retired | unknown "type" : [{ CodeableConcept }], // Kind of product "name" : "<string>", // C? Official name "alias" : ["<string>"], // Alternate names "period" : { Period }, // When the product is available "ownedBy" : { Reference(Organization) }, // Plan issuer "administeredBy" : { Reference(Organization) }, // Product administrator "coverageArea" : [{ Reference(Location) }], // Where product applies "contact" : [{ // Contact for the product "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 }], "endpoint" : [{ Reference(Endpoint) }], // Technical endpoint "network" : [{ Reference(Organization) }], // What networks are Included "coverage" : [{ // Coverage details "type" : { CodeableConcept }, // R! Type of coverage "network" : [{ Reference(Organization) }], // What networks provide coverage "benefit" : [{ // R! List of benefits "type" : { CodeableConcept }, // R! Type of benefit "requirement" : "<string>", // Referral requirements "limit" : [{ // Benefit limits "value" : { Quantity }, // Maximum value allowed "code" : { CodeableConcept } // Benefit limit details }] }] }], "plan" : [{ // Plan details "identifier" : [{ Identifier }], // Business Identifier for Product "type" : { CodeableConcept }, // Type of plan "coverageArea" : [{ Reference(Location) }], // Where product applies "network" : [{ Reference(Organization) }], // What networks provide coverage "generalCost" : [{ // Overall costs "type" : { CodeableConcept }, // Type of cost "groupSize" : "<positiveInt>", // Number of enrollees "cost" : { Money }, // Cost value "comment" : "<string>" // Additional cost information }], "specificCost" : [{ // Specific costs "category" : { CodeableConcept }, // R! General category of benefit "benefit" : [{ // Benefits list "type" : { CodeableConcept }, // R! Type of specific benefit "cost" : [{ // List of the costs "type" : { CodeableConcept }, // R! Type of cost "applicability" : { CodeableConcept }, // in-network | out-of-network | other "qualifiers" : [{ CodeableConcept }], // Additional information about the cost "value" : { Quantity } // The actual cost value }] }] }] }] }
Turtle Template
@prefix fhir: <http://hl7.org/fhir/> . [ a fhir:InsurancePlan; 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:InsurancePlan.identifier [ Identifier ], ... ; # 0..* Business Identifier for Product fhir:InsurancePlan.status [ code ]; # 0..1 draft | active | retired | unknown fhir:InsurancePlan.type [ CodeableConcept ], ... ; # 0..* Kind of product fhir:InsurancePlan.name [ string ]; # 0..1 Official name fhir:InsurancePlan.alias [ string ], ... ; # 0..* Alternate names fhir:InsurancePlan.period [ Period ]; # 0..1 When the product is available fhir:InsurancePlan.ownedBy [ Reference(Organization) ]; # 0..1 Plan issuer fhir:InsurancePlan.administeredBy [ Reference(Organization) ]; # 0..1 Product administrator fhir:InsurancePlan.coverageArea [ Reference(Location) ], ... ; # 0..* Where product applies fhir:InsurancePlan.contact [ # 0..* Contact for the product fhir:InsurancePlan.contact.purpose [ CodeableConcept ]; # 0..1 The type of contact fhir:InsurancePlan.contact.name [ HumanName ]; # 0..1 A name associated with the contact fhir:InsurancePlan.contact.telecom [ ContactPoint ], ... ; # 0..* Contact details (telephone, email, etc.) for a contact fhir:InsurancePlan.contact.address [ Address ]; # 0..1 Visiting or postal addresses for the contact ], ...; fhir:InsurancePlan.endpoint [ Reference(Endpoint) ], ... ; # 0..* Technical endpoint fhir:InsurancePlan.network [ Reference(Organization) ], ... ; # 0..* What networks are Included fhir:InsurancePlan.coverage [ # 0..* Coverage details fhir:InsurancePlan.coverage.type [ CodeableConcept ]; # 1..1 Type of coverage fhir:InsurancePlan.coverage.network [ Reference(Organization) ], ... ; # 0..* What networks provide coverage fhir:InsurancePlan.coverage.benefit [ # 1..* List of benefits fhir:InsurancePlan.coverage.benefit.type [ CodeableConcept ]; # 1..1 Type of benefit fhir:InsurancePlan.coverage.benefit.requirement [ string ]; # 0..1 Referral requirements fhir:InsurancePlan.coverage.benefit.limit [ # 0..* Benefit limits fhir:InsurancePlan.coverage.benefit.limit.value [ Quantity ]; # 0..1 Maximum value allowed fhir:InsurancePlan.coverage.benefit.limit.code [ CodeableConcept ]; # 0..1 Benefit limit details ], ...; ], ...; ], ...; fhir:InsurancePlan.plan [ # 0..* Plan details fhir:InsurancePlan.plan.identifier [ Identifier ], ... ; # 0..* Business Identifier for Product fhir:InsurancePlan.plan.type [ CodeableConcept ]; # 0..1 Type of plan fhir:InsurancePlan.plan.coverageArea [ Reference(Location) ], ... ; # 0..* Where product applies fhir:InsurancePlan.plan.network [ Reference(Organization) ], ... ; # 0..* What networks provide coverage fhir:InsurancePlan.plan.generalCost [ # 0..* Overall costs fhir:InsurancePlan.plan.generalCost.type [ CodeableConcept ]; # 0..1 Type of cost fhir:InsurancePlan.plan.generalCost.groupSize [ positiveInt ]; # 0..1 Number of enrollees fhir:InsurancePlan.plan.generalCost.cost [ Money ]; # 0..1 Cost value fhir:InsurancePlan.plan.generalCost.comment [ string ]; # 0..1 Additional cost information ], ...; fhir:InsurancePlan.plan.specificCost [ # 0..* Specific costs fhir:InsurancePlan.plan.specificCost.category [ CodeableConcept ]; # 1..1 General category of benefit fhir:InsurancePlan.plan.specificCost.benefit [ # 0..* Benefits list fhir:InsurancePlan.plan.specificCost.benefit.type [ CodeableConcept ]; # 1..1 Type of specific benefit fhir:InsurancePlan.plan.specificCost.benefit.cost [ # 0..* List of the costs fhir:InsurancePlan.plan.specificCost.benefit.cost.type [ CodeableConcept ]; # 1..1 Type of cost fhir:InsurancePlan.plan.specificCost.benefit.cost.applicability [ CodeableConcept ]; # 0..1 in-network | out-of-network | other fhir:InsurancePlan.plan.specificCost.benefit.cost.qualifiers [ CodeableConcept ], ... ; # 0..* Additional information about the cost fhir:InsurancePlan.plan.specificCost.benefit.cost.value [ Quantity ]; # 0..1 The actual cost value ], ...; ], ...; ], ...; ], ...; ]
Changes since Release 3
InsurancePlan | |
InsurancePlan.status |
|
InsurancePlan.plan.specificCost.benefit.cost.applicability |
|
See the Full Difference for further information
See the Profiles & Extensions and the alternate definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions, the spreadsheet version & the dependency analysis a
Path | Definition | Type | Reference |
---|---|---|---|
InsurancePlan.status | The lifecycle status of an artifact. | Required | PublicationStatus |
InsurancePlan.type | Used to categorize the product/plan. | Example | InsurancePlanType |
InsurancePlan.contact.purpose | The purpose for which you would contact a contact party. | Extensible | ContactEntityType |
InsurancePlan.plan.specificCost.benefit.cost.applicability | Whether the cost applies to in-network or out-of-network providers. | Required | BenefitCostApplicability |
id | Level | Location | Description | Expression |
ipn-1 | Rule | (base) | The organization SHALL at least have a name or an idendtifier, and possibly more than one | (identifier.count() + name.count()) > 0 |
Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.
Name | Type | Description | Expression | In Common |
address | string | A server defined search that may match any of the string fields in the Address, including line, city, district, state, country, postalCode, and/or text | InsurancePlan.contact.address | |
address-city N | string | A city specified in an address | InsurancePlan.contact.address.city | |
address-country N | string | A country specified in an address | InsurancePlan.contact.address.country | |
address-postalcode N | string | A postal code specified in an address | InsurancePlan.contact.address.postalCode | |
address-state N | string | A state specified in an address | InsurancePlan.contact.address.state | |
address-use N | token | A use code specified in an address | InsurancePlan.contact.address.use | |
administered-by | reference | Product administrator | InsurancePlan.administeredBy (Organization) | |
endpoint | reference | Technical endpoint | InsurancePlan.endpoint (Endpoint) | |
identifier | token | Any identifier for the organization (not the accreditation issuer's identifier) | InsurancePlan.identifier | |
name | string | A portion of the organization's name or alias | name | alias | |
owned-by | reference | An organization of which this organization forms a part | InsurancePlan.ownedBy (Organization) | |
phonetic N | string | A portion of the organization's name using some kind of phonetic matching algorithm | InsurancePlan.name | |
status N | token | Is the Organization record active | InsurancePlan.status | |
type | token | A code for the type of organization | InsurancePlan.type |