Publish-box (todo)
Patient Administration Work Group | Maturity Level: 1 | Trial Use | Security Category: Business | Compartments: No defined compartments |
Details of a Health Insurance product 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.
InsuranceProduct 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.
Structure
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
InsuranceProduct | TU | DomainResource | Details of a Health Insurance product provided by an organization + Rule: The organization SHALL at least have a name or an identifier, and possibly more than one Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension | |
identifier | ΣC | 0..* | Identifier | Business Identifier for Product |
status | ?!Σ | 0..1 | code | draft | active | retired | unknown Binding: PublicationStatus (Required) |
type | Σ | 0..* | CodeableConcept | Kind of product Binding: Insurance Plan Type (Example) |
name | ΣC | 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) | Product issuer |
administeredBy | Σ | 0..1 | Reference(Organization) | Product administrator |
coverageArea | Σ | 0..* | Reference(Location) | Where product applies |
contact | 0..* | ExtendedContactDetail | Official contact details relevant to the health insurance product | |
endpoint | 0..* | Reference(Endpoint) | Technical endpoint | |
network | 0..* | Reference(Organization) | What networks are Included | |
coverage | 0..* | BackboneElement | Coverage details | |
type | 1..1 | CodeableConcept | Classification of Coverage | |
network | 0..* | Reference(Organization) | What networks provide coverage | |
benefit | 1..* | BackboneElement | List of benefits | |
type | 1..1 | CodeableConcept | Classification of benefit provided | |
requirement | 0..1 | string | Referral requirements | |
limit | 0..* | BackboneElement | Limits on the provided benefits | |
value | 0..1 | Quantity | Maximum value allowed | |
code | 0..1 | CodeableConcept | Benefit limit details | |
related | 0..* | BackboneElement | Associated insurance product | |
product | 0..1 | Reference(InsuranceProduct) | Related Product reference | |
relationship | 0..1 | CodeableConcept | Relationship of this product to the related product | |
period | 0..1 | Period | Period that this Relationship is valid | |
Documentation for this format |
See the Extensions for this resource
UML Diagram (Legend)
XML Template
<InsuranceProduct xmlns="http://hl7.org/fhir"> <!-- from Resource: id, meta, implicitRules, and language --> <!-- from DomainResource: text, contained, extension, and modifierExtension --> <identifier><!-- I 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]"/><!-- I 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) Product issuer --></ownedBy> <administeredBy><!-- 0..1 Reference(Organization) Product administrator --></administeredBy> <coverageArea><!-- 0..* Reference(Location) Where product applies --></coverageArea> <contact><!-- 0..* ExtendedContactDetail Official contact details relevant to the health insurance product --></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 Classification of Coverage --></type> <network><!-- 0..* Reference(Organization) What networks provide coverage --></network> <benefit> <!-- 1..* List of benefits --> <type><!-- 1..1 CodeableConcept Classification of benefit provided --></type> <requirement value="[string]"/><!-- 0..1 Referral requirements --> <limit> <!-- 0..* Limits on the provided benefits --> <value><!-- 0..1 Quantity Maximum value allowed --></value> <code><!-- 0..1 CodeableConcept Benefit limit details --></code> </limit> </benefit> </coverage> <related> <!-- 0..* Associated insurance product --> <product><!-- 0..1 Reference(InsuranceProduct) Related Product reference --></product> <relationship><!-- 0..1 CodeableConcept Relationship of this product to the related product --></relationship> <period><!-- 0..1 Period Period that this Relationship is valid --></period> </related> </InsuranceProduct>
JSON Template
{ "resourceType" : "InsuranceProduct", // from Resource: id, meta, implicitRules, and language // from DomainResource: text, contained, extension, and modifierExtension "identifier" : [{ Identifier }], // I Business Identifier for Product "status" : "<code>", // draft | active | retired | unknown "type" : [{ CodeableConcept }], // Kind of product "name" : "<string>", // I Official name "alias" : ["<string>"], // Alternate names "period" : { Period }, // When the product is available "ownedBy" : { Reference(Organization) }, // Product issuer "administeredBy" : { Reference(Organization) }, // Product administrator "coverageArea" : [{ Reference(Location) }], // Where product applies "contact" : [{ ExtendedContactDetail }], // Official contact details relevant to the health insurance product "endpoint" : [{ Reference(Endpoint) }], // Technical endpoint "network" : [{ Reference(Organization) }], // What networks are Included "coverage" : [{ // Coverage details "type" : { CodeableConcept }, // R! Classification of Coverage "network" : [{ Reference(Organization) }], // What networks provide coverage "benefit" : [{ // R! List of benefits "type" : { CodeableConcept }, // R! Classification of benefit provided "requirement" : "<string>", // Referral requirements "limit" : [{ // Limits on the provided benefits "value" : { Quantity }, // Maximum value allowed "code" : { CodeableConcept } // Benefit limit details }] }] }], "related" : [{ // Associated insurance product "product" : { Reference(InsuranceProduct) }, // Related Product reference "relationship" : { CodeableConcept }, // Relationship of this product to the related product "period" : { Period } // Period that this Relationship is valid }] }
Turtle Template
@prefix fhir: <http://hl7.org/fhir/> . [ a fhir:InsuranceProduct; 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:identifier ( [ Identifier ] ... ) ; # 0..* I Business Identifier for Product fhir:status [ code ] ; # 0..1 draft | active | retired | unknown fhir:type ( [ CodeableConcept ] ... ) ; # 0..* Kind of product fhir:name [ string ] ; # 0..1 I Official name fhir:alias ( [ string ] ... ) ; # 0..* Alternate names fhir:period [ Period ] ; # 0..1 When the product is available fhir:ownedBy [ Reference(Organization) ] ; # 0..1 Product issuer fhir:administeredBy [ Reference(Organization) ] ; # 0..1 Product administrator fhir:coverageArea ( [ Reference(Location) ] ... ) ; # 0..* Where product applies fhir:contact ( [ ExtendedContactDetail ] ... ) ; # 0..* Official contact details relevant to the health insurance product fhir:endpoint ( [ Reference(Endpoint) ] ... ) ; # 0..* Technical endpoint fhir:network ( [ Reference(Organization) ] ... ) ; # 0..* What networks are Included fhir:coverage ( [ # 0..* Coverage details fhir:type [ CodeableConcept ] ; # 1..1 Classification of Coverage fhir:network ( [ Reference(Organization) ] ... ) ; # 0..* What networks provide coverage fhir:benefit ( [ # 1..* List of benefits fhir:type [ CodeableConcept ] ; # 1..1 Classification of benefit provided fhir:requirement [ string ] ; # 0..1 Referral requirements fhir:limit ( [ # 0..* Limits on the provided benefits fhir:value [ Quantity ] ; # 0..1 Maximum value allowed fhir:code [ CodeableConcept ] ; # 0..1 Benefit limit details ] ... ) ; ] ... ) ; ] ... ) ; fhir:related ( [ # 0..* Associated insurance product fhir:product [ Reference(InsuranceProduct) ] ; # 0..1 Related Product reference fhir:relationship [ CodeableConcept ] ; # 0..1 Relationship of this product to the related product fhir:period [ Period ] ; # 0..1 Period that this Relationship is valid ] ... ) ; ]
Changes from both R4 and R4B
This resource did not exist in Release R4
See the Full Difference for further information
This analysis is available for R4 as XML or JSON and for R4B as XML or JSON.
Structure
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
InsuranceProduct | TU | DomainResource | Details of a Health Insurance product provided by an organization + Rule: The organization SHALL at least have a name or an identifier, and possibly more than one Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension | |
identifier | ΣC | 0..* | Identifier | Business Identifier for Product |
status | ?!Σ | 0..1 | code | draft | active | retired | unknown Binding: PublicationStatus (Required) |
type | Σ | 0..* | CodeableConcept | Kind of product Binding: Insurance Plan Type (Example) |
name | ΣC | 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) | Product issuer |
administeredBy | Σ | 0..1 | Reference(Organization) | Product administrator |
coverageArea | Σ | 0..* | Reference(Location) | Where product applies |
contact | 0..* | ExtendedContactDetail | Official contact details relevant to the health insurance product | |
endpoint | 0..* | Reference(Endpoint) | Technical endpoint | |
network | 0..* | Reference(Organization) | What networks are Included | |
coverage | 0..* | BackboneElement | Coverage details | |
type | 1..1 | CodeableConcept | Classification of Coverage | |
network | 0..* | Reference(Organization) | What networks provide coverage | |
benefit | 1..* | BackboneElement | List of benefits | |
type | 1..1 | CodeableConcept | Classification of benefit provided | |
requirement | 0..1 | string | Referral requirements | |
limit | 0..* | BackboneElement | Limits on the provided benefits | |
value | 0..1 | Quantity | Maximum value allowed | |
code | 0..1 | CodeableConcept | Benefit limit details | |
related | 0..* | BackboneElement | Associated insurance product | |
product | 0..1 | Reference(InsuranceProduct) | Related Product reference | |
relationship | 0..1 | CodeableConcept | Relationship of this product to the related product | |
period | 0..1 | Period | Period that this Relationship is valid | |
Documentation for this format |
See the Extensions for this resource
XML Template
<InsuranceProduct xmlns="http://hl7.org/fhir"> <!-- from Resource: id, meta, implicitRules, and language --> <!-- from DomainResource: text, contained, extension, and modifierExtension --> <identifier><!-- I 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]"/><!-- I 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) Product issuer --></ownedBy> <administeredBy><!-- 0..1 Reference(Organization) Product administrator --></administeredBy> <coverageArea><!-- 0..* Reference(Location) Where product applies --></coverageArea> <contact><!-- 0..* ExtendedContactDetail Official contact details relevant to the health insurance product --></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 Classification of Coverage --></type> <network><!-- 0..* Reference(Organization) What networks provide coverage --></network> <benefit> <!-- 1..* List of benefits --> <type><!-- 1..1 CodeableConcept Classification of benefit provided --></type> <requirement value="[string]"/><!-- 0..1 Referral requirements --> <limit> <!-- 0..* Limits on the provided benefits --> <value><!-- 0..1 Quantity Maximum value allowed --></value> <code><!-- 0..1 CodeableConcept Benefit limit details --></code> </limit> </benefit> </coverage> <related> <!-- 0..* Associated insurance product --> <product><!-- 0..1 Reference(InsuranceProduct) Related Product reference --></product> <relationship><!-- 0..1 CodeableConcept Relationship of this product to the related product --></relationship> <period><!-- 0..1 Period Period that this Relationship is valid --></period> </related> </InsuranceProduct>
JSON Template
{ "resourceType" : "InsuranceProduct", // from Resource: id, meta, implicitRules, and language // from DomainResource: text, contained, extension, and modifierExtension "identifier" : [{ Identifier }], // I Business Identifier for Product "status" : "<code>", // draft | active | retired | unknown "type" : [{ CodeableConcept }], // Kind of product "name" : "<string>", // I Official name "alias" : ["<string>"], // Alternate names "period" : { Period }, // When the product is available "ownedBy" : { Reference(Organization) }, // Product issuer "administeredBy" : { Reference(Organization) }, // Product administrator "coverageArea" : [{ Reference(Location) }], // Where product applies "contact" : [{ ExtendedContactDetail }], // Official contact details relevant to the health insurance product "endpoint" : [{ Reference(Endpoint) }], // Technical endpoint "network" : [{ Reference(Organization) }], // What networks are Included "coverage" : [{ // Coverage details "type" : { CodeableConcept }, // R! Classification of Coverage "network" : [{ Reference(Organization) }], // What networks provide coverage "benefit" : [{ // R! List of benefits "type" : { CodeableConcept }, // R! Classification of benefit provided "requirement" : "<string>", // Referral requirements "limit" : [{ // Limits on the provided benefits "value" : { Quantity }, // Maximum value allowed "code" : { CodeableConcept } // Benefit limit details }] }] }], "related" : [{ // Associated insurance product "product" : { Reference(InsuranceProduct) }, // Related Product reference "relationship" : { CodeableConcept }, // Relationship of this product to the related product "period" : { Period } // Period that this Relationship is valid }] }
Turtle Template
@prefix fhir: <http://hl7.org/fhir/> . [ a fhir:InsuranceProduct; 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:identifier ( [ Identifier ] ... ) ; # 0..* I Business Identifier for Product fhir:status [ code ] ; # 0..1 draft | active | retired | unknown fhir:type ( [ CodeableConcept ] ... ) ; # 0..* Kind of product fhir:name [ string ] ; # 0..1 I Official name fhir:alias ( [ string ] ... ) ; # 0..* Alternate names fhir:period [ Period ] ; # 0..1 When the product is available fhir:ownedBy [ Reference(Organization) ] ; # 0..1 Product issuer fhir:administeredBy [ Reference(Organization) ] ; # 0..1 Product administrator fhir:coverageArea ( [ Reference(Location) ] ... ) ; # 0..* Where product applies fhir:contact ( [ ExtendedContactDetail ] ... ) ; # 0..* Official contact details relevant to the health insurance product fhir:endpoint ( [ Reference(Endpoint) ] ... ) ; # 0..* Technical endpoint fhir:network ( [ Reference(Organization) ] ... ) ; # 0..* What networks are Included fhir:coverage ( [ # 0..* Coverage details fhir:type [ CodeableConcept ] ; # 1..1 Classification of Coverage fhir:network ( [ Reference(Organization) ] ... ) ; # 0..* What networks provide coverage fhir:benefit ( [ # 1..* List of benefits fhir:type [ CodeableConcept ] ; # 1..1 Classification of benefit provided fhir:requirement [ string ] ; # 0..1 Referral requirements fhir:limit ( [ # 0..* Limits on the provided benefits fhir:value [ Quantity ] ; # 0..1 Maximum value allowed fhir:code [ CodeableConcept ] ; # 0..1 Benefit limit details ] ... ) ; ] ... ) ; ] ... ) ; fhir:related ( [ # 0..* Associated insurance product fhir:product [ Reference(InsuranceProduct) ] ; # 0..1 Related Product reference fhir:relationship [ CodeableConcept ] ; # 0..1 Relationship of this product to the related product fhir:period [ Period ] ; # 0..1 Period that this Relationship is valid ] ... ) ; ]
Changes from both R4 and R4B
This resource did not exist in Release R4
See the Full Difference for further information
This analysis is available for R4 as XML or JSON and for R4B as XML or JSON.
Additional definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions, the spreadsheet version & the dependency analysis
Path | ValueSet | Type | Documentation |
---|---|---|---|
InsuranceProduct.status | PublicationStatus | Required | The lifecycle status of an artifact. |
InsuranceProduct.type | InsurancePlanType | Example | This example value set defines a set of codes that can be used to indicate a type of insurance plan. |
UniqueKey | Level | Location | Description | Expression |
ipn-1 | Rule | (base) | The organization SHALL at least have a name or an identifier, and possibly more than one | (identifier.count() + name.count()) > 0 |
Search parameters for this resource. See also the full list of search parameters for this resource, and check the Extensions registry for search parameters on extensions related to 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 |
administered-by | reference | Product administrator | InsuranceProduct.administeredBy (Organization) |
|
contact-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 | InsuranceProduct.contact.address | |
contact-address-city | string | A city specified in an address | InsuranceProduct.contact.address.city | |
contact-address-country | string | A country specified in an address | InsuranceProduct.contact.address.country | |
contact-address-postalcode | string | A postal code specified in an address | InsuranceProduct.contact.address.postalCode | |
contact-address-state | string | A state specified in an address | InsuranceProduct.contact.address.state | |
contact-address-use | token | A use code specified in an address | InsuranceProduct.contact.address.use | |
endpoint | reference | The endpoint(s) applicable to this product | InsuranceProduct.endpoint (Endpoint) |
|
identifier | token | Any identifier for the product (not the accreditation issuer's identifier) | InsuranceProduct.identifier | |
name | string | A portion of the insurance product's name or alias | InsuranceProduct.name | InsuranceProduct.alias | |
owned-by | reference | The issuer of the insurance product | InsuranceProduct.ownedBy (Organization) |
|
phonetic | string | A portion of the product's name using some kind of phonetic matching algorithm | InsuranceProduct.name | |
status | token | Is the Product record active | InsuranceProduct.status | |
type | token | A code for the type of insurance product | InsuranceProduct.type |