| 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 identifier, and possibly more than one Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension |
|
identifier
|
Σ C | 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
|
Σ C | 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 plan/product
|
|
|
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
Binding: Benefit Cost Applicability ( Required) |
|
|
qualifiers
|
0..* | CodeableConcept | Additional information about the cost
|
|
|
value
|
0..1 | Quantity | The actual cost value
|
|
|
Documentation for this format
|
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