DaVinci Payer Data Exchange (PDex) US Drug Formulary | STU2 Ballot
1.2.0 - STU2 Ballot
DaVinci Payer Data Exchange (PDex) US Drug Formulary | STU2 Ballot
1.2.0 - STU2 Ballot
This page is part of the US Drug Formulary (v1.2.0: STU 2 Ballot 1) based on FHIR R4. The current version which supercedes this version is 2.0.0. For a full list of available versions, see the Directory of published versions 
| Defining URL: | http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PayerInsurancePlan |
| Version: | 1.2.0 |
| Name: | PayerInsurancePlan |
| Title: | Payer Insurance Plan |
| Status: | Active as of 12/3/21 6:37 PM |
| Definition: | The Payer InsurancePlan that defines the health insurance product, which include coverage benefits that are offered, and additional information about the offering, such as a coverage area, contact information, brochure locations, etc. The health insurance product offers one or more types of coverage, each of which may define a plan of covered benefits with the particular cost sharing structure offered to a consumer. Health insurance plans that include drug coverage reference a formulary that provides details about drugs that are covered under the plan including requirements and limitations of the coverage specific to each drug. |
| Publisher: | HL7 Pharmacy Working Group |
| Source Resource: | XML / JSON / Turtle |
The official URL for this profile is:
http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PayerInsurancePlan
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from InsurancePlan
Summary
Mandatory: 15 elements (2 nested mandatory elements)
Must-Support: 29 elements
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Slices
This structure defines the following Slices:
This structure is derived from InsurancePlan
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  InsurancePlan | 0..* | InsurancePlan | Details of a Health Insurance product/plan provided by an organization | |
  meta | ||||
  lastUpdated | 1..1 | instant | When the resource version last changed | |
 identifier | S | 1..* | Identifier | Business Identifier for Product |
| status | S | 1..1 | code | draft | active | retired | unknown |
| type | S | 1..1 | CodeableConcept | Product type Binding: Insurance Product Type (extensible) |
| name | S | 0..1 | string | Official name |
| period | S | 0..1 | Period | When the product is available |
 coverageArea | S | 0..* | Reference(Insurance Plan Location) | Where product applies |
| contact | 0..* | BackboneElement | Contact information for the Insurance Plan including URLs for brochure and formulary information | |
| purpose | 0..1 | CodeableConcept | The type of contact Binding: Type of plan contact (extensible) | |
| name | S | 0..1 | HumanName | A name associated with the contact |
| text | S | 0..1 | string | Text representation of the full name |
 telecom | S | 0..* | ContactPoint | Contact details (telephone, email, etc.) for a contact |
 system | S | 0..1 | code | phone | fax | email | pager | url | sms | other |
| value | S | 0..1 | string | The actual contact point details |
 Slices for coverage | S | 1..* | BackboneElement | Coverage details Slice: Unordered, Open by pattern:type |
 coverage:All Slices | Content/Rules for all slices | |||
  type | S | 1..1 | CodeableConcept | Type of coverage |
  coverage:drug-coverage | S | 1..* | BackboneElement | Coverage details |
  Slices for extension | S | 1..* | Extension | Extension Slice: Unordered, Open by value:url |
| usdf-FormularyReference-extension | S | 1..* | Reference(Formulary) | Formulary Reference URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyReference-extension |
 type | 1..1 | CodeableConcept | Type of coverage Required Pattern: At least the following | |
  coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: DRUGPOL | |
 Slices for benefit | 1..* | BackboneElement | List of benefits Slice: Unordered, Open by pattern:type | |
| benefit:All Slices | Content/Rules for all slices | |||
| type | 1..1 | CodeableConcept | Type of benefit Binding: Type of plan (extensible) | |
| benefit:drug-plan | S | 1..* | BackboneElement | List of benefits |
| type | 1..1 | CodeableConcept | Type of benefit Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PlanTypeCS | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: drug | |
| Slices for plan | S | 1..* | BackboneElement | Plan details Slice: Unordered, Open by pattern:type |
| plan:All Slices | Content/Rules for all slices | |||
| type | 0..1 | CodeableConcept | Type of plan Binding: Type of plan (extensible) | |
| plan:drug-plan | S | 1..* | BackboneElement | Drug plan |
| type | 1..1 | CodeableConcept | Type of plan Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PlanTypeCS | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: drug | |
| network | 0..* | Reference(Organization) | Pharmacy Network Organizations that are part of the drug plan | |
| specificCost | S | 1..* | BackboneElement | Pharmacy network type specific cost |
| category | S | 1..1 | CodeableConcept | Pharmacy Network Type Binding: Type of pharmacies (extensible) |
| benefit | S | 1..* | BackboneElement | Drug tier benefit |
| type | S | 1..1 | CodeableConcept | Type of specific benefit Binding: Drug tier of medication in health plan (required) |
| Slices for cost | S | 1..* | BackboneElement | List of the costs Slice: Unordered, Open by pattern:type |
| cost:All Slices | Content/Rules for all slices | |||
 type | 1..1 | CodeableConcept | Type of cost Binding: Benefit type of cost (extensible) | |
| qualifiers | S | 1..1 | CodeableConcept | Additional information about the cost |
| value | S | 0..1 | Quantity | The actual cost value |
| cost:copay | S | 0..1 | BackboneElement | Copay costs |
| type | 1..1 | CodeableConcept | Type of cost Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: copay | |
| qualifiers | 0..* | CodeableConcept | Additional information about the cost Binding: Qualifier of copay amount (required) | |
 value | 0..1 | MoneyQuantity | An amount of money. With regard to precision, see [Decimal Precision](datatypes.html#precision) | |
| value | S | 1..1 | decimal | Numerical value (with implicit precision) |
| system | 0..1 | uri | System that defines coded unit form Required Pattern: urn:iso:std:iso:4217 | |
| code | 0..1 | code | Coded form of the unit Required Pattern: USD | |
| cost:coinsurance | S | 0..1 | BackboneElement | Coinsurance costs |
| type | 1..1 | CodeableConcept | Type of cost Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: coinsurance | |
| qualifiers | 0..* | CodeableConcept | Additional information about the cost Binding: Qualifier for coinsurance rate (required) | |
| value | ||||
| system | 0..1 | uri | System that defines coded unit form Required Pattern: http://unitsofmeasure.org | |
| code | 0..1 | code | Coded form of the unit Required Pattern: % | |
| Documentation for this format | ||||
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| InsurancePlan | I | 0..* | InsurancePlan | Details of a Health Insurance product/plan provided by an organization |
 id | Σ | 0..1 | string | Logical id of this artifact |
| meta | Σ | 0..1 | Meta | Metadata about the resource |
| id | 0..1 | string | Unique id for inter-element referencing | |
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| versionId | Σ | 0..1 | id | Version specific identifier |
| lastUpdated | Σ | 1..1 | instant | When the resource version last changed |
| source | Σ | 0..1 | uri | Identifies where the resource comes from |
| profile | Σ | 0..* | canonical(StructureDefinition) | Profiles this resource claims to conform to |
| security | Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. |
| tag | Σ | 0..* | Coding | Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". |
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
| language | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages: A human language. | |
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |
| contained | 0..* | Resource | Contained, inline Resources | |
| extension | 0..* | Extension | Additional content defined by implementations | |
 modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
| identifier | SΣI | 1..* | Identifier | Business Identifier for Product |
| status | ?!SΣ | 1..1 | code | draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact. |
| type | SΣ | 1..1 | CodeableConcept | Product type Binding: Insurance Product Type (extensible) |
| name | SΣI | 0..1 | string | Official name |
| alias | 0..* | string | Alternate names | |
| period | S | 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 | SΣ | 0..* | Reference(Insurance Plan Location) | Where product applies |
| contact | 0..* | BackboneElement | Contact information for the Insurance Plan including URLs for brochure and formulary information | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| purpose | 0..1 | CodeableConcept | The type of contact Binding: Type of plan contact (extensible) | |
| name | S | 0..1 | HumanName | A name associated with the contact |
| id | 0..1 | string | Unique id for inter-element referencing | |
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| use | ?!Σ | 0..1 | code | usual | official | temp | nickname | anonymous | old | maiden Binding: NameUse (required): The use of a human name. |
| text | SΣ | 0..1 | string | Text representation of the full name |
| family | Σ | 0..1 | string | Family name (often called 'Surname') |
| given | Σ | 0..* | string | Given names (not always 'first'). Includes middle names This repeating element order: Given Names appear in the correct order for presenting the name |
| prefix | Σ | 0..* | string | Parts that come before the name This repeating element order: Prefixes appear in the correct order for presenting the name |
| suffix | Σ | 0..* | string | Parts that come after the name This repeating element order: Suffixes appear in the correct order for presenting the name |
| period | Σ | 0..1 | Period | Time period when name was/is in use |
| telecom | S | 0..* | ContactPoint | Contact details (telephone, email, etc.) for a contact |
| id | 0..1 | string | Unique id for inter-element referencing | |
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| system | SΣI | 0..1 | code | phone | fax | email | pager | url | sms | other Binding: ContactPointSystem (required): Telecommunications form for contact point. |
| value | SΣ | 0..1 | string | The actual contact point details |
| use | ?!Σ | 0..1 | code | home | work | temp | old | mobile - purpose of this contact point Binding: ContactPointUse (required): Use of contact point. |
| rank | Σ | 0..1 | positiveInt | Specify preferred order of use (1 = highest) |
| period | Σ | 0..1 | Period | Time period when the contact point was/is in use |
| 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 | |
| Slices for coverage | S | 1..* | BackboneElement | Coverage details Slice: Unordered, Open by pattern:type |
| coverage:All Slices | Content/Rules for all slices | |||
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | S | 1..1 | CodeableConcept | Type of coverage |
| network | 0..* | Reference(Organization) | What networks provide coverage | |
| benefit | 1..* | BackboneElement | List of benefits | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Type of benefit | |
| requirement | 0..1 | string | Referral requirements | |
| limit | 0..* | BackboneElement | Benefit limits | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| value | 0..1 | Quantity | Maximum value allowed | |
| code | 0..1 | CodeableConcept | Benefit limit details | |
| coverage:drug-coverage | S | 1..* | BackboneElement | Coverage details |
| id | 0..1 | string | Unique id for inter-element referencing | |
| Slices for extension | S | 1..* | Extension | Extension Slice: Unordered, Open by value:url |
| usdf-FormularyReference-extension | S | 1..* | Reference(Formulary) | Formulary Reference URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyReference-extension |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Type of coverage Required Pattern: At least the following | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: DRUGPOL | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| network | 0..* | Reference(Organization) | What networks provide coverage | |
| Slices for benefit | 1..* | BackboneElement | List of benefits Slice: Unordered, Open by pattern:type | |
| benefit:All Slices | Content/Rules for all slices | |||
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Type of benefit Binding: Type of plan (extensible) | |
| requirement | 0..1 | string | Referral requirements | |
| limit | 0..* | BackboneElement | Benefit limits | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| value | 0..1 | Quantity | Maximum value allowed | |
| code | 0..1 | CodeableConcept | Benefit limit details | |
| benefit:drug-plan | S | 1..* | BackboneElement | List of benefits |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Type of benefit Required Pattern: At least the following | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PlanTypeCS | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: drug | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| requirement | 0..1 | string | Referral requirements | |
| limit | 0..* | BackboneElement | Benefit limits | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| value | 0..1 | Quantity | Maximum value allowed | |
| code | 0..1 | CodeableConcept | Benefit limit details | |
| Slices for plan | S | 1..* | BackboneElement | Plan details Slice: Unordered, Open by pattern:type |
| plan:All Slices | Content/Rules for all slices | |||
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| identifier | Σ | 0..* | Identifier | Business Identifier for Product |
| type | 0..1 | CodeableConcept | Type of plan Binding: Type of plan (extensible) | |
| coverageArea | Σ | 0..* | Reference(Location) | Where product applies |
| network | 0..* | Reference(Organization) | What networks provide coverage | |
| generalCost | 0..* | BackboneElement | Overall costs | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| 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 | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| category | 1..1 | CodeableConcept | General category of benefit | |
| benefit | 0..* | BackboneElement | Benefits list | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Type of specific benefit | |
| cost | 0..* | BackboneElement | List of the costs | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Type of cost | |
| applicability | 0..1 | CodeableConcept | in-network | out-of-network | other Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers. | |
| qualifiers | 0..* | CodeableConcept | Additional information about the cost | |
| value | 0..1 | Quantity | The actual cost value | |
| plan:drug-plan | S | 1..* | BackboneElement | Drug plan |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| identifier | Σ | 0..* | Identifier | Business Identifier for Product |
| type | 1..1 | CodeableConcept | Type of plan Required Pattern: At least the following | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PlanTypeCS | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: drug | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| coverageArea | Σ | 0..* | Reference(Location) | Where product applies |
| network | 0..* | Reference(Organization) | Pharmacy Network Organizations that are part of the drug plan | |
| generalCost | 0..* | BackboneElement | Overall costs | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| 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 | S | 1..* | BackboneElement | Pharmacy network type specific cost |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| category | S | 1..1 | CodeableConcept | Pharmacy Network Type Binding: Type of pharmacies (extensible) |
| benefit | S | 1..* | BackboneElement | Drug tier benefit |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | S | 1..1 | CodeableConcept | Type of specific benefit Binding: Drug tier of medication in health plan (required) |
| Slices for cost | S | 1..* | BackboneElement | List of the costs Slice: Unordered, Open by pattern:type |
| cost:All Slices | Content/Rules for all slices | |||
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Type of cost Binding: Benefit type of cost (extensible) | |
| applicability | 0..1 | CodeableConcept | in-network | out-of-network | other Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers. | |
| qualifiers | S | 1..1 | CodeableConcept | Additional information about the cost |
| value | S | 0..1 | Quantity | The actual cost value |
| cost:copay | S | 0..1 | BackboneElement | Copay costs |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Type of cost Required Pattern: At least the following | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: copay | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| applicability | 0..1 | CodeableConcept | in-network | out-of-network | other Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers. | |
| qualifiers | 0..* | CodeableConcept | Additional information about the cost Binding: Qualifier of copay amount (required) | |
| value | I | 0..1 | MoneyQuantity | An amount of money. With regard to precision, see [Decimal Precision](datatypes.html#precision) |
| id | 0..1 | string | Unique id for inter-element referencing | |
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| value | SΣ | 1..1 | decimal | Numerical value (with implicit precision) |
| comparator | ?!Σ | 0..1 | code | < | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented. |
| unit | Σ | 0..1 | string | Unit representation |
| system | ΣI | 0..1 | uri | System that defines coded unit form Required Pattern: urn:iso:std:iso:4217 |
| code | Σ | 0..1 | code | Coded form of the unit Required Pattern: USD |
| cost:coinsurance | S | 0..1 | BackboneElement | Coinsurance costs |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Type of cost Required Pattern: At least the following | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: coinsurance | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| applicability | 0..1 | CodeableConcept | in-network | out-of-network | other Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers. | |
| qualifiers | 0..* | CodeableConcept | Additional information about the cost Binding: Qualifier for coinsurance rate (required) | |
| value | 0..1 | Quantity | The actual cost value | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| value | Σ | 0..1 | decimal | Numerical value (with implicit precision) |
| comparator | ?!Σ | 0..1 | code | < | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented. |
| unit | Σ | 0..1 | string | Unit representation |
| system | ΣI | 0..1 | uri | System that defines coded unit form Required Pattern: http://unitsofmeasure.org |
| code | Σ | 0..1 | code | Coded form of the unit Required Pattern: % |
| Documentation for this format | ||||
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| InsurancePlan | I | 0..* | InsurancePlan | Details of a Health Insurance product/plan provided by an organization |
| identifier | ΣI | 1..* | Identifier | Business Identifier for Product |
| status | ?!Σ | 1..1 | code | draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact. |
| type | Σ | 1..1 | CodeableConcept | Product type Binding: Insurance Product Type (extensible) |
| name | ΣI | 0..1 | string | Official name |
| period | 0..1 | Period | When the product is available | |
| coverageArea | Σ | 0..* | Reference(Insurance Plan Location) | Where product applies |
| contact | 0..* | BackboneElement | Contact information for the Insurance Plan including URLs for brochure and formulary information | |
| name | 0..1 | HumanName | A name associated with the contact | |
| text | Σ | 0..1 | string | Text representation of the full name |
| telecom | 0..* | ContactPoint | Contact details (telephone, email, etc.) for a contact | |
| system | ΣI | 0..1 | code | phone | fax | email | pager | url | sms | other Binding: ContactPointSystem (required): Telecommunications form for contact point. |
| value | Σ | 0..1 | string | The actual contact point details |
| Slices for coverage | 1..* | BackboneElement | Coverage details Slice: Unordered, Open by pattern:type | |
| coverage:All Slices | Content/Rules for all slices | |||
| type | 1..1 | CodeableConcept | Type of coverage | |
| coverage:drug-coverage | 1..* | BackboneElement | Coverage details | |
| Slices for extension | 1..* | Extension | Extension Slice: Unordered, Open by value:url | |
| usdf-FormularyReference-extension | 1..* | Reference(Formulary) | Formulary Reference URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyReference-extension | |
 benefit:drug-plan | 1..* | BackboneElement | List of benefits | |
| Slices for plan | 1..* | BackboneElement | Plan details Slice: Unordered, Open by pattern:type | |
| plan:drug-plan | 1..* | BackboneElement | Drug plan | |
| specificCost | 1..* | BackboneElement | Pharmacy network type specific cost | |
| category | 1..1 | CodeableConcept | Pharmacy Network Type Binding: Type of pharmacies (extensible) | |
| benefit | 1..* | BackboneElement | Drug tier benefit | |
| type | 1..1 | CodeableConcept | Type of specific benefit Binding: Drug tier of medication in health plan (required) | |
| Slices for cost | 1..* | BackboneElement | List of the costs Slice: Unordered, Open by pattern:type | |
| cost:All Slices | Content/Rules for all slices | |||
| qualifiers | 1..1 | CodeableConcept | Additional information about the cost | |
| value | 0..1 | Quantity | The actual cost value | |
| cost:copay | 0..1 | BackboneElement | Copay costs | |
| value | I | 0..1 | MoneyQuantity | An amount of money. With regard to precision, see [Decimal Precision](datatypes.html#precision) |
| value | Σ | 1..1 | decimal | Numerical value (with implicit precision) |
| cost:coinsurance | 0..1 | BackboneElement | Coinsurance costs | |
| Documentation for this format | ||||
This structure is derived from InsurancePlan
Summary
Mandatory: 15 elements (2 nested mandatory elements)
Must-Support: 29 elements
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Slices
This structure defines the following Slices:
Differential View
This structure is derived from InsurancePlan
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| InsurancePlan | 0..* | InsurancePlan | Details of a Health Insurance product/plan provided by an organization | |
| meta | ||||
| lastUpdated | 1..1 | instant | When the resource version last changed | |
| identifier | S | 1..* | Identifier | Business Identifier for Product |
| status | S | 1..1 | code | draft | active | retired | unknown |
| type | S | 1..1 | CodeableConcept | Product type Binding: Insurance Product Type (extensible) |
| name | S | 0..1 | string | Official name |
| period | S | 0..1 | Period | When the product is available |
| coverageArea | S | 0..* | Reference(Insurance Plan Location) | Where product applies |
| contact | 0..* | BackboneElement | Contact information for the Insurance Plan including URLs for brochure and formulary information | |
| purpose | 0..1 | CodeableConcept | The type of contact Binding: Type of plan contact (extensible) | |
| name | S | 0..1 | HumanName | A name associated with the contact |
| text | S | 0..1 | string | Text representation of the full name |
| telecom | S | 0..* | ContactPoint | Contact details (telephone, email, etc.) for a contact |
| system | S | 0..1 | code | phone | fax | email | pager | url | sms | other |
| value | S | 0..1 | string | The actual contact point details |
| Slices for coverage | S | 1..* | BackboneElement | Coverage details Slice: Unordered, Open by pattern:type |
| coverage:All Slices | Content/Rules for all slices | |||
| type | S | 1..1 | CodeableConcept | Type of coverage |
| coverage:drug-coverage | S | 1..* | BackboneElement | Coverage details |
| Slices for extension | S | 1..* | Extension | Extension Slice: Unordered, Open by value:url |
| usdf-FormularyReference-extension | S | 1..* | Reference(Formulary) | Formulary Reference URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyReference-extension |
| type | 1..1 | CodeableConcept | Type of coverage Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: DRUGPOL | |
| Slices for benefit | 1..* | BackboneElement | List of benefits Slice: Unordered, Open by pattern:type | |
| benefit:All Slices | Content/Rules for all slices | |||
| type | 1..1 | CodeableConcept | Type of benefit Binding: Type of plan (extensible) | |
| benefit:drug-plan | S | 1..* | BackboneElement | List of benefits |
| type | 1..1 | CodeableConcept | Type of benefit Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PlanTypeCS | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: drug | |
| Slices for plan | S | 1..* | BackboneElement | Plan details Slice: Unordered, Open by pattern:type |
| plan:All Slices | Content/Rules for all slices | |||
| type | 0..1 | CodeableConcept | Type of plan Binding: Type of plan (extensible) | |
| plan:drug-plan | S | 1..* | BackboneElement | Drug plan |
| type | 1..1 | CodeableConcept | Type of plan Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PlanTypeCS | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: drug | |
| network | 0..* | Reference(Organization) | Pharmacy Network Organizations that are part of the drug plan | |
| specificCost | S | 1..* | BackboneElement | Pharmacy network type specific cost |
| category | S | 1..1 | CodeableConcept | Pharmacy Network Type Binding: Type of pharmacies (extensible) |
| benefit | S | 1..* | BackboneElement | Drug tier benefit |
| type | S | 1..1 | CodeableConcept | Type of specific benefit Binding: Drug tier of medication in health plan (required) |
| Slices for cost | S | 1..* | BackboneElement | List of the costs Slice: Unordered, Open by pattern:type |
| cost:All Slices | Content/Rules for all slices | |||
| type | 1..1 | CodeableConcept | Type of cost Binding: Benefit type of cost (extensible) | |
| qualifiers | S | 1..1 | CodeableConcept | Additional information about the cost |
| value | S | 0..1 | Quantity | The actual cost value |
| cost:copay | S | 0..1 | BackboneElement | Copay costs |
| type | 1..1 | CodeableConcept | Type of cost Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: copay | |
| qualifiers | 0..* | CodeableConcept | Additional information about the cost Binding: Qualifier of copay amount (required) | |
| value | 0..1 | MoneyQuantity | An amount of money. With regard to precision, see [Decimal Precision](datatypes.html#precision) | |
| value | S | 1..1 | decimal | Numerical value (with implicit precision) |
| system | 0..1 | uri | System that defines coded unit form Required Pattern: urn:iso:std:iso:4217 | |
| code | 0..1 | code | Coded form of the unit Required Pattern: USD | |
| cost:coinsurance | S | 0..1 | BackboneElement | Coinsurance costs |
| type | 1..1 | CodeableConcept | Type of cost Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: coinsurance | |
| qualifiers | 0..* | CodeableConcept | Additional information about the cost Binding: Qualifier for coinsurance rate (required) | |
| value | ||||
| system | 0..1 | uri | System that defines coded unit form Required Pattern: http://unitsofmeasure.org | |
| code | 0..1 | code | Coded form of the unit Required Pattern: % | |
| Documentation for this format | ||||
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| InsurancePlan | I | 0..* | InsurancePlan | Details of a Health Insurance product/plan provided by an organization |
| id | Σ | 0..1 | string | Logical id of this artifact |
| meta | Σ | 0..1 | Meta | Metadata about the resource |
| id | 0..1 | string | Unique id for inter-element referencing | |
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| versionId | Σ | 0..1 | id | Version specific identifier |
| lastUpdated | Σ | 1..1 | instant | When the resource version last changed |
| source | Σ | 0..1 | uri | Identifies where the resource comes from |
| profile | Σ | 0..* | canonical(StructureDefinition) | Profiles this resource claims to conform to |
| security | Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. |
| tag | Σ | 0..* | Coding | Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". |
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
| language | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages: A human language. | |
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |
| contained | 0..* | Resource | Contained, inline Resources | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
| identifier | SΣI | 1..* | Identifier | Business Identifier for Product |
| status | ?!SΣ | 1..1 | code | draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact. |
| type | SΣ | 1..1 | CodeableConcept | Product type Binding: Insurance Product Type (extensible) |
| name | SΣI | 0..1 | string | Official name |
| alias | 0..* | string | Alternate names | |
| period | S | 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 | SΣ | 0..* | Reference(Insurance Plan Location) | Where product applies |
| contact | 0..* | BackboneElement | Contact information for the Insurance Plan including URLs for brochure and formulary information | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| purpose | 0..1 | CodeableConcept | The type of contact Binding: Type of plan contact (extensible) | |
| name | S | 0..1 | HumanName | A name associated with the contact |
| id | 0..1 | string | Unique id for inter-element referencing | |
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| use | ?!Σ | 0..1 | code | usual | official | temp | nickname | anonymous | old | maiden Binding: NameUse (required): The use of a human name. |
| text | SΣ | 0..1 | string | Text representation of the full name |
| family | Σ | 0..1 | string | Family name (often called 'Surname') |
| given | Σ | 0..* | string | Given names (not always 'first'). Includes middle names This repeating element order: Given Names appear in the correct order for presenting the name |
| prefix | Σ | 0..* | string | Parts that come before the name This repeating element order: Prefixes appear in the correct order for presenting the name |
| suffix | Σ | 0..* | string | Parts that come after the name This repeating element order: Suffixes appear in the correct order for presenting the name |
| period | Σ | 0..1 | Period | Time period when name was/is in use |
| telecom | S | 0..* | ContactPoint | Contact details (telephone, email, etc.) for a contact |
| id | 0..1 | string | Unique id for inter-element referencing | |
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| system | SΣI | 0..1 | code | phone | fax | email | pager | url | sms | other Binding: ContactPointSystem (required): Telecommunications form for contact point. |
| value | SΣ | 0..1 | string | The actual contact point details |
| use | ?!Σ | 0..1 | code | home | work | temp | old | mobile - purpose of this contact point Binding: ContactPointUse (required): Use of contact point. |
| rank | Σ | 0..1 | positiveInt | Specify preferred order of use (1 = highest) |
| period | Σ | 0..1 | Period | Time period when the contact point was/is in use |
| 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 | |
| Slices for coverage | S | 1..* | BackboneElement | Coverage details Slice: Unordered, Open by pattern:type |
| coverage:All Slices | Content/Rules for all slices | |||
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | S | 1..1 | CodeableConcept | Type of coverage |
| network | 0..* | Reference(Organization) | What networks provide coverage | |
| benefit | 1..* | BackboneElement | List of benefits | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Type of benefit | |
| requirement | 0..1 | string | Referral requirements | |
| limit | 0..* | BackboneElement | Benefit limits | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| value | 0..1 | Quantity | Maximum value allowed | |
| code | 0..1 | CodeableConcept | Benefit limit details | |
| coverage:drug-coverage | S | 1..* | BackboneElement | Coverage details |
| id | 0..1 | string | Unique id for inter-element referencing | |
| Slices for extension | S | 1..* | Extension | Extension Slice: Unordered, Open by value:url |
| usdf-FormularyReference-extension | S | 1..* | Reference(Formulary) | Formulary Reference URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyReference-extension |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Type of coverage Required Pattern: At least the following | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: DRUGPOL | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| network | 0..* | Reference(Organization) | What networks provide coverage | |
| Slices for benefit | 1..* | BackboneElement | List of benefits Slice: Unordered, Open by pattern:type | |
| benefit:All Slices | Content/Rules for all slices | |||
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Type of benefit Binding: Type of plan (extensible) | |
| requirement | 0..1 | string | Referral requirements | |
| limit | 0..* | BackboneElement | Benefit limits | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| value | 0..1 | Quantity | Maximum value allowed | |
| code | 0..1 | CodeableConcept | Benefit limit details | |
| benefit:drug-plan | S | 1..* | BackboneElement | List of benefits |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Type of benefit Required Pattern: At least the following | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PlanTypeCS | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: drug | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| requirement | 0..1 | string | Referral requirements | |
| limit | 0..* | BackboneElement | Benefit limits | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| value | 0..1 | Quantity | Maximum value allowed | |
| code | 0..1 | CodeableConcept | Benefit limit details | |
| Slices for plan | S | 1..* | BackboneElement | Plan details Slice: Unordered, Open by pattern:type |
| plan:All Slices | Content/Rules for all slices | |||
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| identifier | Σ | 0..* | Identifier | Business Identifier for Product |
| type | 0..1 | CodeableConcept | Type of plan Binding: Type of plan (extensible) | |
| coverageArea | Σ | 0..* | Reference(Location) | Where product applies |
| network | 0..* | Reference(Organization) | What networks provide coverage | |
| generalCost | 0..* | BackboneElement | Overall costs | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| 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 | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| category | 1..1 | CodeableConcept | General category of benefit | |
| benefit | 0..* | BackboneElement | Benefits list | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Type of specific benefit | |
| cost | 0..* | BackboneElement | List of the costs | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Type of cost | |
| applicability | 0..1 | CodeableConcept | in-network | out-of-network | other Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers. | |
| qualifiers | 0..* | CodeableConcept | Additional information about the cost | |
| value | 0..1 | Quantity | The actual cost value | |
| plan:drug-plan | S | 1..* | BackboneElement | Drug plan |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| identifier | Σ | 0..* | Identifier | Business Identifier for Product |
| type | 1..1 | CodeableConcept | Type of plan Required Pattern: At least the following | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PlanTypeCS | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: drug | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| coverageArea | Σ | 0..* | Reference(Location) | Where product applies |
| network | 0..* | Reference(Organization) | Pharmacy Network Organizations that are part of the drug plan | |
| generalCost | 0..* | BackboneElement | Overall costs | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| 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 | S | 1..* | BackboneElement | Pharmacy network type specific cost |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| category | S | 1..1 | CodeableConcept | Pharmacy Network Type Binding: Type of pharmacies (extensible) |
| benefit | S | 1..* | BackboneElement | Drug tier benefit |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | S | 1..1 | CodeableConcept | Type of specific benefit Binding: Drug tier of medication in health plan (required) |
| Slices for cost | S | 1..* | BackboneElement | List of the costs Slice: Unordered, Open by pattern:type |
| cost:All Slices | Content/Rules for all slices | |||
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Type of cost Binding: Benefit type of cost (extensible) | |
| applicability | 0..1 | CodeableConcept | in-network | out-of-network | other Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers. | |
| qualifiers | S | 1..1 | CodeableConcept | Additional information about the cost |
| value | S | 0..1 | Quantity | The actual cost value |
| cost:copay | S | 0..1 | BackboneElement | Copay costs |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Type of cost Required Pattern: At least the following | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: copay | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| applicability | 0..1 | CodeableConcept | in-network | out-of-network | other Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers. | |
| qualifiers | 0..* | CodeableConcept | Additional information about the cost Binding: Qualifier of copay amount (required) | |
| value | I | 0..1 | MoneyQuantity | An amount of money. With regard to precision, see [Decimal Precision](datatypes.html#precision) |
| id | 0..1 | string | Unique id for inter-element referencing | |
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| value | SΣ | 1..1 | decimal | Numerical value (with implicit precision) |
| comparator | ?!Σ | 0..1 | code | < | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented. |
| unit | Σ | 0..1 | string | Unit representation |
| system | ΣI | 0..1 | uri | System that defines coded unit form Required Pattern: urn:iso:std:iso:4217 |
| code | Σ | 0..1 | code | Coded form of the unit Required Pattern: USD |
| cost:coinsurance | S | 0..1 | BackboneElement | Coinsurance costs |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Type of cost Required Pattern: At least the following | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: coinsurance | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| applicability | 0..1 | CodeableConcept | in-network | out-of-network | other Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers. | |
| qualifiers | 0..* | CodeableConcept | Additional information about the cost Binding: Qualifier for coinsurance rate (required) | |
| value | 0..1 | Quantity | The actual cost value | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| value | Σ | 0..1 | decimal | Numerical value (with implicit precision) |
| comparator | ?!Σ | 0..1 | code | < | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented. |
| unit | Σ | 0..1 | string | Unit representation |
| system | ΣI | 0..1 | uri | System that defines coded unit form Required Pattern: http://unitsofmeasure.org |
| code | Σ | 0..1 | code | Coded form of the unit Required Pattern: % |
| Documentation for this format | ||||
Other representations of profile: CSV, Excel, Schematron
| Path | Conformance | ValueSet |
| InsurancePlan.meta.security | extensible | All Security Labels |
| InsurancePlan.meta.tag | example | CommonTags |
| InsurancePlan.language | preferred | CommonLanguages Max Binding: AllLanguages |
| InsurancePlan.status | required | PublicationStatus |
| InsurancePlan.type | extensible | InsuranceProductTypeVS |
| InsurancePlan.contact.purpose | extensible | PlanContactTypeVS |
| InsurancePlan.contact.name.use | required | NameUse |
| InsurancePlan.contact.telecom.system | required | ContactPointSystem |
| InsurancePlan.contact.telecom.use | required | ContactPointUse |
| InsurancePlan.coverage:drug-coverage.benefit.type | extensible | PlanTypeVS |
| InsurancePlan.plan.type | extensible | PlanTypeVS |
| InsurancePlan.plan.specificCost.benefit.cost.applicability | required | BenefitCostApplicability |
| InsurancePlan.plan:drug-plan.specificCost.category | extensible | PharmacyTypeVS |
| InsurancePlan.plan:drug-plan.specificCost.benefit.type | required | DrugTierVS |
| InsurancePlan.plan:drug-plan.specificCost.benefit.cost.type | extensible | BenefitCostTypeVS |
| InsurancePlan.plan:drug-plan.specificCost.benefit.cost.applicability | required | BenefitCostApplicability |
| InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.applicability | required | BenefitCostApplicability |
| InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.qualifiers | required | CopayOptionVS |
| InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.value.comparator | required | QuantityComparator |
| InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.applicability | required | BenefitCostApplicability |
| InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.qualifiers | required | CoinsuranceOptionVS |
| InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.value.comparator | required | QuantityComparator |
IG © 2021+ HL7 Pharmacy Working Group. Package hl7.fhir.us.davinci-drug-formulary#1.2.0 based on FHIR 4.0.1. Generated 2021-12-03
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