DaVinci Payer Data Exchange (PDex) US Drug Formulary
2.1.0 - STU2.1 United States of America flag

This page is part of the US Drug Formulary (v2.1.0: STU2) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Resource Profile: PayerInsurancePlan - Detailed Descriptions

Page standards status: Trial-use

Definitions for the usdf-PayerInsurancePlan resource profile.

Guidance on how to interpret the contents of this table can be found here

0. InsurancePlan
Definition

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

ShortDetails of a Health Insurance product/plan provided by an organization
Control0..*
Is Modifierfalse
Summaryfalse
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
ipn-1: The organization SHALL at least have a name or an idendtifier, and possibly more than one ((identifier.count() + name.count()) > 0)
ipn-1: The organization SHALL at least have a name or an idendtifier, and possibly more than one ((identifier.count() + name.count()) > 0)
2. InsurancePlan.meta
Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

ShortMetadata about the resource
Control0..1
TypeMeta
Is Modifierfalse
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. InsurancePlan.meta.lastUpdated
Definition

When the resource last changed - e.g. when the version changed.

ShortWhen the resource version last changed
Comments

This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.

Control10..1
Typeinstant
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
6. InsurancePlan.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

ShortA set of rules under which this content was created
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Control0..1
Typeuri
Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
8. InsurancePlan.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Summaryfalse
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
10. InsurancePlan.identifier
Definition

Business identifiers assigned to this health insurance product which remain constant as the resource is updated and propagates from server to server.

ShortThe business identifier for the plan. The same InsurancePlan may be present in multiple directories and if they have the same identifier they are assumed to be the same plan.Business Identifier for Product
NoteThis is a business identifier, not a resource identifier (see discussion)
Control10..*
This element is affected by the following invariants: ipn-1
TypeIdentifier
Is Modifierfalse
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
12. InsurancePlan.status
Definition

The current state of the health insurance product.

Shortdraft | active | retired | unknown
Control10..1
BindingThe codes SHALL be taken from PublicationStatushttp://hl7.org/fhir/ValueSet/publication-status|4.0.1
(required to http://hl7.org/fhir/ValueSet/publication-status|4.0.1)

The lifecycle status of an artifact.

Typecode
Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains codes which means that the resource should not be treated as valid
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
Requirements

Need a flag to indicate a record is no longer to be used and should generally be hidden for the user in the UI.

Meaning if MissingDefault interpretation is active.
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
14. InsurancePlan.type
Definition

The kind of health insurance product.

ShortProduct typeKind of product
Control10..1*
BindingUnless not suitable, these codes SHALL be taken from For example codes, see Insurance Product Type VShttp://hl7.org/fhir/ValueSet/insuranceplan-type
(extensible to http://hl7.org/fhir/us/davinci-pdex-plan-net/ValueSet/InsuranceProductTypeVS)
TypeCodeableConcept
Is Modifierfalse
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
16. InsurancePlan.name
Definition

Official name of the health insurance product as designated by the owner.

ShortOfficial name
Comments

If the name of the product/plan changes, consider putting the old name in the alias column so that it can still be located through searches.

Control0..1
This element is affected by the following invariants: ipn-1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
18. InsurancePlan.period
Definition

The period of time that the health insurance product is available.

ShortWhen the product is available
Control0..1
TypePeriod
Is Modifierfalse
Must Supporttrue
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
20. InsurancePlan.coverageArea
Definition

The geographic region in which a health insurance product's benefits apply.

ShortWhere product applies
Control0..*
TypeReference(Insurance Plan Location, Location)
Is Modifierfalse
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
22. InsurancePlan.contact
Definition

The contact for the health insurance product for a certain purpose.

ShortContact information for the Insurance Plan including URLs for brochure and formulary informationContact for the product
Comments

Where multiple contacts for the same purpose are provided there is a standard extension that can be used to determine which one is the preferred contact to use.

Control0..*
TypeBackboneElement
Is Modifierfalse
Summaryfalse
Requirements

Need to keep track of assigned contact points within bigger organization.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
24. InsurancePlan.contact.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
26. InsurancePlan.contact.purpose
Definition

Indicates a purpose for which the contact can be reached.

ShortThe type of contact
Control0..1
BindingUnless not suitable, these codes SHALL be taken from Type of plan contacthttp://hl7.org/fhir/ValueSet/contactentity-type
(extensible to http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/PlanContactTypeVS)
TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Need to distinguish between multiple contact persons.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
28. InsurancePlan.contact.name
Definition

A name associated with the contact.

ShortA name associated with the contact
Control0..1
TypeHumanName
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

Need to be able to track the person by name.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
30. InsurancePlan.contact.name.use
Definition

Identifies the purpose for this name.

Shortusual | official | temp | nickname | anonymous | old | maiden
Comments

Applications can assume that a name is current unless it explicitly says that it is temporary or old.

Control0..1
BindingThe codes SHALL be taken from NameUsehttp://hl7.org/fhir/ValueSet/name-use|4.0.1
(required to http://hl7.org/fhir/ValueSet/name-use|4.0.1)

The use of a human name.

Typecode
Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary or old name etc.for a current/permanent one
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Allows the appropriate name for a particular context of use to be selected from among a set of names.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
32. InsurancePlan.contact.name.text
Definition

Specifies the entire name as it should be displayed e.g. on an application UI. This may be provided instead of or as well as the specific parts.

ShortText representation of the full name
Comments

Can provide both a text representation and parts. Applications updating a name SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.

Control0..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
Requirements

A renderable, unencoded form.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
34. InsurancePlan.contact.telecom
Definition

A contact detail (e.g. a telephone number or an email address) by which the party may be contacted.

ShortContact details (telephone, email, etc.) for a contact
Control0..*
TypeContactPoint
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

People have (primary) ways to contact them in some way such as phone, email.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
36. InsurancePlan.contact.telecom.system
Definition

Telecommunications form for contact point - what communications system is required to make use of the contact.

Shortphone | fax | email | pager | url | sms | other
Control0..1
This element is affected by the following invariants: cpt-2
BindingThe codes SHALL be taken from ContactPointSystemhttp://hl7.org/fhir/ValueSet/contact-point-system|4.0.1
(required to http://hl7.org/fhir/ValueSet/contact-point-system|4.0.1)

Telecommunications form for contact point.

Typecode
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
38. InsurancePlan.contact.telecom.value
Definition

The actual contact point details, in a form that is meaningful to the designated communication system (i.e. phone number or email address).

ShortThe actual contact point details
Comments

Additional text data such as phone extension numbers, or notes about use of the contact are sometimes included in the value.

Control0..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
Requirements

Need to support legacy numbers that are not in a tightly controlled format.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
40. InsurancePlan.contact.telecom.use
Definition

Identifies the purpose for the contact point.

Shorthome | work | temp | old | mobile - purpose of this contact point
Comments

Applications can assume that a contact is current unless it explicitly says that it is temporary or old.

Control0..1
BindingThe codes SHALL be taken from ContactPointUsehttp://hl7.org/fhir/ValueSet/contact-point-use|4.0.1
(required to http://hl7.org/fhir/ValueSet/contact-point-use|4.0.1)

Use of contact point.

Typecode
Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary or old contact etc.for a current/permanent one
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Need to track the way a person uses this contact, so a user can choose which is appropriate for their purpose.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
42. InsurancePlan.coverage
Definition

Details about the coverage offered by the insurance product.

ShortCoverage details
Control10..*
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
SlicingThis element introduces a set of slices on InsurancePlan.coverage. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • pattern @ type
  • 44. InsurancePlan.coverage.modifierExtension
    Definition

    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

    ShortExtensions that cannot be ignored even if unrecognized
    Comments

    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

    Control0..*
    TypeExtension
    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
    Summarytrue
    Requirements

    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

    Alternate Namesextensions, user content, modifiers
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    46. InsurancePlan.coverage.type
    Definition

    Type of coverage (Medical; Dental; Mental Health; Substance Abuse; Vision; Drug; Short Term; Long Term Care; Hospice; Home Health).

    ShortType of coverage
    Control1..1
    TypeCodeableConcept
    Is Modifierfalse
    Must Supporttrue
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    48. InsurancePlan.coverage.benefit
    Definition

    Specific benefits under this type of coverage.

    ShortList of benefits
    Control1..*
    TypeBackboneElement
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    50. InsurancePlan.coverage.benefit.modifierExtension
    Definition

    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

    ShortExtensions that cannot be ignored even if unrecognized
    Comments

    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

    Control0..*
    TypeExtension
    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
    Summarytrue
    Requirements

    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

    Alternate Namesextensions, user content, modifiers
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    52. InsurancePlan.coverage.benefit.type
    Definition

    Type of benefit (primary care; speciality care; inpatient; outpatient).

    ShortType of benefit
    Control1..1
    TypeCodeableConcept
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    54. InsurancePlan.coverage:drug-coverage
    Slice Namedrug-coverage
    Definition

    Details about the coverage offered by the insurance product.

    ShortCoverage details
    Control10..*
    TypeBackboneElement
    Is Modifierfalse
    Must Supporttrue
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    56. InsurancePlan.coverage:drug-coverage.extension
    Definition

    An Extension


    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

    ShortExtensionAdditional content defined by implementations
    Comments

    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

    Control10..*
    TypeExtension
    Is Modifierfalse
    Must Supporttrue
    Summaryfalse
    Alternate Namesextensions, user content
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    SlicingThis element introduces a set of slices on InsurancePlan.coverage.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 58. InsurancePlan.coverage:drug-coverage.extension:usdf-FormularyReference-extension
      Slice Nameusdf-FormularyReference-extension
      Definition

      Reference to the formulary this item belongs to.

      ShortFormulary Reference
      Control1..*
      This element is affected by the following invariants: ele-1
      TypeExtension(Formulary Reference) (Extension Type: Reference(Formulary))
      Is Modifierfalse
      Must Supporttrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      60. InsurancePlan.coverage:drug-coverage.modifierExtension
      Definition

      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
      Summarytrue
      Requirements

      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

      Alternate Namesextensions, user content, modifiers
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      62. InsurancePlan.coverage:drug-coverage.type
      Definition

      Type of coverage (Medical; Dental; Mental Health; Substance Abuse; Vision; Drug; Short Term; Long Term Care; Hospice; Home Health).

      ShortType of coverage
      Control1..1
      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Pattern Value{
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
          "code" : "DRUGPOL"
        }]
      }
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      64. InsurancePlan.coverage:drug-coverage.benefit
      Definition

      Specific benefits under this type of coverage.

      ShortList of benefits
      Control1..*
      TypeBackboneElement
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      SlicingThis element introduces a set of slices on InsurancePlan.coverage.benefit. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • pattern @ type
      • 66. InsurancePlan.coverage:drug-coverage.benefit.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        ShortExtensions that cannot be ignored even if unrecognized
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
        Summarytrue
        Requirements

        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

        Alternate Namesextensions, user content, modifiers
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        68. InsurancePlan.coverage:drug-coverage.benefit.type
        Definition

        Type of benefit (primary care; speciality care; inpatient; outpatient).

        ShortType of benefit
        Control1..1
        BindingUnless not suitable, these codes SHALL be taken from For codes, see Insurance plan type
        (extensible to http://terminology.hl7.org/ValueSet/insuranceplan-type)
        TypeCodeableConcept
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        70. InsurancePlan.coverage:drug-coverage.benefit:drug-plan
        Slice Namedrug-plan
        Definition

        Specific benefits under this type of coverage.

        ShortList of benefits
        Control1..*
        TypeBackboneElement
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        72. InsurancePlan.coverage:drug-coverage.benefit:drug-plan.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        ShortExtensions that cannot be ignored even if unrecognized
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
        Summarytrue
        Requirements

        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

        Alternate Namesextensions, user content, modifiers
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        74. InsurancePlan.coverage:drug-coverage.benefit:drug-plan.type
        Definition

        Type of benefit (primary care; speciality care; inpatient; outpatient).

        ShortType of benefit
        Control1..1
        BindingUnless not suitable, these codes SHALL be taken from For codes, see Insurance plan type
        (extensible to http://terminology.hl7.org/ValueSet/insuranceplan-type)
        TypeCodeableConcept
        Is Modifierfalse
        Summaryfalse
        Pattern Value{
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/insurance-plan-type",
            "code" : "drug",
            "display" : "Drug"
          }]
        }
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        76. InsurancePlan.plan
        Definition

        Details about an insurance plan.

        ShortPlan details
        Control10..*
        TypeBackboneElement
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        SlicingThis element introduces a set of slices on InsurancePlan.plan. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • pattern @ type
        • 78. InsurancePlan.plan.modifierExtension
          Definition

          May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

          ShortExtensions that cannot be ignored even if unrecognized
          Comments

          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

          Control0..*
          TypeExtension
          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
          Summarytrue
          Requirements

          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

          Alternate Namesextensions, user content, modifiers
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          80. InsurancePlan.plan.type
          Definition

          Type of plan. For example, "Platinum" or "High Deductable".

          ShortType of plan
          Control0..1
          BindingUnless not suitable, these codes SHALL be taken from For codes, see Insurance plan type
          (extensible to http://terminology.hl7.org/ValueSet/insuranceplan-type)
          TypeCodeableConcept
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          82. InsurancePlan.plan:drug-plan
          Slice Namedrug-plan
          Definition

          Details about an insurance plan.

          ShortDrug planPlan details
          Control10..*
          TypeBackboneElement
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          84. InsurancePlan.plan:drug-plan.modifierExtension
          Definition

          May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

          ShortExtensions that cannot be ignored even if unrecognized
          Comments

          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

          Control0..*
          TypeExtension
          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
          Summarytrue
          Requirements

          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

          Alternate Namesextensions, user content, modifiers
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          86. InsurancePlan.plan:drug-plan.identifier
          Definition

          Business identifiers assigned to this health insurance plan which remain constant as the resource is updated and propagates from server to server.

          ShortBusiness Identifier for Product
          NoteThis is a business identifier, not a resource identifier (see discussion)
          Control0..*
          TypeIdentifier
          Is Modifierfalse
          Must Supporttrue
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          88. InsurancePlan.plan:drug-plan.type
          Definition

          Type of plan. For example, "Platinum" or "High Deductable".

          ShortType of plan
          Control10..1
          BindingUnless not suitable, these codes SHALL be taken from For codes, see Insurance plan type
          (extensible to http://terminology.hl7.org/ValueSet/insuranceplan-type)
          TypeCodeableConcept
          Is Modifierfalse
          Summaryfalse
          Pattern Value{
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/insurance-plan-type",
              "code" : "drug",
              "display" : "Drug"
            }]
          }
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          90. InsurancePlan.plan:drug-plan.network
          Definition

          Reference to the network that providing the type of coverage.

          ShortPharmacy benefit types that are part of the drug planWhat networks provide coverage
          Comments

          Networks are represented as a hierarchy of organization resources.

          Control0..*
          TypeReference(Organization)
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          92. InsurancePlan.plan:drug-plan.specificCost
          Definition

          Costs associated with the coverage provided by the product.

          ShortPharmacy benefit type specific costSpecific costs
          Control10..*
          TypeBackboneElement
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          94. InsurancePlan.plan:drug-plan.specificCost.modifierExtension
          Definition

          May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

          ShortExtensions that cannot be ignored even if unrecognized
          Comments

          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

          Control0..*
          TypeExtension
          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
          Summarytrue
          Requirements

          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

          Alternate Namesextensions, user content, modifiers
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          96. InsurancePlan.plan:drug-plan.specificCost.category
          Definition

          General category of benefit (Medical; Dental; Vision; Drug; Mental Health; Substance Abuse; Hospice, Home Health).

          ShortPharmacy Benefit TypeGeneral category of benefit
          Control1..1
          BindingUnless not suitable, these codes SHALL be taken from For codes, see Pharmacy benefit types
          (extensible to http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/PharmacyBenefitTypeVS)
          TypeCodeableConcept
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          98. InsurancePlan.plan:drug-plan.specificCost.benefit
          Definition

          List of the specific benefits under this category of benefit.

          ShortDrug tier benefitBenefits list
          Control10..*
          TypeBackboneElement
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          100. InsurancePlan.plan:drug-plan.specificCost.benefit.modifierExtension
          Definition

          May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

          ShortExtensions that cannot be ignored even if unrecognized
          Comments

          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

          Control0..*
          TypeExtension
          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
          Summarytrue
          Requirements

          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

          Alternate Namesextensions, user content, modifiers
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          102. InsurancePlan.plan:drug-plan.specificCost.benefit.type
          Definition

          Type of specific benefit (preventative; primary care office visit; speciality office visit; hospitalization; emergency room; urgent care).

          ShortType of specific benefit
          Control1..1
          BindingUnless not suitable, these codes SHALL be taken from For codes, see Drug tier of medication in health plan
          (extensible to http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/DrugTierVS)
          TypeCodeableConcept
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          104. InsurancePlan.plan:drug-plan.specificCost.benefit.cost
          Definition

          List of the costs associated with a specific benefit.

          ShortList of the costs
          Control10..*
          TypeBackboneElement
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          SlicingThis element introduces a set of slices on InsurancePlan.plan.specificCost.benefit.cost. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • pattern @ type
          • 106. InsurancePlan.plan:drug-plan.specificCost.benefit.cost.modifierExtension
            Definition

            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

            ShortExtensions that cannot be ignored even if unrecognized
            Comments

            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

            Control0..*
            TypeExtension
            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
            Summarytrue
            Requirements

            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

            Alternate Namesextensions, user content, modifiers
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            108. InsurancePlan.plan:drug-plan.specificCost.benefit.cost.type
            Definition

            Type of cost (copay; individual cap; family cap; coinsurance; deductible).

            ShortType of cost
            Control1..1
            BindingUnless not suitable, these codes SHALL be taken from For codes, see Benefit type of cost
            (extensible to http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/BenefitCostTypeVS)
            TypeCodeableConcept
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            110. InsurancePlan.plan:drug-plan.specificCost.benefit.cost.qualifiers
            Definition

            Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA).

            ShortAdditional information about the cost
            Control10..1*
            TypeCodeableConcept
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            112. InsurancePlan.plan:drug-plan.specificCost.benefit.cost.value
            Definition

            The actual cost value. (some of the costs may be represented as percentages rather than currency, e.g. 10% coinsurance).

            ShortThe actual cost value
            Control0..1
            TypeQuantity
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            114. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay
            Slice Namecopay
            Definition

            List of the costs associated with a specific benefit.

            ShortCopay costsList of the costs
            Control0..1*
            TypeBackboneElement
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            116. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.modifierExtension
            Definition

            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

            ShortExtensions that cannot be ignored even if unrecognized
            Comments

            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

            Control0..*
            TypeExtension
            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
            Summarytrue
            Requirements

            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

            Alternate Namesextensions, user content, modifiers
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            118. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.type
            Definition

            Type of cost (copay; individual cap; family cap; coinsurance; deductible).

            ShortType of cost
            Control1..1
            BindingUnless not suitable, these codes SHALL be taken from For codes, see Benefit type of cost
            (extensible to http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/BenefitCostTypeVS)
            TypeCodeableConcept
            Is Modifierfalse
            Summaryfalse
            Pattern Value{
              "coding" : [{
                "system" : "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE",
                "code" : "copay"
              }]
            }
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            120. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.qualifiers
            Definition

            Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA).

            ShortAdditional information about the cost
            Control10..1*
            BindingThe codes SHALL be taken from For codes, see Qualifier of copay amount
            (required to http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/CopayOptionVS)
            TypeCodeableConcept
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            122. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.value
            Definition

            The actual cost value. (some of the costs may be represented as percentages rather than currency, e.g. 10% coinsurance).

            ShortThe actual cost value
            Control10..1
            TypeQuantity(MoneyQuantity)
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            124. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.value.value
            Definition

            The value of the measured amount. The value includes an implicit precision in the presentation of the value.

            ShortNumerical value (with implicit precision)
            Comments

            The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

            Control10..1
            Typedecimal
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Requirements

            Precision is handled implicitly in almost all cases of measurement.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            126. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.value.comparator
            Definition

            How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

            Short< | <= | >= | > - how to understand the value
            Control0..1
            BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
            (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

            How the Quantity should be understood and represented.

            Typecode
            Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

            Meaning if MissingIf there is no comparator, then there is no modification of the value
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            128. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.value.system
            Definition

            The identification of the system that provides the coded form of the unit.

            ShortSystem that defines coded unit form
            Control0..1
            This element is affected by the following invariants: qty-3
            Typeuri
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            Need to know the system that defines the coded form of the unit.

            Pattern Valueurn:iso:std:iso:4217
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            130. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.value.code
            Definition

            A computer processable form of the unit in some unit representation system.

            ShortCoded form of the unit
            Comments

            The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

            Control0..1
            Typecode
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

            Pattern ValueUSD
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            132. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance
            Slice Namecoinsurance
            Definition

            List of the costs associated with a specific benefit.

            ShortCoinsurance costsList of the costs
            Control0..1*
            TypeBackboneElement
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            134. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.modifierExtension
            Definition

            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

            ShortExtensions that cannot be ignored even if unrecognized
            Comments

            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

            Control0..*
            TypeExtension
            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
            Summarytrue
            Requirements

            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

            Alternate Namesextensions, user content, modifiers
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            136. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.type
            Definition

            Type of cost (copay; individual cap; family cap; coinsurance; deductible).

            ShortType of cost
            Control1..1
            BindingUnless not suitable, these codes SHALL be taken from For codes, see Benefit type of cost
            (extensible to http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/BenefitCostTypeVS)
            TypeCodeableConcept
            Is Modifierfalse
            Summaryfalse
            Pattern Value{
              "coding" : [{
                "system" : "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE",
                "code" : "coinsurance"
              }]
            }
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            138. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.qualifiers
            Definition

            Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA).

            ShortAdditional information about the cost
            Control10..1*
            BindingThe codes SHALL be taken from For codes, see Qualifier for coinsurance rate
            (required to http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/CoinsuranceOptionVS)
            TypeCodeableConcept
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            140. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.value
            Definition

            The actual cost value. (some of the costs may be represented as percentages rather than currency, e.g. 10% coinsurance).

            ShortThe actual cost value
            Control10..1
            TypeQuantity
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            142. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.value.value
            Definition

            The value of the measured amount. The value includes an implicit precision in the presentation of the value.

            ShortNumerical value (with implicit precision)
            Comments

            The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

            Control10..1
            Typedecimal
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Requirements

            Precision is handled implicitly in almost all cases of measurement.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            144. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.value.comparator
            Definition

            How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

            Short< | <= | >= | > - how to understand the value
            Control0..1
            BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
            (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

            How the Quantity should be understood and represented.

            Typecode
            Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

            Meaning if MissingIf there is no comparator, then there is no modification of the value
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            146. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.value.system
            Definition

            The identification of the system that provides the coded form of the unit.

            ShortSystem that defines coded unit form
            Control0..1
            This element is affected by the following invariants: qty-3
            Typeuri
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            Need to know the system that defines the coded form of the unit.

            Pattern Valuehttp://unitsofmeasure.org
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            148. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.value.code
            Definition

            A computer processable form of the unit in some unit representation system.

            ShortCoded form of the unit
            Comments

            The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

            Control0..1
            Typecode
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

            Pattern Value%
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

            Guidance on how to interpret the contents of this table can be found here

            0. InsurancePlan
            2. InsurancePlan.meta
            4. InsurancePlan.meta.lastUpdated
            Control1..?
            Must Supporttrue
            6. InsurancePlan.identifier
            ShortThe business identifier for the plan. The same InsurancePlan may be present in multiple directories and if they have the same identifier they are assumed to be the same plan.
            NoteThis is a business identifier, not a resource identifier (see discussion)
            Control1..?
            Must Supporttrue
            8. InsurancePlan.status
            Control1..?
            Must Supporttrue
            10. InsurancePlan.type
            ShortProduct type
            Control1..1
            BindingUnless not suitable, these codes SHALL be taken from Insurance Product Type VS
            (extensible to http://hl7.org/fhir/us/davinci-pdex-plan-net/ValueSet/InsuranceProductTypeVS)
            Must Supporttrue
            12. InsurancePlan.name
            Must Supporttrue
            14. InsurancePlan.period
            Must Supporttrue
            16. InsurancePlan.coverageArea
            TypeReference(Insurance Plan Location)
            Must Supporttrue
            18. InsurancePlan.contact
            ShortContact information for the Insurance Plan including URLs for brochure and formulary information
            20. InsurancePlan.contact.purpose
            BindingUnless not suitable, these codes SHALL be taken from Type of plan contact
            (extensible to http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/PlanContactTypeVS)
            22. InsurancePlan.contact.name
            Must Supporttrue
            24. InsurancePlan.contact.name.text
            Must Supporttrue
            26. InsurancePlan.contact.telecom
            Must Supporttrue
            28. InsurancePlan.contact.telecom.system
            Must Supporttrue
            30. InsurancePlan.contact.telecom.value
            Must Supporttrue
            32. InsurancePlan.coverage
            Control1..?
            Must Supporttrue
            SlicingThis element introduces a set of slices on InsurancePlan.coverage. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • pattern @ type
            • 34. InsurancePlan.coverage.type
              Must Supporttrue
              36. InsurancePlan.coverage:drug-coverage
              Slice Namedrug-coverage
              Control1..*
              Must Supporttrue
              38. InsurancePlan.coverage:drug-coverage.extension
              Control1..?
              Must Supporttrue
              SlicingThis element introduces a set of slices on InsurancePlan.coverage.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 40. InsurancePlan.coverage:drug-coverage.extension:usdf-FormularyReference-extension
                Slice Nameusdf-FormularyReference-extension
                Control1..*
                TypeExtension(Formulary Reference) (Extension Type: Reference(Formulary))
                Must Supporttrue
                42. InsurancePlan.coverage:drug-coverage.type
                Pattern Value{
                  "coding" : [{
                    "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
                    "code" : "DRUGPOL"
                  }]
                }
                44. InsurancePlan.coverage:drug-coverage.benefit
                SlicingThis element introduces a set of slices on InsurancePlan.coverage.benefit. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • pattern @ type
                • 46. InsurancePlan.coverage:drug-coverage.benefit.type
                  BindingUnless not suitable, these codes SHALL be taken from Insurance plan type
                  (extensible to http://terminology.hl7.org/ValueSet/insuranceplan-type)
                  48. InsurancePlan.coverage:drug-coverage.benefit:drug-plan
                  Slice Namedrug-plan
                  Control1..*
                  Must Supporttrue
                  50. InsurancePlan.coverage:drug-coverage.benefit:drug-plan.type
                  Pattern Value{
                    "coding" : [{
                      "system" : "http://terminology.hl7.org/CodeSystem/insurance-plan-type",
                      "code" : "drug",
                      "display" : "Drug"
                    }]
                  }
                  52. InsurancePlan.plan
                  Control1..?
                  Must Supporttrue
                  SlicingThis element introduces a set of slices on InsurancePlan.plan. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • pattern @ type
                  • 54. InsurancePlan.plan.type
                    BindingUnless not suitable, these codes SHALL be taken from Insurance plan type
                    (extensible to http://terminology.hl7.org/ValueSet/insuranceplan-type)
                    56. InsurancePlan.plan:drug-plan
                    Slice Namedrug-plan
                    ShortDrug plan
                    Control1..*
                    Must Supporttrue
                    58. InsurancePlan.plan:drug-plan.identifier
                    NoteThis is a business identifier, not a resource identifier (see discussion)
                    Must Supporttrue
                    60. InsurancePlan.plan:drug-plan.type
                    Control1..?
                    Pattern Value{
                      "coding" : [{
                        "system" : "http://terminology.hl7.org/CodeSystem/insurance-plan-type",
                        "code" : "drug",
                        "display" : "Drug"
                      }]
                    }
                    62. InsurancePlan.plan:drug-plan.network
                    ShortPharmacy benefit types that are part of the drug plan
                    64. InsurancePlan.plan:drug-plan.specificCost
                    ShortPharmacy benefit type specific cost
                    Control1..?
                    Must Supporttrue
                    66. InsurancePlan.plan:drug-plan.specificCost.category
                    ShortPharmacy Benefit Type
                    BindingUnless not suitable, these codes SHALL be taken from Pharmacy benefit types
                    (extensible to http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/PharmacyBenefitTypeVS)
                    Must Supporttrue
                    68. InsurancePlan.plan:drug-plan.specificCost.benefit
                    ShortDrug tier benefit
                    Control1..?
                    Must Supporttrue
                    70. InsurancePlan.plan:drug-plan.specificCost.benefit.type
                    BindingUnless not suitable, these codes SHALL be taken from Drug tier of medication in health plan
                    (extensible to http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/DrugTierVS)
                    Must Supporttrue
                    72. InsurancePlan.plan:drug-plan.specificCost.benefit.cost
                    Control1..?
                    Must Supporttrue
                    SlicingThis element introduces a set of slices on InsurancePlan.plan.specificCost.benefit.cost. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • pattern @ type
                    • 74. InsurancePlan.plan:drug-plan.specificCost.benefit.cost.type
                      BindingUnless not suitable, these codes SHALL be taken from Benefit type of cost
                      (extensible to http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/BenefitCostTypeVS)
                      76. InsurancePlan.plan:drug-plan.specificCost.benefit.cost.qualifiers
                      Control1..1
                      Must Supporttrue
                      78. InsurancePlan.plan:drug-plan.specificCost.benefit.cost.value
                      Must Supporttrue
                      80. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay
                      Slice Namecopay
                      ShortCopay costs
                      Control0..1
                      Must Supporttrue
                      82. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.type
                      Pattern Value{
                        "coding" : [{
                          "system" : "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE",
                          "code" : "copay"
                        }]
                      }
                      84. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.qualifiers
                      BindingThe codes SHALL be taken from Qualifier of copay amount
                      (required to http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/CopayOptionVS)
                      86. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.value
                      Control1..?
                      TypeQuantity(MoneyQuantity)
                      88. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.value.value
                      Control1..?
                      Must Supporttrue
                      90. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.value.system
                      Pattern Valueurn:iso:std:iso:4217
                      92. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.value.code
                      Pattern ValueUSD
                      94. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance
                      Slice Namecoinsurance
                      ShortCoinsurance costs
                      Control0..1
                      Must Supporttrue
                      96. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.type
                      Pattern Value{
                        "coding" : [{
                          "system" : "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE",
                          "code" : "coinsurance"
                        }]
                      }
                      98. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.qualifiers
                      BindingThe codes SHALL be taken from Qualifier for coinsurance rate
                      (required to http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/CoinsuranceOptionVS)
                      100. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.value
                      Control1..?
                      102. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.value.value
                      Control1..?
                      Must Supporttrue
                      104. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.value.system
                      Pattern Valuehttp://unitsofmeasure.org
                      106. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.value.code
                      Pattern Value%

                      Guidance on how to interpret the contents of this table can be found here

                      0. InsurancePlan
                      Definition

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

                      ShortDetails of a Health Insurance product/plan provided by an organization
                      Control0..*
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
                      dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
                      dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
                      dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
                      dom-6: A resource should have narrative for robust management (text.`div`.exists())
                      ipn-1: The organization SHALL at least have a name or an idendtifier, and possibly more than one ((identifier.count() + name.count()) > 0)
                      2. InsurancePlan.id
                      Definition

                      The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

                      ShortLogical id of this artifact
                      Comments

                      The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

                      Control0..1
                      Typeid
                      Is Modifierfalse
                      Summarytrue
                      4. InsurancePlan.meta
                      Definition

                      The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

                      ShortMetadata about the resource
                      Control0..1
                      TypeMeta
                      Is Modifierfalse
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      6. InsurancePlan.meta.id
                      Definition

                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                      ShortUnique id for inter-element referencing
                      Control0..1
                      Typestring
                      Is Modifierfalse
                      XML FormatIn the XML format, this property is represented as an attribute.
                      Summaryfalse
                      8. InsurancePlan.meta.extension
                      Definition

                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                      ShortAdditional content defined by implementations
                      Comments

                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                      Control0..*
                      TypeExtension
                      Is Modifierfalse
                      Summaryfalse
                      Alternate Namesextensions, user content
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      SlicingThis element introduces a set of slices on InsurancePlan.meta.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                      • 10. InsurancePlan.meta.versionId
                        Definition

                        The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.

                        ShortVersion specific identifier
                        Comments

                        The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.

                        Control0..1
                        Typeid
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        12. InsurancePlan.meta.lastUpdated
                        Definition

                        When the resource last changed - e.g. when the version changed.

                        ShortWhen the resource version last changed
                        Comments

                        This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.

                        Control1..1
                        Typeinstant
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        14. InsurancePlan.meta.source
                        Definition

                        A uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.

                        ShortIdentifies where the resource comes from
                        Comments

                        In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used.

                        This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.

                        Control0..1
                        Typeuri
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        16. InsurancePlan.meta.profile
                        Definition

                        A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

                        ShortProfiles this resource claims to conform to
                        Comments

                        It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

                        Control0..*
                        Typecanonical(StructureDefinition)
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        18. InsurancePlan.meta.security
                        Definition

                        Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.

                        ShortSecurity Labels applied to this resource
                        Comments

                        The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

                        Control0..*
                        BindingUnless not suitable, these codes SHALL be taken from All Security Labels
                        (extensible to http://hl7.org/fhir/ValueSet/security-labels)

                        Security Labels from the Healthcare Privacy and Security Classification System.

                        TypeCoding
                        Is Modifierfalse
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        20. InsurancePlan.meta.tag
                        Definition

                        Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

                        ShortTags applied to this resource
                        Comments

                        The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

                        Control0..*
                        BindingFor example codes, see CommonTags
                        (example to http://hl7.org/fhir/ValueSet/common-tags)

                        Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".

                        TypeCoding
                        Is Modifierfalse
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        22. InsurancePlan.implicitRules
                        Definition

                        A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

                        ShortA set of rules under which this content was created
                        Comments

                        Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

                        Control0..1
                        Typeuri
                        Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        24. InsurancePlan.language
                        Definition

                        The base language in which the resource is written.

                        ShortLanguage of the resource content
                        Comments

                        Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

                        Control0..1
                        BindingThe codes SHOULD be taken from CommonLanguages
                        (preferred to http://hl7.org/fhir/ValueSet/languages)

                        A human language.

                        Additional BindingsPurpose
                        AllLanguagesMax Binding
                        Typecode
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        26. InsurancePlan.text
                        Definition

                        A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

                        ShortText summary of the resource, for human interpretation
                        Comments

                        Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

                        Control0..1
                        TypeNarrative
                        Is Modifierfalse
                        Summaryfalse
                        Alternate Namesnarrative, html, xhtml, display
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        28. InsurancePlan.contained
                        Definition

                        These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

                        ShortContained, inline Resources
                        Comments

                        This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

                        Control0..*
                        TypeResource
                        Is Modifierfalse
                        Summaryfalse
                        Alternate Namesinline resources, anonymous resources, contained resources
                        30. InsurancePlan.extension
                        Definition

                        May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                        ShortAdditional content defined by implementations
                        Comments

                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                        Control0..*
                        TypeExtension
                        Is Modifierfalse
                        Summaryfalse
                        Alternate Namesextensions, user content
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        32. InsurancePlan.modifierExtension
                        Definition

                        May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                        ShortExtensions that cannot be ignored
                        Comments

                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                        Control0..*
                        TypeExtension
                        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
                        Summaryfalse
                        Requirements

                        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                        Alternate Namesextensions, user content
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        34. InsurancePlan.identifier
                        Definition

                        Business identifiers assigned to this health insurance product which remain constant as the resource is updated and propagates from server to server.

                        ShortThe business identifier for the plan. The same InsurancePlan may be present in multiple directories and if they have the same identifier they are assumed to be the same plan.
                        NoteThis is a business identifier, not a resource identifier (see discussion)
                        Control1..*
                        This element is affected by the following invariants: ipn-1
                        TypeIdentifier
                        Is Modifierfalse
                        Must Supporttrue
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        36. InsurancePlan.status
                        Definition

                        The current state of the health insurance product.

                        Shortdraft | active | retired | unknown
                        Control1..1
                        BindingThe codes SHALL be taken from PublicationStatus
                        (required to http://hl7.org/fhir/ValueSet/publication-status|4.0.1)

                        The lifecycle status of an artifact.

                        Typecode
                        Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains codes which means that the resource should not be treated as valid
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Requirements

                        Need a flag to indicate a record is no longer to be used and should generally be hidden for the user in the UI.

                        Meaning if MissingDefault interpretation is active.
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        38. InsurancePlan.type
                        Definition

                        The kind of health insurance product.

                        ShortProduct type
                        Control1..1
                        BindingUnless not suitable, these codes SHALL be taken from Insurance Product Type VS
                        (extensible to http://hl7.org/fhir/us/davinci-pdex-plan-net/ValueSet/InsuranceProductTypeVS)
                        TypeCodeableConcept
                        Is Modifierfalse
                        Must Supporttrue
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        40. InsurancePlan.name
                        Definition

                        Official name of the health insurance product as designated by the owner.

                        ShortOfficial name
                        Comments

                        If the name of the product/plan changes, consider putting the old name in the alias column so that it can still be located through searches.

                        Control0..1
                        This element is affected by the following invariants: ipn-1
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        42. InsurancePlan.alias
                        Definition

                        A list of alternate names that the product is known as, or was known as in the past.

                        ShortAlternate names
                        Comments

                        There are no dates associated with the alias/historic names, as this is not intended to track when names were used, but to assist in searching so that older names can still result in identifying the product/plan.

                        Control0..*
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Requirements

                        Over time products/plans go through many changes and can be known by different names.

                        For searching knowing previous names that the product/plan was known by can be very useful.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        44. InsurancePlan.period
                        Definition

                        The period of time that the health insurance product is available.

                        ShortWhen the product is available
                        Control0..1
                        TypePeriod
                        Is Modifierfalse
                        Must Supporttrue
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        46. InsurancePlan.ownedBy
                        Definition

                        The entity that is providing the health insurance product and underwriting the risk. This is typically an insurance carriers, other third-party payers, or health plan sponsors comonly referred to as 'payers'.

                        ShortPlan issuer
                        Control0..1
                        TypeReference(Organization)
                        Is Modifierfalse
                        Summarytrue
                        Alternate NamesPayer
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        48. InsurancePlan.administeredBy
                        Definition

                        An organization which administer other services such as underwriting, customer service and/or claims processing on behalf of the health insurance product owner.

                        ShortProduct administrator
                        Control0..1
                        TypeReference(Organization)
                        Is Modifierfalse
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        50. InsurancePlan.coverageArea
                        Definition

                        The geographic region in which a health insurance product's benefits apply.

                        ShortWhere product applies
                        Control0..*
                        TypeReference(Insurance Plan Location)
                        Is Modifierfalse
                        Must Supporttrue
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        52. InsurancePlan.contact
                        Definition

                        The contact for the health insurance product for a certain purpose.

                        ShortContact information for the Insurance Plan including URLs for brochure and formulary information
                        Comments

                        Where multiple contacts for the same purpose are provided there is a standard extension that can be used to determine which one is the preferred contact to use.

                        Control0..*
                        TypeBackboneElement
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Need to keep track of assigned contact points within bigger organization.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        54. InsurancePlan.contact.id
                        Definition

                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                        ShortUnique id for inter-element referencing
                        Control0..1
                        Typestring
                        Is Modifierfalse
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Summaryfalse
                        56. InsurancePlan.contact.extension
                        Definition

                        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                        ShortAdditional content defined by implementations
                        Comments

                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                        Control0..*
                        TypeExtension
                        Is Modifierfalse
                        Summaryfalse
                        Alternate Namesextensions, user content
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        58. InsurancePlan.contact.modifierExtension
                        Definition

                        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                        ShortExtensions that cannot be ignored even if unrecognized
                        Comments

                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                        Control0..*
                        TypeExtension
                        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                        Summarytrue
                        Requirements

                        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                        Alternate Namesextensions, user content, modifiers
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        60. InsurancePlan.contact.purpose
                        Definition

                        Indicates a purpose for which the contact can be reached.

                        ShortThe type of contact
                        Control0..1
                        BindingUnless not suitable, these codes SHALL be taken from Type of plan contact
                        (extensible to http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/PlanContactTypeVS)
                        TypeCodeableConcept
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Need to distinguish between multiple contact persons.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        62. InsurancePlan.contact.name
                        Definition

                        A name associated with the contact.

                        ShortA name associated with the contact
                        Control0..1
                        TypeHumanName
                        Is Modifierfalse
                        Must Supporttrue
                        Summaryfalse
                        Requirements

                        Need to be able to track the person by name.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        64. InsurancePlan.contact.name.id
                        Definition

                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                        ShortUnique id for inter-element referencing
                        Control0..1
                        Typestring
                        Is Modifierfalse
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Summaryfalse
                        66. InsurancePlan.contact.name.extension
                        Definition

                        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                        ShortAdditional content defined by implementations
                        Comments

                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                        Control0..*
                        TypeExtension
                        Is Modifierfalse
                        Summaryfalse
                        Alternate Namesextensions, user content
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        SlicingThis element introduces a set of slices on InsurancePlan.contact.name.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                        • value @ url
                        • 68. InsurancePlan.contact.name.use
                          Definition

                          Identifies the purpose for this name.

                          Shortusual | official | temp | nickname | anonymous | old | maiden
                          Comments

                          Applications can assume that a name is current unless it explicitly says that it is temporary or old.

                          Control0..1
                          BindingThe codes SHALL be taken from NameUse
                          (required to http://hl7.org/fhir/ValueSet/name-use|4.0.1)

                          The use of a human name.

                          Typecode
                          Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary or old name etc.for a current/permanent one
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Summarytrue
                          Requirements

                          Allows the appropriate name for a particular context of use to be selected from among a set of names.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          70. InsurancePlan.contact.name.text
                          Definition

                          Specifies the entire name as it should be displayed e.g. on an application UI. This may be provided instead of or as well as the specific parts.

                          ShortText representation of the full name
                          Comments

                          Can provide both a text representation and parts. Applications updating a name SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.

                          Control0..1
                          Typestring
                          Is Modifierfalse
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Must Supporttrue
                          Summarytrue
                          Requirements

                          A renderable, unencoded form.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          72. InsurancePlan.contact.name.family
                          Definition

                          The part of a name that links to the genealogy. In some cultures (e.g. Eritrea) the family name of a son is the first name of his father.

                          ShortFamily name (often called 'Surname')
                          Comments

                          Family Name may be decomposed into specific parts using extensions (de, nl, es related cultures).

                          Control0..1
                          Typestring
                          Is Modifierfalse
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Summarytrue
                          Alternate Namessurname
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          74. InsurancePlan.contact.name.given
                          Definition

                          Given name.

                          ShortGiven names (not always 'first'). Includes middle names
                          Comments

                          If only initials are recorded, they may be used in place of the full name parts. Initials may be separated into multiple given names but often aren't due to paractical limitations. This element is not called "first name" since given names do not always come first.

                          Control0..*
                          Typestring
                          Is Modifierfalse
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Summarytrue
                          Alternate Namesfirst name, middle name
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          76. InsurancePlan.contact.name.prefix
                          Definition

                          Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the start of the name.

                          ShortParts that come before the name
                          Control0..*
                          Typestring
                          Is Modifierfalse
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Summarytrue
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          78. InsurancePlan.contact.name.suffix
                          Definition

                          Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the end of the name.

                          ShortParts that come after the name
                          Control0..*
                          Typestring
                          Is Modifierfalse
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Summarytrue
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          80. InsurancePlan.contact.name.period
                          Definition

                          Indicates the period of time when this name was valid for the named person.

                          ShortTime period when name was/is in use
                          Control0..1
                          TypePeriod
                          Is Modifierfalse
                          Summarytrue
                          Requirements

                          Allows names to be placed in historical context.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          82. InsurancePlan.contact.telecom
                          Definition

                          A contact detail (e.g. a telephone number or an email address) by which the party may be contacted.

                          ShortContact details (telephone, email, etc.) for a contact
                          Control0..*
                          TypeContactPoint
                          Is Modifierfalse
                          Must Supporttrue
                          Summaryfalse
                          Requirements

                          People have (primary) ways to contact them in some way such as phone, email.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          84. InsurancePlan.contact.telecom.id
                          Definition

                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                          ShortUnique id for inter-element referencing
                          Control0..1
                          Typestring
                          Is Modifierfalse
                          XML FormatIn the XML format, this property is represented as an attribute.
                          Summaryfalse
                          86. InsurancePlan.contact.telecom.extension
                          Definition

                          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                          ShortAdditional content defined by implementations
                          Comments

                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                          Control0..*
                          TypeExtension
                          Is Modifierfalse
                          Summaryfalse
                          Alternate Namesextensions, user content
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          SlicingThis element introduces a set of slices on InsurancePlan.contact.telecom.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                          • value @ url
                          • 88. InsurancePlan.contact.telecom.system
                            Definition

                            Telecommunications form for contact point - what communications system is required to make use of the contact.

                            Shortphone | fax | email | pager | url | sms | other
                            Control0..1
                            This element is affected by the following invariants: cpt-2
                            BindingThe codes SHALL be taken from ContactPointSystem
                            (required to http://hl7.org/fhir/ValueSet/contact-point-system|4.0.1)

                            Telecommunications form for contact point.

                            Typecode
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Must Supporttrue
                            Summarytrue
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            90. InsurancePlan.contact.telecom.value
                            Definition

                            The actual contact point details, in a form that is meaningful to the designated communication system (i.e. phone number or email address).

                            ShortThe actual contact point details
                            Comments

                            Additional text data such as phone extension numbers, or notes about use of the contact are sometimes included in the value.

                            Control0..1
                            Typestring
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Must Supporttrue
                            Summarytrue
                            Requirements

                            Need to support legacy numbers that are not in a tightly controlled format.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            92. InsurancePlan.contact.telecom.use
                            Definition

                            Identifies the purpose for the contact point.

                            Shorthome | work | temp | old | mobile - purpose of this contact point
                            Comments

                            Applications can assume that a contact is current unless it explicitly says that it is temporary or old.

                            Control0..1
                            BindingThe codes SHALL be taken from ContactPointUse
                            (required to http://hl7.org/fhir/ValueSet/contact-point-use|4.0.1)

                            Use of contact point.

                            Typecode
                            Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary or old contact etc.for a current/permanent one
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            Requirements

                            Need to track the way a person uses this contact, so a user can choose which is appropriate for their purpose.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            94. InsurancePlan.contact.telecom.rank
                            Definition

                            Specifies a preferred order in which to use a set of contacts. ContactPoints with lower rank values are more preferred than those with higher rank values.

                            ShortSpecify preferred order of use (1 = highest)
                            Comments

                            Note that rank does not necessarily follow the order in which the contacts are represented in the instance.

                            Control0..1
                            TypepositiveInt
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            96. InsurancePlan.contact.telecom.period
                            Definition

                            Time period when the contact point was/is in use.

                            ShortTime period when the contact point was/is in use
                            Control0..1
                            TypePeriod
                            Is Modifierfalse
                            Summarytrue
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            98. InsurancePlan.contact.address
                            Definition

                            Visiting or postal addresses for the contact.

                            ShortVisiting or postal addresses for the contact
                            Control0..1
                            TypeAddress
                            Is Modifierfalse
                            Summaryfalse
                            Requirements

                            May need to keep track of a contact party's address for contacting, billing or reporting requirements.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            100. InsurancePlan.endpoint
                            Definition

                            The technical endpoints providing access to services operated for the health insurance product.

                            ShortTechnical endpoint
                            Control0..*
                            TypeReference(Endpoint)
                            Is Modifierfalse
                            Summaryfalse
                            Requirements

                            Organizations have multiple systems that provide various services and need to be able to define the technical connection details for how to connect to them, and for what purpose.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            102. InsurancePlan.network
                            Definition

                            Reference to the network included in the health insurance product.

                            ShortWhat networks are Included
                            Comments

                            Networks are represented as a hierarchy of organization resources.

                            Control0..*
                            TypeReference(Organization)
                            Is Modifierfalse
                            Summaryfalse
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            104. InsurancePlan.coverage
                            Definition

                            Details about the coverage offered by the insurance product.

                            ShortCoverage details
                            Control1..*
                            TypeBackboneElement
                            Is Modifierfalse
                            Must Supporttrue
                            Summaryfalse
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            SlicingThis element introduces a set of slices on InsurancePlan.coverage. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                            • pattern @ type
                            • 106. InsurancePlan.coverage.id
                              Definition

                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                              ShortUnique id for inter-element referencing
                              Control0..1
                              Typestring
                              Is Modifierfalse
                              XML FormatIn the XML format, this property is represented as an attribute.
                              Summaryfalse
                              108. InsurancePlan.coverage.extension
                              Definition

                              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                              ShortAdditional content defined by implementations
                              Comments

                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                              Control0..*
                              TypeExtension
                              Is Modifierfalse
                              Summaryfalse
                              Alternate Namesextensions, user content
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              110. InsurancePlan.coverage.modifierExtension
                              Definition

                              May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                              ShortExtensions that cannot be ignored even if unrecognized
                              Comments

                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                              Control0..*
                              TypeExtension
                              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                              Summarytrue
                              Requirements

                              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                              Alternate Namesextensions, user content, modifiers
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              112. InsurancePlan.coverage.type
                              Definition

                              Type of coverage (Medical; Dental; Mental Health; Substance Abuse; Vision; Drug; Short Term; Long Term Care; Hospice; Home Health).

                              ShortType of coverage
                              Control1..1
                              TypeCodeableConcept
                              Is Modifierfalse
                              Must Supporttrue
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              114. InsurancePlan.coverage.network
                              Definition

                              Reference to the network that providing the type of coverage.

                              ShortWhat networks provide coverage
                              Comments

                              Networks are represented as a hierarchy of organization resources.

                              Control0..*
                              TypeReference(Organization)
                              Is Modifierfalse
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              116. InsurancePlan.coverage.benefit
                              Definition

                              Specific benefits under this type of coverage.

                              ShortList of benefits
                              Control1..*
                              TypeBackboneElement
                              Is Modifierfalse
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              118. InsurancePlan.coverage.benefit.id
                              Definition

                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                              ShortUnique id for inter-element referencing
                              Control0..1
                              Typestring
                              Is Modifierfalse
                              XML FormatIn the XML format, this property is represented as an attribute.
                              Summaryfalse
                              120. InsurancePlan.coverage.benefit.extension
                              Definition

                              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                              ShortAdditional content defined by implementations
                              Comments

                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                              Control0..*
                              TypeExtension
                              Is Modifierfalse
                              Summaryfalse
                              Alternate Namesextensions, user content
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              122. InsurancePlan.coverage.benefit.modifierExtension
                              Definition

                              May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                              ShortExtensions that cannot be ignored even if unrecognized
                              Comments

                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                              Control0..*
                              TypeExtension
                              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                              Summarytrue
                              Requirements

                              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                              Alternate Namesextensions, user content, modifiers
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              124. InsurancePlan.coverage.benefit.type
                              Definition

                              Type of benefit (primary care; speciality care; inpatient; outpatient).

                              ShortType of benefit
                              Control1..1
                              TypeCodeableConcept
                              Is Modifierfalse
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              126. InsurancePlan.coverage.benefit.requirement
                              Definition

                              The referral requirements to have access/coverage for this benefit.

                              ShortReferral requirements
                              Control0..1
                              Typestring
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              128. InsurancePlan.coverage.benefit.limit
                              Definition

                              The specific limits on the benefit.

                              ShortBenefit limits
                              Control0..*
                              TypeBackboneElement
                              Is Modifierfalse
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              130. InsurancePlan.coverage.benefit.limit.id
                              Definition

                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                              ShortUnique id for inter-element referencing
                              Control0..1
                              Typestring
                              Is Modifierfalse
                              XML FormatIn the XML format, this property is represented as an attribute.
                              Summaryfalse
                              132. InsurancePlan.coverage.benefit.limit.extension
                              Definition

                              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                              ShortAdditional content defined by implementations
                              Comments

                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                              Control0..*
                              TypeExtension
                              Is Modifierfalse
                              Summaryfalse
                              Alternate Namesextensions, user content
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              134. InsurancePlan.coverage.benefit.limit.modifierExtension
                              Definition

                              May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                              ShortExtensions that cannot be ignored even if unrecognized
                              Comments

                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                              Control0..*
                              TypeExtension
                              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                              Summarytrue
                              Requirements

                              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                              Alternate Namesextensions, user content, modifiers
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              136. InsurancePlan.coverage.benefit.limit.value
                              Definition

                              The maximum amount of a service item a plan will pay for a covered benefit. For examples. wellness visits, or eyeglasses.

                              ShortMaximum value allowed
                              Comments

                              May also be called “eligible expense,” “payment allowance,” or “negotiated rate.”.

                              Control0..1
                              TypeQuantity
                              Is Modifierfalse
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              138. InsurancePlan.coverage.benefit.limit.code
                              Definition

                              The specific limit on the benefit.

                              ShortBenefit limit details
                              Comments

                              Use CodeableConcept.text element if the data is free (uncoded) text.

                              Control0..1
                              TypeCodeableConcept
                              Is Modifierfalse
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              140. InsurancePlan.coverage:drug-coverage
                              Slice Namedrug-coverage
                              Definition

                              Details about the coverage offered by the insurance product.

                              ShortCoverage details
                              Control1..*
                              TypeBackboneElement
                              Is Modifierfalse
                              Must Supporttrue
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              142. InsurancePlan.coverage:drug-coverage.id
                              Definition

                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                              ShortUnique id for inter-element referencing
                              Control0..1
                              Typestring
                              Is Modifierfalse
                              XML FormatIn the XML format, this property is represented as an attribute.
                              Summaryfalse
                              144. InsurancePlan.coverage:drug-coverage.extension
                              Definition

                              An Extension

                              ShortExtension
                              Control1..*
                              TypeExtension
                              Is Modifierfalse
                              Must Supporttrue
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              SlicingThis element introduces a set of slices on InsurancePlan.coverage.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                              • value @ url
                              • 146. InsurancePlan.coverage:drug-coverage.extension:usdf-FormularyReference-extension
                                Slice Nameusdf-FormularyReference-extension
                                Definition

                                Reference to the formulary this item belongs to.

                                ShortFormulary Reference
                                Control1..*
                                This element is affected by the following invariants: ele-1
                                TypeExtension(Formulary Reference) (Extension Type: Reference(Formulary))
                                Is Modifierfalse
                                Must Supporttrue
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                148. InsurancePlan.coverage:drug-coverage.modifierExtension
                                Definition

                                May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                ShortExtensions that cannot be ignored even if unrecognized
                                Comments

                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                Control0..*
                                TypeExtension
                                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                Summarytrue
                                Requirements

                                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                Alternate Namesextensions, user content, modifiers
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                150. InsurancePlan.coverage:drug-coverage.type
                                Definition

                                Type of coverage (Medical; Dental; Mental Health; Substance Abuse; Vision; Drug; Short Term; Long Term Care; Hospice; Home Health).

                                ShortType of coverage
                                Control1..1
                                TypeCodeableConcept
                                Is Modifierfalse
                                Must Supporttrue
                                Summaryfalse
                                Pattern Value{
                                  "coding" : [{
                                    "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
                                    "code" : "DRUGPOL"
                                  }]
                                }
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                152. InsurancePlan.coverage:drug-coverage.network
                                Definition

                                Reference to the network that providing the type of coverage.

                                ShortWhat networks provide coverage
                                Comments

                                Networks are represented as a hierarchy of organization resources.

                                Control0..*
                                TypeReference(Organization)
                                Is Modifierfalse
                                Summaryfalse
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                154. InsurancePlan.coverage:drug-coverage.benefit
                                Definition

                                Specific benefits under this type of coverage.

                                ShortList of benefits
                                Control1..*
                                TypeBackboneElement
                                Is Modifierfalse
                                Summaryfalse
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                SlicingThis element introduces a set of slices on InsurancePlan.coverage.benefit. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                • pattern @ type
                                • 156. InsurancePlan.coverage:drug-coverage.benefit.id
                                  Definition

                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                  ShortUnique id for inter-element referencing
                                  Control0..1
                                  Typestring
                                  Is Modifierfalse
                                  XML FormatIn the XML format, this property is represented as an attribute.
                                  Summaryfalse
                                  158. InsurancePlan.coverage:drug-coverage.benefit.extension
                                  Definition

                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                  ShortAdditional content defined by implementations
                                  Comments

                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                  Control0..*
                                  TypeExtension
                                  Is Modifierfalse
                                  Summaryfalse
                                  Alternate Namesextensions, user content
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                  160. InsurancePlan.coverage:drug-coverage.benefit.modifierExtension
                                  Definition

                                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                  ShortExtensions that cannot be ignored even if unrecognized
                                  Comments

                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                  Control0..*
                                  TypeExtension
                                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                  Summarytrue
                                  Requirements

                                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                  Alternate Namesextensions, user content, modifiers
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                  162. InsurancePlan.coverage:drug-coverage.benefit.type
                                  Definition

                                  Type of benefit (primary care; speciality care; inpatient; outpatient).

                                  ShortType of benefit
                                  Control1..1
                                  BindingUnless not suitable, these codes SHALL be taken from Insurance plan type
                                  (extensible to http://terminology.hl7.org/ValueSet/insuranceplan-type)
                                  TypeCodeableConcept
                                  Is Modifierfalse
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  164. InsurancePlan.coverage:drug-coverage.benefit.requirement
                                  Definition

                                  The referral requirements to have access/coverage for this benefit.

                                  ShortReferral requirements
                                  Control0..1
                                  Typestring
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  166. InsurancePlan.coverage:drug-coverage.benefit.limit
                                  Definition

                                  The specific limits on the benefit.

                                  ShortBenefit limits
                                  Control0..*
                                  TypeBackboneElement
                                  Is Modifierfalse
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  168. InsurancePlan.coverage:drug-coverage.benefit.limit.id
                                  Definition

                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                  ShortUnique id for inter-element referencing
                                  Control0..1
                                  Typestring
                                  Is Modifierfalse
                                  XML FormatIn the XML format, this property is represented as an attribute.
                                  Summaryfalse
                                  170. InsurancePlan.coverage:drug-coverage.benefit.limit.extension
                                  Definition

                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                  ShortAdditional content defined by implementations
                                  Comments

                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                  Control0..*
                                  TypeExtension
                                  Is Modifierfalse
                                  Summaryfalse
                                  Alternate Namesextensions, user content
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                  172. InsurancePlan.coverage:drug-coverage.benefit.limit.modifierExtension
                                  Definition

                                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                  ShortExtensions that cannot be ignored even if unrecognized
                                  Comments

                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                  Control0..*
                                  TypeExtension
                                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                  Summarytrue
                                  Requirements

                                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                  Alternate Namesextensions, user content, modifiers
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                  174. InsurancePlan.coverage:drug-coverage.benefit.limit.value
                                  Definition

                                  The maximum amount of a service item a plan will pay for a covered benefit. For examples. wellness visits, or eyeglasses.

                                  ShortMaximum value allowed
                                  Comments

                                  May also be called “eligible expense,” “payment allowance,” or “negotiated rate.”.

                                  Control0..1
                                  TypeQuantity
                                  Is Modifierfalse
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  176. InsurancePlan.coverage:drug-coverage.benefit.limit.code
                                  Definition

                                  The specific limit on the benefit.

                                  ShortBenefit limit details
                                  Comments

                                  Use CodeableConcept.text element if the data is free (uncoded) text.

                                  Control0..1
                                  TypeCodeableConcept
                                  Is Modifierfalse
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  178. InsurancePlan.coverage:drug-coverage.benefit:drug-plan
                                  Slice Namedrug-plan
                                  Definition

                                  Specific benefits under this type of coverage.

                                  ShortList of benefits
                                  Control1..*
                                  TypeBackboneElement
                                  Is Modifierfalse
                                  Must Supporttrue
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  180. InsurancePlan.coverage:drug-coverage.benefit:drug-plan.id
                                  Definition

                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                  ShortUnique id for inter-element referencing
                                  Control0..1
                                  Typestring
                                  Is Modifierfalse
                                  XML FormatIn the XML format, this property is represented as an attribute.
                                  Summaryfalse
                                  182. InsurancePlan.coverage:drug-coverage.benefit:drug-plan.extension
                                  Definition

                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                  ShortAdditional content defined by implementations
                                  Comments

                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                  Control0..*
                                  TypeExtension
                                  Is Modifierfalse
                                  Summaryfalse
                                  Alternate Namesextensions, user content
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                  184. InsurancePlan.coverage:drug-coverage.benefit:drug-plan.modifierExtension
                                  Definition

                                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                  ShortExtensions that cannot be ignored even if unrecognized
                                  Comments

                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                  Control0..*
                                  TypeExtension
                                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                  Summarytrue
                                  Requirements

                                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                  Alternate Namesextensions, user content, modifiers
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                  186. InsurancePlan.coverage:drug-coverage.benefit:drug-plan.type
                                  Definition

                                  Type of benefit (primary care; speciality care; inpatient; outpatient).

                                  ShortType of benefit
                                  Control1..1
                                  BindingUnless not suitable, these codes SHALL be taken from Insurance plan type
                                  (extensible to http://terminology.hl7.org/ValueSet/insuranceplan-type)
                                  TypeCodeableConcept
                                  Is Modifierfalse
                                  Summaryfalse
                                  Pattern Value{
                                    "coding" : [{
                                      "system" : "http://terminology.hl7.org/CodeSystem/insurance-plan-type",
                                      "code" : "drug",
                                      "display" : "Drug"
                                    }]
                                  }
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  188. InsurancePlan.coverage:drug-coverage.benefit:drug-plan.requirement
                                  Definition

                                  The referral requirements to have access/coverage for this benefit.

                                  ShortReferral requirements
                                  Control0..1
                                  Typestring
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  190. InsurancePlan.coverage:drug-coverage.benefit:drug-plan.limit
                                  Definition

                                  The specific limits on the benefit.

                                  ShortBenefit limits
                                  Control0..*
                                  TypeBackboneElement
                                  Is Modifierfalse
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  192. InsurancePlan.coverage:drug-coverage.benefit:drug-plan.limit.id
                                  Definition

                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                  ShortUnique id for inter-element referencing
                                  Control0..1
                                  Typestring
                                  Is Modifierfalse
                                  XML FormatIn the XML format, this property is represented as an attribute.
                                  Summaryfalse
                                  194. InsurancePlan.coverage:drug-coverage.benefit:drug-plan.limit.extension
                                  Definition

                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                  ShortAdditional content defined by implementations
                                  Comments

                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                  Control0..*
                                  TypeExtension
                                  Is Modifierfalse
                                  Summaryfalse
                                  Alternate Namesextensions, user content
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                  196. InsurancePlan.coverage:drug-coverage.benefit:drug-plan.limit.modifierExtension
                                  Definition

                                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                  ShortExtensions that cannot be ignored even if unrecognized
                                  Comments

                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                  Control0..*
                                  TypeExtension
                                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                  Summarytrue
                                  Requirements

                                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                  Alternate Namesextensions, user content, modifiers
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                  198. InsurancePlan.coverage:drug-coverage.benefit:drug-plan.limit.value
                                  Definition

                                  The maximum amount of a service item a plan will pay for a covered benefit. For examples. wellness visits, or eyeglasses.

                                  ShortMaximum value allowed
                                  Comments

                                  May also be called “eligible expense,” “payment allowance,” or “negotiated rate.”.

                                  Control0..1
                                  TypeQuantity
                                  Is Modifierfalse
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  200. InsurancePlan.coverage:drug-coverage.benefit:drug-plan.limit.code
                                  Definition

                                  The specific limit on the benefit.

                                  ShortBenefit limit details
                                  Comments

                                  Use CodeableConcept.text element if the data is free (uncoded) text.

                                  Control0..1
                                  TypeCodeableConcept
                                  Is Modifierfalse
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  202. InsurancePlan.plan
                                  Definition

                                  Details about an insurance plan.

                                  ShortPlan details
                                  Control1..*
                                  TypeBackboneElement
                                  Is Modifierfalse
                                  Must Supporttrue
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  SlicingThis element introduces a set of slices on InsurancePlan.plan. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                  • pattern @ type
                                  • 204. InsurancePlan.plan.id
                                    Definition

                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                    ShortUnique id for inter-element referencing
                                    Control0..1
                                    Typestring
                                    Is Modifierfalse
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    Summaryfalse
                                    206. InsurancePlan.plan.extension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                    ShortAdditional content defined by implementations
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifierfalse
                                    Summaryfalse
                                    Alternate Namesextensions, user content
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    208. InsurancePlan.plan.modifierExtension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                    ShortExtensions that cannot be ignored even if unrecognized
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                    Summarytrue
                                    Requirements

                                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                    Alternate Namesextensions, user content, modifiers
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    210. InsurancePlan.plan.identifier
                                    Definition

                                    Business identifiers assigned to this health insurance plan which remain constant as the resource is updated and propagates from server to server.

                                    ShortBusiness Identifier for Product
                                    NoteThis is a business identifier, not a resource identifier (see discussion)
                                    Control0..*
                                    TypeIdentifier
                                    Is Modifierfalse
                                    Summarytrue
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    212. InsurancePlan.plan.type
                                    Definition

                                    Type of plan. For example, "Platinum" or "High Deductable".

                                    ShortType of plan
                                    Control0..1
                                    BindingUnless not suitable, these codes SHALL be taken from Insurance plan type
                                    (extensible to http://terminology.hl7.org/ValueSet/insuranceplan-type)
                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    214. InsurancePlan.plan.coverageArea
                                    Definition

                                    The geographic region in which a health insurance plan's benefits apply.

                                    ShortWhere product applies
                                    Control0..*
                                    TypeReference(Location)
                                    Is Modifierfalse
                                    Summarytrue
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    216. InsurancePlan.plan.network
                                    Definition

                                    Reference to the network that providing the type of coverage.

                                    ShortWhat networks provide coverage
                                    Comments

                                    Networks are represented as a hierarchy of organization resources.

                                    Control0..*
                                    TypeReference(Organization)
                                    Is Modifierfalse
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    218. InsurancePlan.plan.generalCost
                                    Definition

                                    Overall costs associated with the plan.

                                    ShortOverall costs
                                    Control0..*
                                    TypeBackboneElement
                                    Is Modifierfalse
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    220. InsurancePlan.plan.generalCost.id
                                    Definition

                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                    ShortUnique id for inter-element referencing
                                    Control0..1
                                    Typestring
                                    Is Modifierfalse
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    Summaryfalse
                                    222. InsurancePlan.plan.generalCost.extension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                    ShortAdditional content defined by implementations
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifierfalse
                                    Summaryfalse
                                    Alternate Namesextensions, user content
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    224. InsurancePlan.plan.generalCost.modifierExtension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                    ShortExtensions that cannot be ignored even if unrecognized
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                    Summarytrue
                                    Requirements

                                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                    Alternate Namesextensions, user content, modifiers
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    226. InsurancePlan.plan.generalCost.type
                                    Definition

                                    Type of cost.

                                    ShortType of cost
                                    Control0..1
                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    228. InsurancePlan.plan.generalCost.groupSize
                                    Definition

                                    Number of participants enrolled in the plan.

                                    ShortNumber of enrollees
                                    Control0..1
                                    TypepositiveInt
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    230. InsurancePlan.plan.generalCost.cost
                                    Definition

                                    Value of the cost.

                                    ShortCost value
                                    Control0..1
                                    TypeMoney
                                    Is Modifierfalse
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    232. InsurancePlan.plan.generalCost.comment
                                    Definition

                                    Additional information about the general costs associated with this plan.

                                    ShortAdditional cost information
                                    Control0..1
                                    Typestring
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    234. InsurancePlan.plan.specificCost
                                    Definition

                                    Costs associated with the coverage provided by the product.

                                    ShortSpecific costs
                                    Control0..*
                                    TypeBackboneElement
                                    Is Modifierfalse
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    236. InsurancePlan.plan.specificCost.id
                                    Definition

                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                    ShortUnique id for inter-element referencing
                                    Control0..1
                                    Typestring
                                    Is Modifierfalse
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    Summaryfalse
                                    238. InsurancePlan.plan.specificCost.extension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                    ShortAdditional content defined by implementations
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifierfalse
                                    Summaryfalse
                                    Alternate Namesextensions, user content
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    240. InsurancePlan.plan.specificCost.modifierExtension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                    ShortExtensions that cannot be ignored even if unrecognized
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                    Summarytrue
                                    Requirements

                                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                    Alternate Namesextensions, user content, modifiers
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    242. InsurancePlan.plan.specificCost.category
                                    Definition

                                    General category of benefit (Medical; Dental; Vision; Drug; Mental Health; Substance Abuse; Hospice, Home Health).

                                    ShortGeneral category of benefit
                                    Control1..1
                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    244. InsurancePlan.plan.specificCost.benefit
                                    Definition

                                    List of the specific benefits under this category of benefit.

                                    ShortBenefits list
                                    Control0..*
                                    TypeBackboneElement
                                    Is Modifierfalse
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    246. InsurancePlan.plan.specificCost.benefit.id
                                    Definition

                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                    ShortUnique id for inter-element referencing
                                    Control0..1
                                    Typestring
                                    Is Modifierfalse
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    Summaryfalse
                                    248. InsurancePlan.plan.specificCost.benefit.extension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                    ShortAdditional content defined by implementations
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifierfalse
                                    Summaryfalse
                                    Alternate Namesextensions, user content
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    250. InsurancePlan.plan.specificCost.benefit.modifierExtension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                    ShortExtensions that cannot be ignored even if unrecognized
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                    Summarytrue
                                    Requirements

                                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                    Alternate Namesextensions, user content, modifiers
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    252. InsurancePlan.plan.specificCost.benefit.type
                                    Definition

                                    Type of specific benefit (preventative; primary care office visit; speciality office visit; hospitalization; emergency room; urgent care).

                                    ShortType of specific benefit
                                    Control1..1
                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    254. InsurancePlan.plan.specificCost.benefit.cost
                                    Definition

                                    List of the costs associated with a specific benefit.

                                    ShortList of the costs
                                    Control0..*
                                    TypeBackboneElement
                                    Is Modifierfalse
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    256. InsurancePlan.plan.specificCost.benefit.cost.id
                                    Definition

                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                    ShortUnique id for inter-element referencing
                                    Control0..1
                                    Typestring
                                    Is Modifierfalse
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    Summaryfalse
                                    258. InsurancePlan.plan.specificCost.benefit.cost.extension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                    ShortAdditional content defined by implementations
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifierfalse
                                    Summaryfalse
                                    Alternate Namesextensions, user content
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    260. InsurancePlan.plan.specificCost.benefit.cost.modifierExtension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                    ShortExtensions that cannot be ignored even if unrecognized
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                    Summarytrue
                                    Requirements

                                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                    Alternate Namesextensions, user content, modifiers
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    262. InsurancePlan.plan.specificCost.benefit.cost.type
                                    Definition

                                    Type of cost (copay; individual cap; family cap; coinsurance; deductible).

                                    ShortType of cost
                                    Control1..1
                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    264. InsurancePlan.plan.specificCost.benefit.cost.applicability
                                    Definition

                                    Whether the cost applies to in-network or out-of-network providers (in-network; out-of-network; other).

                                    Shortin-network | out-of-network | other
                                    Control0..1
                                    BindingThe codes SHALL be taken from BenefitCostApplicability
                                    (required to http://hl7.org/fhir/ValueSet/insuranceplan-applicability|4.0.1)

                                    Whether the cost applies to in-network or out-of-network providers.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    266. InsurancePlan.plan.specificCost.benefit.cost.qualifiers
                                    Definition

                                    Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA).

                                    ShortAdditional information about the cost
                                    Control0..*
                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    268. InsurancePlan.plan.specificCost.benefit.cost.value
                                    Definition

                                    The actual cost value. (some of the costs may be represented as percentages rather than currency, e.g. 10% coinsurance).

                                    ShortThe actual cost value
                                    Control0..1
                                    TypeQuantity
                                    Is Modifierfalse
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    270. InsurancePlan.plan:drug-plan
                                    Slice Namedrug-plan
                                    Definition

                                    Details about an insurance plan.

                                    ShortDrug plan
                                    Control1..*
                                    TypeBackboneElement
                                    Is Modifierfalse
                                    Must Supporttrue
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    272. InsurancePlan.plan:drug-plan.id
                                    Definition

                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                    ShortUnique id for inter-element referencing
                                    Control0..1
                                    Typestring
                                    Is Modifierfalse
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    Summaryfalse
                                    274. InsurancePlan.plan:drug-plan.extension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                    ShortAdditional content defined by implementations
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifierfalse
                                    Summaryfalse
                                    Alternate Namesextensions, user content
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    276. InsurancePlan.plan:drug-plan.modifierExtension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                    ShortExtensions that cannot be ignored even if unrecognized
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                    Summarytrue
                                    Requirements

                                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                    Alternate Namesextensions, user content, modifiers
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    278. InsurancePlan.plan:drug-plan.identifier
                                    Definition

                                    Business identifiers assigned to this health insurance plan which remain constant as the resource is updated and propagates from server to server.

                                    ShortBusiness Identifier for Product
                                    NoteThis is a business identifier, not a resource identifier (see discussion)
                                    Control0..*
                                    TypeIdentifier
                                    Is Modifierfalse
                                    Must Supporttrue
                                    Summarytrue
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    280. InsurancePlan.plan:drug-plan.type
                                    Definition

                                    Type of plan. For example, "Platinum" or "High Deductable".

                                    ShortType of plan
                                    Control1..1
                                    BindingUnless not suitable, these codes SHALL be taken from Insurance plan type
                                    (extensible to http://terminology.hl7.org/ValueSet/insuranceplan-type)
                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Pattern Value{
                                      "coding" : [{
                                        "system" : "http://terminology.hl7.org/CodeSystem/insurance-plan-type",
                                        "code" : "drug",
                                        "display" : "Drug"
                                      }]
                                    }
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    282. InsurancePlan.plan:drug-plan.coverageArea
                                    Definition

                                    The geographic region in which a health insurance plan's benefits apply.

                                    ShortWhere product applies
                                    Control0..*
                                    TypeReference(Location)
                                    Is Modifierfalse
                                    Summarytrue
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    284. InsurancePlan.plan:drug-plan.network
                                    Definition

                                    Reference to the network that providing the type of coverage.

                                    ShortPharmacy benefit types that are part of the drug plan
                                    Comments

                                    Networks are represented as a hierarchy of organization resources.

                                    Control0..*
                                    TypeReference(Organization)
                                    Is Modifierfalse
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    286. InsurancePlan.plan:drug-plan.generalCost
                                    Definition

                                    Overall costs associated with the plan.

                                    ShortOverall costs
                                    Control0..*
                                    TypeBackboneElement
                                    Is Modifierfalse
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    288. InsurancePlan.plan:drug-plan.generalCost.id
                                    Definition

                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                    ShortUnique id for inter-element referencing
                                    Control0..1
                                    Typestring
                                    Is Modifierfalse
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    Summaryfalse
                                    290. InsurancePlan.plan:drug-plan.generalCost.extension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                    ShortAdditional content defined by implementations
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifierfalse
                                    Summaryfalse
                                    Alternate Namesextensions, user content
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    292. InsurancePlan.plan:drug-plan.generalCost.modifierExtension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                    ShortExtensions that cannot be ignored even if unrecognized
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                    Summarytrue
                                    Requirements

                                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                    Alternate Namesextensions, user content, modifiers
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    294. InsurancePlan.plan:drug-plan.generalCost.type
                                    Definition

                                    Type of cost.

                                    ShortType of cost
                                    Control0..1
                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    296. InsurancePlan.plan:drug-plan.generalCost.groupSize
                                    Definition

                                    Number of participants enrolled in the plan.

                                    ShortNumber of enrollees
                                    Control0..1
                                    TypepositiveInt
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    298. InsurancePlan.plan:drug-plan.generalCost.cost
                                    Definition

                                    Value of the cost.

                                    ShortCost value
                                    Control0..1
                                    TypeMoney
                                    Is Modifierfalse
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    300. InsurancePlan.plan:drug-plan.generalCost.comment
                                    Definition

                                    Additional information about the general costs associated with this plan.

                                    ShortAdditional cost information
                                    Control0..1
                                    Typestring
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    302. InsurancePlan.plan:drug-plan.specificCost
                                    Definition

                                    Costs associated with the coverage provided by the product.

                                    ShortPharmacy benefit type specific cost
                                    Control1..*
                                    TypeBackboneElement
                                    Is Modifierfalse
                                    Must Supporttrue
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    304. InsurancePlan.plan:drug-plan.specificCost.id
                                    Definition

                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                    ShortUnique id for inter-element referencing
                                    Control0..1
                                    Typestring
                                    Is Modifierfalse
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    Summaryfalse
                                    306. InsurancePlan.plan:drug-plan.specificCost.extension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                    ShortAdditional content defined by implementations
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifierfalse
                                    Summaryfalse
                                    Alternate Namesextensions, user content
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    308. InsurancePlan.plan:drug-plan.specificCost.modifierExtension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                    ShortExtensions that cannot be ignored even if unrecognized
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                    Summarytrue
                                    Requirements

                                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                    Alternate Namesextensions, user content, modifiers
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    310. InsurancePlan.plan:drug-plan.specificCost.category
                                    Definition

                                    General category of benefit (Medical; Dental; Vision; Drug; Mental Health; Substance Abuse; Hospice, Home Health).

                                    ShortPharmacy Benefit Type
                                    Control1..1
                                    BindingUnless not suitable, these codes SHALL be taken from Pharmacy benefit types
                                    (extensible to http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/PharmacyBenefitTypeVS)
                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Must Supporttrue
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    312. InsurancePlan.plan:drug-plan.specificCost.benefit
                                    Definition

                                    List of the specific benefits under this category of benefit.

                                    ShortDrug tier benefit
                                    Control1..*
                                    TypeBackboneElement
                                    Is Modifierfalse
                                    Must Supporttrue
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    314. InsurancePlan.plan:drug-plan.specificCost.benefit.id
                                    Definition

                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                    ShortUnique id for inter-element referencing
                                    Control0..1
                                    Typestring
                                    Is Modifierfalse
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    Summaryfalse
                                    316. InsurancePlan.plan:drug-plan.specificCost.benefit.extension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                    ShortAdditional content defined by implementations
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifierfalse
                                    Summaryfalse
                                    Alternate Namesextensions, user content
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    318. InsurancePlan.plan:drug-plan.specificCost.benefit.modifierExtension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                    ShortExtensions that cannot be ignored even if unrecognized
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                    Summarytrue
                                    Requirements

                                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                    Alternate Namesextensions, user content, modifiers
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    320. InsurancePlan.plan:drug-plan.specificCost.benefit.type
                                    Definition

                                    Type of specific benefit (preventative; primary care office visit; speciality office visit; hospitalization; emergency room; urgent care).

                                    ShortType of specific benefit
                                    Control1..1
                                    BindingUnless not suitable, these codes SHALL be taken from Drug tier of medication in health plan
                                    (extensible to http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/DrugTierVS)
                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Must Supporttrue
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    322. InsurancePlan.plan:drug-plan.specificCost.benefit.cost
                                    Definition

                                    List of the costs associated with a specific benefit.

                                    ShortList of the costs
                                    Control1..*
                                    TypeBackboneElement
                                    Is Modifierfalse
                                    Must Supporttrue
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    SlicingThis element introduces a set of slices on InsurancePlan.plan.specificCost.benefit.cost. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                    • pattern @ type
                                    • 324. InsurancePlan.plan:drug-plan.specificCost.benefit.cost.id
                                      Definition

                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                      ShortUnique id for inter-element referencing
                                      Control0..1
                                      Typestring
                                      Is Modifierfalse
                                      XML FormatIn the XML format, this property is represented as an attribute.
                                      Summaryfalse
                                      326. InsurancePlan.plan:drug-plan.specificCost.benefit.cost.extension
                                      Definition

                                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                      ShortAdditional content defined by implementations
                                      Comments

                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                      Control0..*
                                      TypeExtension
                                      Is Modifierfalse
                                      Summaryfalse
                                      Alternate Namesextensions, user content
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      328. InsurancePlan.plan:drug-plan.specificCost.benefit.cost.modifierExtension
                                      Definition

                                      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                      ShortExtensions that cannot be ignored even if unrecognized
                                      Comments

                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                      Control0..*
                                      TypeExtension
                                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                      Summarytrue
                                      Requirements

                                      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                      Alternate Namesextensions, user content, modifiers
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      330. InsurancePlan.plan:drug-plan.specificCost.benefit.cost.type
                                      Definition

                                      Type of cost (copay; individual cap; family cap; coinsurance; deductible).

                                      ShortType of cost
                                      Control1..1
                                      BindingUnless not suitable, these codes SHALL be taken from Benefit type of cost
                                      (extensible to http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/BenefitCostTypeVS)
                                      TypeCodeableConcept
                                      Is Modifierfalse
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      332. InsurancePlan.plan:drug-plan.specificCost.benefit.cost.applicability
                                      Definition

                                      Whether the cost applies to in-network or out-of-network providers (in-network; out-of-network; other).

                                      Shortin-network | out-of-network | other
                                      Control0..1
                                      BindingThe codes SHALL be taken from BenefitCostApplicability
                                      (required to http://hl7.org/fhir/ValueSet/insuranceplan-applicability|4.0.1)

                                      Whether the cost applies to in-network or out-of-network providers.

                                      TypeCodeableConcept
                                      Is Modifierfalse
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      334. InsurancePlan.plan:drug-plan.specificCost.benefit.cost.qualifiers
                                      Definition

                                      Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA).

                                      ShortAdditional information about the cost
                                      Control1..1
                                      TypeCodeableConcept
                                      Is Modifierfalse
                                      Must Supporttrue
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      336. InsurancePlan.plan:drug-plan.specificCost.benefit.cost.value
                                      Definition

                                      The actual cost value. (some of the costs may be represented as percentages rather than currency, e.g. 10% coinsurance).

                                      ShortThe actual cost value
                                      Control0..1
                                      TypeQuantity
                                      Is Modifierfalse
                                      Must Supporttrue
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      338. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay
                                      Slice Namecopay
                                      Definition

                                      List of the costs associated with a specific benefit.

                                      ShortCopay costs
                                      Control0..1
                                      TypeBackboneElement
                                      Is Modifierfalse
                                      Must Supporttrue
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      340. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.id
                                      Definition

                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                      ShortUnique id for inter-element referencing
                                      Control0..1
                                      Typestring
                                      Is Modifierfalse
                                      XML FormatIn the XML format, this property is represented as an attribute.
                                      Summaryfalse
                                      342. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.extension
                                      Definition

                                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                      ShortAdditional content defined by implementations
                                      Comments

                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                      Control0..*
                                      TypeExtension
                                      Is Modifierfalse
                                      Summaryfalse
                                      Alternate Namesextensions, user content
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      344. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.modifierExtension
                                      Definition

                                      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                      ShortExtensions that cannot be ignored even if unrecognized
                                      Comments

                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                      Control0..*
                                      TypeExtension
                                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                      Summarytrue
                                      Requirements

                                      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                      Alternate Namesextensions, user content, modifiers
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      346. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.type
                                      Definition

                                      Type of cost (copay; individual cap; family cap; coinsurance; deductible).

                                      ShortType of cost
                                      Control1..1
                                      BindingUnless not suitable, these codes SHALL be taken from Benefit type of cost
                                      (extensible to http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/BenefitCostTypeVS)
                                      TypeCodeableConcept
                                      Is Modifierfalse
                                      Summaryfalse
                                      Pattern Value{
                                        "coding" : [{
                                          "system" : "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE",
                                          "code" : "copay"
                                        }]
                                      }
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      348. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.applicability
                                      Definition

                                      Whether the cost applies to in-network or out-of-network providers (in-network; out-of-network; other).

                                      Shortin-network | out-of-network | other
                                      Control0..1
                                      BindingThe codes SHALL be taken from BenefitCostApplicability
                                      (required to http://hl7.org/fhir/ValueSet/insuranceplan-applicability|4.0.1)

                                      Whether the cost applies to in-network or out-of-network providers.

                                      TypeCodeableConcept
                                      Is Modifierfalse
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      350. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.qualifiers
                                      Definition

                                      Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA).

                                      ShortAdditional information about the cost
                                      Control1..1
                                      BindingThe codes SHALL be taken from Qualifier of copay amount
                                      (required to http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/CopayOptionVS)
                                      TypeCodeableConcept
                                      Is Modifierfalse
                                      Must Supporttrue
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      352. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.value
                                      Definition

                                      The actual cost value. (some of the costs may be represented as percentages rather than currency, e.g. 10% coinsurance).

                                      ShortThe actual cost value
                                      Control1..1
                                      TypeQuantity(MoneyQuantity)
                                      Is Modifierfalse
                                      Must Supporttrue
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      354. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.value.id
                                      Definition

                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                      ShortUnique id for inter-element referencing
                                      Control0..1
                                      Typestring
                                      Is Modifierfalse
                                      XML FormatIn the XML format, this property is represented as an attribute.
                                      Summaryfalse
                                      356. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.value.extension
                                      Definition

                                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                      ShortAdditional content defined by implementations
                                      Comments

                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                      Control0..*
                                      TypeExtension
                                      Is Modifierfalse
                                      Summaryfalse
                                      Alternate Namesextensions, user content
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      SlicingThis element introduces a set of slices on InsurancePlan.plan.specificCost.benefit.cost.value.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                      • value @ url
                                      • 358. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.value.value
                                        Definition

                                        The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                                        ShortNumerical value (with implicit precision)
                                        Comments

                                        The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                                        Control1..1
                                        Typedecimal
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Must Supporttrue
                                        Summarytrue
                                        Requirements

                                        Precision is handled implicitly in almost all cases of measurement.

                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        360. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.value.comparator
                                        Definition

                                        How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                                        Short< | <= | >= | > - how to understand the value
                                        Control0..1
                                        BindingThe codes SHALL be taken from QuantityComparator
                                        (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                                        How the Quantity should be understood and represented.

                                        Typecode
                                        Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summarytrue
                                        Requirements

                                        Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                                        Meaning if MissingIf there is no comparator, then there is no modification of the value
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        362. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.value.unit
                                        Definition

                                        A human-readable form of the unit.

                                        ShortUnit representation
                                        Control0..1
                                        Typestring
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summarytrue
                                        Requirements

                                        There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        364. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.value.system
                                        Definition

                                        The identification of the system that provides the coded form of the unit.

                                        ShortSystem that defines coded unit form
                                        Control0..1
                                        This element is affected by the following invariants: qty-3
                                        Typeuri
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summarytrue
                                        Requirements

                                        Need to know the system that defines the coded form of the unit.

                                        Pattern Valueurn:iso:std:iso:4217
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        366. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.value.code
                                        Definition

                                        A computer processable form of the unit in some unit representation system.

                                        ShortCoded form of the unit
                                        Comments

                                        The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                                        Control0..1
                                        Typecode
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summarytrue
                                        Requirements

                                        Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                                        Pattern ValueUSD
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        368. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance
                                        Slice Namecoinsurance
                                        Definition

                                        List of the costs associated with a specific benefit.

                                        ShortCoinsurance costs
                                        Control0..1
                                        TypeBackboneElement
                                        Is Modifierfalse
                                        Must Supporttrue
                                        Summaryfalse
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        370. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.id
                                        Definition

                                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                        ShortUnique id for inter-element referencing
                                        Control0..1
                                        Typestring
                                        Is Modifierfalse
                                        XML FormatIn the XML format, this property is represented as an attribute.
                                        Summaryfalse
                                        372. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.extension
                                        Definition

                                        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                        ShortAdditional content defined by implementations
                                        Comments

                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                        Control0..*
                                        TypeExtension
                                        Is Modifierfalse
                                        Summaryfalse
                                        Alternate Namesextensions, user content
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                        374. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.modifierExtension
                                        Definition

                                        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                        ShortExtensions that cannot be ignored even if unrecognized
                                        Comments

                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                        Control0..*
                                        TypeExtension
                                        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                        Summarytrue
                                        Requirements

                                        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                        Alternate Namesextensions, user content, modifiers
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                        376. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.type
                                        Definition

                                        Type of cost (copay; individual cap; family cap; coinsurance; deductible).

                                        ShortType of cost
                                        Control1..1
                                        BindingUnless not suitable, these codes SHALL be taken from Benefit type of cost
                                        (extensible to http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/BenefitCostTypeVS)
                                        TypeCodeableConcept
                                        Is Modifierfalse
                                        Summaryfalse
                                        Pattern Value{
                                          "coding" : [{
                                            "system" : "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE",
                                            "code" : "coinsurance"
                                          }]
                                        }
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        378. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.applicability
                                        Definition

                                        Whether the cost applies to in-network or out-of-network providers (in-network; out-of-network; other).

                                        Shortin-network | out-of-network | other
                                        Control0..1
                                        BindingThe codes SHALL be taken from BenefitCostApplicability
                                        (required to http://hl7.org/fhir/ValueSet/insuranceplan-applicability|4.0.1)

                                        Whether the cost applies to in-network or out-of-network providers.

                                        TypeCodeableConcept
                                        Is Modifierfalse
                                        Summaryfalse
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        380. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.qualifiers
                                        Definition

                                        Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA).

                                        ShortAdditional information about the cost
                                        Control1..1
                                        BindingThe codes SHALL be taken from Qualifier for coinsurance rate
                                        (required to http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/CoinsuranceOptionVS)
                                        TypeCodeableConcept
                                        Is Modifierfalse
                                        Must Supporttrue
                                        Summaryfalse
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        382. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.value
                                        Definition

                                        The actual cost value. (some of the costs may be represented as percentages rather than currency, e.g. 10% coinsurance).

                                        ShortThe actual cost value
                                        Control1..1
                                        TypeQuantity
                                        Is Modifierfalse
                                        Must Supporttrue
                                        Summaryfalse
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        384. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.value.id
                                        Definition

                                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                        ShortUnique id for inter-element referencing
                                        Control0..1
                                        Typestring
                                        Is Modifierfalse
                                        XML FormatIn the XML format, this property is represented as an attribute.
                                        Summaryfalse
                                        386. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.value.extension
                                        Definition

                                        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                        ShortAdditional content defined by implementations
                                        Comments

                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                        Control0..*
                                        TypeExtension
                                        Is Modifierfalse
                                        Summaryfalse
                                        Alternate Namesextensions, user content
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                        SlicingThis element introduces a set of slices on InsurancePlan.plan.specificCost.benefit.cost.value.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                        • value @ url
                                        • 388. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.value.value
                                          Definition

                                          The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                                          ShortNumerical value (with implicit precision)
                                          Comments

                                          The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                                          Control1..1
                                          Typedecimal
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Must Supporttrue
                                          Summarytrue
                                          Requirements

                                          Precision is handled implicitly in almost all cases of measurement.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          390. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.value.comparator
                                          Definition

                                          How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                                          Short< | <= | >= | > - how to understand the value
                                          Control0..1
                                          BindingThe codes SHALL be taken from QuantityComparator
                                          (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                                          How the Quantity should be understood and represented.

                                          Typecode
                                          Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summarytrue
                                          Requirements

                                          Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                                          Meaning if MissingIf there is no comparator, then there is no modification of the value
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          392. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.value.unit
                                          Definition

                                          A human-readable form of the unit.

                                          ShortUnit representation
                                          Control0..1
                                          Typestring
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summarytrue
                                          Requirements

                                          There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          394. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.value.system
                                          Definition

                                          The identification of the system that provides the coded form of the unit.

                                          ShortSystem that defines coded unit form
                                          Control0..1
                                          This element is affected by the following invariants: qty-3
                                          Typeuri
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summarytrue
                                          Requirements

                                          Need to know the system that defines the coded form of the unit.

                                          Pattern Valuehttp://unitsofmeasure.org
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          396. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.value.code
                                          Definition

                                          A computer processable form of the unit in some unit representation system.

                                          ShortCoded form of the unit
                                          Comments

                                          The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                                          Control0..1
                                          Typecode
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summarytrue
                                          Requirements

                                          Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                                          Pattern Value%
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))