DaVinci PDEX Plan Net STU Ballot
This page is part of the DaVinci PDEX Plan Net (v0.1.0: STU 1 Ballot 1) based on FHIR R4. The current version which supercedes this version is 1.1.0. For a full list of available versions, see the Directory of published versions 
<InsurancePlan xmlns="http://hl7.org/fhir"> <id value="insuranceplan1"/> <meta> <profile value="http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/plannet-InsurancePlan"/> </meta> <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: insuranceplan1</p><p><b>identifier</b>: HIOS product ID = 1234567891 (OFFICIAL)</p><p><b>status</b>: active</p><p><b>type</b>: Bronze <span style="background: LightGoldenRodYellow">(Details : {http://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristics code 'bronze' = 'Bronze', given as 'Bronze'})</span></p><p><b>name</b>: Patriot PPO Standard</p><p><b>alias</b>: Patriot Plus</p><p><b>period</b>: Jun 6, 2018, 12:00:00 AM --> Jan 1, 2019, 12:00:00 AM</p><p><b>ownedBy</b>: <a href="Organization-homeland.html">Homeland Health Insurance. Generated Summary: id: homeland; active; <span title="Codes: {http://terminology.hl7.org/CodeSystem/organization-type ins}">Health System</span>; name: Homeland Health Insurance</a></p><p><b>administeredBy</b>: <a href="Organization-homeland.html">Homeland Health Insurance. Generated Summary: id: homeland; active; <span title="Codes: {http://terminology.hl7.org/CodeSystem/organization-type ins}">Health System</span>; name: Homeland Health Insurance</a></p><p><b>coverageArea</b>: <a href="Location-wash-dc-metro.html">Washington, DC metro area. Generated Summary: id: wash-dc-metro; status: active; name: Washington, DC metro area; <span title="Codes: {http://terminology.hl7.org/CodeSystem/location-physical-type area}">Area</span></a></p><h3>Contacts</h3><table class="grid"><tr><td>-</td><td><b>Purpose</b></td><td><b>Telecom</b></td></tr><tr><td>*</td><td>General information <span style="background: LightGoldenRodYellow">(Details : {http://terminology.hl7.org/CodeSystem/contactentity-type code 'PATINF' = 'Patient', given as 'Patient'})</span></td><td>ph: 202-123-5555</td></tr></table><p><b>endpoint</b>: patriot plan endpoint hub</p><p><b>network</b>: </p><ul><li><a href="Organization-patriotppo.html">Patriot Preferred Provider Network. Generated Summary: id: patriotppo; Healthcare.gov Network ID = DCN001 (SECONDARY); active; <span title="Codes: {http://hl7.org/fhir/uv/vhdir/CodeSystem/network-type ppo}">PPO</span>; name: Patriot Preferred Provider Network; alias: Patriot PPO</a></li><li><a href="Organization-patriotdental.html">Patriot Dental Provider Network. Generated Summary: id: patriotdental; active; <span title="Codes: {http://terminology.hl7.org/CodeSystem/organization-type pay}">Health System</span>; name: Patriot Dental Provider Network</a></li></ul><blockquote><p><b>coverage</b></p><p><b>type</b>: Coverage related to medical inpatient, outpatient, diagnostic, and preventive care <span style="background: LightGoldenRodYellow">(Details : {[not stated] code 'medical' = 'medical', given as 'Medical'})</span></p><p><b>network</b>: <a href="Organization-patriotppo.html">Patriot Preferred Provider Network. Generated Summary: id: patriotppo; Healthcare.gov Network ID = DCN001 (SECONDARY); active; <span title="Codes: {http://hl7.org/fhir/uv/vhdir/CodeSystem/network-type ppo}">PPO</span>; name: Patriot Preferred Provider Network; alias: Patriot PPO</a></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Primary care visit to treat an injury or illness <span style="background: LightGoldenRodYellow">(Details : {[not stated] code '001' = '001', given as 'Primary care visit to treat an injury or illness'})</span></p><p><b>requirement</b>: N/A</p><h3>Limits</h3><table class="grid"><tr><td>-</td><td><b>Code</b></td></tr><tr><td>*</td><td>unlimited <span style="background: LightGoldenRodYellow">(Details )</span></td></tr></table></blockquote></blockquote><blockquote><p><b>coverage</b></p><p><b>type</b>: Coverage related to dental care <span style="background: LightGoldenRodYellow">(Details : {[not stated] code 'dental' = 'dental', given as 'Dental'})</span></p><p><b>network</b>: <a href="Organization-patriotdental.html">Patriot Dental Provider Network. Generated Summary: id: patriotdental; active; <span title="Codes: {http://terminology.hl7.org/CodeSystem/organization-type pay}">Health System</span>; name: Patriot Dental Provider Network</a></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Periodic oral checkup <span style="background: LightGoldenRodYellow">(Details : {[not stated] code '052' = '052', given as 'Basic Dental Care – Adult'})</span></p><p><b>requirement</b>: N/A</p><h3>Limits</h3><table class="grid"><tr><td>-</td><td><b>Value</b></td><td><b>Code</b></td></tr><tr><td>*</td><td>2 visit/yr<span style="background: LightGoldenRodYellow"> (Details: UCUM code {visit}/a = '{visit}/a')</span></td><td>biannual oral checkup <span style="background: LightGoldenRodYellow">(Details )</span></td></tr></table></blockquote></blockquote><blockquote><p><b>plan</b></p><p><b>identifier</b>: HIOS plan ID = 123456789101112 (OFFICIAL)</p><p><b>type</b>: Bronze <span style="background: LightGoldenRodYellow">(Details : {[not stated] code 'bronze' = 'bronze', given as 'Bronze'})</span></p><p><b>coverageArea</b>: <a href="Location-wash-dc-metro.html">Washington, DC metro area. Generated Summary: id: wash-dc-metro; status: active; name: Washington, DC metro area; <span title="Codes: {http://terminology.hl7.org/CodeSystem/location-physical-type area}">Area</span></a></p><p><b>network</b>: <a href="Organization-patriotdental.html">Patriot Dental Provider Network. Generated Summary: id: patriotdental; active; <span title="Codes: {http://terminology.hl7.org/CodeSystem/organization-type pay}">Health System</span>; name: Patriot Dental Provider Network</a></p><h3>GeneralCosts</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td><td><b>GroupSize</b></td><td><b>Cost</b></td><td><b>Comment</b></td></tr><tr><td>*</td><td>Deductible <span style="background: LightGoldenRodYellow">(Details : {[not stated] code 'deductible' = 'deductible', given as 'Deductible'})</span></td><td>1</td><td/><td>Includes all prescription and medical costs for in-network providers</td></tr></table><blockquote><p><b>specificCost</b></p><p><b>category</b>: Medical <span style="background: LightGoldenRodYellow">(Details : {[not stated] code 'medical' = 'medical', given as 'Medical'})</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Primary care visit to treat an injury or illness <span style="background: LightGoldenRodYellow">(Details : {[not stated] code '001' = '001', given as 'Primary care visit to treat an injury or illness'})</span></p><h3>Costs</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td><td><b>Applicability</b></td><td><b>Qualifiers</b></td><td><b>Value</b></td></tr><tr><td>*</td><td>Copay <span style="background: LightGoldenRodYellow">(Details : {[not stated] code 'copay' = 'copay', given as 'Copay'})</span></td><td>In Network <span style="background: LightGoldenRodYellow">(Details : {http://terminology.hl7.org/CodeSystem/applicability code 'in-network' = 'In Network', given as 'In Network'})</span></td><td>in-network preferred provider <span style="background: LightGoldenRodYellow">(Details )</span></td><td>50 dollars<span style="background: LightGoldenRodYellow"> (Details: urn:iso:std:iso:4217 code USD = 'United States dollar')</span></td></tr></table></blockquote></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: Dental <span style="background: LightGoldenRodYellow">(Details : {[not stated] code 'dental' = 'dental', given as 'Dental'})</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Basic Dental Care – Adult <span style="background: LightGoldenRodYellow">(Details : {[not stated] code '052' = '052', given as 'Basic Dental Care – Adult'})</span></p><h3>Costs</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td><td><b>Applicability</b></td><td><b>Qualifiers</b></td><td><b>Value</b></td></tr><tr><td>*</td><td>Coinsurance <span style="background: LightGoldenRodYellow">(Details : {[not stated] code 'coinsurance' = 'coinsurance', given as 'Coinsurance'})</span></td><td>In Network <span style="background: LightGoldenRodYellow">(Details : {http://terminology.hl7.org/CodeSystem/applicability code 'in-network' = 'In Network', given as 'In Network'})</span></td><td>in-network provider <span style="background: LightGoldenRodYellow">(Details )</span></td><td>10 percent</td></tr></table></blockquote></blockquote></blockquote></div> </text> <identifier> <use value="official"/> <type> <coding> <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/> <code value="NIIP"/> <display value="National Insurance Payor Identifier (Payor)"/> <userSelected value="true"/> </coding> <text value="HIOS product ID"/> </type> <system value="https://www.cms.gov/CCIIO/"/> <value value="1234567891"/> <assigner> <display value="Centers for Medicare and Medicaid Services"/> </assigner> </identifier> <status value="active"/> <type> <coding> <system value="http://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristics"/> <code value="bronze"/> <display value="Bronze"/> </coding> </type> <name value="Patriot PPO Standard"/> <alias value="Patriot Plus"/> <period> <start value="2018-06-06"/> <end value="2019-01-01"/> </period> <ownedBy> <reference value="Organization/homeland"/> <display value="Homeland Health Insurance"/> </ownedBy> <administeredBy> <reference value="Organization/homeland"/> <display value="Homeland Health Insurance"/> </administeredBy> <coverageArea> <reference value="Location/wash-dc-metro"/> <display value="Washington, DC metro area"/> </coverageArea> <contact> <purpose> <coding> <system value="http://terminology.hl7.org/CodeSystem/contactentity-type"/> <code value="PATINF"/> <display value="Patient"/> </coding> <text value="General information"/> </purpose> <telecom> <system value="phone"/> <value value="202-123-5555"/> </telecom> <telecom> <system value="email"/> <value value="info@homelandinc.org"/> </telecom> </contact> <endpoint> <display value="patriot plan endpoint hub"/> </endpoint> <network> <reference value="Organization/patriotppo"/> <display value="Patriot Preferred Provider Network"/> </network> <network> <reference value="Organization/patriotdental"/> <display value="Patriot Dental Provider Network"/> </network> </InsurancePlan>
©2019+
HL7 Financial Management WG.
Package hl7.fhir.us.davinci-pdex-plan-net#0.1.0 based on FHIR 4.0.0.
Generated 2019-10-24.
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