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 
The official URL for this profile is:
http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/plannet-InsurancePlan
A InsurancePlan is a discrete package of health insurance coverage benefits that are offered under a particular network type. A given payer’s products typically differ by network type and/or covered benefits. A plan pairs a product’s covered benefits with the particular cost sharing structure offered to a consumer. A given product may comprise multiple plans (i.e. each plan offers different cost sharing requirements for the same set of covered benefits).
InsurancePlan describes a health insurance offering comprised of a list of covered benefits (i.e. the product), costs associated with those benefits (i.e. the plan), and additional information about the offering, such as who it is owned and administered by, a coverage area, contact information, etc.
This profile builds on InsurancePlan.
This profile was published on Wed Oct 23 00:00:00 EDT 2019 as a draft by HL7 Financial Management WG.
Summary
Mandatory: 0 element (3 nested mandatory elements)
Must-Support: 33 elements
Prohibited: 2 elements
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Mapping Source
This structure represents the following mapping definition:
plannet.InsurancePlan maps to InsurancePlan: PN_Identifier.IdentifierUse maps to identifier.use PN_Identifier.IdentifierSystem maps to identifier.system PN_Identifier.IdentifierValue maps to identifier.value PN_Identifier.IdentifierType maps to identifier.type PN_Identifier.IdentifierPeriod maps to identifier.period PN_Identifier.IdentifierAssigner maps to identifier.assigner InsurancePlanStatus maps to status InsurancePlanType maps to type InsurancePlanName maps to name InsurancePlanAlias maps to alias OwnedBy maps to ownedBy Period maps to period CoverageArea maps to coverageArea AdministeredBy maps to administeredBy InsurancePlanContact maps to contact InsurancePlanContact.ContactPurpose maps to contact.purpose InsurancePlanContact.HumanName maps to contact.name InsurancePlanContact.HumanName.Purpose maps to contact.name.use InsurancePlanContact.HumanName.Name maps to contact.name.text InsurancePlanContact.HumanName.FamilyName maps to contact.name.family InsurancePlanContact.HumanName.GivenName maps to contact.name.given InsurancePlanContact.HumanName.Prefix maps to contact.name.prefix InsurancePlanContact.HumanName.Suffix maps to contact.name.suffix InsurancePlanContact.HumanName.EffectiveTimePeriod maps to contact.name.period InsurancePlanContact.ContactPoint maps to contact.telecom InsurancePlanContact.ContactPoint.TelecomNumberOrAddress maps to contact.telecom.value InsurancePlanContact.ContactPoint.Purpose maps to contact.telecom.use InsurancePlanContact.ContactPoint.PriorityRank maps to contact.telecom.rank InsurancePlanContact.ContactPoint.EffectiveTimePeriod maps to contact.telecom.period InsurancePlanContact.ContactPoint.Type maps to contact.telecom.system TAvailableTime maps to contact.telecom.extension TViaIntermediary maps to contact.telecom.extension InsurancePlanNetwork maps to network InsurancePlanEndpoint maps to endpoint constrain ownedBy to 1..1 constrain plan to 0..0 constrain coverage to 0..0
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  InsurancePlan | plannet-InsurancePlan | |||
 identifier | ||||
 use | S | |||
| type | S | |||
| system | S | |||
| value | S | |||
| period | S | |||
  assigner | S | Reference(plannet-Organization) | ||
| status | S | 1..1 | ||
| type | S | 0..1 | ||
| name | S | |||
| alias | S | |||
| ownedBy | S | 1..1 | Reference(plannet-Organization) | |
| administeredBy | S | 1..1 | Reference(plannet-Organization) | |
| coverageArea | S | Reference(plannet-Location) | ||
| contact | S | |||
| purpose | S | |||
| name | S | |||
| use | S | |||
| text | S | |||
| family | S | |||
| given | S | |||
| prefix | S | |||
| suffix | S | |||
| period | S | |||
| telecom | S | |||
  contactpoint-availabletime | S | 0..* | (Complex) | Available time URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/contactpoint-availabletime |
| plannet-CViaIntermediary-extension | S | 0..* | Reference(plannet-PractitionerRole | plannet-Organization | plannet-OrganizationAffiliation | plannet-Location) | CViaIntermediary URL: http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/plannet-CViaIntermediary-extension |
| system | S | |||
| value | S | |||
| use | S | |||
| rank | S | |||
| period | S | |||
| endpoint | S | Reference(plannet-Endpoint) | ||
| network | S | Reference(plannet-Network) | ||
| coverage | 0..0 | |||
| plan | 0..0 | |||
| Documentation for this format | ||||
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| InsurancePlan | I | 0..* | plannet-InsurancePlan ipn-1: The organization SHALL at least have a name or an idendtifier, and possibly more than one | |
 id | Σ | 0..1 | id | Logical id of this artifact |
 meta | Σ | 0..1 | Meta | Metadata about the resource |
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
| language | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages | |
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |
 contained | 0..* | Resource | Contained, inline Resources | |
 extension | 0..* | Extension | Additional content defined by implementations | |
 modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
| identifier | ΣI | 0..* | Identifier | Business Identifier for Product |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| use | ?!SΣ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required) |
| type | SΣ | 0..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible) |
| system | SΣ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient |
| value | SΣ | 0..1 | string | The value that is unique Example General: 123456 |
| period | SΣ | 0..1 | Period | Time period when id is/was valid for use |
| assigner | SΣ | 0..1 | Reference(plannet-Organization) | Organization that issued id (may be just text) |
| status | ?!SΣ | 1..1 | code | draft | active | retired | unknown Binding: PublicationStatus (required) |
| type | SΣ | 0..1 | CodeableConcept | Kind of product Binding: InsurancePlanType (example) |
| name | SΣI | 0..1 | string | Official name |
| alias | S | 0..* | string | Alternate names |
| period | 0..1 | Period | When the product is available | |
| ownedBy | SΣ | 1..1 | Reference(plannet-Organization) | Plan issuer |
| administeredBy | SΣ | 1..1 | Reference(plannet-Organization) | Product administrator |
| coverageArea | SΣ | 0..* | Reference(plannet-Location) | Where product applies |
| contact | SI | 0..* | BackboneElement | Contact for the product |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| purpose | S | 0..1 | CodeableConcept | The type of contact Binding: ContactEntityType (extensible) |
| name | S | 0..1 | HumanName | A name associated with the contact |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| use | ?!SΣ | 0..1 | code | usual | official | temp | nickname | anonymous | old | maiden Binding: NameUse (required) |
| text | SΣ | 0..1 | string | Text representation of the full name |
| family | SΣ | 0..1 | string | Family name (often called 'Surname') |
| given | SΣ | 0..* | string | Given names (not always 'first'). Includes middle names This repeating element order: Given Names appear in the correct order for presenting the name |
| prefix | SΣ | 0..* | string | Parts that come before the name This repeating element order: Prefixes appear in the correct order for presenting the name |
| suffix | SΣ | 0..* | string | Parts that come after the name This repeating element order: Suffixes appear in the correct order for presenting the name |
| period | SΣ | 0..1 | Period | Time period when name was/is in use |
| telecom | S | 0..* | ContactPoint | Contact details (telephone, email, etc.) for a contact |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| contactpoint-availabletime | S | 0..* | (Complex) | Available time URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/contactpoint-availabletime |
| plannet-CViaIntermediary-extension | S | 0..* | Reference(plannet-PractitionerRole | plannet-Organization | plannet-OrganizationAffiliation | plannet-Location) | CViaIntermediary URL: http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/plannet-CViaIntermediary-extension |
| system | SΣI | 0..1 | code | phone | fax | email | pager | url | sms | other Binding: ContactPointSystem (required) |
| value | SΣ | 0..1 | string | The actual contact point details |
| use | ?!SΣ | 0..1 | code | home | work | temp | old | mobile - purpose of this contact point Binding: ContactPointUse (required) |
| rank | SΣ | 0..1 | positiveInt | Specify preferred order of use (1 = highest) |
| period | SΣ | 0..1 | Period | Time period when the contact point was/is in use |
| address | 0..1 | Address | Visiting or postal addresses for the contact | |
| endpoint | S | 0..* | Reference(plannet-Endpoint) | Technical endpoint |
| network | S | 0..* | Reference(plannet-Network) | What networks are Included |
| Documentation for this format | ||||
Summary
Mandatory: 0 element (3 nested mandatory elements)
Must-Support: 33 elements
Prohibited: 2 elements
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Mapping Source
This structure represents the following mapping definition:
plannet.InsurancePlan maps to InsurancePlan: PN_Identifier.IdentifierUse maps to identifier.use PN_Identifier.IdentifierSystem maps to identifier.system PN_Identifier.IdentifierValue maps to identifier.value PN_Identifier.IdentifierType maps to identifier.type PN_Identifier.IdentifierPeriod maps to identifier.period PN_Identifier.IdentifierAssigner maps to identifier.assigner InsurancePlanStatus maps to status InsurancePlanType maps to type InsurancePlanName maps to name InsurancePlanAlias maps to alias OwnedBy maps to ownedBy Period maps to period CoverageArea maps to coverageArea AdministeredBy maps to administeredBy InsurancePlanContact maps to contact InsurancePlanContact.ContactPurpose maps to contact.purpose InsurancePlanContact.HumanName maps to contact.name InsurancePlanContact.HumanName.Purpose maps to contact.name.use InsurancePlanContact.HumanName.Name maps to contact.name.text InsurancePlanContact.HumanName.FamilyName maps to contact.name.family InsurancePlanContact.HumanName.GivenName maps to contact.name.given InsurancePlanContact.HumanName.Prefix maps to contact.name.prefix InsurancePlanContact.HumanName.Suffix maps to contact.name.suffix InsurancePlanContact.HumanName.EffectiveTimePeriod maps to contact.name.period InsurancePlanContact.ContactPoint maps to contact.telecom InsurancePlanContact.ContactPoint.TelecomNumberOrAddress maps to contact.telecom.value InsurancePlanContact.ContactPoint.Purpose maps to contact.telecom.use InsurancePlanContact.ContactPoint.PriorityRank maps to contact.telecom.rank InsurancePlanContact.ContactPoint.EffectiveTimePeriod maps to contact.telecom.period InsurancePlanContact.ContactPoint.Type maps to contact.telecom.system TAvailableTime maps to contact.telecom.extension TViaIntermediary maps to contact.telecom.extension InsurancePlanNetwork maps to network InsurancePlanEndpoint maps to endpoint constrain ownedBy to 1..1 constrain plan to 0..0 constrain coverage to 0..0
Differential View
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| InsurancePlan | plannet-InsurancePlan | |||
| identifier | ||||
| use | S | |||
| type | S | |||
| system | S | |||
| value | S | |||
| period | S | |||
| assigner | S | Reference(plannet-Organization) | ||
| status | S | 1..1 | ||
| type | S | 0..1 | ||
| name | S | |||
| alias | S | |||
| ownedBy | S | 1..1 | Reference(plannet-Organization) | |
| administeredBy | S | 1..1 | Reference(plannet-Organization) | |
| coverageArea | S | Reference(plannet-Location) | ||
| contact | S | |||
| purpose | S | |||
| name | S | |||
| use | S | |||
| text | S | |||
| family | S | |||
| given | S | |||
| prefix | S | |||
| suffix | S | |||
| period | S | |||
| telecom | S | |||
| contactpoint-availabletime | S | 0..* | (Complex) | Available time URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/contactpoint-availabletime |
| plannet-CViaIntermediary-extension | S | 0..* | Reference(plannet-PractitionerRole | plannet-Organization | plannet-OrganizationAffiliation | plannet-Location) | CViaIntermediary URL: http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/plannet-CViaIntermediary-extension |
| system | S | |||
| value | S | |||
| use | S | |||
| rank | S | |||
| period | S | |||
| endpoint | S | Reference(plannet-Endpoint) | ||
| network | S | Reference(plannet-Network) | ||
| coverage | 0..0 | |||
| plan | 0..0 | |||
| Documentation for this format | ||||
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| InsurancePlan | I | 0..* | plannet-InsurancePlan ipn-1: The organization SHALL at least have a name or an idendtifier, and possibly more than one | |
| id | Σ | 0..1 | id | Logical id of this artifact |
| meta | Σ | 0..1 | Meta | Metadata about the resource |
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
| language | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages | |
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |
| contained | 0..* | Resource | Contained, inline Resources | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
| identifier | ΣI | 0..* | Identifier | Business Identifier for Product |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| use | ?!SΣ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required) |
| type | SΣ | 0..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible) |
| system | SΣ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient |
| value | SΣ | 0..1 | string | The value that is unique Example General: 123456 |
| period | SΣ | 0..1 | Period | Time period when id is/was valid for use |
| assigner | SΣ | 0..1 | Reference(plannet-Organization) | Organization that issued id (may be just text) |
| status | ?!SΣ | 1..1 | code | draft | active | retired | unknown Binding: PublicationStatus (required) |
| type | SΣ | 0..1 | CodeableConcept | Kind of product Binding: InsurancePlanType (example) |
| name | SΣI | 0..1 | string | Official name |
| alias | S | 0..* | string | Alternate names |
| period | 0..1 | Period | When the product is available | |
| ownedBy | SΣ | 1..1 | Reference(plannet-Organization) | Plan issuer |
| administeredBy | SΣ | 1..1 | Reference(plannet-Organization) | Product administrator |
| coverageArea | SΣ | 0..* | Reference(plannet-Location) | Where product applies |
| contact | SI | 0..* | BackboneElement | Contact for the product |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| purpose | S | 0..1 | CodeableConcept | The type of contact Binding: ContactEntityType (extensible) |
| name | S | 0..1 | HumanName | A name associated with the contact |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| use | ?!SΣ | 0..1 | code | usual | official | temp | nickname | anonymous | old | maiden Binding: NameUse (required) |
| text | SΣ | 0..1 | string | Text representation of the full name |
| family | SΣ | 0..1 | string | Family name (often called 'Surname') |
| given | SΣ | 0..* | string | Given names (not always 'first'). Includes middle names This repeating element order: Given Names appear in the correct order for presenting the name |
| prefix | SΣ | 0..* | string | Parts that come before the name This repeating element order: Prefixes appear in the correct order for presenting the name |
| suffix | SΣ | 0..* | string | Parts that come after the name This repeating element order: Suffixes appear in the correct order for presenting the name |
| period | SΣ | 0..1 | Period | Time period when name was/is in use |
| telecom | S | 0..* | ContactPoint | Contact details (telephone, email, etc.) for a contact |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| contactpoint-availabletime | S | 0..* | (Complex) | Available time URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/contactpoint-availabletime |
| plannet-CViaIntermediary-extension | S | 0..* | Reference(plannet-PractitionerRole | plannet-Organization | plannet-OrganizationAffiliation | plannet-Location) | CViaIntermediary URL: http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/plannet-CViaIntermediary-extension |
| system | SΣI | 0..1 | code | phone | fax | email | pager | url | sms | other Binding: ContactPointSystem (required) |
| value | SΣ | 0..1 | string | The actual contact point details |
| use | ?!SΣ | 0..1 | code | home | work | temp | old | mobile - purpose of this contact point Binding: ContactPointUse (required) |
| rank | SΣ | 0..1 | positiveInt | Specify preferred order of use (1 = highest) |
| period | SΣ | 0..1 | Period | Time period when the contact point was/is in use |
| address | 0..1 | Address | Visiting or postal addresses for the contact | |
| endpoint | S | 0..* | Reference(plannet-Endpoint) | Technical endpoint |
| network | S | 0..* | Reference(plannet-Network) | What networks are Included |
| Documentation for this format | ||||
Downloads: StructureDefinition: (XML, JSON, TTL), Schema: XML Schematron
| Path | Conformance | ValueSet |
| InsurancePlan.language | preferred | CommonLanguages Max Binding: AllLanguages |
| InsurancePlan.identifier.use | required | IdentifierUse |
| InsurancePlan.identifier.type | extensible | Identifier Type Codes |
| InsurancePlan.status | required | PublicationStatus |
| InsurancePlan.type | example | InsurancePlanType |
| InsurancePlan.contact.purpose | extensible | ContactEntityType |
| InsurancePlan.contact.name.use | required | NameUse |
| InsurancePlan.contact.telecom.system | required | ContactPointSystem |
| InsurancePlan.contact.telecom.use | required | ContactPointUse |
| InsurancePlan.plan.specificCost.benefit.cost.applicability | required | BenefitCostApplicability |
| Id | Path | Details | Requirements |
| dom-2 | InsurancePlan | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
| dom-4 | InsurancePlan | 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-3 | InsurancePlan | 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-6 | InsurancePlan | A resource should have narrative for robust management : text.div.exists() | |
| dom-5 | InsurancePlan | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
| ipn-1 | InsurancePlan | The organization SHALL at least have a name or an idendtifier, and possibly more than one : (identifier.count() + name.count()) > 0 | |
| ele-1 | InsurancePlan.contact | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | InsurancePlan.coverage.benefit | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | InsurancePlan.coverage.benefit.limit | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | InsurancePlan.plan.generalCost | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | InsurancePlan.plan.specificCost | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | InsurancePlan.plan.specificCost.benefit | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | InsurancePlan.plan.specificCost.benefit.cost | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
©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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