Da Vinci PDex Plan Net
1.2.0 - STU1.2 United States of America flag

This page is part of the DaVinci PDEX Plan Net (v1.2.0: STU 1) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Resource Profile: Plan-Net InsurancePlan

Official URL: http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/plannet-InsurancePlan Version: 1.2.0
Standards status: Trial-use Computable Name: PlannetInsurancePlan

An 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.

Usage:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan C 0..* InsurancePlan Details of a Health Insurance product/plan provided by an organization
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
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
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
dom-6: A resource should have narrative for robust management
ipn-1: The organization SHALL at least have a name or an idendtifier, and possibly more than one
network-or-plan-Network: If an insuranceplan does not define a network, then each plan must define one
plan-type-is-distinct: Each InsurancePlan.plan should have a distinct plan.type.
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
ele-1: All FHIR elements must have a @value or children
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
... identifier ΣC 0..* Identifier Business Identifier for Product
ele-1: All FHIR elements must have a @value or children
.... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .


ele-1: All FHIR elements must have a @value or children
.... type SΣ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.


ele-1: All FHIR elements must have a @value or children
.... value SΣ 0..1 string The value that is unique
ele-1: All FHIR elements must have a @value or children
Example General: 123456
.... assigner SΣ 0..1 Reference(Organization) Organization that issued id (may be just text)
ele-1: All FHIR elements must have a @value or children
... type SΣ 1..1 CodeableConcept Product Type
Binding: Insurance Product Type VS (extensible)
ele-1: All FHIR elements must have a @value or children
... name SΣC 0..1 string Official name
ele-1: All FHIR elements must have a @value or children
... alias S 0..* string Alternate names
ele-1: All FHIR elements must have a @value or children
... period S 0..1 Period When the product is available
ele-1: All FHIR elements must have a @value or children
... ownedBy SΣ 1..1 Reference(Plan-Net Organization) Plan issuer
ele-1: All FHIR elements must have a @value or children
... administeredBy SΣ 1..1 Reference(Plan-Net Organization) Product administrator
ele-1: All FHIR elements must have a @value or children
... coverageArea SΣ 0..* Reference(Plan-Net Location) Where product applies
ele-1: All FHIR elements must have a @value or children
... contact S 0..* BackboneElement Contact for the product
ele-1: All FHIR elements must have a @value or children
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... name S 0..1 HumanName A name associated with the contact
ele-1: All FHIR elements must have a @value or children
..... use ?!Σ 0..1 code usual | official | temp | nickname | anonymous | old | maiden
Binding: NameUse (required): The use of a human name.


ele-1: All FHIR elements must have a @value or children
..... text SΣ 0..1 string Text representation of the full name
ele-1: All FHIR elements must have a @value or children
.... telecom S 0..* ContactPoint Contact details (telephone, email, etc.) for a contact
ele-1: All FHIR elements must have a @value or children
..... system SΣC 0..1 code phone | fax | email | pager | url | sms | other
Binding: ContactPointSystem (required): Telecommunications form for contact point.


ele-1: All FHIR elements must have a @value or children
..... value SΣ 0..1 string The actual contact point details
ele-1: All FHIR elements must have a @value or children
..... use ?!Σ 0..1 code home | work | temp | old | mobile - purpose of this contact point
Binding: ContactPointUse (required): Use of contact point.


ele-1: All FHIR elements must have a @value or children
... endpoint S 0..* Reference(Plan-Net Endpoint) Technical endpoint
ele-1: All FHIR elements must have a @value or children
... network S 0..* Reference(Plan-Net Network) What networks are Included
ele-1: All FHIR elements must have a @value or children
... plan 0..* BackboneElement Cost sharing details for the plan
ele-1: All FHIR elements must have a @value or children
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... type S 0..1 CodeableConcept Categorization of the cost sharing for the plan
Binding: Insurance Plan TypeVS (extensible)
ele-1: All FHIR elements must have a @value or children
.... coverageArea SΣ 0..* Reference(Plan-Net Location) Where product applies
ele-1: All FHIR elements must have a @value or children
.... network 0..* Reference(Plan-Net Network) What networks provide coverage
ele-1: All FHIR elements must have a @value or children

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
InsurancePlan.identifier.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
InsurancePlan.identifier.typeextensibleIdentifier Type Codes
http://hl7.org/fhir/ValueSet/identifier-type
from the FHIR Standard
InsurancePlan.statusrequiredFixed Value: active
http://hl7.org/fhir/ValueSet/publication-status|4.0.1
from the FHIR Standard
InsurancePlan.typeextensibleInsuranceProductTypeVS (a valid code from Insurance Product Type)
http://hl7.org/fhir/us/davinci-pdex-plan-net/ValueSet/InsuranceProductTypeVS
from this IG
InsurancePlan.contact.name.userequiredNameUse
http://hl7.org/fhir/ValueSet/name-use|4.0.1
from the FHIR Standard
InsurancePlan.contact.telecom.systemrequiredContactPointSystem
http://hl7.org/fhir/ValueSet/contact-point-system|4.0.1
from the FHIR Standard
InsurancePlan.contact.telecom.userequiredContactPointUse
http://hl7.org/fhir/ValueSet/contact-point-use|4.0.1
from the FHIR Standard
InsurancePlan.plan.typeextensibleInsurancePlanTypeVS (a valid code from Insurance Plan Type)
http://hl7.org/fhir/us/davinci-pdex-plan-net/ValueSet/InsurancePlanTypeVS
from this IG

Constraints

IdGradePath(s)DetailsRequirements
network-or-plan-NetworkerrorInsurancePlanIf an insuranceplan does not define a network, then each plan must define one
: network.exists() or plan.network.exists()
plan-type-is-distincterrorInsurancePlanEach InsurancePlan.plan should have a distinct plan.type.
: plan.type.coding.code.isDistinct()

This structure is derived from InsurancePlan

NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan C 0..* InsurancePlan Details of a Health Insurance product/plan provided by an organization
network-or-plan-Network: If an insuranceplan does not define a network, then each plan must define one
plan-type-is-distinct: Each InsurancePlan.plan should have a distinct plan.type.
... identifier
.... type S 0..1 CodeableConcept Description of identifier
.... value S 0..1 string The value that is unique
.... assigner S 0..1 Reference(Organization) Organization that issued id (may be just text)
... status S 1..1 code draft | active | retired | unknown
Fixed Value: active
... type S 1..1 CodeableConcept Product Type
Binding: Insurance Product Type VS (extensible)
... alias S 0..* string Alternate names
... period S 0..1 Period When the product is available
... ownedBy S 1..1 Reference(Plan-Net Organization) Plan issuer
... administeredBy S 1..1 Reference(Plan-Net Organization) Product administrator
... coverageArea S 0..* Reference(Plan-Net Location) Where product applies
... contact S 0..* BackboneElement Contact for the product
.... name S 0..1 HumanName A name associated with the contact
..... text S 0..1 string Text representation of the full name
.... telecom S 0..* ContactPoint Contact details (telephone, email, etc.) for a contact
..... system S 0..1 code phone | fax | email | pager | url | sms | other
..... value S 0..1 string The actual contact point details
... endpoint S 0..* Reference(Plan-Net Endpoint) Technical endpoint
... network S 0..* Reference(Plan-Net Network) What networks are Included
... plan 0..* BackboneElement Cost sharing details for the plan
.... type S 0..1 CodeableConcept Categorization of the cost sharing for the plan
Binding: Insurance Plan TypeVS (extensible)
.... coverageArea S 0..* Reference(Plan-Net Location) Where product applies
.... network 0..* Reference(Plan-Net Network) What networks provide coverage

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
InsurancePlan.typeextensibleInsuranceProductTypeVS (a valid code from Insurance Product Type)
http://hl7.org/fhir/us/davinci-pdex-plan-net/ValueSet/InsuranceProductTypeVS
from this IG
InsurancePlan.plan.typeextensibleInsurancePlanTypeVS (a valid code from Insurance Plan Type)
http://hl7.org/fhir/us/davinci-pdex-plan-net/ValueSet/InsurancePlanTypeVS
from this IG

Constraints

IdGradePath(s)DetailsRequirements
network-or-plan-NetworkerrorInsurancePlanIf an insuranceplan does not define a network, then each plan must define one
: network.exists() or plan.network.exists()
plan-type-is-distincterrorInsurancePlanEach InsurancePlan.plan should have a distinct plan.type.
: plan.type.coding.code.isDistinct()
NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan C 0..* InsurancePlan Details of a Health Insurance product/plan provided by an organization
ipn-1: The organization SHALL at least have a name or an idendtifier, and possibly more than one
network-or-plan-Network: If an insuranceplan does not define a network, then each plan must define one
plan-type-is-distinct: Each InsurancePlan.plan should have a distinct plan.type.
... 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
... 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 ΣC 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 ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

.... type SΣ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

.... system Σ 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 Σ 0..1 Period Time period when id is/was valid for use
.... assigner SΣ 0..1 Reference(Organization) Organization that issued id (may be just text)
... status ?!SΣ 1..1 code draft | active | retired | unknown
Binding: PublicationStatus (required): The lifecycle status of an artifact.


Fixed Value: active
... type SΣ 1..1 CodeableConcept Product Type
Binding: Insurance Product Type VS (extensible)
... name SΣC 0..1 string Official name
... alias S 0..* string Alternate names
... period S 0..1 Period When the product is available
... ownedBy SΣ 1..1 Reference(Plan-Net Organization) Plan issuer
... administeredBy SΣ 1..1 Reference(Plan-Net Organization) Product administrator
... coverageArea SΣ 0..* Reference(Plan-Net Location) Where product applies
... contact S 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 0..1 CodeableConcept The type of contact
Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party.

.... 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 ?!Σ 0..1 code usual | official | temp | nickname | anonymous | old | maiden
Binding: NameUse (required): The use of a human name.

..... text SΣ 0..1 string Text representation of the full name
..... family Σ 0..1 string Family name (often called 'Surname')
..... given Σ 0..* string Given names (not always 'first'). Includes middle names
This repeating element order: Given Names appear in the correct order for presenting the name
..... prefix Σ 0..* string Parts that come before the name
This repeating element order: Prefixes appear in the correct order for presenting the name
..... suffix Σ 0..* string Parts that come after the name
This repeating element order: Suffixes appear in the correct order for presenting the name
..... period Σ 0..1 Period Time period when name was/is in use
.... telecom S 0..* ContactPoint Contact details (telephone, email, etc.) for a contact
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... system SΣC 0..1 code phone | fax | email | pager | url | sms | other
Binding: ContactPointSystem (required): Telecommunications form for contact point.

..... value SΣ 0..1 string The actual contact point details
..... use ?!Σ 0..1 code home | work | temp | old | mobile - purpose of this contact point
Binding: ContactPointUse (required): Use of contact point.

..... rank Σ 0..1 positiveInt Specify preferred order of use (1 = highest)
..... period Σ 0..1 Period Time period when the contact point was/is in use
.... address 0..1 Address Visiting or postal addresses for the contact
... endpoint S 0..* Reference(Plan-Net Endpoint) Technical endpoint
... network S 0..* Reference(Plan-Net Network) What networks are Included
... coverage 0..* BackboneElement Coverage details
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 CodeableConcept Type of coverage
.... network 0..* Reference(Organization) What networks provide coverage
.... benefit 1..* BackboneElement List of benefits
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type 1..1 CodeableConcept Type of benefit
..... requirement 0..1 string Referral requirements
..... limit 0..* BackboneElement Benefit limits
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... value 0..1 Quantity Maximum value allowed
...... code 0..1 CodeableConcept Benefit limit details
... plan 0..* BackboneElement Cost sharing details for the plan
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... identifier Σ 0..* Identifier Business Identifier for Product
.... type S 0..1 CodeableConcept Categorization of the cost sharing for the plan
Binding: Insurance Plan TypeVS (extensible)
.... coverageArea SΣ 0..* Reference(Plan-Net Location) Where product applies
.... network 0..* Reference(Plan-Net Network) What networks provide coverage
.... generalCost 0..* BackboneElement Overall costs
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type 0..1 CodeableConcept Type of cost
..... groupSize 0..1 positiveInt Number of enrollees
..... cost 0..1 Money Cost value
..... comment 0..1 string Additional cost information
.... specificCost 0..* BackboneElement Specific costs
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category 1..1 CodeableConcept General category of benefit
..... benefit 0..* BackboneElement Benefits list
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... type 1..1 CodeableConcept Type of specific benefit
...... cost 0..* BackboneElement List of the costs
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
....... type 1..1 CodeableConcept Type of cost
....... applicability 0..1 CodeableConcept in-network | out-of-network | other
Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.

....... qualifiers 0..* CodeableConcept Additional information about the cost
....... value 0..1 Quantity The actual cost value

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
InsurancePlan.languagepreferredCommonLanguages
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
Additional Bindings Purpose
AllLanguages Max Binding
InsurancePlan.identifier.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
InsurancePlan.identifier.typeextensibleIdentifier Type Codes
http://hl7.org/fhir/ValueSet/identifier-type
from the FHIR Standard
InsurancePlan.statusrequiredFixed Value: active
http://hl7.org/fhir/ValueSet/publication-status|4.0.1
from the FHIR Standard
InsurancePlan.typeextensibleInsuranceProductTypeVS (a valid code from Insurance Product Type)
http://hl7.org/fhir/us/davinci-pdex-plan-net/ValueSet/InsuranceProductTypeVS
from this IG
InsurancePlan.contact.purposeextensibleContactEntityType
http://hl7.org/fhir/ValueSet/contactentity-type
from the FHIR Standard
InsurancePlan.contact.name.userequiredNameUse
http://hl7.org/fhir/ValueSet/name-use|4.0.1
from the FHIR Standard
InsurancePlan.contact.telecom.systemrequiredContactPointSystem
http://hl7.org/fhir/ValueSet/contact-point-system|4.0.1
from the FHIR Standard
InsurancePlan.contact.telecom.userequiredContactPointUse
http://hl7.org/fhir/ValueSet/contact-point-use|4.0.1
from the FHIR Standard
InsurancePlan.plan.typeextensibleInsurancePlanTypeVS (a valid code from Insurance Plan Type)
http://hl7.org/fhir/us/davinci-pdex-plan-net/ValueSet/InsurancePlanTypeVS
from this IG
InsurancePlan.plan.specificCost.benefit.cost.applicabilityrequiredBenefitCostApplicability
http://hl7.org/fhir/ValueSet/insuranceplan-applicability|4.0.1
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
network-or-plan-NetworkerrorInsurancePlanIf an insuranceplan does not define a network, then each plan must define one
: network.exists() or plan.network.exists()
plan-type-is-distincterrorInsurancePlanEach InsurancePlan.plan should have a distinct plan.type.
: plan.type.coding.code.isDistinct()

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan C 0..* InsurancePlan Details of a Health Insurance product/plan provided by an organization
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
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
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
dom-6: A resource should have narrative for robust management
ipn-1: The organization SHALL at least have a name or an idendtifier, and possibly more than one
network-or-plan-Network: If an insuranceplan does not define a network, then each plan must define one
plan-type-is-distinct: Each InsurancePlan.plan should have a distinct plan.type.
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
ele-1: All FHIR elements must have a @value or children
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
... identifier ΣC 0..* Identifier Business Identifier for Product
ele-1: All FHIR elements must have a @value or children
.... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .


ele-1: All FHIR elements must have a @value or children
.... type SΣ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.


ele-1: All FHIR elements must have a @value or children
.... value SΣ 0..1 string The value that is unique
ele-1: All FHIR elements must have a @value or children
Example General: 123456
.... assigner SΣ 0..1 Reference(Organization) Organization that issued id (may be just text)
ele-1: All FHIR elements must have a @value or children
... type SΣ 1..1 CodeableConcept Product Type
Binding: Insurance Product Type VS (extensible)
ele-1: All FHIR elements must have a @value or children
... name SΣC 0..1 string Official name
ele-1: All FHIR elements must have a @value or children
... alias S 0..* string Alternate names
ele-1: All FHIR elements must have a @value or children
... period S 0..1 Period When the product is available
ele-1: All FHIR elements must have a @value or children
... ownedBy SΣ 1..1 Reference(Plan-Net Organization) Plan issuer
ele-1: All FHIR elements must have a @value or children
... administeredBy SΣ 1..1 Reference(Plan-Net Organization) Product administrator
ele-1: All FHIR elements must have a @value or children
... coverageArea SΣ 0..* Reference(Plan-Net Location) Where product applies
ele-1: All FHIR elements must have a @value or children
... contact S 0..* BackboneElement Contact for the product
ele-1: All FHIR elements must have a @value or children
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... name S 0..1 HumanName A name associated with the contact
ele-1: All FHIR elements must have a @value or children
..... use ?!Σ 0..1 code usual | official | temp | nickname | anonymous | old | maiden
Binding: NameUse (required): The use of a human name.


ele-1: All FHIR elements must have a @value or children
..... text SΣ 0..1 string Text representation of the full name
ele-1: All FHIR elements must have a @value or children
.... telecom S 0..* ContactPoint Contact details (telephone, email, etc.) for a contact
ele-1: All FHIR elements must have a @value or children
..... system SΣC 0..1 code phone | fax | email | pager | url | sms | other
Binding: ContactPointSystem (required): Telecommunications form for contact point.


ele-1: All FHIR elements must have a @value or children
..... value SΣ 0..1 string The actual contact point details
ele-1: All FHIR elements must have a @value or children
..... use ?!Σ 0..1 code home | work | temp | old | mobile - purpose of this contact point
Binding: ContactPointUse (required): Use of contact point.


ele-1: All FHIR elements must have a @value or children
... endpoint S 0..* Reference(Plan-Net Endpoint) Technical endpoint
ele-1: All FHIR elements must have a @value or children
... network S 0..* Reference(Plan-Net Network) What networks are Included
ele-1: All FHIR elements must have a @value or children
... plan 0..* BackboneElement Cost sharing details for the plan
ele-1: All FHIR elements must have a @value or children
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... type S 0..1 CodeableConcept Categorization of the cost sharing for the plan
Binding: Insurance Plan TypeVS (extensible)
ele-1: All FHIR elements must have a @value or children
.... coverageArea SΣ 0..* Reference(Plan-Net Location) Where product applies
ele-1: All FHIR elements must have a @value or children
.... network 0..* Reference(Plan-Net Network) What networks provide coverage
ele-1: All FHIR elements must have a @value or children

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
InsurancePlan.identifier.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
InsurancePlan.identifier.typeextensibleIdentifier Type Codes
http://hl7.org/fhir/ValueSet/identifier-type
from the FHIR Standard
InsurancePlan.statusrequiredFixed Value: active
http://hl7.org/fhir/ValueSet/publication-status|4.0.1
from the FHIR Standard
InsurancePlan.typeextensibleInsuranceProductTypeVS (a valid code from Insurance Product Type)
http://hl7.org/fhir/us/davinci-pdex-plan-net/ValueSet/InsuranceProductTypeVS
from this IG
InsurancePlan.contact.name.userequiredNameUse
http://hl7.org/fhir/ValueSet/name-use|4.0.1
from the FHIR Standard
InsurancePlan.contact.telecom.systemrequiredContactPointSystem
http://hl7.org/fhir/ValueSet/contact-point-system|4.0.1
from the FHIR Standard
InsurancePlan.contact.telecom.userequiredContactPointUse
http://hl7.org/fhir/ValueSet/contact-point-use|4.0.1
from the FHIR Standard
InsurancePlan.plan.typeextensibleInsurancePlanTypeVS (a valid code from Insurance Plan Type)
http://hl7.org/fhir/us/davinci-pdex-plan-net/ValueSet/InsurancePlanTypeVS
from this IG

Constraints

IdGradePath(s)DetailsRequirements
network-or-plan-NetworkerrorInsurancePlanIf an insuranceplan does not define a network, then each plan must define one
: network.exists() or plan.network.exists()
plan-type-is-distincterrorInsurancePlanEach InsurancePlan.plan should have a distinct plan.type.
: plan.type.coding.code.isDistinct()

Differential View

This structure is derived from InsurancePlan

NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan C 0..* InsurancePlan Details of a Health Insurance product/plan provided by an organization
network-or-plan-Network: If an insuranceplan does not define a network, then each plan must define one
plan-type-is-distinct: Each InsurancePlan.plan should have a distinct plan.type.
... identifier
.... type S 0..1 CodeableConcept Description of identifier
.... value S 0..1 string The value that is unique
.... assigner S 0..1 Reference(Organization) Organization that issued id (may be just text)
... status S 1..1 code draft | active | retired | unknown
Fixed Value: active
... type S 1..1 CodeableConcept Product Type
Binding: Insurance Product Type VS (extensible)
... alias S 0..* string Alternate names
... period S 0..1 Period When the product is available
... ownedBy S 1..1 Reference(Plan-Net Organization) Plan issuer
... administeredBy S 1..1 Reference(Plan-Net Organization) Product administrator
... coverageArea S 0..* Reference(Plan-Net Location) Where product applies
... contact S 0..* BackboneElement Contact for the product
.... name S 0..1 HumanName A name associated with the contact
..... text S 0..1 string Text representation of the full name
.... telecom S 0..* ContactPoint Contact details (telephone, email, etc.) for a contact
..... system S 0..1 code phone | fax | email | pager | url | sms | other
..... value S 0..1 string The actual contact point details
... endpoint S 0..* Reference(Plan-Net Endpoint) Technical endpoint
... network S 0..* Reference(Plan-Net Network) What networks are Included
... plan 0..* BackboneElement Cost sharing details for the plan
.... type S 0..1 CodeableConcept Categorization of the cost sharing for the plan
Binding: Insurance Plan TypeVS (extensible)
.... coverageArea S 0..* Reference(Plan-Net Location) Where product applies
.... network 0..* Reference(Plan-Net Network) What networks provide coverage

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
InsurancePlan.typeextensibleInsuranceProductTypeVS (a valid code from Insurance Product Type)
http://hl7.org/fhir/us/davinci-pdex-plan-net/ValueSet/InsuranceProductTypeVS
from this IG
InsurancePlan.plan.typeextensibleInsurancePlanTypeVS (a valid code from Insurance Plan Type)
http://hl7.org/fhir/us/davinci-pdex-plan-net/ValueSet/InsurancePlanTypeVS
from this IG

Constraints

IdGradePath(s)DetailsRequirements
network-or-plan-NetworkerrorInsurancePlanIf an insuranceplan does not define a network, then each plan must define one
: network.exists() or plan.network.exists()
plan-type-is-distincterrorInsurancePlanEach InsurancePlan.plan should have a distinct plan.type.
: plan.type.coding.code.isDistinct()

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan C 0..* InsurancePlan Details of a Health Insurance product/plan provided by an organization
ipn-1: The organization SHALL at least have a name or an idendtifier, and possibly more than one
network-or-plan-Network: If an insuranceplan does not define a network, then each plan must define one
plan-type-is-distinct: Each InsurancePlan.plan should have a distinct plan.type.
... 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
... 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 ΣC 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 ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

.... type SΣ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

.... system Σ 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 Σ 0..1 Period Time period when id is/was valid for use
.... assigner SΣ 0..1 Reference(Organization) Organization that issued id (may be just text)
... status ?!SΣ 1..1 code draft | active | retired | unknown
Binding: PublicationStatus (required): The lifecycle status of an artifact.


Fixed Value: active
... type SΣ 1..1 CodeableConcept Product Type
Binding: Insurance Product Type VS (extensible)
... name SΣC 0..1 string Official name
... alias S 0..* string Alternate names
... period S 0..1 Period When the product is available
... ownedBy SΣ 1..1 Reference(Plan-Net Organization) Plan issuer
... administeredBy SΣ 1..1 Reference(Plan-Net Organization) Product administrator
... coverageArea SΣ 0..* Reference(Plan-Net Location) Where product applies
... contact S 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 0..1 CodeableConcept The type of contact
Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party.

.... 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 ?!Σ 0..1 code usual | official | temp | nickname | anonymous | old | maiden
Binding: NameUse (required): The use of a human name.

..... text SΣ 0..1 string Text representation of the full name
..... family Σ 0..1 string Family name (often called 'Surname')
..... given Σ 0..* string Given names (not always 'first'). Includes middle names
This repeating element order: Given Names appear in the correct order for presenting the name
..... prefix Σ 0..* string Parts that come before the name
This repeating element order: Prefixes appear in the correct order for presenting the name
..... suffix Σ 0..* string Parts that come after the name
This repeating element order: Suffixes appear in the correct order for presenting the name
..... period Σ 0..1 Period Time period when name was/is in use
.... telecom S 0..* ContactPoint Contact details (telephone, email, etc.) for a contact
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... system SΣC 0..1 code phone | fax | email | pager | url | sms | other
Binding: ContactPointSystem (required): Telecommunications form for contact point.

..... value SΣ 0..1 string The actual contact point details
..... use ?!Σ 0..1 code home | work | temp | old | mobile - purpose of this contact point
Binding: ContactPointUse (required): Use of contact point.

..... rank Σ 0..1 positiveInt Specify preferred order of use (1 = highest)
..... period Σ 0..1 Period Time period when the contact point was/is in use
.... address 0..1 Address Visiting or postal addresses for the contact
... endpoint S 0..* Reference(Plan-Net Endpoint) Technical endpoint
... network S 0..* Reference(Plan-Net Network) What networks are Included
... coverage 0..* BackboneElement Coverage details
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 CodeableConcept Type of coverage
.... network 0..* Reference(Organization) What networks provide coverage
.... benefit 1..* BackboneElement List of benefits
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type 1..1 CodeableConcept Type of benefit
..... requirement 0..1 string Referral requirements
..... limit 0..* BackboneElement Benefit limits
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... value 0..1 Quantity Maximum value allowed
...... code 0..1 CodeableConcept Benefit limit details
... plan 0..* BackboneElement Cost sharing details for the plan
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... identifier Σ 0..* Identifier Business Identifier for Product
.... type S 0..1 CodeableConcept Categorization of the cost sharing for the plan
Binding: Insurance Plan TypeVS (extensible)
.... coverageArea SΣ 0..* Reference(Plan-Net Location) Where product applies
.... network 0..* Reference(Plan-Net Network) What networks provide coverage
.... generalCost 0..* BackboneElement Overall costs
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type 0..1 CodeableConcept Type of cost
..... groupSize 0..1 positiveInt Number of enrollees
..... cost 0..1 Money Cost value
..... comment 0..1 string Additional cost information
.... specificCost 0..* BackboneElement Specific costs
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category 1..1 CodeableConcept General category of benefit
..... benefit 0..* BackboneElement Benefits list
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... type 1..1 CodeableConcept Type of specific benefit
...... cost 0..* BackboneElement List of the costs
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
....... type 1..1 CodeableConcept Type of cost
....... applicability 0..1 CodeableConcept in-network | out-of-network | other
Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.

....... qualifiers 0..* CodeableConcept Additional information about the cost
....... value 0..1 Quantity The actual cost value

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
InsurancePlan.languagepreferredCommonLanguages
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
Additional Bindings Purpose
AllLanguages Max Binding
InsurancePlan.identifier.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
InsurancePlan.identifier.typeextensibleIdentifier Type Codes
http://hl7.org/fhir/ValueSet/identifier-type
from the FHIR Standard
InsurancePlan.statusrequiredFixed Value: active
http://hl7.org/fhir/ValueSet/publication-status|4.0.1
from the FHIR Standard
InsurancePlan.typeextensibleInsuranceProductTypeVS (a valid code from Insurance Product Type)
http://hl7.org/fhir/us/davinci-pdex-plan-net/ValueSet/InsuranceProductTypeVS
from this IG
InsurancePlan.contact.purposeextensibleContactEntityType
http://hl7.org/fhir/ValueSet/contactentity-type
from the FHIR Standard
InsurancePlan.contact.name.userequiredNameUse
http://hl7.org/fhir/ValueSet/name-use|4.0.1
from the FHIR Standard
InsurancePlan.contact.telecom.systemrequiredContactPointSystem
http://hl7.org/fhir/ValueSet/contact-point-system|4.0.1
from the FHIR Standard
InsurancePlan.contact.telecom.userequiredContactPointUse
http://hl7.org/fhir/ValueSet/contact-point-use|4.0.1
from the FHIR Standard
InsurancePlan.plan.typeextensibleInsurancePlanTypeVS (a valid code from Insurance Plan Type)
http://hl7.org/fhir/us/davinci-pdex-plan-net/ValueSet/InsurancePlanTypeVS
from this IG
InsurancePlan.plan.specificCost.benefit.cost.applicabilityrequiredBenefitCostApplicability
http://hl7.org/fhir/ValueSet/insuranceplan-applicability|4.0.1
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
network-or-plan-NetworkerrorInsurancePlanIf an insuranceplan does not define a network, then each plan must define one
: network.exists() or plan.network.exists()
plan-type-is-distincterrorInsurancePlanEach InsurancePlan.plan should have a distinct plan.type.
: plan.type.coding.code.isDistinct()

 

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