# Benefit Limitation Extension - CARIN Digital Insurance Card v2.0.0-ballot

* [**Table of Contents**](toc.md)
* [**Artifacts Summary**](artifacts.md)
* **Benefit Limitation Extension**

## Extension: Benefit Limitation Extension (Experimental) 

| | |
| :--- | :--- |
| *Official URL*:http://hl7.org/fhir/us/insurance-card/StructureDefinition/benefit-limitation | *Version*:2.0.0-ballot |
| * Standards status: *[Informative](http://hl7.org/fhir/R4/versions.html#std-process) | *Computable Name*:BenefitLimitation |
| *Other Identifiers:*OID:2.16.840.1.113883.4.642.40.9.42.16 | |

Extension for documenting limitations and exceptions that apply to specific benefits in the SBC, carrying the limitation text as displayed along with an optional structured representation of the limit (type, value, and period)

**Context of Use**

This extension may be used on the following element(s):

* Element ID InsurancePlan.coverage.benefit
* Element ID InsurancePlan.plan.specificCost.benefit

**Usage info**

**Usages:**

* Use this Extension: [SBC Insurance Plan Profile](StructureDefinition-sbc-insurance-plan.md)
* Examples for this Extension: [Sample Health HMO Gold Plan](InsurancePlan-SBCExampleHMO.md)

You can also check for [usages in the FHIR IG Statistics](https://packages2.fhir.org/xig/resource/hl7.fhir.us.insurance-card|current/StructureDefinition/StructureDefinition-benefit-limitation.json)

### Formal Views of Extension Content

 [Description of Profiles, Differentials, Snapshots, and how the XML and JSON presentations work](http://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#structure-definitions). 

 

Other representations of profile: [CSV](StructureDefinition-benefit-limitation.csv), [Excel](StructureDefinition-benefit-limitation.xlsx), [Schematron](StructureDefinition-benefit-limitation.sch) 

#### Terminology Bindings

#### Constraints



## Resource Content

```json
{
  "resourceType" : "StructureDefinition",
  "id" : "benefit-limitation",
  "extension" : [{
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
    "valueCode" : "claims"
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
    "valueCode" : "informative",
    "_valueCode" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
        "valueCanonical" : "http://hl7.org/fhir/us/insurance-card/ImplementationGuide/hl7.fhir.us.insurance-card"
      }]
    }
  }],
  "url" : "http://hl7.org/fhir/us/insurance-card/StructureDefinition/benefit-limitation",
  "identifier" : [{
    "system" : "urn:ietf:rfc:3986",
    "value" : "urn:oid:2.16.840.1.113883.4.642.40.9.42.16"
  }],
  "version" : "2.0.0-ballot",
  "name" : "BenefitLimitation",
  "title" : "Benefit Limitation Extension",
  "status" : "draft",
  "experimental" : true,
  "date" : "2026-08-13T02:29:19+10:00",
  "publisher" : "HL7 International / Payer/Provider Information Exchange Work Group",
  "contact" : [{
    "name" : "HL7 International / Payer/Provider Information Exchange Work Group",
    "telecom" : [{
      "system" : "url",
      "value" : "http://www.hl7.org/Special/committees/claims"
    },
    {
      "system" : "email",
      "value" : "pie@lists.HL7.org"
    }]
  }],
  "description" : "Extension for documenting limitations and exceptions that apply to specific benefits in the SBC, carrying the limitation text as displayed along with an optional structured representation of the limit (type, value, and period)",
  "jurisdiction" : [{
    "coding" : [{
      "system" : "urn:iso:std:iso:3166",
      "code" : "US"
    }]
  }],
  "fhirVersion" : "4.0.1",
  "mapping" : [{
    "identity" : "rim",
    "uri" : "http://hl7.org/v3",
    "name" : "RIM Mapping"
  }],
  "kind" : "complex-type",
  "abstract" : false,
  "context" : [{
    "type" : "element",
    "expression" : "InsurancePlan.coverage.benefit"
  },
  {
    "type" : "element",
    "expression" : "InsurancePlan.plan.specificCost.benefit"
  }],
  "type" : "Extension",
  "baseDefinition" : "http://hl7.org/fhir/StructureDefinition/Extension",
  "derivation" : "constraint",
  "differential" : {
    "element" : [{
      "id" : "Extension",
      "path" : "Extension",
      "short" : "Benefit Limitation Extension",
      "definition" : "Extension for documenting limitations and exceptions that apply to specific benefits in the SBC, carrying the limitation text as displayed along with an optional structured representation of the limit (type, value, and period)"
    },
    {
      "id" : "Extension.extension:limitText",
      "path" : "Extension.extension",
      "sliceName" : "limitText",
      "short" : "Limitation or Exception",
      "definition" : "Text describing limitations, exceptions, or additional requirements that apply to this benefit, as displayed in the SBC",
      "min" : 0,
      "max" : "1"
    },
    {
      "id" : "Extension.extension:limitText.extension",
      "path" : "Extension.extension.extension",
      "max" : "0"
    },
    {
      "id" : "Extension.extension:limitText.url",
      "path" : "Extension.extension.url",
      "fixedUri" : "limitText"
    },
    {
      "id" : "Extension.extension:limitText.value[x]",
      "path" : "Extension.extension.value[x]",
      "type" : [{
        "code" : "string"
      }]
    },
    {
      "id" : "Extension.extension:limitType",
      "path" : "Extension.extension",
      "sliceName" : "limitType",
      "short" : "What the limit counts",
      "definition" : "The unit of measure for the limit, such as visits, days, or dollars",
      "min" : 0,
      "max" : "1"
    },
    {
      "id" : "Extension.extension:limitType.extension",
      "path" : "Extension.extension.extension",
      "max" : "0"
    },
    {
      "id" : "Extension.extension:limitType.url",
      "path" : "Extension.extension.url",
      "fixedUri" : "limitType"
    },
    {
      "id" : "Extension.extension:limitType.value[x]",
      "path" : "Extension.extension.value[x]",
      "type" : [{
        "code" : "CodeableConcept"
      }],
      "binding" : {
        "strength" : "extensible",
        "valueSet" : "http://hl7.org/fhir/us/insurance-card/ValueSet/limit-type"
      }
    },
    {
      "id" : "Extension.extension:limitValue",
      "path" : "Extension.extension",
      "sliceName" : "limitValue",
      "short" : "Limit amount",
      "definition" : "The numeric value of the limit",
      "min" : 0,
      "max" : "1"
    },
    {
      "id" : "Extension.extension:limitValue.extension",
      "path" : "Extension.extension.extension",
      "max" : "0"
    },
    {
      "id" : "Extension.extension:limitValue.url",
      "path" : "Extension.extension.url",
      "fixedUri" : "limitValue"
    },
    {
      "id" : "Extension.extension:limitValue.value[x]",
      "path" : "Extension.extension.value[x]",
      "type" : [{
        "code" : "Quantity"
      }]
    },
    {
      "id" : "Extension.extension:limitPeriod",
      "path" : "Extension.extension",
      "sliceName" : "limitPeriod",
      "short" : "Period over which the limit applies",
      "definition" : "The period over which the limit accrues, such as plan year, calendar year, benefit period, or lifetime",
      "min" : 0,
      "max" : "1"
    },
    {
      "id" : "Extension.extension:limitPeriod.extension",
      "path" : "Extension.extension.extension",
      "max" : "0"
    },
    {
      "id" : "Extension.extension:limitPeriod.url",
      "path" : "Extension.extension.url",
      "fixedUri" : "limitPeriod"
    },
    {
      "id" : "Extension.extension:limitPeriod.value[x]",
      "path" : "Extension.extension.value[x]",
      "type" : [{
        "code" : "CodeableConcept"
      }],
      "binding" : {
        "strength" : "extensible",
        "valueSet" : "http://hl7.org/fhir/us/insurance-card/ValueSet/limit-period"
      }
    },
    {
      "id" : "Extension.url",
      "path" : "Extension.url",
      "fixedUri" : "http://hl7.org/fhir/us/insurance-card/StructureDefinition/benefit-limitation"
    },
    {
      "id" : "Extension.value[x]",
      "path" : "Extension.value[x]",
      "max" : "0"
    }]
  }
}

```
