CARIN Digital Insurance Card
2.0.0-ballot - STU 2 Ballot

CARIN Digital Insurance Card - Downloaded Version 2.0.0-ballot See the Directory of published versions

## 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 | 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
- Examples for this Extension: Sample Health HMO Gold Plan

You can also check for usages in the FHIR IG Statistics

### Formal Views of Extension Content

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

- Text Summary
- Differential Table
- Snapshot Table
- All

This structure is derived from Extension

Summary

Complex Extension: 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)

- limitText: string: Text describing limitations, exceptions, or additional requirements that apply to this benefit, as displayed in the SBC
- limitType: CodeableConcept: The unit of measure for the limit, such as visits, days, or dollars
- limitValue: Quantity: The numeric value of the limit
- limitPeriod: CodeableConcept: The period over which the limit accrues, such as plan year, calendar year, benefit period, or lifetime

This structure is derived from Extension

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Extension |  | 0..* | Extension | Benefit Limitation Extension
Slices for extension |  |  |  | Content/Rules for all slices
extension:limitText |  | 0..1 | Extension | Limitation or Exception
extension |  | 0..0 |  | Extension
url |  | 1..1 | uri | "limitText"
value[x] |  | 0..1 | string | Value of extension
extension:limitType |  | 0..1 | Extension | What the limit counts
extension |  | 0..0 |  | Extension
url |  | 1..1 | uri | "limitType"
value[x] |  | 0..1 | CodeableConcept | Value of extension Binding: Limit Type Value Set (extensible)
extension:limitValue |  | 0..1 | Extension | Limit amount
extension |  | 0..0 |  | Extension
url |  | 1..1 | uri | "limitValue"
value[x] |  | 0..1 | Quantity | Value of extension
extension:limitPeriod |  | 0..1 | Extension | Period over which the limit applies
extension |  | 0..0 |  | Extension
url |  | 1..1 | uri | "limitPeriod"
value[x] |  | 0..1 | CodeableConcept | Value of extension Binding: Limit Period Value Set (extensible)
url |  | 1..1 | uri | "http://hl7.org/fhir/us/insurance-card/StructureDefinition/benefit-limitation"
value[x] |  | 0..0 |  | Value of extension
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Extension |  | 0..* | Extension | Benefit Limitation Extension
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
extension:limitText |  | 0..1 | Extension | Limitation or Exception
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "limitText"
value[x] |  | 0..1 | string | Value of extension
extension:limitType |  | 0..1 | Extension | What the limit counts
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "limitType"
value[x] |  | 0..1 | CodeableConcept | Value of extension Binding: Limit Type Value Set (extensible)
extension:limitValue |  | 0..1 | Extension | Limit amount
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "limitValue"
value[x] |  | 0..1 | Quantity | Value of extension
extension:limitPeriod |  | 0..1 | Extension | Period over which the limit applies
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "limitPeriod"
value[x] |  | 0..1 | CodeableConcept | Value of extension Binding: Limit Period Value Set (extensible)
url |  | 1..1 | uri | "http://hl7.org/fhir/us/insurance-card/StructureDefinition/benefit-limitation"
Documentation for this format

This structure is derived from Extension

Summary

Complex Extension: 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)

- limitText: string: Text describing limitations, exceptions, or additional requirements that apply to this benefit, as displayed in the SBC
- limitType: CodeableConcept: The unit of measure for the limit, such as visits, days, or dollars
- limitValue: Quantity: The numeric value of the limit
- limitPeriod: CodeableConcept: The period over which the limit accrues, such as plan year, calendar year, benefit period, or lifetime

Differential View

This structure is derived from Extension

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Extension |  | 0..* | Extension | Benefit Limitation Extension
Slices for extension |  |  |  | Content/Rules for all slices
extension:limitText |  | 0..1 | Extension | Limitation or Exception
extension |  | 0..0 |  | Extension
url |  | 1..1 | uri | "limitText"
value[x] |  | 0..1 | string | Value of extension
extension:limitType |  | 0..1 | Extension | What the limit counts
extension |  | 0..0 |  | Extension
url |  | 1..1 | uri | "limitType"
value[x] |  | 0..1 | CodeableConcept | Value of extension Binding: Limit Type Value Set (extensible)
extension:limitValue |  | 0..1 | Extension | Limit amount
extension |  | 0..0 |  | Extension
url |  | 1..1 | uri | "limitValue"
value[x] |  | 0..1 | Quantity | Value of extension
extension:limitPeriod |  | 0..1 | Extension | Period over which the limit applies
extension |  | 0..0 |  | Extension
url |  | 1..1 | uri | "limitPeriod"
value[x] |  | 0..1 | CodeableConcept | Value of extension Binding: Limit Period Value Set (extensible)
url |  | 1..1 | uri | "http://hl7.org/fhir/us/insurance-card/StructureDefinition/benefit-limitation"
value[x] |  | 0..0 |  | Value of extension
Documentation for this format

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Extension |  | 0..* | Extension | Benefit Limitation Extension
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
extension:limitText |  | 0..1 | Extension | Limitation or Exception
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "limitText"
value[x] |  | 0..1 | string | Value of extension
extension:limitType |  | 0..1 | Extension | What the limit counts
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "limitType"
value[x] |  | 0..1 | CodeableConcept | Value of extension Binding: Limit Type Value Set (extensible)
extension:limitValue |  | 0..1 | Extension | Limit amount
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "limitValue"
value[x] |  | 0..1 | Quantity | Value of extension
extension:limitPeriod |  | 0..1 | Extension | Period over which the limit applies
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "limitPeriod"
value[x] |  | 0..1 | CodeableConcept | Value of extension Binding: Limit Period Value Set (extensible)
url |  | 1..1 | uri | "http://hl7.org/fhir/us/insurance-card/StructureDefinition/benefit-limitation"
Documentation for this format

Other representations of profile: CSV, Excel, Schematron

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Extension.extension:limitType.​value[x] | Base | extensible | Limit Type Value Set | 📦2.0.0-ballot | This IG
Extension.extension:limitPeriod.​value[x] | Base | extensible | Limit Period Value Set | 📦2.0.0-ballot | This IG

#### Constraints

Id | Grade | Path(s) | Description | Expression