This page is part of the Validated Healthcare Directory FHIR IG (v0.2.0: STU 1 Ballot 2) based on FHIR v3.5.0. . For a full list of available versions, see the Directory of published versions
Patriot PPO Standard
Generated Narrative with Details
id: insuranceplan1
identifier: HIOS product ID = 1234567891 (OFFICIAL)
status: ACTIVE
type: Bronze (Details : {http://hl7.org/fhir/uv/vhdir/CodeSystem/codesystem-payercharacteristics code 'bronze' = 'Bronze', given as 'Bronze'})
name: Patriot PPO Standard
alias: Patriot Plus
period: 06/06/2018 --> 01/01/2019
administeredBy: Homeland Health Insurance. Generated Summary: id: homeland; active; Health System; name: Homeland Health Insurance
coverageArea: Washington, DC metro area. Generated Summary: id: wash-dc-metro; status: active; name: Washington, DC metro area; Area
Contacts
- | Purpose | Telecom |
* | General information (Details : {http://terminology.hl7.org/CodeSystem/contactentity-type code 'PATINF' = 'Patient', given as 'Patient'}) | ph: 202-123-5555 |
endpoint: patriot plan endpoint hub
network:
- Patriot Preferred Provider Network. Generated Summary: id: patriotppo; Healthcare.gov Network ID = DCN001 (SECONDARY); active; PPO; name: Patriot Preferred Provider Network; alias: Patriot PPO
- Patriot Dental Provider Network. Generated Summary: id: patriotdental; active; Health System; name: Patriot Dental Provider Network
coverage
type: Coverage related to medical inpatient, outpatient, diagnostic, and preventive care (Details : {[not stated] code 'medical' = 'medical', given as 'Medical'})
benefit
type: Primary care visit to treat an injury or illness (Details : {[not stated] code '001' = '001', given as 'Primary care visit to treat an injury or illness'})
requirement: N/A
Limits
- Code * unlimited (Details )
coverage
type: Coverage related to dental care (Details : {[not stated] code 'dental' = 'dental', given as 'Dental'})
benefit
type: Periodic oral checkup (Details : {[not stated] code '052' = '052', given as 'Basic Dental Care – Adult'})
requirement: N/A
Limits
- Value Code * 2 visit/yr (Details: UCUM code {visit}/a = '{visit}/a') biannual oral checkup (Details )
plan
identifier: HIOS plan ID = 123456789101112 (OFFICIAL)
type: Bronze (Details : {[not stated] code 'bronze' = 'bronze', given as 'Bronze'})
coverageArea: Washington, DC metro area. Generated Summary: id: wash-dc-metro; status: active; name: Washington, DC metro area; Area
GeneralCosts
- Type GroupSize Cost Comment * Deductible (Details : {[not stated] code 'deductible' = 'deductible', given as 'Deductible'}) 1 Includes all prescription and medical costs for in-network providers specificCost
category: Medical (Details : {[not stated] code 'medical' = 'medical', given as 'Medical'})
benefit
type: Primary care visit to treat an injury or illness (Details : {[not stated] code '001' = '001', given as 'Primary care visit to treat an injury or illness'})
Costs
- Type Applicability Qualifiers Value * Copay (Details : {[not stated] code 'copay' = 'copay', given as 'Copay'}) In Network (Details : {http://terminology.hl7.org/CodeSystem/applicability code 'in-network' = 'In Network', given as 'In Network'}) in-network preferred provider (Details ) 50 dollars (Details: urn:iso:std:iso:4217 code USD = 'United States dollar') specificCost
category: Dental (Details : {[not stated] code 'dental' = 'dental', given as 'Dental'})
benefit
type: Basic Dental Care – Adult (Details : {[not stated] code '052' = '052', given as 'Basic Dental Care – Adult'})
Costs
- Type Applicability Qualifiers Value * Coinsurance (Details : {[not stated] code 'coinsurance' = 'coinsurance', given as 'Coinsurance'}) In Network (Details : {http://terminology.hl7.org/CodeSystem/applicability code 'in-network' = 'In Network', given as 'In Network'}) in-network provider (Details ) 10 percent