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 
JSON Format: InsurancePlan-insuranceplan1
Raw json
{
"resourceType" : "InsurancePlan",
"id" : "insuranceplan1",
"text" : {
"status" : "generated",
"div" : "<div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: insuranceplan1</p><p><b>identifier</b>: HIOS product ID = 1234567891 (OFFICIAL)</p><p><b>status</b>: ACTIVE</p><p><b>type</b>: Bronze <span style="background: LightGoldenRodYellow">(Details : {http://hl7.org/fhir/uv/vhdir/CodeSystem/codesystem-payercharacteristics code 'bronze' = 'Bronze', given as 'Bronze'})</span></p><p><b>name</b>: Patriot PPO Standard</p><p><b>alias</b>: Patriot Plus</p><p><b>period</b>: 06/06/2018 --> 01/01/2019</p><p><b>ownedBy</b>: <a href="Organization-homeland.html">Homeland Health Insurance. Generated Summary: id: homeland; active; <span title="Codes: {http://terminology.hl7.org/CodeSystem/organization-type ins}">Health System</span>; name: Homeland Health Insurance</a></p><p><b>administeredBy</b>: <a href="Organization-homeland.html">Homeland Health Insurance. Generated Summary: id: homeland; active; <span title="Codes: {http://terminology.hl7.org/CodeSystem/organization-type ins}">Health System</span>; name: Homeland Health Insurance</a></p><p><b>coverageArea</b>: <a href="Location-wash-dc-metro.html">Washington, DC metro area. Generated Summary: id: wash-dc-metro; status: active; name: Washington, DC metro area; <span title="Codes: {http://terminology.hl7.org/CodeSystem/location-physical-type area}">Area</span></a></p><h3>Contacts</h3><table class="grid"><tr><td>-</td><td><b>Purpose</b></td><td><b>Telecom</b></td></tr><tr><td>*</td><td>General information <span style="background: LightGoldenRodYellow">(Details : {http://terminology.hl7.org/CodeSystem/contactentity-type code 'PATINF' = 'Patient', given as 'Patient'})</span></td><td>ph: 202-123-5555</td></tr></table><p><b>endpoint</b>: patriot plan endpoint hub</p><p><b>network</b>: </p><ul><li><a href="Organization-patriotppo.html">Patriot Preferred Provider Network. Generated Summary: id: patriotppo; Healthcare.gov Network ID = DCN001 (SECONDARY); active; <span title="Codes: {http://hl7.org/fhir/uv/vhdir/CodeSystem/codesystem-network-type ppo}">PPO</span>; name: Patriot Preferred Provider Network; alias: Patriot PPO</a></li><li><a href="Organization-patriotdental.html">Patriot Dental Provider Network. Generated Summary: id: patriotdental; active; <span title="Codes: {http://terminology.hl7.org/CodeSystem/organization-type pay}">Health System</span>; name: Patriot Dental Provider Network</a></li></ul><blockquote><p><b>coverage</b></p><p><b>type</b>: Coverage related to medical inpatient, outpatient, diagnostic, and preventive care <span style="background: LightGoldenRodYellow">(Details : {[not stated] code 'medical' = 'medical', given as 'Medical'})</span></p><p><b>network</b>: <a href="Organization-patriotppo.html">Patriot Preferred Provider Network. Generated Summary: id: patriotppo; Healthcare.gov Network ID = DCN001 (SECONDARY); active; <span title="Codes: {http://hl7.org/fhir/uv/vhdir/CodeSystem/codesystem-network-type ppo}">PPO</span>; name: Patriot Preferred Provider Network; alias: Patriot PPO</a></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Primary care visit to treat an injury or illness <span style="background: LightGoldenRodYellow">(Details : {[not stated] code '001' = '001', given as 'Primary care visit to treat an injury or illness'})</span></p><p><b>requirement</b>: N/A</p><h3>Limits</h3><table class="grid"><tr><td>-</td><td><b>Code</b></td></tr><tr><td>*</td><td>unlimited <span style="background: LightGoldenRodYellow">(Details )</span></td></tr></table></blockquote></blockquote><blockquote><p><b>coverage</b></p><p><b>type</b>: Coverage related to dental care <span style="background: LightGoldenRodYellow">(Details : {[not stated] code 'dental' = 'dental', given as 'Dental'})</span></p><p><b>network</b>: <a href="Organization-patriotdental.html">Patriot Dental Provider Network. Generated Summary: id: patriotdental; active; <span title="Codes: {http://terminology.hl7.org/CodeSystem/organization-type pay}">Health System</span>; name: Patriot Dental Provider Network</a></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Periodic oral checkup <span style="background: LightGoldenRodYellow">(Details : {[not stated] code '052' = '052', given as 'Basic Dental Care – Adult'})</span></p><p><b>requirement</b>: N/A</p><h3>Limits</h3><table class="grid"><tr><td>-</td><td><b>Value</b></td><td><b>Code</b></td></tr><tr><td>*</td><td>2 visit/yr<span style="background: LightGoldenRodYellow"> (Details: UCUM code {visit}/a = '{visit}/a')</span></td><td>biannual oral checkup <span style="background: LightGoldenRodYellow">(Details )</span></td></tr></table></blockquote></blockquote><blockquote><p><b>plan</b></p><p><b>identifier</b>: HIOS plan ID = 123456789101112 (OFFICIAL)</p><p><b>type</b>: Bronze <span style="background: LightGoldenRodYellow">(Details : {[not stated] code 'bronze' = 'bronze', given as 'Bronze'})</span></p><p><b>coverageArea</b>: <a href="Location-wash-dc-metro.html">Washington, DC metro area. Generated Summary: id: wash-dc-metro; status: active; name: Washington, DC metro area; <span title="Codes: {http://terminology.hl7.org/CodeSystem/location-physical-type area}">Area</span></a></p><p><b>network</b>: <a href="Organization-patriotdental.html">Patriot Dental Provider Network. Generated Summary: id: patriotdental; active; <span title="Codes: {http://terminology.hl7.org/CodeSystem/organization-type pay}">Health System</span>; name: Patriot Dental Provider Network</a></p><h3>GeneralCosts</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td><td><b>GroupSize</b></td><td><b>Cost</b></td><td><b>Comment</b></td></tr><tr><td>*</td><td>Deductible <span style="background: LightGoldenRodYellow">(Details : {[not stated] code 'deductible' = 'deductible', given as 'Deductible'})</span></td><td>1</td><td/><td>Includes all prescription and medical costs for in-network providers</td></tr></table><blockquote><p><b>specificCost</b></p><p><b>category</b>: Medical <span style="background: LightGoldenRodYellow">(Details : {[not stated] code 'medical' = 'medical', given as 'Medical'})</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Primary care visit to treat an injury or illness <span style="background: LightGoldenRodYellow">(Details : {[not stated] code '001' = '001', given as 'Primary care visit to treat an injury or illness'})</span></p><h3>Costs</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td><td><b>Applicability</b></td><td><b>Qualifiers</b></td><td><b>Value</b></td></tr><tr><td>*</td><td>Copay <span style="background: LightGoldenRodYellow">(Details : {[not stated] code 'copay' = 'copay', given as 'Copay'})</span></td><td>In Network <span style="background: LightGoldenRodYellow">(Details : {http://terminology.hl7.org/CodeSystem/applicability code 'in-network' = 'In Network', given as 'In Network'})</span></td><td>in-network preferred provider <span style="background: LightGoldenRodYellow">(Details )</span></td><td>50 dollars<span style="background: LightGoldenRodYellow"> (Details: urn:iso:std:iso:4217 code USD = 'United States dollar')</span></td></tr></table></blockquote></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: Dental <span style="background: LightGoldenRodYellow">(Details : {[not stated] code 'dental' = 'dental', given as 'Dental'})</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Basic Dental Care – Adult <span style="background: LightGoldenRodYellow">(Details : {[not stated] code '052' = '052', given as 'Basic Dental Care – Adult'})</span></p><h3>Costs</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td><td><b>Applicability</b></td><td><b>Qualifiers</b></td><td><b>Value</b></td></tr><tr><td>*</td><td>Coinsurance <span style="background: LightGoldenRodYellow">(Details : {[not stated] code 'coinsurance' = 'coinsurance', given as 'Coinsurance'})</span></td><td>In Network <span style="background: LightGoldenRodYellow">(Details : {http://terminology.hl7.org/CodeSystem/applicability code 'in-network' = 'In Network', given as 'In Network'})</span></td><td>in-network provider <span style="background: LightGoldenRodYellow">(Details )</span></td><td>10 percent</td></tr></table></blockquote></blockquote></blockquote></div>"
},
"identifier" : [
{
"use" : "official",
"type" : {
"text" : "HIOS product ID"
},
"system" : "https://www.cms.gov/CCIIO/",
"value" : "1234567891",
"assigner" : {
"display" : "Centers for Medicare and Medicaid Services"
}
}
],
"status" : "active",
"type" : [
{
"coding" : [
{
"system" : "http://hl7.org/fhir/uv/vhdir/CodeSystem/codesystem-payercharacteristics",
"code" : "bronze",
"display" : "Bronze"
}
]
}
],
"name" : "Patriot PPO Standard",
"alias" : [
"Patriot Plus"
],
"period" : {
"start" : "2018-06-06",
"end" : "2019-01-01"
},
"ownedBy" : {
"reference" : "Organization/homeland",
"display" : "Homeland Health Insurance"
},
"administeredBy" : {
"reference" : "Organization/homeland",
"display" : "Homeland Health Insurance"
},
"coverageArea" : [
{
"reference" : "Location/wash-dc-metro",
"display" : "Washington, DC metro area"
}
],
"contact" : [
{
"purpose" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/contactentity-type",
"code" : "PATINF",
"display" : "Patient"
}
],
"text" : "General information"
},
"telecom" : [
{
"system" : "phone",
"value" : "202-123-5555"
},
{
"system" : "email",
"value" : "info@homelandinc.org"
}
]
}
],
"endpoint" : [
{
"display" : "patriot plan endpoint hub"
}
],
"network" : [
{
"reference" : "Organization/patriotppo",
"display" : "Patriot Preferred Provider Network"
},
{
"reference" : "Organization/patriotdental",
"display" : "Patriot Dental Provider Network"
}
],
"coverage" : [
{
"type" : {
"coding" : [
{
"code" : "medical",
"display" : "Medical"
}
],
"text" : "Coverage related to medical inpatient, outpatient, diagnostic, and preventive care"
},
"network" : [
{
"reference" : "Organization/patriotppo",
"display" : "Patriot Preferred Provider Network"
}
],
"benefit" : [
{
"type" : {
"coding" : [
{
"code" : "001",
"display" : "Primary care visit to treat an injury or illness"
}
]
},
"requirement" : "N/A",
"limit" : [
{
"code" : {
"text" : "unlimited"
}
}
]
}
]
},
{
"type" : {
"coding" : [
{
"code" : "dental",
"display" : "Dental"
}
],
"text" : "Coverage related to dental care"
},
"network" : [
{
"reference" : "Organization/patriotdental",
"display" : "Patriot Dental Provider Network"
}
],
"benefit" : [
{
"type" : {
"coding" : [
{
"code" : "052",
"display" : "Basic Dental Care – Adult"
}
],
"text" : "Periodic oral checkup"
},
"requirement" : "N/A",
"limit" : [
{
"value" : {
"value" : 2,
"unit" : "visit/yr",
"system" : "http://unitsofmeasure.org",
"code" : "{visit}/a"
},
"code" : {
"text" : "biannual oral checkup"
}
}
]
}
]
}
],
"plan" : [
{
"identifier" : [
{
"use" : "official",
"type" : {
"text" : "HIOS plan ID"
},
"system" : "https://www.cms.gov/CCIIO/",
"value" : "123456789101112",
"assigner" : {
"display" : "Centers for Medicare and Medicaid Services"
}
}
],
"type" : {
"coding" : [
{
"code" : "bronze",
"display" : "Bronze"
}
],
"text" : "Bronze"
},
"coverageArea" : [
{
"reference" : "Location/wash-dc-metro",
"display" : "Washington, DC metro area"
}
],
"network" : [
{
"reference" : "Organization/patriotdental",
"display" : "Patriot Dental Provider Network"
}
],
"generalCost" : [
{
"type" : {
"coding" : [
{
"code" : "deductible",
"display" : "Deductible"
}
],
"text" : "Deductible"
},
"groupSize" : 1,
"cost" : {
"value" : 6200,
"currency" : "USD"
},
"comment" : "Includes all prescription and medical costs for in-network providers"
}
],
"specificCost" : [
{
"category" : {
"coding" : [
{
"code" : "medical",
"display" : "Medical"
}
]
},
"benefit" : [
{
"type" : {
"coding" : [
{
"code" : "001",
"display" : "Primary care visit to treat an injury or illness"
}
]
},
"cost" : [
{
"type" : {
"coding" : [
{
"code" : "copay",
"display" : "Copay"
}
]
},
"applicability" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/applicability",
"code" : "in-network",
"display" : "In Network"
}
]
},
"qualifiers" : [
{
"text" : "in-network preferred provider"
}
],
"value" : {
"value" : 50,
"unit" : "dollars",
"system" : "urn:iso:std:iso:4217",
"code" : "USD"
}
}
]
}
]
},
{
"category" : {
"coding" : [
{
"code" : "dental",
"display" : "Dental"
}
]
},
"benefit" : [
{
"type" : {
"coding" : [
{
"code" : "052",
"display" : "Basic Dental Care – Adult"
}
]
},
"cost" : [
{
"type" : {
"coding" : [
{
"code" : "coinsurance",
"display" : "Coinsurance"
}
]
},
"applicability" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/applicability",
"code" : "in-network",
"display" : "In Network"
}
]
},
"qualifiers" : [
{
"text" : "in-network provider"
}
],
"value" : {
"value" : 10,
"unit" : "percent"
}
}
]
}
]
}
]
}
]
}
