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 
XML Format: InsurancePlan-insuranceplan1
Raw xml
<InsurancePlan xmlns="http://hl7.org/fhir"> <id value="insuranceplan1"/> <text> <status value="generated"/> <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> </text> <identifier> <use value="official"/> <type> <text value="HIOS product ID"/> </type> <system value="https://www.cms.gov/CCIIO/"/> <value value="1234567891"/> <assigner> <display value="Centers for Medicare and Medicaid Services"/> </assigner> </identifier> <status value="active"/> <type> <coding> <system value="http://hl7.org/fhir/uv/vhdir/CodeSystem/codesystem-payercharacteristics"/> <code value="bronze"/> <display value="Bronze"/> </coding> </type> <name value="Patriot PPO Standard"/> <alias value="Patriot Plus"/> <period> <start value="2018-06-06"/> <end value="2019-01-01"/> </period> <ownedBy> <reference value="Organization/homeland"/> <display value="Homeland Health Insurance"/> </ownedBy> <administeredBy> <reference value="Organization/homeland"/> <display value="Homeland Health Insurance"/> </administeredBy> <coverageArea> <reference value="Location/wash-dc-metro"/> <display value="Washington, DC metro area"/> </coverageArea> <contact> <purpose> <coding> <system value="http://terminology.hl7.org/CodeSystem/contactentity-type"/> <code value="PATINF"/> <display value="Patient"/> </coding> <text value="General information"/> </purpose> <telecom> <system value="phone"/> <value value="202-123-5555"/> </telecom> <telecom> <system value="email"/> <value value="info@homelandinc.org"/> </telecom> </contact> <endpoint> <display value="patriot plan endpoint hub"/> </endpoint> <network> <reference value="Organization/patriotppo"/> <display value="Patriot Preferred Provider Network"/> </network> <network> <reference value="Organization/patriotdental"/> <display value="Patriot Dental Provider Network"/> </network> <coverage> <type> <coding> <code value="medical"/> <display value="Medical"/> </coding> <text value="Coverage related to medical inpatient, outpatient, diagnostic, and preventive care"/> </type> <network> <reference value="Organization/patriotppo"/> <display value="Patriot Preferred Provider Network"/> </network> <benefit> <type> <coding> <code value="001"/> <display value="Primary care visit to treat an injury or illness"/> </coding> </type> <requirement value="N/A"/> <limit> <code> <text value="unlimited"/> </code> </limit> </benefit> </coverage> <coverage> <type> <coding> <code value="dental"/> <display value="Dental"/> </coding> <text value="Coverage related to dental care"/> </type> <network> <reference value="Organization/patriotdental"/> <display value="Patriot Dental Provider Network"/> </network> <benefit> <type> <coding> <code value="052"/> <display value="Basic Dental Care – Adult"/> </coding> <text value="Periodic oral checkup"/> </type> <requirement value="N/A"/> <limit> <value> <value value="2"/> <unit value="visit/yr"/> <system value="http://unitsofmeasure.org"/> <code value="{visit}/a"/> </value> <code> <text value="biannual oral checkup"/> </code> </limit> </benefit> </coverage> <plan> <identifier> <use value="official"/> <type> <text value="HIOS plan ID"/> </type> <system value="https://www.cms.gov/CCIIO/"/> <value value="123456789101112"/> <assigner> <display value="Centers for Medicare and Medicaid Services"/> </assigner> </identifier> <type> <coding> <code value="bronze"/> <display value="Bronze"/> </coding> <text value="Bronze"/> </type> <coverageArea> <reference value="Location/wash-dc-metro"/> <display value="Washington, DC metro area"/> </coverageArea> <network> <reference value="Organization/patriotdental"/> <display value="Patriot Dental Provider Network"/> </network> <generalCost> <type> <coding> <code value="deductible"/> <display value="Deductible"/> </coding> <text value="Deductible"/> </type> <groupSize value="1"/> <cost> <value value="6200"/> <currency value="USD"/> </cost> <comment value="Includes all prescription and medical costs for in-network providers"/> </generalCost> <specificCost> <category> <coding> <code value="medical"/> <display value="Medical"/> </coding> </category> <benefit> <type> <coding> <code value="001"/> <display value="Primary care visit to treat an injury or illness"/> </coding> </type> <cost> <type> <coding> <code value="copay"/> <display value="Copay"/> </coding> </type> <applicability> <coding> <system value="http://terminology.hl7.org/CodeSystem/applicability"/> <code value="in-network"/> <display value="In Network"/> </coding> </applicability> <qualifiers> <text value="in-network preferred provider"/> </qualifiers> <value> <value value="50"/> <unit value="dollars"/> <system value="urn:iso:std:iso:4217"/> <code value="USD"/> </value> </cost> </benefit> </specificCost> <specificCost> <category> <coding> <code value="dental"/> <display value="Dental"/> </coding> </category> <benefit> <type> <coding> <code value="052"/> <display value="Basic Dental Care – Adult"/> </coding> </type> <cost> <type> <coding> <code value="coinsurance"/> <display value="Coinsurance"/> </coding> </type> <applicability> <coding> <system value="http://terminology.hl7.org/CodeSystem/applicability"/> <code value="in-network"/> <display value="In Network"/> </coding> </applicability> <qualifiers> <text value="in-network provider"/> </qualifiers> <value> <value value="10"/> <unit value="percent"/> </value> </cost> </benefit> </specificCost> </plan> </InsurancePlan>
