VhDir Implementation Guide CI Build: STU2 Ballot

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

StructureDefinition-vhdir-insuranceplan

This profile sets minimum expectations for searching for and fetching information associated with a health insurance product/plan. It identifies which core elements, extensions, vocabularies and value sets SHALL be present in the InsurancePlan resource when using this profile.

Background & Scope

A product is a discrete package of health insurance coverage benefits that are offered under a particular network type. A given payer’s products typically differ by network type and/or covered benefits. A plan pairs a product’s covered benefits with the particular cost sharing structure offered to a consumer. A given product may comprise multiple plans (i.e. each plan offers different cost sharing requirements for the same set of covered benefits).

InsurancePlan describes a health insurance offering comprised of a list of covered benefits (i.e. the product), costs associated with those benefits (i.e. the plan), and additional information about the offering, such as who it is owned and administered by, a coverage area, contact information, etc.

This profile modifies the base InsurancePlan resource in the following manner:

  • Constrains the cardinality of InsurancePlan.status (1..1), InsurancePlan.ownedBy (1..1), InsurancePlan.administeredBy (1..1), InsurancePlan.contact.name.family (1..1), InsurancePlan.contact.name.given (1..*), InsurancePlan.contact.telecom.system (1..1), and InsurancePlan.contact.telecom.value (1..1)

  • All references SHALL conform to the appropriate Validated Healthcare Directory Implementation Guide profile

  • Adds extensions:

  1. Identifier status (1..1) - indicates the status of a product or plan’s identifier
  2. Via intermediary (0..1) - a reference to an alternative point of contact for this InsurancePlan
  3. Available time (0..*) - indicates when the point of contact for an InsurancePlan is available
  4. Restriction (0..*) - indicates whether disclosure of any data associated with a service is restricted
  • Adds new value sets/updates value set bindings:

TBD

Examples:

The following are example uses for the vhdir-insuranceplan profile:

Mandatory Data Elements

The following data-elements are mandatory (i.e data MUST be present). These are presented below in a simple human-readable explanation. The Formal Profile Definition below provides the formal summary, definitions, and terminology requirements.

Each insurancePlan resource must have:

  1. A coded value in InsurancePlan.status
  2. A reference to an organization that issues the product/plan in InsurancePlan.ownedBy
  3. A reference to an organization that administers the product/plan in InsurancePlan.administeredBy
  4. For each set of coverage details, one coded type of coverage in InsurancePlan.coverage.type
  5. For each set of coverage details, at least one covered benefit in InsurancePlan.coverage.benefit, including a coded type of benefit in InsurancePlan.coverage.benefit.type
  6. For each set of specific costs associated with a Plan, a coded value indicating the general category of benefit the cost applies to in InsurancePlan.plan.specificCost.category
  7. For each set specific costs associated with a covered benefit, a coded type of benefit in InsurancePlan.plan.specificCost.benefit.type
  8. For each set of specific costs associated with covered benefits, a coded type of cost in InsurancePlan.plan.specificCost.benefit.cost.type

Formal Views of Profile Content

Description of Profiles, Differentials, and Snapshots.

The official URL for this profile is: http://hl7.org/fhir/uv/vhdir/StructureDefinition/vhdir-insuranceplan

Published on Wed Dec 06 03:38:42 AEST 2017 as a active by .

This profile builds on InsurancePlan

Complete Summary of the Mandatory Requirements

  1. A coded value in InsurancePlan.status
  2. A reference to an organization that issues the product/plan in InsurancePlan.ownedBy
  3. A reference to an organization that administers the product/plan in InsurancePlan.administeredBy
  4. For each set of coverage details, one coded type of coverage in InsurancePlan.coverage.type
  5. For each set of coverage details, at least one covered benefit in InsurancePlan.coverage.benefit, including a coded type of benefit in InsurancePlan.coverage.benefit.type
  6. For each set of specific costs associated with a Plan, a coded value indicating the general category of benefit the cost applies to in InsurancePlan.plan.specificCost.category
  7. For each set specific costs associated with a covered benefit, a coded type of benefit in InsurancePlan.plan.specificCost.benefit.type
  8. For each set of specific costs associated with covered benefits, a coded type of cost in InsurancePlan.plan.specificCost.benefit.cost.type
NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan 0..*
... id 0..1id
... meta 0..1Meta
... text 0..1Narrative
... extension 0..*ExtensionSlice: Unordered, Open by value:url
... usage-restriction 0..*Reference(VhDir Restriction)Restriction
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/usage-restriction
... identifier 0..*Identifier
.... extension 0..*ExtensionSlice: Unordered, Open by value:url
.... identifier-status 0..1codeStatus
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/identifier-status
Binding: VhDir Identifier Status Value Set (example)
.... assigner 0..1Reference(VhDir Organization)
... status 1..1code
... ownedBy 1..1Reference(VhDir Organization)
... administeredBy 1..1Reference(VhDir Organization)
... coverageArea 0..*Reference(VhDir Location)
... contact 0..*BackboneElement
.... name 0..1HumanName
..... family 1..1string
..... given 1..*string
.... telecom 0..*ContactPoint
..... extension 0..*ExtensionSlice: Unordered, Open by value:url
..... contactpoint-viaintermediary 0..1Reference(VhDir Practitionerrole | VhDir Organization | VhDir OrganizationAffiliation | VhDir Location)viaintermediary
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/contactpoint-viaintermediary
..... contactpoint-availabletime 0..*(Complex)Available time
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/contactpoint-availabletime
..... system 1..1code
..... value 1..1string
... endpoint 0..*Reference(VhDir Endpoint)
... network 0..*Reference(VhDir Network)
... coverage 0..*BackboneElement
.... type 1..1CodeableConceptBinding: VhDir Coverage Type (example)
.... network 0..*Reference(VhDir Network)
.... benefit 1..*BackboneElement
..... type 1..1CodeableConceptBinding: VhDir Benefit Type (example)
..... limit 0..*BackboneElement
...... code 0..1CodeableConceptBinding: VhDir Limit Unit (example)
... plan 0..*BackboneElement
.... identifier 0..*IdentifierBusiness identifier for plan
..... extension 0..*ExtensionSlice: Unordered, Open by value:url
..... identifier-status 0..1codeStatus
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/identifier-status
Binding: VhDir Identifier Status Value Set (example)
..... assigner 0..1Reference(VhDir Organization)
.... type 0..1CodeableConceptBinding: VhDir Plan Type (example)
.... coverageArea 0..*Reference(VhDir Location)Where plan applies
.... network 0..*Reference(VhDir Network)
.... generalCost 0..*BackboneElement
..... type 0..1CodeableConceptBinding: VhDir Insurance Plan Cost Type (example)
.... specificCost 0..*BackboneElement
..... category 1..1CodeableConceptBinding: VhDir Insurance Plan Cost Category (example)
..... benefit 0..*BackboneElement
...... type 1..1CodeableConceptBinding: VhDir Insurance Plan Benefit Type (example)
...... cost 0..*BackboneElement
....... type 1..1CodeableConceptBinding: VhDir Insurance Plan Benefit Cost Type (example)
....... qualifiers 0..*CodeableConcept

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan I0..*Details of a Health Insurance product/plan provided by an organization
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: Common Languages (preferred)
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... usage-restriction 0..*Reference(VhDir Restriction)Restriction
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/usage-restriction
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier ΣI0..*IdentifierBusiness Identifier for Product
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... identifier-status 0..1codeExtension
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/identifier-status
Binding: VhDir Identifier Status Value Set (example)
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... url 1..1"http://hl7.org/fhir/uv/vhdir/StructureDefinition/identifier-status"
..... valueCode 1..1codeactive|inactive|issued in error|revoked|pending
Binding: VhDir Identifier Status Value Set (example)
.... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required)
.... type Σ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible)
.... system Σ0..1uriThe namespace for the identifier value
Example General': http://www.acme.com/identifiers/patient
.... value Σ0..1stringThe value that is unique
Example General': 123456
.... period Σ0..1PeriodTime period when id is/was valid for use
.... assigner Σ0..1Reference(VhDir Organization)Organization that issued id (may be just text)
... status ?!Σ1..1codedraft | active | retired | unknown
Binding: PublicationStatus (required)
... type Σ0..*CodeableConceptKind of product
Binding: InsurancePlanType (example)
... name ΣI0..1stringOfficial name
... alias 0..*stringAlternate names
... period 0..1PeriodWhen the product is available
... ownedBy Σ1..1Reference(VhDir Organization)Plan issuer
... administeredBy Σ1..1Reference(VhDir Organization)Product administrator
... coverageArea Σ0..*Reference(VhDir Location)Where product applies
... contact I0..*BackboneElementContact for the product
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored if unrecognized
.... purpose 0..1CodeableConceptThe type of contact
Binding: ContactEntityType (extensible)
.... name 0..1HumanNameA name associated with the contact
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ0..1codeusual | official | temp | nickname | anonymous | old | maiden
Binding: NameUse (required)
..... text Σ0..1stringText representation of the full name
..... family Σ1..1stringFamily name (often called 'Surname')
..... given Σ1..*stringGiven names (not always 'first'). Includes middle names
This repeating element order: Given Names appear in the correct order for presenting the name
..... prefix Σ0..*stringParts that come before the name
This repeating element order: Prefixes appear in the correct order for presenting the name
..... suffix Σ0..*stringParts that come after the name
This repeating element order: Suffixes appear in the correct order for presenting the name
..... period Σ0..1PeriodTime period when name was/is in use
.... telecom 0..*ContactPointContact details (telephone, email, etc.) for a contact
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
..... contactpoint-viaintermediary 0..1Reference(VhDir Practitionerrole | VhDir Organization | VhDir OrganizationAffiliation | VhDir Location)Extension
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/contactpoint-viaintermediary
...... id 0..1stringxml:id (or equivalent in JSON)
...... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... url 1..1"http://hl7.org/fhir/uv/vhdir/StructureDefinition/contactpoint-viaintermediary"
...... valueReference 1..1Reference(VhDir Practitionerrole | VhDir Organization | VhDir OrganizationAffiliation | VhDir Location)Via intermediary
..... contactpoint-availabletime 0..*(Complex)Extension
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/contactpoint-availabletime
...... id 0..1stringxml:id (or equivalent in JSON)
...... extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
...... extension 0..*ExtensionDays of week
....... id 0..1stringxml:id (or equivalent in JSON)
....... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
....... url 1..1"daysOfWeek"
....... valueCode 1..1codeDays of the week - mon|tue|wed|thu|fri|sat|sun
Binding: DaysOfWeek (required)
...... extension 0..1ExtensionAll day
....... id 0..1stringxml:id (or equivalent in JSON)
....... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
....... url 1..1"allDay"
....... valueBoolean 1..1booleanAll day
...... extension 0..1ExtensionAvailable start time
....... id 0..1stringxml:id (or equivalent in JSON)
....... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
....... url 1..1"availableStartTime"
....... valueTime 1..1timeAvailable start time
...... extension 0..1ExtensionAvailable end time
....... id 0..1stringxml:id (or equivalent in JSON)
....... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
....... url 1..1"availableEndTime"
....... valueTime 1..1timeAvailable end time
...... url 1..1"http://hl7.org/fhir/uv/vhdir/StructureDefinition/contactpoint-availabletime"
..... system ΣI1..1codephone | fax | email | pager | url | sms | other
Binding: ContactPointSystem (required)
..... value Σ1..1stringThe actual contact point details
..... use ?!Σ0..1codehome | work | temp | old | mobile - purpose of this contact point
Binding: ContactPointUse (required)
..... rank Σ0..1positiveIntSpecify preferred order of use (1 = highest)
..... period Σ0..1PeriodTime period when the contact point was/is in use
.... address 0..1AddressVisiting or postal addresses for the contact
... endpoint 0..*Reference(VhDir Endpoint)Technical endpoint
... network 0..*Reference(VhDir Network)What networks are Included
... coverage I0..*BackboneElementCoverage details
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored if unrecognized
.... type 1..1CodeableConceptType of coverage
Binding: VhDir Coverage Type (example)
.... network 0..*Reference(VhDir Network)What networks provide coverage
.... benefit I1..*BackboneElementList of benefits
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored if unrecognized
..... type 1..1CodeableConceptType of benefit
Binding: VhDir Benefit Type (example)
..... requirement 0..1stringReferral requirements
..... limit I0..*BackboneElementBenefit limits
...... id 0..1stringxml:id (or equivalent in JSON)
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored if unrecognized
...... value 0..1QuantityMaximum value allowed
...... code 0..1CodeableConceptBenefit limit details
Binding: VhDir Limit Unit (example)
... plan I0..*BackboneElementPlan details
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored if unrecognized
.... identifier Σ0..*IdentifierBusiness identifier for plan
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
..... identifier-status 0..1codeExtension
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/identifier-status
Binding: VhDir Identifier Status Value Set (example)
...... id 0..1stringxml:id (or equivalent in JSON)
...... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... url 1..1"http://hl7.org/fhir/uv/vhdir/StructureDefinition/identifier-status"
...... valueCode 1..1codeactive|inactive|issued in error|revoked|pending
Binding: VhDir Identifier Status Value Set (example)
..... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required)
..... type Σ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible)
..... system Σ0..1uriThe namespace for the identifier value
Example General': http://www.acme.com/identifiers/patient
..... value Σ0..1stringThe value that is unique
Example General': 123456
..... period Σ0..1PeriodTime period when id is/was valid for use
..... assigner Σ0..1Reference(VhDir Organization)Organization that issued id (may be just text)
.... type 0..1CodeableConceptType of plan
Binding: VhDir Plan Type (example)
.... coverageArea Σ0..*Reference(VhDir Location)Where plan applies
.... network 0..*Reference(VhDir Network)What networks provide coverage
.... generalCost I0..*BackboneElementOverall costs
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored if unrecognized
..... type 0..1CodeableConceptType of cost
Binding: VhDir Insurance Plan Cost Type (example)
..... groupSize 0..1positiveIntNumber of enrollees
..... cost 0..1MoneyCost value
..... comment 0..1stringAdditional cost information
.... specificCost I0..*BackboneElementSpecific costs
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored if unrecognized
..... category 1..1CodeableConceptGeneral category of benefit
Binding: VhDir Insurance Plan Cost Category (example)
..... benefit I0..*BackboneElementBenefits list
...... id 0..1stringxml:id (or equivalent in JSON)
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored if unrecognized
...... type 1..1CodeableConceptType of specific benefit
Binding: VhDir Insurance Plan Benefit Type (example)
...... cost I0..*BackboneElementList of the costs
....... id 0..1stringxml:id (or equivalent in JSON)
....... extension 0..*ExtensionAdditional content defined by implementations
....... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored if unrecognized
....... type 1..1CodeableConceptType of cost
Binding: VhDir Insurance Plan Benefit Cost Type (example)
....... applicability 0..1CodeableConceptin-network | out-of-network | other
Binding: BenefitCostApplicability (required)
....... qualifiers 0..*CodeableConceptAdditional information about the cost
....... value 0..1QuantityThe actual cost value

doco Documentation for this format

Differential View

NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan 0..*
... id 0..1id
... meta 0..1Meta
... text 0..1Narrative
... extension 0..*ExtensionSlice: Unordered, Open by value:url
... usage-restriction 0..*Reference(VhDir Restriction)Restriction
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/usage-restriction
... identifier 0..*Identifier
.... extension 0..*ExtensionSlice: Unordered, Open by value:url
.... identifier-status 0..1codeStatus
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/identifier-status
Binding: VhDir Identifier Status Value Set (example)
.... assigner 0..1Reference(VhDir Organization)
... status 1..1code
... ownedBy 1..1Reference(VhDir Organization)
... administeredBy 1..1Reference(VhDir Organization)
... coverageArea 0..*Reference(VhDir Location)
... contact 0..*BackboneElement
.... name 0..1HumanName
..... family 1..1string
..... given 1..*string
.... telecom 0..*ContactPoint
..... extension 0..*ExtensionSlice: Unordered, Open by value:url
..... contactpoint-viaintermediary 0..1Reference(VhDir Practitionerrole | VhDir Organization | VhDir OrganizationAffiliation | VhDir Location)viaintermediary
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/contactpoint-viaintermediary
..... contactpoint-availabletime 0..*(Complex)Available time
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/contactpoint-availabletime
..... system 1..1code
..... value 1..1string
... endpoint 0..*Reference(VhDir Endpoint)
... network 0..*Reference(VhDir Network)
... coverage 0..*BackboneElement
.... type 1..1CodeableConceptBinding: VhDir Coverage Type (example)
.... network 0..*Reference(VhDir Network)
.... benefit 1..*BackboneElement
..... type 1..1CodeableConceptBinding: VhDir Benefit Type (example)
..... limit 0..*BackboneElement
...... code 0..1CodeableConceptBinding: VhDir Limit Unit (example)
... plan 0..*BackboneElement
.... identifier 0..*IdentifierBusiness identifier for plan
..... extension 0..*ExtensionSlice: Unordered, Open by value:url
..... identifier-status 0..1codeStatus
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/identifier-status
Binding: VhDir Identifier Status Value Set (example)
..... assigner 0..1Reference(VhDir Organization)
.... type 0..1CodeableConceptBinding: VhDir Plan Type (example)
.... coverageArea 0..*Reference(VhDir Location)Where plan applies
.... network 0..*Reference(VhDir Network)
.... generalCost 0..*BackboneElement
..... type 0..1CodeableConceptBinding: VhDir Insurance Plan Cost Type (example)
.... specificCost 0..*BackboneElement
..... category 1..1CodeableConceptBinding: VhDir Insurance Plan Cost Category (example)
..... benefit 0..*BackboneElement
...... type 1..1CodeableConceptBinding: VhDir Insurance Plan Benefit Type (example)
...... cost 0..*BackboneElement
....... type 1..1CodeableConceptBinding: VhDir Insurance Plan Benefit Cost Type (example)
....... qualifiers 0..*CodeableConcept

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan I0..*Details of a Health Insurance product/plan provided by an organization
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: Common Languages (preferred)
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... usage-restriction 0..*Reference(VhDir Restriction)Restriction
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/usage-restriction
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier ΣI0..*IdentifierBusiness Identifier for Product
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... identifier-status 0..1codeExtension
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/identifier-status
Binding: VhDir Identifier Status Value Set (example)
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... url 1..1"http://hl7.org/fhir/uv/vhdir/StructureDefinition/identifier-status"
..... valueCode 1..1codeactive|inactive|issued in error|revoked|pending
Binding: VhDir Identifier Status Value Set (example)
.... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required)
.... type Σ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible)
.... system Σ0..1uriThe namespace for the identifier value
Example General': http://www.acme.com/identifiers/patient
.... value Σ0..1stringThe value that is unique
Example General': 123456
.... period Σ0..1PeriodTime period when id is/was valid for use
.... assigner Σ0..1Reference(VhDir Organization)Organization that issued id (may be just text)
... status ?!Σ1..1codedraft | active | retired | unknown
Binding: PublicationStatus (required)
... type Σ0..*CodeableConceptKind of product
Binding: InsurancePlanType (example)
... name ΣI0..1stringOfficial name
... alias 0..*stringAlternate names
... period 0..1PeriodWhen the product is available
... ownedBy Σ1..1Reference(VhDir Organization)Plan issuer
... administeredBy Σ1..1Reference(VhDir Organization)Product administrator
... coverageArea Σ0..*Reference(VhDir Location)Where product applies
... contact I0..*BackboneElementContact for the product
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored if unrecognized
.... purpose 0..1CodeableConceptThe type of contact
Binding: ContactEntityType (extensible)
.... name 0..1HumanNameA name associated with the contact
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ0..1codeusual | official | temp | nickname | anonymous | old | maiden
Binding: NameUse (required)
..... text Σ0..1stringText representation of the full name
..... family Σ1..1stringFamily name (often called 'Surname')
..... given Σ1..*stringGiven names (not always 'first'). Includes middle names
This repeating element order: Given Names appear in the correct order for presenting the name
..... prefix Σ0..*stringParts that come before the name
This repeating element order: Prefixes appear in the correct order for presenting the name
..... suffix Σ0..*stringParts that come after the name
This repeating element order: Suffixes appear in the correct order for presenting the name
..... period Σ0..1PeriodTime period when name was/is in use
.... telecom 0..*ContactPointContact details (telephone, email, etc.) for a contact
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
..... contactpoint-viaintermediary 0..1Reference(VhDir Practitionerrole | VhDir Organization | VhDir OrganizationAffiliation | VhDir Location)Extension
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/contactpoint-viaintermediary
...... id 0..1stringxml:id (or equivalent in JSON)
...... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... url 1..1"http://hl7.org/fhir/uv/vhdir/StructureDefinition/contactpoint-viaintermediary"
...... valueReference 1..1Reference(VhDir Practitionerrole | VhDir Organization | VhDir OrganizationAffiliation | VhDir Location)Via intermediary
..... contactpoint-availabletime 0..*(Complex)Extension
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/contactpoint-availabletime
...... id 0..1stringxml:id (or equivalent in JSON)
...... extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
...... extension 0..*ExtensionDays of week
....... id 0..1stringxml:id (or equivalent in JSON)
....... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
....... url 1..1"daysOfWeek"
....... valueCode 1..1codeDays of the week - mon|tue|wed|thu|fri|sat|sun
Binding: DaysOfWeek (required)
...... extension 0..1ExtensionAll day
....... id 0..1stringxml:id (or equivalent in JSON)
....... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
....... url 1..1"allDay"
....... valueBoolean 1..1booleanAll day
...... extension 0..1ExtensionAvailable start time
....... id 0..1stringxml:id (or equivalent in JSON)
....... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
....... url 1..1"availableStartTime"
....... valueTime 1..1timeAvailable start time
...... extension 0..1ExtensionAvailable end time
....... id 0..1stringxml:id (or equivalent in JSON)
....... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
....... url 1..1"availableEndTime"
....... valueTime 1..1timeAvailable end time
...... url 1..1"http://hl7.org/fhir/uv/vhdir/StructureDefinition/contactpoint-availabletime"
..... system ΣI1..1codephone | fax | email | pager | url | sms | other
Binding: ContactPointSystem (required)
..... value Σ1..1stringThe actual contact point details
..... use ?!Σ0..1codehome | work | temp | old | mobile - purpose of this contact point
Binding: ContactPointUse (required)
..... rank Σ0..1positiveIntSpecify preferred order of use (1 = highest)
..... period Σ0..1PeriodTime period when the contact point was/is in use
.... address 0..1AddressVisiting or postal addresses for the contact
... endpoint 0..*Reference(VhDir Endpoint)Technical endpoint
... network 0..*Reference(VhDir Network)What networks are Included
... coverage I0..*BackboneElementCoverage details
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored if unrecognized
.... type 1..1CodeableConceptType of coverage
Binding: VhDir Coverage Type (example)
.... network 0..*Reference(VhDir Network)What networks provide coverage
.... benefit I1..*BackboneElementList of benefits
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored if unrecognized
..... type 1..1CodeableConceptType of benefit
Binding: VhDir Benefit Type (example)
..... requirement 0..1stringReferral requirements
..... limit I0..*BackboneElementBenefit limits
...... id 0..1stringxml:id (or equivalent in JSON)
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored if unrecognized
...... value 0..1QuantityMaximum value allowed
...... code 0..1CodeableConceptBenefit limit details
Binding: VhDir Limit Unit (example)
... plan I0..*BackboneElementPlan details
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored if unrecognized
.... identifier Σ0..*IdentifierBusiness identifier for plan
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
..... identifier-status 0..1codeExtension
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/identifier-status
Binding: VhDir Identifier Status Value Set (example)
...... id 0..1stringxml:id (or equivalent in JSON)
...... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... url 1..1"http://hl7.org/fhir/uv/vhdir/StructureDefinition/identifier-status"
...... valueCode 1..1codeactive|inactive|issued in error|revoked|pending
Binding: VhDir Identifier Status Value Set (example)
..... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required)
..... type Σ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible)
..... system Σ0..1uriThe namespace for the identifier value
Example General': http://www.acme.com/identifiers/patient
..... value Σ0..1stringThe value that is unique
Example General': 123456
..... period Σ0..1PeriodTime period when id is/was valid for use
..... assigner Σ0..1Reference(VhDir Organization)Organization that issued id (may be just text)
.... type 0..1CodeableConceptType of plan
Binding: VhDir Plan Type (example)
.... coverageArea Σ0..*Reference(VhDir Location)Where plan applies
.... network 0..*Reference(VhDir Network)What networks provide coverage
.... generalCost I0..*BackboneElementOverall costs
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored if unrecognized
..... type 0..1CodeableConceptType of cost
Binding: VhDir Insurance Plan Cost Type (example)
..... groupSize 0..1positiveIntNumber of enrollees
..... cost 0..1MoneyCost value
..... comment 0..1stringAdditional cost information
.... specificCost I0..*BackboneElementSpecific costs
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored if unrecognized
..... category 1..1CodeableConceptGeneral category of benefit
Binding: VhDir Insurance Plan Cost Category (example)
..... benefit I0..*BackboneElementBenefits list
...... id 0..1stringxml:id (or equivalent in JSON)
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored if unrecognized
...... type 1..1CodeableConceptType of specific benefit
Binding: VhDir Insurance Plan Benefit Type (example)
...... cost I0..*BackboneElementList of the costs
....... id 0..1stringxml:id (or equivalent in JSON)
....... extension 0..*ExtensionAdditional content defined by implementations
....... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored if unrecognized
....... type 1..1CodeableConceptType of cost
Binding: VhDir Insurance Plan Benefit Cost Type (example)
....... applicability 0..1CodeableConceptin-network | out-of-network | other
Binding: BenefitCostApplicability (required)
....... qualifiers 0..*CodeableConceptAdditional information about the cost
....... value 0..1QuantityThe actual cost value

doco Documentation for this format

Downloads: StructureDefinition: (XML, JSON), Schema: XML Schematron


Quick Start

Below is an overview of the required set of RESTful FHIR interactions - for example, search and read operations - for this profile. See the Conformance requirements for a complete list of supported RESTful interactions for this IG.

Supported Searches

  1. GET [base]/InsurancePlan?insuranceplan-administered-by=[id]

    Support: SHOULD support search by the insuranceplan-administered-by parameter

    • with a target type: Organization
    • including the modifiers: above, below
    • including these search paramaters which may be chained: organization-identifier, organization-name, organization-partof

  1. GET [base]/InsurancePlan?insuranceplan-coverage-benefit-type=[code]

    Support: SHALL support search by the insuranceplan-coverage-benefit-type parameter

    • including the modifiers: text

  1. GET [base]/InsurancePlan?insuranceplan-coverage-limit-value=[prefix][number]|[system]|[code]

    Support: MAY support search by the insuranceplan-coverage-limit-value parameter

    • including the comparators: eq, gt, lt, ge, le, sa, eb

  1. GET [base]/InsurancePlan?insuranceplan-coverage-network=[id]

    Support: SHALL support search by the insuranceplan-coverage-network parameter

    • with a target type: Organization
    • including these search paramaters which may be chained: organization-identifier, organization-name, organization-partof

  1. GET [base]/InsurancePlan?insuranceplan-coverage-type=[code]

    Support: SHALL support search by the insuranceplan-coverage-type parameter

    • including the modifiers: text

  1. GET [base]/InsurancePlan?insuranceplan-endpoint=[id]

    Support: SHOULD support search by the endpoint parameter

    • with a target type: Endpoint
    • including these search paramaters which may be chained: endpoint-identifier, endpoint-connection-type, endpoint-organization

  1. GET [base]/InsurancePlan?insuranceplan-general-cost-groupsize=[number]

    Support: MAY support search by the insuranceplan-general-cost-groupsize parameter

    • including the comparators: eq, gt, lt, ge, le, sa, eb

  1. GET [base]/InsurancePlan?insuranceplan-general-cost-type=[code]

    Support: MAY support search by the insuranceplan-general-cost-type parameter

    • including the modifiers: text

  1. GET [base]/InsurancePlan?insuranceplan-general-cost-value=[prefix][number]|[system]|[code]

    Support: MAY support search by the insuranceplan-general-cost-value parameter

    • including the comparators: eq, gt, lt, ge, le, sa, eb

  1. GET [base]/InsurancePlan?insuranceplan-name=[string]

    Support: SHOULD support search by the insuranceplan-name parameter

    • including the modifiers: exact, contains

  1. GET [base]/InsurancePlan?insuranceplan-owned-by=[id]

    Support: SHALL support search by the insuranceplan-owned-by parameter

    • with a target type: Organization
    • including the modifiers: above, below
    • including these search paramaters which may be chained: organization-identifier, organization-name, organization-partof

  1. GET [base]/InsurancePlan?insuranceplan-plan-coverage-area=[id]

    Support: SHOULD support search by the insuranceplan-plan-coverage-area parameter

    • with a target type: Location
    • including these search paramaters which may be chained: location-identifier, location-contains

  1. GET [base]/InsurancePlan?insuranceplan-plan-identifier=[code]

    Support: SHALL support search by the insuranceplan-plan-identifier parameter

    • including the modifiers: text, ofType

  1. GET [base]/InsurancePlan?insuranceplan-plan-network=[id]

    Support: SHALL support search by the insuranceplan-plan-network parameter

    • with a target type: Organization
    • including these search paramaters which may be chained: organization-identifier, organization-name, organization-partof

  1. GET [base]/InsurancePlan?insuranceplan-plan-type=[code]

    Support: SHALL support search by the insuranceplan-plan-type parameter

    • including the modifiers: text

  1. GET [base]/InsurancePlan?insuranceplan-product-coverage-area=[id]

    Support: SHOULD support search by the insuranceplan-product-coverage-area parameter

    • with a target type: Location
    • including these search paramaters which may be chained: location-identifier, location-contains

  1. `GET [base]/InsurancePlan?insuranceplan-product-identifier=[code]

    Support: SHALL support search by the insuranceplan-product-identifier parameter

  1. GET [base]/InsurancePlan?insuranceplan-product-network=[id]

    Support: SHALL support search by the insuranceplan-product-network parameter

    • with a target type: Organization
    • including these search paramaters which may be chained: organization-identifier, organization-name, organization-partof

  1. GET [base]/InsurancePlan?insuranceplan-product-type=[code]

    Support: SHALL support search by the insuranceplan-product-type parameter

    • including the modifiers: text

  1. GET [base]/InsurancePlan?insuranceplan-specific-cost-benefit-type=[code]

    Support: SHOULD support search by the insuranceplan-specific-cost-benefit-type parameter

    • including the modifiers: text

  1. GET [base]/InsurancePlan?insuranceplan-specific-cost-category=[code]

    Support: SHOULD support search by the insuranceplan-specific-cost-category parameter

    • including the modifiers: text

  1. GET [base]/InsurancePlan?insuranceplan-specific-cost-cost-type=[code]

    Support: MAY support search by the insuranceplan-specific-cost-cost-type parameter

    • including the modifiers: text

  1. GET [base]/InsurancePlan?insuranceplan-specific-cost-value=[prefix][number]|[system]|[code]

    Support: MAY support search by the insuranceplan-specific-cost-value parameter

    • including the comparators: eq, gt, lt, ge, le, sa, eb

  1. GET [base]/InsurancePlan?insuranceplan-status=[code]

    Support: SHALL support search by the insuranceplan-status parameter