This page is part of the DaVinci PDEX Plan Net (v0.1.0: STU 1 Ballot 1) based on FHIR R4. The current version which supercedes this version is 1.1.0. For a full list of available versions, see the Directory of published versions
Definitions for plannet-InsurancePlan.
1. InsurancePlan | |
Definition | A InsurancePlan 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. |
Control | 0..* |
Invariants | Defined on this element dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (: contained.contained.empty()) dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()) dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()) dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (: contained.meta.security.empty()) dom-6: A resource should have narrative for robust management (: text.div.exists()) ipn-1: The organization SHALL at least have a name or an idendtifier, and possibly more than one (: (identifier.count() + name.count()) > 0) |
2. InsurancePlan.id | |
Definition | The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. |
Control | 0..1 |
Type | id |
Comments | The only time that a resource does not have an id is when it is being submitted to the server using a create operation. |
3. InsurancePlan.meta | |
Definition | The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource. |
Control | 0..1 |
Type | Meta |
4. InsurancePlan.implicitRules | |
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. |
Control | 0..1 |
Type | uri |
Is Modifier | true |
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. |
5. InsurancePlan.language | |
Definition | The base language in which the resource is written. |
Control | 0..1 |
Binding | A human language. The codes SHOULD be taken from CommonLanguages Max Binding: AllLanguages |
Type | code |
Comments | Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). |
6. InsurancePlan.text | |
Definition | A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. |
Control | 0..1 |
Type | Narrative |
Alternate Names | narrative, html, xhtml, display |
Comments | Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later. |
7. InsurancePlan.contained | |
Definition | These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. |
Control | 0..* |
Type | Resource |
Alternate Names | inline resources, anonymous resources, contained resources |
Comments | This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels. |
8. InsurancePlan.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
9. InsurancePlan.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
10. InsurancePlan.identifier | |
Definition | Business identifiers assigned to this health insurance product which remain constant as the resource is updated and propagates from server to server. |
Note | This is a business identifier, not a resource identifier (see discussion) |
Control | 0..* This element is affected by the following invariants: ipn-1 |
Type | Identifier |
11. InsurancePlan.identifier.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
12. InsurancePlan.identifier.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Slicing | This element introduces a set of slices on InsurancePlan.identifier.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
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13. InsurancePlan.identifier.use | |
Definition | The purpose of this identifier. |
Control | 0..1 |
Binding | Identifies the purpose for this identifier, if known . The codes SHALL be taken from IdentifierUse |
Type | code |
Is Modifier | true |
Must Support | true |
Requirements | Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. |
Comments | Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. |
14. InsurancePlan.identifier.type | |
Definition | A coded type for the identifier that can be used to determine which identifier to use for a specific purpose. |
Control | 0..1 |
Binding | A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. The codes SHALL be taken from Identifier Type Codes; other codes may be used where these codes are not suitable |
Type | CodeableConcept |
Must Support | true |
Requirements | Allows users to make use of identifiers when the identifier system is not known. |
Comments | This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type. |
15. InsurancePlan.identifier.system | |
Definition | Establishes the namespace for the value - that is, a URL that describes a set values that are unique. |
Control | 0..1 |
Type | uri |
Must Support | true |
Requirements | There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers. |
Comments | Identifier.system is always case sensitive. |
Example | General:http://www.acme.com/identifiers/patient |
16. InsurancePlan.identifier.value | |
Definition | The portion of the identifier typically relevant to the user and which is unique within the context of the system. |
Control | 0..1 |
Type | string |
Must Support | true |
Comments | If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe. |
Example | General:123456 |
17. InsurancePlan.identifier.period | |
Definition | Time period during which identifier is/was valid for use. |
Control | 0..1 |
Type | Period |
Must Support | true |
18. InsurancePlan.identifier.assigner | |
Definition | Organization that issued/manages the identifier. |
Control | 0..1 |
Type | Reference(Organization) |
Must Support | true |
Comments | The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization. |
19. InsurancePlan.status | |
Definition | The current state of the health insurance product. |
Control | 1..1 |
Binding | The lifecycle status of an artifact. The codes SHALL be taken from PublicationStatus |
Type | code |
Is Modifier | true |
Must Support | true |
Requirements | Need a flag to indicate a record is no longer to be used and should generally be hidden for the user in the UI. |
Meaning if Missing | Default interpretation is active. |
20. InsurancePlan.type | |
Definition | The kind of health insurance product. |
Control | 0..1 |
Binding | Used to categorize the product/plan. For example codes, see InsurancePlanType |
Type | CodeableConcept |
Must Support | true |
21. InsurancePlan.name | |
Definition | Official name of the health insurance product as designated by the owner. |
Control | 0..1 This element is affected by the following invariants: ipn-1 |
Type | string |
Must Support | true |
Comments | If the name of the product/plan changes, consider putting the old name in the alias column so that it can still be located through searches. |
22. InsurancePlan.alias | |
Definition | A list of alternate names that the product is known as, or was known as in the past. |
Control | 0..* |
Type | string |
Must Support | true |
Requirements | Over time products/plans go through many changes and can be known by different names. For searching knowing previous names that the product/plan was known by can be very useful. |
Comments | There are no dates associated with the alias/historic names, as this is not intended to track when names were used, but to assist in searching so that older names can still result in identifying the product/plan. |
23. InsurancePlan.period | |
Definition | The period of time that the health insurance product is available. |
Control | 0..1 |
Type | Period |
24. InsurancePlan.ownedBy | |
Definition | The entity that is providing the health insurance product and underwriting the risk. This is typically an insurance carriers, other third-party payers, or health plan sponsors comonly referred to as 'payers'. |
Control | 1..1 |
Type | Reference(Organization) |
Must Support | true |
Alternate Names | Payer |
25. InsurancePlan.administeredBy | |
Definition | An organization which administer other services such as underwriting, customer service and/or claims processing on behalf of the health insurance product owner. |
Control | 1..1 |
Type | Reference(Organization) |
Must Support | true |
26. InsurancePlan.coverageArea | |
Definition | The geographic region in which a health insurance product's benefits apply. |
Control | 0..* |
Type | Reference(Location) |
Must Support | true |
27. InsurancePlan.contact | |
Definition | The contact for the health insurance product for a certain purpose. |
Control | 0..* |
Type | BackboneElement |
Must Support | true |
Requirements | Need to keep track of assigned contact points within bigger organization. |
Comments | Where multiple contacts for the same purpose are provided there is a standard extension that can be used to determine which one is the preferred contact to use. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
28. InsurancePlan.contact.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
29. InsurancePlan.contact.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
30. InsurancePlan.contact.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
31. InsurancePlan.contact.purpose | |
Definition | Indicates a purpose for which the contact can be reached. |
Control | 0..1 |
Binding | The purpose for which you would contact a contact party. The codes SHALL be taken from ContactEntityType; other codes may be used where these codes are not suitable |
Type | CodeableConcept |
Must Support | true |
Requirements | Need to distinguish between multiple contact persons. |
32. InsurancePlan.contact.name | |
Definition | A name associated with the contact. |
Control | 0..1 |
Type | HumanName |
Must Support | true |
Requirements | Need to be able to track the person by name. |
33. InsurancePlan.contact.name.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
34. InsurancePlan.contact.name.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Slicing | This element introduces a set of slices on InsurancePlan.contact.name.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
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35. InsurancePlan.contact.name.use | |
Definition | Identifies the purpose for this name. |
Control | 0..1 |
Binding | The use of a human name. The codes SHALL be taken from NameUse |
Type | code |
Is Modifier | true |
Must Support | true |
Requirements | Allows the appropriate name for a particular context of use to be selected from among a set of names. |
Comments | Applications can assume that a name is current unless it explicitly says that it is temporary or old. |
36. InsurancePlan.contact.name.text | |
Definition | Specifies the entire name as it should be displayed e.g. on an application UI. This may be provided instead of or as well as the specific parts. |
Control | 0..1 |
Type | string |
Must Support | true |
Requirements | A renderable, unencoded form. |
Comments | Can provide both a text representation and parts. Applications updating a name SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part. |
37. InsurancePlan.contact.name.family | |
Definition | The part of a name that links to the genealogy. In some cultures (e.g. Eritrea) the family name of a son is the first name of his father. |
Control | 0..1 |
Type | string |
Must Support | true |
Alternate Names | surname |
Comments | Family Name may be decomposed into specific parts using extensions (de, nl, es related cultures). |
38. InsurancePlan.contact.name.given | |
Definition | Given name. |
Control | 0..* |
Type | string |
Must Support | true |
Alternate Names | first name, middle name |
Comments | If only initials are recorded, they may be used in place of the full name parts. Initials may be separated into multiple given names but often aren't due to paractical limitations. This element is not called "first name" since given names do not always come first. |
39. InsurancePlan.contact.name.prefix | |
Definition | Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the start of the name. |
Control | 0..* |
Type | string |
Must Support | true |
40. InsurancePlan.contact.name.suffix | |
Definition | Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the end of the name. |
Control | 0..* |
Type | string |
Must Support | true |
41. InsurancePlan.contact.name.period | |
Definition | Indicates the period of time when this name was valid for the named person. |
Control | 0..1 |
Type | Period |
Must Support | true |
Requirements | Allows names to be placed in historical context. |
42. InsurancePlan.contact.telecom | |
Definition | A contact detail (e.g. a telephone number or an email address) by which the party may be contacted. |
Control | 0..* |
Type | ContactPoint |
Must Support | true |
Requirements | People have (primary) ways to contact them in some way such as phone, email. |
43. InsurancePlan.contact.telecom.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
44. InsurancePlan.contact.telecom.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Slicing | This element introduces a set of slices on InsurancePlan.contact.telecom.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
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45. InsurancePlan.contact.telecom.extension:tavailabletime | |
SliceName | tavailabletime |
Definition | AvailableTime indicates when an organization is available for contact |
Control | 0..* |
Type | Extension(ContactPointAvailableTime) (Extension Type: Choice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, ContactDetail, Contributor, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Dosage) |
Must Support | true |
46. InsurancePlan.contact.telecom.extension:tviaintermediary | |
SliceName | tviaintermediary |
Definition | A reference to an alternative point of contact (plannet-PractitionerRole, plannet-Organization, plannet-OrganizationAffiliation, or plannet-Location) for this organization |
Control | 0..* |
Type | Extension(CViaIntermediary) (Extension Type: Reference(PractitionerRole | Organization | OrganizationAffiliation | Location)) |
Must Support | true |
47. InsurancePlan.contact.telecom.system | |
Definition | Telecommunications form for contact point - what communications system is required to make use of the contact. |
Control | 0..1 This element is affected by the following invariants: cpt-2 |
Binding | Telecommunications form for contact point. The codes SHALL be taken from ContactPointSystem |
Type | code |
Must Support | true |
48. InsurancePlan.contact.telecom.value | |
Definition | The actual contact point details, in a form that is meaningful to the designated communication system (i.e. phone number or email address). |
Control | 0..1 |
Type | string |
Must Support | true |
Requirements | Need to support legacy numbers that are not in a tightly controlled format. |
Comments | Additional text data such as phone extension numbers, or notes about use of the contact are sometimes included in the value. |
49. InsurancePlan.contact.telecom.use | |
Definition | Identifies the purpose for the contact point. |
Control | 0..1 |
Binding | Use of contact point. The codes SHALL be taken from ContactPointUse |
Type | code |
Is Modifier | true |
Must Support | true |
Requirements | Need to track the way a person uses this contact, so a user can choose which is appropriate for their purpose. |
Comments | Applications can assume that a contact is current unless it explicitly says that it is temporary or old. |
50. InsurancePlan.contact.telecom.rank | |
Definition | Specifies a preferred order in which to use a set of contacts. ContactPoints with lower rank values are more preferred than those with higher rank values. |
Control | 0..1 |
Type | positiveInt |
Must Support | true |
Comments | Note that rank does not necessarily follow the order in which the contacts are represented in the instance. |
51. InsurancePlan.contact.telecom.period | |
Definition | Time period when the contact point was/is in use. |
Control | 0..1 |
Type | Period |
Must Support | true |
52. InsurancePlan.contact.address | |
Definition | Visiting or postal addresses for the contact. |
Control | 0..1 |
Type | Address |
Requirements | May need to keep track of a contact party's address for contacting, billing or reporting requirements. |
53. InsurancePlan.endpoint | |
Definition | The technical endpoints providing access to services operated for the health insurance product. |
Control | 0..* |
Type | Reference(Endpoint) |
Must Support | true |
Requirements | Organizations have multiple systems that provide various services and need to be able to define the technical connection details for how to connect to them, and for what purpose. |
54. InsurancePlan.network | |
Definition | Reference to the network included in the health insurance product. |
Control | 0..* |
Type | Reference(Network) |
Must Support | true |
Comments | Networks are represented as a hierarchy of organization resources. |
55. InsurancePlan.coverage | |
Definition | Details about the coverage offered by the insurance product. |
Control | 0..0 |
Type | BackboneElement |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
56. InsurancePlan.coverage.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
57. InsurancePlan.coverage.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
58. InsurancePlan.coverage.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
59. InsurancePlan.coverage.type | |
Definition | Type of coverage (Medical; Dental; Mental Health; Substance Abuse; Vision; Drug; Short Term; Long Term Care; Hospice; Home Health). |
Control | 1..1 |
Type | CodeableConcept |
60. InsurancePlan.coverage.network | |
Definition | Reference to the network that providing the type of coverage. |
Control | 0..* |
Type | Reference(Organization) |
Comments | Networks are represented as a hierarchy of organization resources. |
61. InsurancePlan.coverage.benefit | |
Definition | Specific benefits under this type of coverage. |
Control | 1..* |
Type | BackboneElement |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
62. InsurancePlan.coverage.benefit.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
63. InsurancePlan.coverage.benefit.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
64. InsurancePlan.coverage.benefit.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
65. InsurancePlan.coverage.benefit.type | |
Definition | Type of benefit (primary care; speciality care; inpatient; outpatient). |
Control | 1..1 |
Type | CodeableConcept |
66. InsurancePlan.coverage.benefit.requirement | |
Definition | The referral requirements to have access/coverage for this benefit. |
Control | 0..1 |
Type | string |
67. InsurancePlan.coverage.benefit.limit | |
Definition | The specific limits on the benefit. |
Control | 0..* |
Type | BackboneElement |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
68. InsurancePlan.coverage.benefit.limit.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
69. InsurancePlan.coverage.benefit.limit.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
70. InsurancePlan.coverage.benefit.limit.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
71. InsurancePlan.coverage.benefit.limit.value | |
Definition | The maximum amount of a service item a plan will pay for a covered benefit. For examples. wellness visits, or eyeglasses. |
Control | 0..1 |
Type | Quantity |
Comments | May also be called “eligible expense,” “payment allowance,” or “negotiated rate.”. |
72. InsurancePlan.coverage.benefit.limit.code | |
Definition | The specific limit on the benefit. |
Control | 0..1 |
Type | CodeableConcept |
Comments | Use |
73. InsurancePlan.plan | |
Definition | Details about an insurance plan. |
Control | 0..0 |
Type | BackboneElement |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
74. InsurancePlan.plan.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
75. InsurancePlan.plan.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
76. InsurancePlan.plan.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
77. InsurancePlan.plan.identifier | |
Definition | Business identifiers assigned to this health insurance plan which remain constant as the resource is updated and propagates from server to server. |
Note | This is a business identifier, not a resource identifier (see discussion) |
Control | 0..* |
Type | Identifier |
78. InsurancePlan.plan.type | |
Definition | Type of plan. For example, "Platinum" or "High Deductable". |
Control | 0..1 |
Type | CodeableConcept |
79. InsurancePlan.plan.coverageArea | |
Definition | The geographic region in which a health insurance plan's benefits apply. |
Control | 0..* |
Type | Reference(Location) |
80. InsurancePlan.plan.network | |
Definition | Reference to the network that providing the type of coverage. |
Control | 0..* |
Type | Reference(Organization) |
Comments | Networks are represented as a hierarchy of organization resources. |
81. InsurancePlan.plan.generalCost | |
Definition | Overall costs associated with the plan. |
Control | 0..* |
Type | BackboneElement |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
82. InsurancePlan.plan.generalCost.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
83. InsurancePlan.plan.generalCost.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
84. InsurancePlan.plan.generalCost.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
85. InsurancePlan.plan.generalCost.type | |
Definition | Type of cost. |
Control | 0..1 |
Type | CodeableConcept |
86. InsurancePlan.plan.generalCost.groupSize | |
Definition | Number of participants enrolled in the plan. |
Control | 0..1 |
Type | positiveInt |
87. InsurancePlan.plan.generalCost.cost | |
Definition | Value of the cost. |
Control | 0..1 |
Type | Money |
88. InsurancePlan.plan.generalCost.comment | |
Definition | Additional information about the general costs associated with this plan. |
Control | 0..1 |
Type | string |
89. InsurancePlan.plan.specificCost | |
Definition | Costs associated with the coverage provided by the product. |
Control | 0..* |
Type | BackboneElement |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
90. InsurancePlan.plan.specificCost.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
91. InsurancePlan.plan.specificCost.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
92. InsurancePlan.plan.specificCost.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
93. InsurancePlan.plan.specificCost.category | |
Definition | General category of benefit (Medical; Dental; Vision; Drug; Mental Health; Substance Abuse; Hospice, Home Health). |
Control | 1..1 |
Type | CodeableConcept |
94. InsurancePlan.plan.specificCost.benefit | |
Definition | List of the specific benefits under this category of benefit. |
Control | 0..* |
Type | BackboneElement |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
95. InsurancePlan.plan.specificCost.benefit.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
96. InsurancePlan.plan.specificCost.benefit.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
97. InsurancePlan.plan.specificCost.benefit.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
98. InsurancePlan.plan.specificCost.benefit.type | |
Definition | Type of specific benefit (preventative; primary care office visit; speciality office visit; hospitalization; emergency room; urgent care). |
Control | 1..1 |
Type | CodeableConcept |
99. InsurancePlan.plan.specificCost.benefit.cost | |
Definition | List of the costs associated with a specific benefit. |
Control | 0..* |
Type | BackboneElement |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
100. InsurancePlan.plan.specificCost.benefit.cost.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
101. InsurancePlan.plan.specificCost.benefit.cost.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
102. InsurancePlan.plan.specificCost.benefit.cost.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
103. InsurancePlan.plan.specificCost.benefit.cost.type | |
Definition | Type of cost (copay; individual cap; family cap; coinsurance; deductible). |
Control | 1..1 |
Type | CodeableConcept |
104. InsurancePlan.plan.specificCost.benefit.cost.applicability | |
Definition | Whether the cost applies to in-network or out-of-network providers (in-network; out-of-network; other). |
Control | 0..1 |
Binding | Whether the cost applies to in-network or out-of-network providers. The codes SHALL be taken from BenefitCostApplicability |
Type | CodeableConcept |
105. InsurancePlan.plan.specificCost.benefit.cost.qualifiers | |
Definition | Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA). |
Control | 0..* |
Type | CodeableConcept |
106. InsurancePlan.plan.specificCost.benefit.cost.value | |
Definition | The actual cost value. (some of the costs may be represented as percentages rather than currency, e.g. 10% coinsurance). |
Control | 0..1 |
Type | Quantity |