National Directory of Healthcare Providers & Services (NDH) Implementation Guide
1.0.0-ballot - ballot United States of America flag

This page is part of the National Directory of Healthcare Providers and Services (NDH) Implementation Guide (v1.0.0-ballot: STU1 Ballot 1) based on FHIR R4. . For a full list of available versions, see the Directory of published versions

Resource Profile: NDH Exchange InsurancePlan Profile

Official URL: http://hl7.org/fhir/us/ndh/StructureDefinition/ndhEx-InsurancePlan Version: 1.0.0-ballot
Active as of 2023-07-30 Computable Name: NdhExInsurancePlan

An 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.

Usage:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from NdhInsurancePlan

NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan C0..*NdhInsurancePlanDetails of a Health Insurance product/plan provided by an organization
plan-type-is-distinct: Each InsurancePlan.plan should have a distinct plan.type.
... meta
.... profile 1..1canonical(StructureDefinition)Profiles this resource claims to conform to
... extension 1..*ExtensionExtension
... extension:verification-status S1..1VerificationStatusNDH Verification Status
.... extension 1..*ExtensionExtension
.... extension:identifier-status S1..1IdentifierStatusNDH Identifier Status
.... use S0..1codeusual | official | temp | secondary | old (If known)
.... type S0..1CodeableConceptDescription of identifier
.... system S0..1uriThe namespace for the identifier value
.... value S0..1stringThe value that is unique
.... assigner S0..1Reference(NDH Exchange Organization Profile)Organization that issued id (may be just text)
... alias S0..*stringAlternate names
... period S0..1PeriodWhen the product is available
... ownedBy 1..1Reference(NDH Exchange Organization Profile)Plan issuer
... administeredBy 1..1Reference(NDH Exchange Organization Profile)Product administrator
... coverageArea 0..*Reference(NDH Exchange Location Profile)Where product applies
... contact S0..*BackboneElementContact for the product
.... purpose S0..1CodeableConceptThe type of contact
.... name S0..1HumanNameA name associated with the contact
..... use S0..1codeusual | official | temp | nickname | anonymous | old | maiden
..... text S0..1stringText representation of the full name
..... family S0..1stringFamily name (often called 'Surname')
..... given S0..*stringGiven names (not always 'first'). Includes middle names
..... prefix S0..*stringParts that come before the name
..... suffix S0..*stringParts that come after the name
..... period S0..1PeriodTime period when name was/is in use
.... telecom S0..*ContactPointContact details (telephone, email, etc.) for a contact
..... extension:contactpoint-availabletime S0..*ContactPointAvailableTimeNDH Contactpoint Availabletime
..... extension:via-intermediary S0..1ViaIntermediaryNDH Via Intermediary
..... system S0..1codephone | fax | email | pager | url | sms | other
..... value S0..1stringThe actual contact point details
..... use S0..1codehome | work | temp | old | mobile - purpose of this contact point
..... rank S0..1positiveIntSpecify preferred order of use (1 = highest)
... endpoint S0..*Reference(NDH Exchange Endpoint Profile)Technical endpoint
... network 0..*Reference(NDH Exchange Network Profile)What networks are Included
... coverage S0..*BackboneElementCoverage details
.... type S1..1CodeableConceptType of coverage
.... network 0..*Reference(NDH Exchange Network Profile)What networks provide coverage
.... benefit S1..*BackboneElementList of benefits
..... type S1..1CodeableConceptType of benefit
..... requirement S0..1stringReferral requirements
..... limit S0..*BackboneElementBenefit limits
...... value S0..1QuantityMaximum value allowed
...... code S0..1CodeableConceptBenefit limit details
... plan S0..*BackboneElementCost sharing details for the plan
.... identifier S0..*IdentifierBusiness Identifier for Product
..... extension:identifier-status S0..1IdentifierStatusNDH Identifier Status
..... use S0..1codeusual | official | temp | secondary | old (If known)
..... type S0..1CodeableConceptDescription of identifier
..... system S0..1uriThe namespace for the identifier value
..... value S0..1stringThe value that is unique
..... period S0..1PeriodTime period when id is/was valid for use
..... assigner S0..1Reference(NDH Exchange Organization Profile)Organization that issued id (may be just text)
.... type S0..1CodeableConceptCategorization of the cost sharing for the plan
.... coverageArea S0..*Reference(NDH Exchange Location Profile)Where product applies
.... network S0..*Reference(NDH Exchange Network Profile)What networks provide coverage
.... generalCost S0..*BackboneElementOverall costs
..... type S0..1CodeableConceptType of cost
..... groupSize S0..1positiveIntNumber of enrollees
..... cost S0..1MoneyCost value
..... comment S0..1stringAdditional cost information
.... specificCost S0..*BackboneElementSpecific costs
..... category S1..1CodeableConceptGeneral category of benefit
..... benefit S0..*BackboneElementBenefits list
...... type S1..1CodeableConceptType of specific benefit
...... cost S0..*BackboneElementList of the costs
....... type S1..1CodeableConceptType of cost
....... applicability S0..1CodeableConceptin-network | out-of-network | other
....... qualifiers S0..*CodeableConceptAdditional information about the cost
....... value S0..1QuantityThe actual cost value

doco Documentation for this format

Constraints

IdGradePath(s)DetailsRequirements
plan-type-is-distincterrorInsurancePlanEach InsurancePlan.plan should have a distinct plan.type.
: plan.type.coding.code.isDistinct()
NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan C0..*NdhInsurancePlanDetails of a Health Insurance product/plan provided by an organization
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
... usage-restriction 0..*Reference(NDH Base Restriction) {c}Usage Restriction
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-usage-restriction
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier SΣC0..*IdentifierBusiness Identifier for Product
.... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
.... identifier-status S1..1codeNDH Identifier Status
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-identifier-status
Binding: Identifier Status Value Set (required)
.... use ?!SΣ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

.... type SΣ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

.... system SΣ0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value SΣ0..1stringThe value that is unique
Example General: 123456
.... assigner SΣ0..1Reference(NDH Exchange Organization Profile)Organization that issued id (may be just text)
... status ?!SΣ1..1codedraft | active | retired | unknown
Binding: PublicationStatus (required): The lifecycle status of an artifact.


Fixed Value: active
... type SΣ1..1CodeableConceptProduct Type
Binding: Insurance Product Type Value Set (extensible)
... name SΣC0..1stringOfficial name
... alias S0..*stringAlternate names
... period S0..1PeriodWhen the product is available
... ownedBy SΣ1..1Reference(NDH Exchange Organization Profile)Plan issuer
... administeredBy SΣ1..1Reference(NDH Exchange Organization Profile)Product administrator
... coverageArea SΣ0..*Reference(NDH Exchange Location Profile)Where product applies
... contact S0..*BackboneElementContact for the product
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... purpose S0..1CodeableConceptThe type of contact
Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party.

.... name S0..1HumanNameA name associated with the contact
..... use ?!SΣ0..1codeusual | official | temp | nickname | anonymous | old | maiden
Binding: NameUse (required): The use of a human name.

..... text SΣ0..1stringText representation of the full name
..... family SΣ0..1stringFamily name (often called 'Surname')
..... given SΣ0..*stringGiven names (not always 'first'). Includes middle names
This repeating element order: Given Names appear in the correct order for presenting the name
..... prefix SΣ0..*stringParts that come before the name
This repeating element order: Prefixes appear in the correct order for presenting the name
..... suffix SΣ0..*stringParts that come after the name
This repeating element order: Suffixes appear in the correct order for presenting the name
..... period SΣ0..1PeriodTime period when name was/is in use
.... telecom S0..*ContactPointContact details (telephone, email, etc.) for a contact
..... contactpoint-availabletime S0..*(Complex)NDH Contactpoint Availabletime
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-contactpoint-availabletime
..... via-intermediary S0..1Reference(NDH Base PractitionerRole | NDH Base OrganizationAffiliation Profile | NDH Base Location Profile | NDH Base Organization Profile)NDH Via Intermediary
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-via-intermediary
..... system SΣC0..1codephone | fax | email | pager | url | sms | other
Binding: ContactPointSystem (required): Telecommunications form for contact point.

..... value SΣ0..1stringThe actual contact point details
..... use ?!SΣ0..1codehome | work | temp | old | mobile - purpose of this contact point
Binding: ContactPointUse (required): Use of contact point.

..... rank SΣ0..1positiveIntSpecify preferred order of use (1 = highest)
... endpoint S0..*Reference(NDH Exchange Endpoint Profile)Technical endpoint
... network S0..*Reference(NDH Exchange Network Profile)What networks are Included
... coverage S0..*BackboneElementCoverage details
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type S1..1CodeableConceptType of coverage
Binding: NDH Insurance Coverage Type Value Set (extensible)
.... network S0..*Reference(NDH Exchange Network Profile)What networks provide coverage
.... benefit S1..*BackboneElementList of benefits
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type S1..1CodeableConceptType of benefit
Binding: NDH Benefit Type Value Set (extensible)
..... requirement S0..1stringReferral requirements
..... limit S0..*BackboneElementBenefit limits
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... value S0..1QuantityMaximum value allowed
...... code S0..1CodeableConceptBenefit limit details
... plan S0..*BackboneElementCost sharing details for the plan
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... identifier SΣ0..*IdentifierBusiness Identifier for Product
..... identifier-status S0..1codeNDH Identifier Status
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-identifier-status
Binding: Identifier Status Value Set (required)
..... use ?!SΣ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type SΣ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

..... system SΣ0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value SΣ0..1stringThe value that is unique
Example General: 123456
..... period SΣ0..1PeriodTime period when id is/was valid for use
..... assigner SΣ0..1Reference(NDH Exchange Organization Profile)Organization that issued id (may be just text)
.... type S0..1CodeableConceptCategorization of the cost sharing for the plan
Binding: Insurance Plan Type Value Set (extensible)
.... coverageArea SΣ0..*Reference(NDH Exchange Location Profile)Where product applies
.... network S0..*Reference(NDH Exchange Network Profile)What networks provide coverage
.... generalCost S0..*BackboneElementOverall costs
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type S0..1CodeableConceptType of cost
..... groupSize S0..1positiveIntNumber of enrollees
..... cost S0..1MoneyCost value
..... comment S0..1stringAdditional cost information
.... specificCost S0..*BackboneElementSpecific costs
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... category S1..1CodeableConceptGeneral category of benefit
..... benefit S0..*BackboneElementBenefits list
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... type S1..1CodeableConceptType of specific benefit
...... cost S0..*BackboneElementList of the costs
....... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
....... type S1..1CodeableConceptType of cost
....... applicability S0..1CodeableConceptin-network | out-of-network | other
Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.

....... qualifiers S0..*CodeableConceptAdditional information about the cost
....... value S0..1QuantityThe actual cost value

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
InsurancePlan.identifier.userequiredIdentifierUse
InsurancePlan.identifier.typeextensibleIdentifier Type Codes
InsurancePlan.statusrequiredFixed Value: active
InsurancePlan.typeextensibleInsuranceProductTypeVS (a valid code from Insurance Product Type Code System)
InsurancePlan.contact.purposeextensibleContactEntityType
InsurancePlan.contact.name.userequiredNameUse
InsurancePlan.contact.telecom.systemrequiredContactPointSystem
InsurancePlan.contact.telecom.userequiredContactPointUse
InsurancePlan.coverage.typeextensibleNdhCoverageTypeVS
InsurancePlan.coverage.benefit.typeextensibleNdhBenefitTypeVS
InsurancePlan.plan.identifier.userequiredIdentifierUse
InsurancePlan.plan.identifier.typeextensibleIdentifier Type Codes
InsurancePlan.plan.typeextensibleInsurancePlanTypeVS (a valid code from Insurance Plan Type Code System)
InsurancePlan.plan.specificCost.benefit.cost.applicabilityrequiredBenefitCostApplicability
NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan C0..*NdhInsurancePlanDetails of a Health Insurance product/plan provided by an organization
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... versionId Σ0..1idVersion specific identifier
.... lastUpdated Σ1..1instantWhen the resource version last changed
.... source Σ0..1uriIdentifies where the resource comes from
.... profile Σ1..1canonical(StructureDefinition)Profiles this resource claims to conform to
.... security Σ0..*CodingSecurity Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.


.... tag Σ0..*CodingTags applied to this resource
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".


... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
... usage-restriction 0..*Reference(NDH Base Restriction) {c}Usage Restriction
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-usage-restriction
... verification-status S1..1CodeableConceptNDH Verification Status
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-verification-status
Binding: NDH Verification Status Value Set (extensible)
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier SΣC0..*IdentifierBusiness Identifier for Product
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
.... identifier-status S1..1codeNDH Identifier Status
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-identifier-status
Binding: Identifier Status Value Set (required)
.... use ?!SΣ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

.... type SΣ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

.... system SΣ0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value SΣ0..1stringThe value that is unique
Example General: 123456
.... period Σ0..1PeriodTime period when id is/was valid for use
.... assigner SΣ0..1Reference(NDH Exchange Organization Profile)Organization that issued id (may be just text)
... status ?!SΣ1..1codedraft | active | retired | unknown
Binding: PublicationStatus (required): The lifecycle status of an artifact.


Fixed Value: active
... type SΣ1..1CodeableConceptProduct Type
Binding: Insurance Product Type Value Set (extensible)
... name SΣC0..1stringOfficial name
... alias S0..*stringAlternate names
... period S0..1PeriodWhen the product is available
... ownedBy SΣ1..1Reference(NDH Exchange Organization Profile)Plan issuer
... administeredBy SΣ1..1Reference(NDH Exchange Organization Profile)Product administrator
... coverageArea SΣ0..*Reference(NDH Exchange Location Profile)Where product applies
... contact S0..*BackboneElementContact for the product
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... purpose S0..1CodeableConceptThe type of contact
Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party.

.... name S0..1HumanNameA name associated with the contact
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!SΣ0..1codeusual | official | temp | nickname | anonymous | old | maiden
Binding: NameUse (required): The use of a human name.

..... text SΣ0..1stringText representation of the full name
..... family SΣ0..1stringFamily name (often called 'Surname')
..... given SΣ0..*stringGiven names (not always 'first'). Includes middle names
This repeating element order: Given Names appear in the correct order for presenting the name
..... prefix SΣ0..*stringParts that come before the name
This repeating element order: Prefixes appear in the correct order for presenting the name
..... suffix SΣ0..*stringParts that come after the name
This repeating element order: Suffixes appear in the correct order for presenting the name
..... period SΣ0..1PeriodTime period when name was/is in use
.... telecom S0..*ContactPointContact details (telephone, email, etc.) for a contact
..... id 0..1stringUnique id for inter-element referencing
..... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... contactpoint-availabletime S0..*(Complex)NDH Contactpoint Availabletime
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-contactpoint-availabletime
..... via-intermediary S0..1Reference(NDH Base PractitionerRole | NDH Base OrganizationAffiliation Profile | NDH Base Location Profile | NDH Base Organization Profile)NDH Via Intermediary
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-via-intermediary
..... system SΣC0..1codephone | fax | email | pager | url | sms | other
Binding: ContactPointSystem (required): Telecommunications form for contact point.

..... value SΣ0..1stringThe actual contact point details
..... use ?!SΣ0..1codehome | work | temp | old | mobile - purpose of this contact point
Binding: ContactPointUse (required): Use of contact point.

..... rank SΣ0..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 S0..*Reference(NDH Exchange Endpoint Profile)Technical endpoint
... network S0..*Reference(NDH Exchange Network Profile)What networks are Included
... coverage S0..*BackboneElementCoverage details
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type S1..1CodeableConceptType of coverage
Binding: NDH Insurance Coverage Type Value Set (extensible)
.... network S0..*Reference(NDH Exchange Network Profile)What networks provide coverage
.... benefit S1..*BackboneElementList of benefits
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type S1..1CodeableConceptType of benefit
Binding: NDH Benefit Type Value Set (extensible)
..... requirement S0..1stringReferral requirements
..... limit S0..*BackboneElementBenefit limits
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... value S0..1QuantityMaximum value allowed
...... code S0..1CodeableConceptBenefit limit details
... plan S0..*BackboneElementCost sharing details for the plan
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... identifier SΣ0..*IdentifierBusiness Identifier for Product
..... id 0..1stringUnique id for inter-element referencing
..... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... identifier-status S0..1codeNDH Identifier Status
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-identifier-status
Binding: Identifier Status Value Set (required)
..... use ?!SΣ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type SΣ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

..... system SΣ0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value SΣ0..1stringThe value that is unique
Example General: 123456
..... period SΣ0..1PeriodTime period when id is/was valid for use
..... assigner SΣ0..1Reference(NDH Exchange Organization Profile)Organization that issued id (may be just text)
.... type S0..1CodeableConceptCategorization of the cost sharing for the plan
Binding: Insurance Plan Type Value Set (extensible)
.... coverageArea SΣ0..*Reference(NDH Exchange Location Profile)Where product applies
.... network S0..*Reference(NDH Exchange Network Profile)What networks provide coverage
.... generalCost S0..*BackboneElementOverall costs
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type S0..1CodeableConceptType of cost
..... groupSize S0..1positiveIntNumber of enrollees
..... cost S0..1MoneyCost value
..... comment S0..1stringAdditional cost information
.... specificCost S0..*BackboneElementSpecific costs
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... category S1..1CodeableConceptGeneral category of benefit
..... benefit S0..*BackboneElementBenefits list
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... type S1..1CodeableConceptType of specific benefit
...... cost S0..*BackboneElementList of the costs
....... id 0..1stringUnique id for inter-element referencing
....... extension 0..*ExtensionAdditional content defined by implementations
....... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
....... type S1..1CodeableConceptType of cost
....... applicability S0..1CodeableConceptin-network | out-of-network | other
Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.

....... qualifiers S0..*CodeableConceptAdditional information about the cost
....... value S0..1QuantityThe actual cost value

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
InsurancePlan.meta.securityextensibleAll Security Labels
InsurancePlan.meta.tagexampleCommonTags
InsurancePlan.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
InsurancePlan.identifier.userequiredIdentifierUse
InsurancePlan.identifier.typeextensibleIdentifier Type Codes
InsurancePlan.statusrequiredFixed Value: active
InsurancePlan.typeextensibleInsuranceProductTypeVS (a valid code from Insurance Product Type Code System)
InsurancePlan.contact.purposeextensibleContactEntityType
InsurancePlan.contact.name.userequiredNameUse
InsurancePlan.contact.telecom.systemrequiredContactPointSystem
InsurancePlan.contact.telecom.userequiredContactPointUse
InsurancePlan.coverage.typeextensibleNdhCoverageTypeVS
InsurancePlan.coverage.benefit.typeextensibleNdhBenefitTypeVS
InsurancePlan.plan.identifier.userequiredIdentifierUse
InsurancePlan.plan.identifier.typeextensibleIdentifier Type Codes
InsurancePlan.plan.typeextensibleInsurancePlanTypeVS (a valid code from Insurance Plan Type Code System)
InsurancePlan.plan.specificCost.benefit.cost.applicabilityrequiredBenefitCostApplicability

Differential View

This structure is derived from NdhInsurancePlan

NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan C0..*NdhInsurancePlanDetails of a Health Insurance product/plan provided by an organization
plan-type-is-distinct: Each InsurancePlan.plan should have a distinct plan.type.
... meta
.... profile 1..1canonical(StructureDefinition)Profiles this resource claims to conform to
... extension 1..*ExtensionExtension
... extension:verification-status S1..1VerificationStatusNDH Verification Status
.... extension 1..*ExtensionExtension
.... extension:identifier-status S1..1IdentifierStatusNDH Identifier Status
.... use S0..1codeusual | official | temp | secondary | old (If known)
.... type S0..1CodeableConceptDescription of identifier
.... system S0..1uriThe namespace for the identifier value
.... value S0..1stringThe value that is unique
.... assigner S0..1Reference(NDH Exchange Organization Profile)Organization that issued id (may be just text)
... alias S0..*stringAlternate names
... period S0..1PeriodWhen the product is available
... ownedBy 1..1Reference(NDH Exchange Organization Profile)Plan issuer
... administeredBy 1..1Reference(NDH Exchange Organization Profile)Product administrator
... coverageArea 0..*Reference(NDH Exchange Location Profile)Where product applies
... contact S0..*BackboneElementContact for the product
.... purpose S0..1CodeableConceptThe type of contact
.... name S0..1HumanNameA name associated with the contact
..... use S0..1codeusual | official | temp | nickname | anonymous | old | maiden
..... text S0..1stringText representation of the full name
..... family S0..1stringFamily name (often called 'Surname')
..... given S0..*stringGiven names (not always 'first'). Includes middle names
..... prefix S0..*stringParts that come before the name
..... suffix S0..*stringParts that come after the name
..... period S0..1PeriodTime period when name was/is in use
.... telecom S0..*ContactPointContact details (telephone, email, etc.) for a contact
..... extension:contactpoint-availabletime S0..*ContactPointAvailableTimeNDH Contactpoint Availabletime
..... extension:via-intermediary S0..1ViaIntermediaryNDH Via Intermediary
..... system S0..1codephone | fax | email | pager | url | sms | other
..... value S0..1stringThe actual contact point details
..... use S0..1codehome | work | temp | old | mobile - purpose of this contact point
..... rank S0..1positiveIntSpecify preferred order of use (1 = highest)
... endpoint S0..*Reference(NDH Exchange Endpoint Profile)Technical endpoint
... network 0..*Reference(NDH Exchange Network Profile)What networks are Included
... coverage S0..*BackboneElementCoverage details
.... type S1..1CodeableConceptType of coverage
.... network 0..*Reference(NDH Exchange Network Profile)What networks provide coverage
.... benefit S1..*BackboneElementList of benefits
..... type S1..1CodeableConceptType of benefit
..... requirement S0..1stringReferral requirements
..... limit S0..*BackboneElementBenefit limits
...... value S0..1QuantityMaximum value allowed
...... code S0..1CodeableConceptBenefit limit details
... plan S0..*BackboneElementCost sharing details for the plan
.... identifier S0..*IdentifierBusiness Identifier for Product
..... extension:identifier-status S0..1IdentifierStatusNDH Identifier Status
..... use S0..1codeusual | official | temp | secondary | old (If known)
..... type S0..1CodeableConceptDescription of identifier
..... system S0..1uriThe namespace for the identifier value
..... value S0..1stringThe value that is unique
..... period S0..1PeriodTime period when id is/was valid for use
..... assigner S0..1Reference(NDH Exchange Organization Profile)Organization that issued id (may be just text)
.... type S0..1CodeableConceptCategorization of the cost sharing for the plan
.... coverageArea S0..*Reference(NDH Exchange Location Profile)Where product applies
.... network S0..*Reference(NDH Exchange Network Profile)What networks provide coverage
.... generalCost S0..*BackboneElementOverall costs
..... type S0..1CodeableConceptType of cost
..... groupSize S0..1positiveIntNumber of enrollees
..... cost S0..1MoneyCost value
..... comment S0..1stringAdditional cost information
.... specificCost S0..*BackboneElementSpecific costs
..... category S1..1CodeableConceptGeneral category of benefit
..... benefit S0..*BackboneElementBenefits list
...... type S1..1CodeableConceptType of specific benefit
...... cost S0..*BackboneElementList of the costs
....... type S1..1CodeableConceptType of cost
....... applicability S0..1CodeableConceptin-network | out-of-network | other
....... qualifiers S0..*CodeableConceptAdditional information about the cost
....... value S0..1QuantityThe actual cost value

doco Documentation for this format

Constraints

IdGradePath(s)DetailsRequirements
plan-type-is-distincterrorInsurancePlanEach InsurancePlan.plan should have a distinct plan.type.
: plan.type.coding.code.isDistinct()

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan C0..*NdhInsurancePlanDetails of a Health Insurance product/plan provided by an organization
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
... usage-restriction 0..*Reference(NDH Base Restriction) {c}Usage Restriction
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-usage-restriction
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier SΣC0..*IdentifierBusiness Identifier for Product
.... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
.... identifier-status S1..1codeNDH Identifier Status
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-identifier-status
Binding: Identifier Status Value Set (required)
.... use ?!SΣ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

.... type SΣ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

.... system SΣ0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value SΣ0..1stringThe value that is unique
Example General: 123456
.... assigner SΣ0..1Reference(NDH Exchange Organization Profile)Organization that issued id (may be just text)
... status ?!SΣ1..1codedraft | active | retired | unknown
Binding: PublicationStatus (required): The lifecycle status of an artifact.


Fixed Value: active
... type SΣ1..1CodeableConceptProduct Type
Binding: Insurance Product Type Value Set (extensible)
... name SΣC0..1stringOfficial name
... alias S0..*stringAlternate names
... period S0..1PeriodWhen the product is available
... ownedBy SΣ1..1Reference(NDH Exchange Organization Profile)Plan issuer
... administeredBy SΣ1..1Reference(NDH Exchange Organization Profile)Product administrator
... coverageArea SΣ0..*Reference(NDH Exchange Location Profile)Where product applies
... contact S0..*BackboneElementContact for the product
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... purpose S0..1CodeableConceptThe type of contact
Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party.

.... name S0..1HumanNameA name associated with the contact
..... use ?!SΣ0..1codeusual | official | temp | nickname | anonymous | old | maiden
Binding: NameUse (required): The use of a human name.

..... text SΣ0..1stringText representation of the full name
..... family SΣ0..1stringFamily name (often called 'Surname')
..... given SΣ0..*stringGiven names (not always 'first'). Includes middle names
This repeating element order: Given Names appear in the correct order for presenting the name
..... prefix SΣ0..*stringParts that come before the name
This repeating element order: Prefixes appear in the correct order for presenting the name
..... suffix SΣ0..*stringParts that come after the name
This repeating element order: Suffixes appear in the correct order for presenting the name
..... period SΣ0..1PeriodTime period when name was/is in use
.... telecom S0..*ContactPointContact details (telephone, email, etc.) for a contact
..... contactpoint-availabletime S0..*(Complex)NDH Contactpoint Availabletime
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-contactpoint-availabletime
..... via-intermediary S0..1Reference(NDH Base PractitionerRole | NDH Base OrganizationAffiliation Profile | NDH Base Location Profile | NDH Base Organization Profile)NDH Via Intermediary
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-via-intermediary
..... system SΣC0..1codephone | fax | email | pager | url | sms | other
Binding: ContactPointSystem (required): Telecommunications form for contact point.

..... value SΣ0..1stringThe actual contact point details
..... use ?!SΣ0..1codehome | work | temp | old | mobile - purpose of this contact point
Binding: ContactPointUse (required): Use of contact point.

..... rank SΣ0..1positiveIntSpecify preferred order of use (1 = highest)
... endpoint S0..*Reference(NDH Exchange Endpoint Profile)Technical endpoint
... network S0..*Reference(NDH Exchange Network Profile)What networks are Included
... coverage S0..*BackboneElementCoverage details
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type S1..1CodeableConceptType of coverage
Binding: NDH Insurance Coverage Type Value Set (extensible)
.... network S0..*Reference(NDH Exchange Network Profile)What networks provide coverage
.... benefit S1..*BackboneElementList of benefits
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type S1..1CodeableConceptType of benefit
Binding: NDH Benefit Type Value Set (extensible)
..... requirement S0..1stringReferral requirements
..... limit S0..*BackboneElementBenefit limits
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... value S0..1QuantityMaximum value allowed
...... code S0..1CodeableConceptBenefit limit details
... plan S0..*BackboneElementCost sharing details for the plan
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... identifier SΣ0..*IdentifierBusiness Identifier for Product
..... identifier-status S0..1codeNDH Identifier Status
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-identifier-status
Binding: Identifier Status Value Set (required)
..... use ?!SΣ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type SΣ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

..... system SΣ0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value SΣ0..1stringThe value that is unique
Example General: 123456
..... period SΣ0..1PeriodTime period when id is/was valid for use
..... assigner SΣ0..1Reference(NDH Exchange Organization Profile)Organization that issued id (may be just text)
.... type S0..1CodeableConceptCategorization of the cost sharing for the plan
Binding: Insurance Plan Type Value Set (extensible)
.... coverageArea SΣ0..*Reference(NDH Exchange Location Profile)Where product applies
.... network S0..*Reference(NDH Exchange Network Profile)What networks provide coverage
.... generalCost S0..*BackboneElementOverall costs
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type S0..1CodeableConceptType of cost
..... groupSize S0..1positiveIntNumber of enrollees
..... cost S0..1MoneyCost value
..... comment S0..1stringAdditional cost information
.... specificCost S0..*BackboneElementSpecific costs
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... category S1..1CodeableConceptGeneral category of benefit
..... benefit S0..*BackboneElementBenefits list
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... type S1..1CodeableConceptType of specific benefit
...... cost S0..*BackboneElementList of the costs
....... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
....... type S1..1CodeableConceptType of cost
....... applicability S0..1CodeableConceptin-network | out-of-network | other
Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.

....... qualifiers S0..*CodeableConceptAdditional information about the cost
....... value S0..1QuantityThe actual cost value

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
InsurancePlan.identifier.userequiredIdentifierUse
InsurancePlan.identifier.typeextensibleIdentifier Type Codes
InsurancePlan.statusrequiredFixed Value: active
InsurancePlan.typeextensibleInsuranceProductTypeVS (a valid code from Insurance Product Type Code System)
InsurancePlan.contact.purposeextensibleContactEntityType
InsurancePlan.contact.name.userequiredNameUse
InsurancePlan.contact.telecom.systemrequiredContactPointSystem
InsurancePlan.contact.telecom.userequiredContactPointUse
InsurancePlan.coverage.typeextensibleNdhCoverageTypeVS
InsurancePlan.coverage.benefit.typeextensibleNdhBenefitTypeVS
InsurancePlan.plan.identifier.userequiredIdentifierUse
InsurancePlan.plan.identifier.typeextensibleIdentifier Type Codes
InsurancePlan.plan.typeextensibleInsurancePlanTypeVS (a valid code from Insurance Plan Type Code System)
InsurancePlan.plan.specificCost.benefit.cost.applicabilityrequiredBenefitCostApplicability

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan C0..*NdhInsurancePlanDetails of a Health Insurance product/plan provided by an organization
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... versionId Σ0..1idVersion specific identifier
.... lastUpdated Σ1..1instantWhen the resource version last changed
.... source Σ0..1uriIdentifies where the resource comes from
.... profile Σ1..1canonical(StructureDefinition)Profiles this resource claims to conform to
.... security Σ0..*CodingSecurity Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.


.... tag Σ0..*CodingTags applied to this resource
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".


... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
... usage-restriction 0..*Reference(NDH Base Restriction) {c}Usage Restriction
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-usage-restriction
... verification-status S1..1CodeableConceptNDH Verification Status
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-verification-status
Binding: NDH Verification Status Value Set (extensible)
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier SΣC0..*IdentifierBusiness Identifier for Product
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
.... identifier-status S1..1codeNDH Identifier Status
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-identifier-status
Binding: Identifier Status Value Set (required)
.... use ?!SΣ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

.... type SΣ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

.... system SΣ0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value SΣ0..1stringThe value that is unique
Example General: 123456
.... period Σ0..1PeriodTime period when id is/was valid for use
.... assigner SΣ0..1Reference(NDH Exchange Organization Profile)Organization that issued id (may be just text)
... status ?!SΣ1..1codedraft | active | retired | unknown
Binding: PublicationStatus (required): The lifecycle status of an artifact.


Fixed Value: active
... type SΣ1..1CodeableConceptProduct Type
Binding: Insurance Product Type Value Set (extensible)
... name SΣC0..1stringOfficial name
... alias S0..*stringAlternate names
... period S0..1PeriodWhen the product is available
... ownedBy SΣ1..1Reference(NDH Exchange Organization Profile)Plan issuer
... administeredBy SΣ1..1Reference(NDH Exchange Organization Profile)Product administrator
... coverageArea SΣ0..*Reference(NDH Exchange Location Profile)Where product applies
... contact S0..*BackboneElementContact for the product
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... purpose S0..1CodeableConceptThe type of contact
Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party.

.... name S0..1HumanNameA name associated with the contact
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!SΣ0..1codeusual | official | temp | nickname | anonymous | old | maiden
Binding: NameUse (required): The use of a human name.

..... text SΣ0..1stringText representation of the full name
..... family SΣ0..1stringFamily name (often called 'Surname')
..... given SΣ0..*stringGiven names (not always 'first'). Includes middle names
This repeating element order: Given Names appear in the correct order for presenting the name
..... prefix SΣ0..*stringParts that come before the name
This repeating element order: Prefixes appear in the correct order for presenting the name
..... suffix SΣ0..*stringParts that come after the name
This repeating element order: Suffixes appear in the correct order for presenting the name
..... period SΣ0..1PeriodTime period when name was/is in use
.... telecom S0..*ContactPointContact details (telephone, email, etc.) for a contact
..... id 0..1stringUnique id for inter-element referencing
..... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... contactpoint-availabletime S0..*(Complex)NDH Contactpoint Availabletime
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-contactpoint-availabletime
..... via-intermediary S0..1Reference(NDH Base PractitionerRole | NDH Base OrganizationAffiliation Profile | NDH Base Location Profile | NDH Base Organization Profile)NDH Via Intermediary
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-via-intermediary
..... system SΣC0..1codephone | fax | email | pager | url | sms | other
Binding: ContactPointSystem (required): Telecommunications form for contact point.

..... value SΣ0..1stringThe actual contact point details
..... use ?!SΣ0..1codehome | work | temp | old | mobile - purpose of this contact point
Binding: ContactPointUse (required): Use of contact point.

..... rank SΣ0..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 S0..*Reference(NDH Exchange Endpoint Profile)Technical endpoint
... network S0..*Reference(NDH Exchange Network Profile)What networks are Included
... coverage S0..*BackboneElementCoverage details
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type S1..1CodeableConceptType of coverage
Binding: NDH Insurance Coverage Type Value Set (extensible)
.... network S0..*Reference(NDH Exchange Network Profile)What networks provide coverage
.... benefit S1..*BackboneElementList of benefits
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type S1..1CodeableConceptType of benefit
Binding: NDH Benefit Type Value Set (extensible)
..... requirement S0..1stringReferral requirements
..... limit S0..*BackboneElementBenefit limits
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... value S0..1QuantityMaximum value allowed
...... code S0..1CodeableConceptBenefit limit details
... plan S0..*BackboneElementCost sharing details for the plan
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... identifier SΣ0..*IdentifierBusiness Identifier for Product
..... id 0..1stringUnique id for inter-element referencing
..... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... identifier-status S0..1codeNDH Identifier Status
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-identifier-status
Binding: Identifier Status Value Set (required)
..... use ?!SΣ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type SΣ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

..... system SΣ0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value SΣ0..1stringThe value that is unique
Example General: 123456
..... period SΣ0..1PeriodTime period when id is/was valid for use
..... assigner SΣ0..1Reference(NDH Exchange Organization Profile)Organization that issued id (may be just text)
.... type S0..1CodeableConceptCategorization of the cost sharing for the plan
Binding: Insurance Plan Type Value Set (extensible)
.... coverageArea SΣ0..*Reference(NDH Exchange Location Profile)Where product applies
.... network S0..*Reference(NDH Exchange Network Profile)What networks provide coverage
.... generalCost S0..*BackboneElementOverall costs
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type S0..1CodeableConceptType of cost
..... groupSize S0..1positiveIntNumber of enrollees
..... cost S0..1MoneyCost value
..... comment S0..1stringAdditional cost information
.... specificCost S0..*BackboneElementSpecific costs
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... category S1..1CodeableConceptGeneral category of benefit
..... benefit S0..*BackboneElementBenefits list
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... type S1..1CodeableConceptType of specific benefit
...... cost S0..*BackboneElementList of the costs
....... id 0..1stringUnique id for inter-element referencing
....... extension 0..*ExtensionAdditional content defined by implementations
....... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
....... type S1..1CodeableConceptType of cost
....... applicability S0..1CodeableConceptin-network | out-of-network | other
Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.

....... qualifiers S0..*CodeableConceptAdditional information about the cost
....... value S0..1QuantityThe actual cost value

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
InsurancePlan.meta.securityextensibleAll Security Labels
InsurancePlan.meta.tagexampleCommonTags
InsurancePlan.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
InsurancePlan.identifier.userequiredIdentifierUse
InsurancePlan.identifier.typeextensibleIdentifier Type Codes
InsurancePlan.statusrequiredFixed Value: active
InsurancePlan.typeextensibleInsuranceProductTypeVS (a valid code from Insurance Product Type Code System)
InsurancePlan.contact.purposeextensibleContactEntityType
InsurancePlan.contact.name.userequiredNameUse
InsurancePlan.contact.telecom.systemrequiredContactPointSystem
InsurancePlan.contact.telecom.userequiredContactPointUse
InsurancePlan.coverage.typeextensibleNdhCoverageTypeVS
InsurancePlan.coverage.benefit.typeextensibleNdhBenefitTypeVS
InsurancePlan.plan.identifier.userequiredIdentifierUse
InsurancePlan.plan.identifier.typeextensibleIdentifier Type Codes
InsurancePlan.plan.typeextensibleInsurancePlanTypeVS (a valid code from Insurance Plan Type Code System)
InsurancePlan.plan.specificCost.benefit.cost.applicabilityrequiredBenefitCostApplicability

 

Other representations of profile: CSV, Excel, Schematron