LinuxForHealth FHIR Implementation Guide
8.0.0 - draft
LinuxForHealth FHIR Implementation Guide - Local Development build (v8.0.0). See the Directory of published versions
<InsurancePlan xmlns="http://hl7.org/fhir">
<id value="InsurancePlanExample"/>
<meta>
<source value="http://acme-health.com/WellnessInsuranceCompany"/>
<profile
value="http://linuxforhealth.org/fhir/cdm/StructureDefinition/cdm-insurance-plan"/>
</meta>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: InsurancePlan</b><a name="InsurancePlanExample"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource InsurancePlan "InsurancePlanExample" </p><p style="margin-bottom: 0px">Information Source: http://acme-health.com/WellnessInsuranceCompany!</p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-cdm-insurance-plan.html">CDM Insurance Plan</a></p></div><p><b>Payer Medical Coverage Indicator</b>: Y</p><p><b>Payer Dental Coverage Indicator</b>: Y</p><p><b>Payer Drug Coverage Indicator</b>: Y</p><p><b>Payer Hearing Coverage Indicator</b>: Y</p><p><b>Payer Vision Coverage Indicator</b>: Y</p><p><b>Payer Psychiatric Coverage Indicator</b>: N</p><p><b>Payer Shortterm Care Coverage Indicator</b>: Y</p><p><b>Payer Longterm Care Coverage Indicator</b>: Y</p><p><b>Payer Substance Abuse Ambulatory Coverage Indicator</b>: N</p><p><b>Payer Substance Abuse Day-Night Coverage Indicator</b>: N</p><p><b>Payer Substance Abuse Inpatient Coverage Indicator</b>: N</p><p><b>Payer Mental Health Ambulatory Coverage Indicator</b>: N</p><p><b>Payer Mental Health Day Night Coverage Indicator</b>: N</p><p><b>Payer Mental Health Inpatient Coverage Indicator</b>: N</p><p><b>Dental Fully Insured Indicator</b>: Y</p><p><b>Drug Fully Insured Indicator</b>: Y</p><p><b>Enrollment Type</b>: LocalEnrollType <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (local-enrollment-type#LocalEnrollType)</span></p><p><b>Exchange Plan Indicator</b>: N</p><p><b>Industry Classification</b>: 621112 <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-naics.html">North American Industry Classification System</a>#621112)</span></p><p><b>Medical Fully Insured Indicator</b>: Y</p><p><b>Vision Fully Insured Indicator</b>: Y</p><p><b>Payer Managed Care Plan Type</b>: LocalManagedCarePlan <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (local-managed-care-plan-type#LocalManagedCarePlan)</span></p><p><b>identifier</b>: Source System Row Identifier: plan_code_1234(use: OFFICIAL), Source System Row Identifier: account_id_1234(use: SECONDARY), Source System Row Identifier: dental-plan_code_5555(use: OFFICIAL), Source System Row Identifier: vision-plan_code_2345(use: OFFICIAL)</p><p><b>type</b>: Medical <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-insurance-plan-type.html">Insurance plan type</a>#medical)</span>, Dental <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-insurance-plan-type.html">Insurance plan type</a>#dental)</span>, Drug <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-insurance-plan-type.html">Insurance plan type</a>#Drug)</span>, Hearing <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-type.html">Insurance Plan Type Codes</a>#hearing)</span>, Vision <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-insurance-plan-type.html">Insurance plan type</a>#vision)</span>, Mental Health <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-insurance-plan-type.html">Insurance plan type</a>#mental)</span>, Substance Abuse <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-insurance-plan-type.html">Insurance plan type</a>#subst-ab)</span>, Short Term <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-insurance-plan-type.html">Insurance plan type</a>#short-term)</span>, Long Term Care <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-insurance-plan-type.html">Insurance plan type</a>#long-term)</span>, Substance Abuse Ambulatory <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-type.html">Insurance Plan Type Codes</a>#substance-abuse-ambulatory)</span>, Substance Abuse Day Night <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-type.html">Insurance Plan Type Codes</a>#substance-abuse-day-night)</span>, Substance Abuse Inpatient <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-type.html">Insurance Plan Type Codes</a>#substance-abuse-inpatient)</span>, Mental Health Ambulatory <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-type.html">Insurance Plan Type Codes</a>#mental-health-ambulatory)</span>, Mental Health Day Night <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-type.html">Insurance Plan Type Codes</a>#mental-health-day-night)</span>, Mental Health Inpatient <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-type.html">Insurance Plan Type Codes</a>#mental-health-inpatient)</span></p><p><b>ownedBy</b>: <a href="Organization-GeneralHospital.html">Organization/GeneralHospital</a> "General Hospital"</p><blockquote><p><b>coverage</b></p><p><b>type</b>: Medical <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-insurance-plan-type.html">Insurance plan type</a>#medical)</span></p><p><b>network</b>: <a href="Organization-GeneralHospital.html">Organization/GeneralHospital</a> "General Hospital"</p><h3>Benefits</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td></tr><tr><td>*</td><td>Medical <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-insurance-plan-type.html">Insurance plan type</a>#medical)</span></td></tr></table></blockquote><blockquote><p><b>coverage</b></p><p><b>type</b>: Dental <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-insurance-plan-type.html">Insurance plan type</a>#dental)</span></p><h3>Benefits</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td></tr><tr><td>*</td><td>Dental <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-insurance-plan-type.html">Insurance plan type</a>#dental)</span></td></tr></table></blockquote><blockquote><p><b>coverage</b></p><p><b>type</b>: Drug <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-insurance-plan-type.html">Insurance plan type</a>#Drug)</span></p><h3>Benefits</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td></tr><tr><td>*</td><td>Drug <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-insurance-plan-type.html">Insurance plan type</a>#Drug)</span></td></tr></table></blockquote><blockquote><p><b>coverage</b></p><p><b>type</b>: Hearing <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-type.html">Insurance Plan Type Codes</a>#hearing)</span></p><h3>Benefits</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td></tr><tr><td>*</td><td>Hearing <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-type.html">Insurance Plan Type Codes</a>#hearing)</span></td></tr></table></blockquote><blockquote><p><b>coverage</b></p><p><b>type</b>: Vision <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-insurance-plan-type.html">Insurance plan type</a>#vision)</span></p><h3>Benefits</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td></tr><tr><td>*</td><td>Vision <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-insurance-plan-type.html">Insurance plan type</a>#vision)</span></td></tr></table></blockquote><blockquote><p><b>coverage</b></p><p><b>type</b>: Mental Health <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-insurance-plan-type.html">Insurance plan type</a>#mental)</span></p><h3>Benefits</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td></tr><tr><td>*</td><td>Mental Health <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-insurance-plan-type.html">Insurance plan type</a>#mental)</span></td></tr></table></blockquote><blockquote><p><b>coverage</b></p><p><b>type</b>: Substance Abuse <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-insurance-plan-type.html">Insurance plan type</a>#subst-ab)</span></p><h3>Benefits</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td></tr><tr><td>*</td><td>Substance Abuse <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-insurance-plan-type.html">Insurance plan type</a>#subst-ab)</span></td></tr></table></blockquote><blockquote><p><b>coverage</b></p><p><b>type</b>: Short Term <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-insurance-plan-type.html">Insurance plan type</a>#short-term)</span></p><h3>Benefits</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td></tr><tr><td>*</td><td>Short Term <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-insurance-plan-type.html">Insurance plan type</a>#short-term)</span></td></tr></table></blockquote><blockquote><p><b>coverage</b></p><p><b>type</b>: Long Term Care <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-insurance-plan-type.html">Insurance plan type</a>#long-term)</span></p><h3>Benefits</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td></tr><tr><td>*</td><td>Long Term Care <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-insurance-plan-type.html">Insurance plan type</a>#long-term)</span></td></tr></table></blockquote><blockquote><p><b>coverage</b></p><p><b>type</b>: Substance Abuse Ambulatory <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-type.html">Insurance Plan Type Codes</a>#substance-abuse-ambulatory)</span></p><h3>Benefits</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td></tr><tr><td>*</td><td>Substance Abuse Ambulatory <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-type.html">Insurance Plan Type Codes</a>#substance-abuse-ambulatory)</span></td></tr></table></blockquote><blockquote><p><b>coverage</b></p><p><b>type</b>: Substance Abuse Day Night <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-type.html">Insurance Plan Type Codes</a>#substance-abuse-day-night)</span></p><h3>Benefits</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td></tr><tr><td>*</td><td>Substance Abuse Day Night <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-type.html">Insurance Plan Type Codes</a>#substance-abuse-day-night)</span></td></tr></table></blockquote><blockquote><p><b>coverage</b></p><p><b>type</b>: Substance Abuse Inpatient <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-type.html">Insurance Plan Type Codes</a>#substance-abuse-inpatient)</span></p><h3>Benefits</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td></tr><tr><td>*</td><td>Substance Abuse Inpatient <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-type.html">Insurance Plan Type Codes</a>#substance-abuse-inpatient)</span></td></tr></table></blockquote><blockquote><p><b>coverage</b></p><p><b>type</b>: Mental Health Ambulatory <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-type.html">Insurance Plan Type Codes</a>#mental-health-ambulatory)</span></p><h3>Benefits</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td></tr><tr><td>*</td><td>Mental Health Ambulatory <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-type.html">Insurance Plan Type Codes</a>#mental-health-ambulatory)</span></td></tr></table></blockquote><blockquote><p><b>coverage</b></p><p><b>type</b>: Mental Health Day Night <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-type.html">Insurance Plan Type Codes</a>#mental-health-day-night)</span></p><h3>Benefits</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td></tr><tr><td>*</td><td>Mental Health Day Night <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-type.html">Insurance Plan Type Codes</a>#mental-health-day-night)</span></td></tr></table></blockquote><blockquote><p><b>coverage</b></p><p><b>type</b>: Mental Health Inpatient <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-type.html">Insurance Plan Type Codes</a>#mental-health-inpatient)</span></p><h3>Benefits</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td></tr><tr><td>*</td><td>Mental Health Inpatient <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-type.html">Insurance Plan Type Codes</a>#mental-health-inpatient)</span></td></tr></table></blockquote><blockquote><p><b>plan</b></p><p><b>ACA Health Insurance Oversight System Plan</b>: LocalACAPlanCd <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (local-aca-health-insurance-oversight-system-plan#LocalACAPlanCd)</span></p><p><b>ACA Health Insurance Oversight System Product</b>: LocalACAProductCd <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (local-aca-health-insurance-oversight-system-product#LocalACAProductCd)</span></p><p><b>ACA Market Type</b>: LocalACAMarketTypeCd <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (local-aca-market-type#LocalACAMarketTypeCd)</span></p><p><b>ACA Metal Tier</b>: LocalACAMetalTierCd <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (local-aca-metal-tier#LocalACAMetalTierCd)</span></p><p><b>Capitation Arrangement</b>: LocalCapArrangement <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (local-capitation-arrangement#LocalCapArrangement)</span></p><p><b>Carve Out</b>: LocalCarveOutCode <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (local-carve-out#LocalCarveOutCode)</span></p><p><b>Cost Sharing Reduction Variant</b>: LocalCostSharingCd <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (local-cost-sharing-reduction-variant#LocalCostSharingCd)</span></p><p><b>Funding Arrangement</b>: LocalFundArrangement <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (local-funding-arrangement#LocalFundArrangement)</span></p><p><b>Level Of Care</b>: LocalLevelOfCare <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (local-level-of-care#LocalLevelOfCare)</span></p><p><b>Longterm Care Duration</b>: 36</p><p><b>Longterm Care Waiting Period</b>: 90</p><p><b>Rating Area</b>: LocalRatingArea <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (local-rating-area#LocalRatingArea)</span></p><p><b>Shortterm Care Duration</b>: 16</p><p><b>Shortterm Care Waiting Period</b>: 1</p><blockquote><p><b>specificCost</b></p><p><b>category</b>: Drug <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-cost-category.html">Insurance Plan Cost Category Codes</a>#drug)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Administrative Fee <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-benefit-type.html">Insurance Plan Benefit Type Codes</a>#administrative-fee)</span></p><h3>Costs</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td><td><b>Value</b></td></tr><tr><td>*</td><td>Administrative Fee <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-benefit-type.html">Insurance Plan Benefit Type Codes</a>#administrative-fee)</span></td><td>3</td></tr></table></blockquote></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: Medical <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-cost-category.html">Insurance Plan Cost Category Codes</a>#medical)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Administrative Fee <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-benefit-type.html">Insurance Plan Benefit Type Codes</a>#administrative-fee)</span></p><h3>Costs</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td><td><b>Value</b></td></tr><tr><td>*</td><td>Administrative Fee <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-benefit-type.html">Insurance Plan Benefit Type Codes</a>#administrative-fee)</span></td><td>75</td></tr></table></blockquote></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: Drug <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-cost-category.html">Insurance Plan Cost Category Codes</a>#drug)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Employee Contribution <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-benefit-type.html">Insurance Plan Benefit Type Codes</a>#employee-contribution)</span></p><h3>Costs</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td><td><b>Value</b></td></tr><tr><td>*</td><td>Employee Contribution <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-benefit-type.html">Insurance Plan Benefit Type Codes</a>#employee-contribution)</span></td><td>15</td></tr></table></blockquote></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: Medical <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-cost-category.html">Insurance Plan Cost Category Codes</a>#medical)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Employee Contribution <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-benefit-type.html">Insurance Plan Benefit Type Codes</a>#employee-contribution)</span></p><h3>Costs</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td><td><b>Value</b></td></tr><tr><td>*</td><td>Employee Contribution <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-benefit-type.html">Insurance Plan Benefit Type Codes</a>#employee-contribution)</span></td><td>125</td></tr></table></blockquote></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: Drug <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-cost-category.html">Insurance Plan Cost Category Codes</a>#drug)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Monthly Premium Paid <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-benefit-type.html">Insurance Plan Benefit Type Codes</a>#monthly-premium-paid)</span></p><h3>Costs</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td><td><b>Value</b></td></tr><tr><td>*</td><td>Monthly Premium Paid <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-benefit-type.html">Insurance Plan Benefit Type Codes</a>#monthly-premium-paid)</span></td><td>25</td></tr></table></blockquote></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: Medical <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-cost-category.html">Insurance Plan Cost Category Codes</a>#medical)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Monthly Premium Paid <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-benefit-type.html">Insurance Plan Benefit Type Codes</a>#monthly-premium-paid)</span></p><h3>Costs</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td><td><b>Value</b></td></tr><tr><td>*</td><td>Monthly Premium Paid <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-benefit-type.html">Insurance Plan Benefit Type Codes</a>#monthly-premium-paid)</span></td><td>55</td></tr></table></blockquote></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: Other <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-cost-category.html">Insurance Plan Cost Category Codes</a>#other)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Non Claim Payment <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-benefit-type.html">Insurance Plan Benefit Type Codes</a>#non-claim-payment)</span></p><h3>Costs</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td><td><b>Value</b></td></tr><tr><td>*</td><td>Non Claim Payment <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-benefit-type.html">Insurance Plan Benefit Type Codes</a>#non-claim-payment)</span></td><td>5</td></tr></table></blockquote></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: Dental <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-cost-category.html">Insurance Plan Cost Category Codes</a>#dental)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Administrative Fee <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-benefit-type.html">Insurance Plan Benefit Type Codes</a>#administrative-fee)</span></p><h3>Costs</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td><td><b>Value</b></td></tr><tr><td>*</td><td>Administrative Fee <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-benefit-type.html">Insurance Plan Benefit Type Codes</a>#administrative-fee)</span></td><td>2</td></tr></table></blockquote></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: Vision <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-cost-category.html">Insurance Plan Cost Category Codes</a>#vision)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Administrative Fee <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-benefit-type.html">Insurance Plan Benefit Type Codes</a>#administrative-fee)</span></p><h3>Costs</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td><td><b>Value</b></td></tr><tr><td>*</td><td>Administrative Fee <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-benefit-type.html">Insurance Plan Benefit Type Codes</a>#administrative-fee)</span></td><td>3</td></tr></table></blockquote></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: Dental <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-cost-category.html">Insurance Plan Cost Category Codes</a>#dental)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Employee Contribution <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-benefit-type.html">Insurance Plan Benefit Type Codes</a>#employee-contribution)</span></p><h3>Costs</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td><td><b>Value</b></td></tr><tr><td>*</td><td>Employee Contribution <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-benefit-type.html">Insurance Plan Benefit Type Codes</a>#employee-contribution)</span></td><td>0</td></tr></table></blockquote></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: Vision <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-cost-category.html">Insurance Plan Cost Category Codes</a>#vision)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Employee Contribution <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-benefit-type.html">Insurance Plan Benefit Type Codes</a>#employee-contribution)</span></p><h3>Costs</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td><td><b>Value</b></td></tr><tr><td>*</td><td>Employee Contribution <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-benefit-type.html">Insurance Plan Benefit Type Codes</a>#employee-contribution)</span></td><td>0</td></tr></table></blockquote></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: Other <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-cost-category.html">Insurance Plan Cost Category Codes</a>#other)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Capitation Amount <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-benefit-type.html">Insurance Plan Benefit Type Codes</a>#capitation-amount)</span></p><h3>Costs</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td><td><b>Value</b></td></tr><tr><td>*</td><td>Capitation Amount <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-benefit-type.html">Insurance Plan Benefit Type Codes</a>#capitation-amount)</span></td><td>0</td></tr></table></blockquote></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: Other <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-cost-category.html">Insurance Plan Cost Category Codes</a>#other)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Monthly Premium Billed <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-benefit-type.html">Insurance Plan Benefit Type Codes</a>#monthly-premium-billed)</span></p><h3>Costs</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td><td><b>Value</b></td></tr><tr><td>*</td><td>Monthly Premium Billed <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-benefit-type.html">Insurance Plan Benefit Type Codes</a>#monthly-premium-billed)</span></td><td>10</td></tr></table></blockquote></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: Dental <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-cost-category.html">Insurance Plan Cost Category Codes</a>#dental)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Monthly Premium Paid <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-benefit-type.html">Insurance Plan Benefit Type Codes</a>#monthly-premium-paid)</span></p><h3>Costs</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td><td><b>Value</b></td></tr><tr><td>*</td><td>Monthly Premium Paid <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-benefit-type.html">Insurance Plan Benefit Type Codes</a>#monthly-premium-paid)</span></td><td>5</td></tr></table></blockquote></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: Vision <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-cost-category.html">Insurance Plan Cost Category Codes</a>#vision)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Monthly Premium Paid <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-benefit-type.html">Insurance Plan Benefit Type Codes</a>#monthly-premium-paid)</span></p><h3>Costs</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td><td><b>Value</b></td></tr><tr><td>*</td><td>Monthly Premium Paid <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-benefit-type.html">Insurance Plan Benefit Type Codes</a>#monthly-premium-paid)</span></td><td>2</td></tr></table></blockquote></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: Other <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-cost-category.html">Insurance Plan Cost Category Codes</a>#other)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Administrative Fee <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-benefit-type.html">Insurance Plan Benefit Type Codes</a>#administrative-fee)</span></p><h3>Costs</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td><td><b>Value</b></td></tr><tr><td>*</td><td>Administrative Fee <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-benefit-type.html">Insurance Plan Benefit Type Codes</a>#administrative-fee)</span></td><td>2</td></tr></table></blockquote></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: Other <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-cost-category.html">Insurance Plan Cost Category Codes</a>#other)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Employee Contribution <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-benefit-type.html">Insurance Plan Benefit Type Codes</a>#employee-contribution)</span></p><h3>Costs</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td><td><b>Value</b></td></tr><tr><td>*</td><td>Employee Contribution <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-benefit-type.html">Insurance Plan Benefit Type Codes</a>#employee-contribution)</span></td><td>6</td></tr></table></blockquote></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: Other <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-cost-category.html">Insurance Plan Cost Category Codes</a>#other)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Monthly Premium Paid <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-benefit-type.html">Insurance Plan Benefit Type Codes</a>#monthly-premium-paid)</span></p><h3>Costs</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td><td><b>Value</b></td></tr><tr><td>*</td><td>Monthly Premium Paid <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-insurance-plan-benefit-type.html">Insurance Plan Benefit Type Codes</a>#monthly-premium-paid)</span></td><td>6</td></tr></table></blockquote></blockquote></blockquote></div>
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<extension
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<extension
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<extension
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<extension
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<extension
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<extension
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<extension
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<extension
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<extension
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<extension
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<extension
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<extension
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<extension
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<extension
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<extension
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<extension
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<system
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<code value="SSRI"/>
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<system value="http://acme-health.com/plan/insuranceplan1"/>
<value value="account_id_1234"/>
<assigner>
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<coding>
<system
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<code value="SSRI"/>
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<system value="http://acme-health.com/plan/DentalInsurancePlan"/>
<value value="dental-plan_code_5555"/>
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<system
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<code value="SSRI"/>
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<system value="http://acme-health.com/plan/VisionInsurancePlan"/>
<value value="vision-plan_code_2345"/>
<assigner>
<display value="Acme Health - Vision Insurance Plan"/>
</assigner>
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<coding>
<system
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<code value="medical"/>
</coding>
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<type>
<coding>
<system
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<code value="dental"/>
</coding>
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<type>
<coding>
<system
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<code value="Drug"/>
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<system
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<type>
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<system
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<type>
<coding>
<system
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<code value="subst-ab"/>
</coding>
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<type>
<coding>
<system
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<code value="short-term"/>
</coding>
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<type>
<coding>
<system
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<type>
<coding>
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<coding>
<system
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<code value="mental-health-ambulatory"/>
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<type>
<coding>
<system
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<type>
<coding>
<system
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<code value="mental-health-inpatient"/>
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<ownedBy>
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<network>
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</network>
<benefit>
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<coding>
<system
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<coding>
<system
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<benefit>
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<coding>
<system
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<coding>
<system
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<coding>
<system
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<coding>
<system
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<coverage>
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<coding>
<system
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</coding>
</type>
<benefit>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/insurance-plan-type"/>
<code value="vision"/>
</coding>
</type>
</benefit>
</coverage>
<coverage>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/insurance-plan-type"/>
<code value="mental"/>
</coding>
</type>
<benefit>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/insurance-plan-type"/>
<code value="mental"/>
</coding>
</type>
</benefit>
</coverage>
<coverage>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/insurance-plan-type"/>
<code value="subst-ab"/>
</coding>
</type>
<benefit>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/insurance-plan-type"/>
<code value="subst-ab"/>
</coding>
</type>
</benefit>
</coverage>
<coverage>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/insurance-plan-type"/>
<code value="short-term"/>
</coding>
</type>
<benefit>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/insurance-plan-type"/>
<code value="short-term"/>
</coding>
</type>
</benefit>
</coverage>
<coverage>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/insurance-plan-type"/>
<code value="long-term"/>
</coding>
</type>
<benefit>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/insurance-plan-type"/>
<code value="long-term"/>
</coding>
</type>
</benefit>
</coverage>
<coverage>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-type"/>
<code value="substance-abuse-ambulatory"/>
</coding>
</type>
<benefit>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-type"/>
<code value="substance-abuse-ambulatory"/>
</coding>
</type>
</benefit>
</coverage>
<coverage>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-type"/>
<code value="substance-abuse-day-night"/>
</coding>
</type>
<benefit>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-type"/>
<code value="substance-abuse-day-night"/>
</coding>
</type>
</benefit>
</coverage>
<coverage>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-type"/>
<code value="substance-abuse-inpatient"/>
</coding>
</type>
<benefit>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-type"/>
<code value="substance-abuse-inpatient"/>
</coding>
</type>
</benefit>
</coverage>
<coverage>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-type"/>
<code value="mental-health-ambulatory"/>
</coding>
</type>
<benefit>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-type"/>
<code value="mental-health-ambulatory"/>
</coding>
</type>
</benefit>
</coverage>
<coverage>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-type"/>
<code value="mental-health-day-night"/>
</coding>
</type>
<benefit>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-type"/>
<code value="mental-health-day-night"/>
</coding>
</type>
</benefit>
</coverage>
<coverage>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-type"/>
<code value="mental-health-inpatient"/>
</coding>
</type>
<benefit>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-type"/>
<code value="mental-health-inpatient"/>
</coding>
</type>
</benefit>
</coverage>
<plan>
<extension
url="http://linuxforhealth.org/fhir/cdm/StructureDefinition/aca-health-insurance-oversight-system-plan">
<valueCodeableConcept>
<coding>
<system
value="http://acme-health.com/CodeSystem/local-aca-health-insurance-oversight-system-plan"/>
<code value="LocalACAPlanCd"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://linuxforhealth.org/fhir/cdm/StructureDefinition/aca-health-insurance-oversight-system-product">
<valueCodeableConcept>
<coding>
<system
value="http://acme-health.com/CodeSystem/local-aca-health-insurance-oversight-system-product"/>
<code value="LocalACAProductCd"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://linuxforhealth.org/fhir/cdm/StructureDefinition/aca-market-type">
<valueCodeableConcept>
<coding>
<system
value="http://acme-health.com/CodeSystem/local-aca-market-type"/>
<code value="LocalACAMarketTypeCd"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://linuxforhealth.org/fhir/cdm/StructureDefinition/aca-metal-tier">
<valueCodeableConcept>
<coding>
<system
value="http://acme-health.com/CodeSystem/local-aca-metal-tier"/>
<code value="LocalACAMetalTierCd"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://linuxforhealth.org/fhir/cdm/StructureDefinition/capitation-arrangement">
<valueCodeableConcept>
<coding>
<system
value="http://acme-health.com/CodeSystem/local-capitation-arrangement"/>
<code value="LocalCapArrangement"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://linuxforhealth.org/fhir/cdm/StructureDefinition/carve-out">
<valueCodeableConcept>
<coding>
<system value="http://acme-health.com/CodeSystem/local-carve-out"/>
<code value="LocalCarveOutCode"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://linuxforhealth.org/fhir/cdm/StructureDefinition/cost-sharing-reduction-variant">
<valueCodeableConcept>
<coding>
<system
value="http://acme-health.com/CodeSystem/local-cost-sharing-reduction-variant"/>
<code value="LocalCostSharingCd"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://linuxforhealth.org/fhir/cdm/StructureDefinition/funding-arrangement">
<valueCodeableConcept>
<coding>
<system
value="http://acme-health.com/CodeSystem/local-funding-arrangement"/>
<code value="LocalFundArrangement"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://linuxforhealth.org/fhir/cdm/StructureDefinition/level-of-care">
<valueCodeableConcept>
<coding>
<system
value="http://acme-health.com/CodeSystem/local-level-of-care"/>
<code value="LocalLevelOfCare"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://linuxforhealth.org/fhir/cdm/StructureDefinition/long-term-care-duration">
<valueInteger value="36"/>
</extension>
<extension
url="http://linuxforhealth.org/fhir/cdm/StructureDefinition/long-term-care-waiting-period">
<valueInteger value="90"/>
</extension>
<extension
url="http://linuxforhealth.org/fhir/cdm/StructureDefinition/rating-area">
<valueCodeableConcept>
<coding>
<system
value="http://acme-health.com/CodeSystem/local-rating-area"/>
<code value="LocalRatingArea"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://linuxforhealth.org/fhir/cdm/StructureDefinition/short-term-care-duration">
<valueInteger value="16"/>
</extension>
<extension
url="http://linuxforhealth.org/fhir/cdm/StructureDefinition/short-term-care-waiting-period">
<valueInteger value="1"/>
</extension>
<specificCost>
<category>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-cost-category"/>
<code value="drug"/>
</coding>
</category>
<benefit>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-benefit-type"/>
<code value="administrative-fee"/>
</coding>
</type>
<cost>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-benefit-type"/>
<code value="administrative-fee"/>
</coding>
</type>
<value>
<value value="3"/>
</value>
</cost>
</benefit>
</specificCost>
<specificCost>
<category>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-cost-category"/>
<code value="medical"/>
</coding>
</category>
<benefit>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-benefit-type"/>
<code value="administrative-fee"/>
</coding>
</type>
<cost>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-benefit-type"/>
<code value="administrative-fee"/>
</coding>
</type>
<value>
<value value="75"/>
</value>
</cost>
</benefit>
</specificCost>
<specificCost>
<category>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-cost-category"/>
<code value="drug"/>
</coding>
</category>
<benefit>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-benefit-type"/>
<code value="employee-contribution"/>
</coding>
</type>
<cost>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-benefit-type"/>
<code value="employee-contribution"/>
</coding>
</type>
<value>
<value value="15"/>
</value>
</cost>
</benefit>
</specificCost>
<specificCost>
<category>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-cost-category"/>
<code value="medical"/>
</coding>
</category>
<benefit>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-benefit-type"/>
<code value="employee-contribution"/>
</coding>
</type>
<cost>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-benefit-type"/>
<code value="employee-contribution"/>
</coding>
</type>
<value>
<value value="125"/>
</value>
</cost>
</benefit>
</specificCost>
<specificCost>
<category>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-cost-category"/>
<code value="drug"/>
</coding>
</category>
<benefit>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-benefit-type"/>
<code value="monthly-premium-paid"/>
</coding>
</type>
<cost>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-benefit-type"/>
<code value="monthly-premium-paid"/>
</coding>
</type>
<value>
<value value="25"/>
</value>
</cost>
</benefit>
</specificCost>
<specificCost>
<category>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-cost-category"/>
<code value="medical"/>
</coding>
</category>
<benefit>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-benefit-type"/>
<code value="monthly-premium-paid"/>
</coding>
</type>
<cost>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-benefit-type"/>
<code value="monthly-premium-paid"/>
</coding>
</type>
<value>
<value value="55"/>
</value>
</cost>
</benefit>
</specificCost>
<specificCost>
<category>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-cost-category"/>
<code value="other"/>
</coding>
</category>
<benefit>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-benefit-type"/>
<code value="non-claim-payment"/>
</coding>
</type>
<cost>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-benefit-type"/>
<code value="non-claim-payment"/>
</coding>
</type>
<value>
<value value="5"/>
</value>
</cost>
</benefit>
</specificCost>
<specificCost>
<category>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-cost-category"/>
<code value="dental"/>
</coding>
</category>
<benefit>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-benefit-type"/>
<code value="administrative-fee"/>
</coding>
</type>
<cost>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-benefit-type"/>
<code value="administrative-fee"/>
</coding>
</type>
<value>
<value value="2"/>
</value>
</cost>
</benefit>
</specificCost>
<specificCost>
<category>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-cost-category"/>
<code value="vision"/>
</coding>
</category>
<benefit>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-benefit-type"/>
<code value="administrative-fee"/>
</coding>
</type>
<cost>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-benefit-type"/>
<code value="administrative-fee"/>
</coding>
</type>
<value>
<value value="3"/>
</value>
</cost>
</benefit>
</specificCost>
<specificCost>
<category>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-cost-category"/>
<code value="dental"/>
</coding>
</category>
<benefit>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-benefit-type"/>
<code value="employee-contribution"/>
</coding>
</type>
<cost>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-benefit-type"/>
<code value="employee-contribution"/>
</coding>
</type>
<value>
<value value="0"/>
</value>
</cost>
</benefit>
</specificCost>
<specificCost>
<category>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-cost-category"/>
<code value="vision"/>
</coding>
</category>
<benefit>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-benefit-type"/>
<code value="employee-contribution"/>
</coding>
</type>
<cost>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-benefit-type"/>
<code value="employee-contribution"/>
</coding>
</type>
<value>
<value value="0"/>
</value>
</cost>
</benefit>
</specificCost>
<specificCost>
<category>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-cost-category"/>
<code value="other"/>
</coding>
</category>
<benefit>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-benefit-type"/>
<code value="capitation-amount"/>
</coding>
</type>
<cost>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-benefit-type"/>
<code value="capitation-amount"/>
</coding>
</type>
<value>
<value value="0"/>
</value>
</cost>
</benefit>
</specificCost>
<specificCost>
<category>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-cost-category"/>
<code value="other"/>
</coding>
</category>
<benefit>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-benefit-type"/>
<code value="monthly-premium-billed"/>
</coding>
</type>
<cost>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-benefit-type"/>
<code value="monthly-premium-billed"/>
</coding>
</type>
<value>
<value value="10"/>
</value>
</cost>
</benefit>
</specificCost>
<specificCost>
<category>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-cost-category"/>
<code value="dental"/>
</coding>
</category>
<benefit>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-benefit-type"/>
<code value="monthly-premium-paid"/>
</coding>
</type>
<cost>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-benefit-type"/>
<code value="monthly-premium-paid"/>
</coding>
</type>
<value>
<value value="5"/>
</value>
</cost>
</benefit>
</specificCost>
<specificCost>
<category>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-cost-category"/>
<code value="vision"/>
</coding>
</category>
<benefit>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-benefit-type"/>
<code value="monthly-premium-paid"/>
</coding>
</type>
<cost>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-benefit-type"/>
<code value="monthly-premium-paid"/>
</coding>
</type>
<value>
<value value="2"/>
</value>
</cost>
</benefit>
</specificCost>
<specificCost>
<category>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-cost-category"/>
<code value="other"/>
</coding>
</category>
<benefit>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-benefit-type"/>
<code value="administrative-fee"/>
</coding>
</type>
<cost>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-benefit-type"/>
<code value="administrative-fee"/>
</coding>
</type>
<value>
<value value="2"/>
</value>
</cost>
</benefit>
</specificCost>
<specificCost>
<category>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-cost-category"/>
<code value="other"/>
</coding>
</category>
<benefit>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-benefit-type"/>
<code value="employee-contribution"/>
</coding>
</type>
<cost>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-benefit-type"/>
<code value="employee-contribution"/>
</coding>
</type>
<value>
<value value="6"/>
</value>
</cost>
</benefit>
</specificCost>
<specificCost>
<category>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-cost-category"/>
<code value="other"/>
</coding>
</category>
<benefit>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-benefit-type"/>
<code value="monthly-premium-paid"/>
</coding>
</type>
<cost>
<type>
<coding>
<system
value="http://linuxforhealth.org/fhir/cdm/CodeSystem/insurance-plan-benefit-type"/>
<code value="monthly-premium-paid"/>
</coding>
</type>
<value>
<value value="6"/>
</value>
</cost>
</benefit>
</specificCost>
</plan>
</InsurancePlan>
IG © 2021+ LinuxForHealth Team. Package linuxforhealth.fhir.ig#8.0.0 based on FHIR 4.0.1. Generated 2022-11-10
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