LinuxForHealth FHIR Implementation Guide
8.0.0 - draft
LinuxForHealth FHIR Implementation Guide
8.0.0 - draft
LinuxForHealth FHIR Implementation Guide - Local Development build (v8.0.0). See the Directory of published versions
| Official URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/cdm-insurance-plan | Version: 8.0.0 | |||
| Active as of 2022-11-10 | Computable Name: CDMInsurancePlan | |||
LinuxForHealth Common Data Model definition of what fields we currently define for an insurance plan
Usage:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from InsurancePlan
| Path | Conformance | ValueSet |
| InsurancePlan.extension:IndustryClassification.valueCodeableConcept | example | PayerJobTitleValueSet |
| InsurancePlan.type | extensible | InsurancePlanTypeValueSet |
| InsurancePlan.coverage.type | extensible | InsurancePlanTypeValueSet |
| Path | Conformance | ValueSet |
| InsurancePlan.extension:IndustryClassification.value[x]:valueCodeableConcept | example | PayerJobTitleValueSet |
| InsurancePlan.status | required | PublicationStatus |
| InsurancePlan.type | extensible | InsurancePlanTypeValueSet |
| Name | Flags | Card. | Type | Description & Constraints | ||||
|---|---|---|---|---|---|---|---|---|
  InsurancePlan | C | 0..* | InsurancePlan | Details of a Health Insurance product/plan provided by an organization | ||||
  id | Σ | 0..1 | id | Logical id of this artifact | ||||
 meta | 0..1 | ProcessMeta | Metadata about a resource | |||||
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
| language | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
 Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
 dentalFullyInsuredIndicator | 0..1 | string | Indicator of the fully insured dental coverage for the member or employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/dental-fully-insured-indicator | |||||
| drugFullyInsuredIndicator | 0..1 | string | Indicator of the fully insured drug coverage for the member or employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/drug-fully-insured-indicator | |||||
| enrollmentType | 0..1 | CodeableConcept | Code for the type of enrollment URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/enrollment-type | |||||
| exchangePlanIndicator | 0..1 | string | Indicator that identifies if the plan is available on a healthcare exchange marketplace URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/exchange-plan-indicator | |||||
 IndustryClassification | 0..1 | CodeableConcept | Industry classification code which can be based on the North American Industry Classification System (NAICS) URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/industry-classification | |||||
  id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..0 | |||||||
| url | 1..1 | uri | "http://linuxforhealth.org/fhir/cdm/StructureDefinition/industry-classification" | |||||
  Slices for value[x] | 0..1 | CodeableConcept | Value of extension Slice: Unordered, Closed by type:$this | |||||
  value[x]:valueCodeableConcept | 0..1 | CodeableConcept | Value of extension Binding: Payer Job Title Value Set (example) | |||||
| medicalFullyInsuredIndicator | 0..1 | string | Indicator of the fully insured medical coverage for the member or employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/medical-fully-insured-indicator | |||||
| visionFullyInsuredIndicator | 0..1 | string | Indicator of the fully insured vision coverage for the member or employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/vision-fully-insured-indicator | |||||
| payerDentalCoverageIndicator | 0..1 | string | Indicates whether the member has dental benefit coverage: Y or N URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/payer-dental-coverage-indicator | |||||
| payerDrugCoverageIndicator | 0..1 | string | Indicates whether the member has drug benefit coverage: Y or N URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/payer-drug-coverage-indicator | |||||
| payerHearingCoverageIndicator | 0..1 | string | Indicates whether the member has hearing benefit coverage: Y or N URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/payer-hearing-coverage-indicator | |||||
| payerLongtermCareCoverageIndicator | 0..1 | string | Indicates whether the member or employee has long-term care benefit coverage URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/payer-long-term-care-coverage-indicator | |||||
| payerManagedCarePlanType | 0..1 | CodeableConcept | Code for the managed care plan type under which the eligible individual is enrolled URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/payer-managed-care-plan-type | |||||
| payerMedicalCoverageIndicator | 0..1 | string | Indicates whether the member has medical benefit coverage: Y or N URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/payer-medical-coverage-indicator | |||||
| payerMentalHealthAmbulatoryCoverageIndicator | 0..1 | string | Indicates whether the member has mental health ambulatory benefit coverage: Y or N. URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/payer-mental-health-ambulatory-coverage-indicator | |||||
| payerMentalHealthDayNightCoverageIndicator | 0..1 | string | Indicates whether the member has mental health day-night benefit coverage: Y or N. URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/payer-mental-health-day-night-coverage-indicator | |||||
| payerMentalHealthInpatientCoverageIndicator | 0..1 | string | Indicates whether the member has mental health inpatient benefit coverage: Y or N. URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/payer-mental-health-inpatient-coverage-indicator | |||||
| payerPsychCoverageIndicator | 0..1 | string | Indicates whether the member has mental health and substance abuse benefit coverage: Y or N URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/payer-psych-coverage-indicator | |||||
| payerShorttermCareCoverageIndicator | 0..1 | string | Indicates whether the member or employee has short-term care benefit coverage URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/payer-short-term-care-coverage-indicator | |||||
| payerSubstanceAbuseAmbulatoryCoverageIndicator | 0..1 | string | Indicator of Substance Abuse (chemical dependency) Ambulatory benefit coverage for the member URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/payer-substance-abuse-ambulatory-coverage-indicator | |||||
| payerSubstanceAbuseDayNightCoverageIndicator | 0..1 | string | Indicator of Substance Abuse (chemical dependency) day-night benefit coverage for the member URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/payer-substance-abuse-day-night-coverage-indicator | |||||
| payerSubstanceAbuseInpatientCoverageIndicator | 0..1 | string | Indicator of Substance Abuse (chemical dependency) inpatient benefit coverage for the member URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/payer-substance-abuse-inpatient-coverage-indicator | |||||
| payerVisionCoverageIndicator | 0..1 | string | Indicates whether the member has vision benefit coverage: Y or N URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/payer-vision-coverage-indicator | |||||
 modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ||||
| identifier | ΣC | 0..* | Identifier | Business Identifier for Product | ||||
| status | ?!Σ | 0..1 | code | draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact. | ||||
| type | Σ | 0..* | CodeableConcept | Kind of product Binding: Insurance Plan Type Value Set (extensible) | ||||
| name | ΣC | 0..1 | string | Official name | ||||
| alias | 0..* | string | Alternate names | |||||
| period | 0..1 | Period | When the product is available | |||||
 ownedBy | Σ | 0..1 | Reference(Organization) | Plan issuer | ||||
| administeredBy | Σ | 0..1 | Reference(Organization) | Product administrator | ||||
| coverageArea | Σ | 0..* | Reference(Location) | Where product applies | ||||
| contact | 0..* | BackboneElement | Contact for the product | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| purpose | 0..1 | CodeableConcept | The type of contact Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party. | |||||
| name | 0..1 | HumanName | A name associated with the contact | |||||
| telecom | 0..* | ContactPoint | Contact details (telephone, email, etc.) for a contact | |||||
 address | 0..1 | Address | Visiting or postal addresses for the contact | |||||
| endpoint | 0..* | Reference(Endpoint) | Technical endpoint | |||||
| network | 0..* | Reference(Organization) | What networks are Included | |||||
| coverage | 0..* | BackboneElement | Coverage details | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 1..1 | CodeableConcept | Type of coverage Binding: Insurance Plan Type Value Set (extensible) | |||||
| network | 0..* | Reference(Organization) | What networks provide coverage | |||||
 benefit | 1..* | BackboneElement | List of benefits | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 1..1 | CodeableConcept | Type of benefit | |||||
| requirement | 0..1 | string | Referral requirements | |||||
| limit | 0..* | BackboneElement | Benefit limits | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| value | 0..1 | Quantity | Maximum value allowed | |||||
| code | 0..1 | CodeableConcept | Benefit limit details | |||||
| plan | 0..* | BackboneElement | Plan details | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| acaHealthInsuranceOversightSystemPlan | 0..1 | CodeableConcept | Code for Affordable Care Act (ACA) HIOS plan URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/aca-health-insurance-oversight-system-plan | |||||
| acaHealthInsuranceOversightSystemProduct | 0..1 | CodeableConcept | Code for Affordable Care Act (ACA) HIOS product ID and component code of the associated plan URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/aca-health-insurance-oversight-system-product | |||||
| acaMarketType | 0..1 | CodeableConcept | Code for Affordable Care Act (ACA) market type of the associated plan URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/aca-market-type | |||||
| acaMetalTier | 0..1 | CodeableConcept | Code for Affordable Care Act (ACA) metal tier of the associated plan URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/aca-metal-tier | |||||
| capitationArrangement | 0..1 | CodeableConcept | Code for the capitation arrangement URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/capitation-arrangement | |||||
| carveOut | 0..1 | CodeableConcept | Code for the carveout group URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/carve-out | |||||
| costSharingReductionVariant | 0..1 | CodeableConcept | Code for Affordable Care Act (ACA) cost sharing reduction variant of the associated plan URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/cost-sharing-reduction-variant | |||||
| fundingArrangement | 0..1 | CodeableConcept | Code for the funding arrangement URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/funding-arrangement | |||||
| levelOfCare | 0..1 | CodeableConcept | Code for the level of care URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/level-of-care | |||||
| longtermCareDuration | 0..1 | integer | Number of weeks for which the employee is eligible for long-term disability (LTD) benefits URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/long-term-care-duration | |||||
| longtermCareWaitingPeriod | 0..1 | integer | Elimination or waiting period for the long-term disability (LTD) benefit (for example, 90, 180 or 365 days). URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/long-term-care-waiting-period | |||||
| ratingArea | 0..1 | CodeableConcept | Code for the geographic insurance rating area of the associated plan URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/rating-area | |||||
| shorttermCareDuration | 0..1 | integer | Number of weeks for which the employee is eligible for short-term disability (STD) benefits URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/short-term-care-duration | |||||
| shorttermCareWaitingPeriod | 0..1 | integer | Elimination or waiting period for the short-term disability (STD) benefit (for example, 90, 180 or 365 days). URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/short-term-care-waiting-period | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| identifier | Σ | 0..* | Identifier | Business Identifier for Product | ||||
| type | 0..1 | CodeableConcept | Type of plan | |||||
| coverageArea | Σ | 0..* | Reference(Location) | Where product applies | ||||
| network | 0..* | Reference(Organization) | What networks provide coverage | |||||
| generalCost | 0..* | BackboneElement | Overall costs | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 0..1 | CodeableConcept | Type of cost | |||||
| groupSize | 0..1 | positiveInt | Number of enrollees | |||||
| cost | 0..1 | Money | Cost value | |||||
| comment | 0..1 | string | Additional cost information | |||||
| specificCost | 0..* | BackboneElement | Specific costs | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| category | 1..1 | CodeableConcept | General category of benefit | |||||
| benefit | 0..* | BackboneElement | Benefits list | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 1..1 | CodeableConcept | Type of specific benefit | |||||
| cost | 0..* | BackboneElement | List of the costs | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 1..1 | CodeableConcept | Type of cost | |||||
| applicability | 0..1 | CodeableConcept | in-network | out-of-network | other Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers. | |||||
| qualifiers | 0..* | CodeableConcept | Additional information about the cost | |||||
| value | 0..1 | Quantity | The actual cost value | |||||
| Documentation for this format | ||||||||
| Path | Conformance | ValueSet | ||||
| InsurancePlan.language | preferred | CommonLanguages
| ||||
| InsurancePlan.extension:IndustryClassification.value[x]:valueCodeableConcept | example | PayerJobTitleValueSet | ||||
| InsurancePlan.status | required | PublicationStatus | ||||
| InsurancePlan.type | extensible | InsurancePlanTypeValueSet | ||||
| InsurancePlan.contact.purpose | extensible | ContactEntityType | ||||
| InsurancePlan.coverage.type | extensible | InsurancePlanTypeValueSet | ||||
| InsurancePlan.plan.specificCost.benefit.cost.applicability | required | BenefitCostApplicability |
This structure is derived from InsurancePlan
Summary
Prohibited: 1 element
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Differential View
This structure is derived from InsurancePlan
| Path | Conformance | ValueSet |
| InsurancePlan.extension:IndustryClassification.valueCodeableConcept | example | PayerJobTitleValueSet |
| InsurancePlan.type | extensible | InsurancePlanTypeValueSet |
| InsurancePlan.coverage.type | extensible | InsurancePlanTypeValueSet |
Key Elements View
| Path | Conformance | ValueSet |
| InsurancePlan.extension:IndustryClassification.value[x]:valueCodeableConcept | example | PayerJobTitleValueSet |
| InsurancePlan.status | required | PublicationStatus |
| InsurancePlan.type | extensible | InsurancePlanTypeValueSet |
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints | ||||
|---|---|---|---|---|---|---|---|---|
| InsurancePlan | C | 0..* | InsurancePlan | Details of a Health Insurance product/plan provided by an organization | ||||
| id | Σ | 0..1 | id | Logical id of this artifact | ||||
| meta | 0..1 | ProcessMeta | Metadata about a resource | |||||
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
| language | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| dentalFullyInsuredIndicator | 0..1 | string | Indicator of the fully insured dental coverage for the member or employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/dental-fully-insured-indicator | |||||
| drugFullyInsuredIndicator | 0..1 | string | Indicator of the fully insured drug coverage for the member or employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/drug-fully-insured-indicator | |||||
| enrollmentType | 0..1 | CodeableConcept | Code for the type of enrollment URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/enrollment-type | |||||
| exchangePlanIndicator | 0..1 | string | Indicator that identifies if the plan is available on a healthcare exchange marketplace URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/exchange-plan-indicator | |||||
| IndustryClassification | 0..1 | CodeableConcept | Industry classification code which can be based on the North American Industry Classification System (NAICS) URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/industry-classification | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..0 | |||||||
| url | 1..1 | uri | "http://linuxforhealth.org/fhir/cdm/StructureDefinition/industry-classification" | |||||
| Slices for value[x] | 0..1 | CodeableConcept | Value of extension Slice: Unordered, Closed by type:$this | |||||
| value[x]:valueCodeableConcept | 0..1 | CodeableConcept | Value of extension Binding: Payer Job Title Value Set (example) | |||||
| medicalFullyInsuredIndicator | 0..1 | string | Indicator of the fully insured medical coverage for the member or employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/medical-fully-insured-indicator | |||||
| visionFullyInsuredIndicator | 0..1 | string | Indicator of the fully insured vision coverage for the member or employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/vision-fully-insured-indicator | |||||
| payerDentalCoverageIndicator | 0..1 | string | Indicates whether the member has dental benefit coverage: Y or N URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/payer-dental-coverage-indicator | |||||
| payerDrugCoverageIndicator | 0..1 | string | Indicates whether the member has drug benefit coverage: Y or N URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/payer-drug-coverage-indicator | |||||
| payerHearingCoverageIndicator | 0..1 | string | Indicates whether the member has hearing benefit coverage: Y or N URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/payer-hearing-coverage-indicator | |||||
| payerLongtermCareCoverageIndicator | 0..1 | string | Indicates whether the member or employee has long-term care benefit coverage URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/payer-long-term-care-coverage-indicator | |||||
| payerManagedCarePlanType | 0..1 | CodeableConcept | Code for the managed care plan type under which the eligible individual is enrolled URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/payer-managed-care-plan-type | |||||
| payerMedicalCoverageIndicator | 0..1 | string | Indicates whether the member has medical benefit coverage: Y or N URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/payer-medical-coverage-indicator | |||||
| payerMentalHealthAmbulatoryCoverageIndicator | 0..1 | string | Indicates whether the member has mental health ambulatory benefit coverage: Y or N. URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/payer-mental-health-ambulatory-coverage-indicator | |||||
| payerMentalHealthDayNightCoverageIndicator | 0..1 | string | Indicates whether the member has mental health day-night benefit coverage: Y or N. URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/payer-mental-health-day-night-coverage-indicator | |||||
| payerMentalHealthInpatientCoverageIndicator | 0..1 | string | Indicates whether the member has mental health inpatient benefit coverage: Y or N. URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/payer-mental-health-inpatient-coverage-indicator | |||||
| payerPsychCoverageIndicator | 0..1 | string | Indicates whether the member has mental health and substance abuse benefit coverage: Y or N URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/payer-psych-coverage-indicator | |||||
| payerShorttermCareCoverageIndicator | 0..1 | string | Indicates whether the member or employee has short-term care benefit coverage URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/payer-short-term-care-coverage-indicator | |||||
| payerSubstanceAbuseAmbulatoryCoverageIndicator | 0..1 | string | Indicator of Substance Abuse (chemical dependency) Ambulatory benefit coverage for the member URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/payer-substance-abuse-ambulatory-coverage-indicator | |||||
| payerSubstanceAbuseDayNightCoverageIndicator | 0..1 | string | Indicator of Substance Abuse (chemical dependency) day-night benefit coverage for the member URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/payer-substance-abuse-day-night-coverage-indicator | |||||
| payerSubstanceAbuseInpatientCoverageIndicator | 0..1 | string | Indicator of Substance Abuse (chemical dependency) inpatient benefit coverage for the member URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/payer-substance-abuse-inpatient-coverage-indicator | |||||
| payerVisionCoverageIndicator | 0..1 | string | Indicates whether the member has vision benefit coverage: Y or N URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/payer-vision-coverage-indicator | |||||
| modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ||||
| identifier | ΣC | 0..* | Identifier | Business Identifier for Product | ||||
| status | ?!Σ | 0..1 | code | draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact. | ||||
| type | Σ | 0..* | CodeableConcept | Kind of product Binding: Insurance Plan Type Value Set (extensible) | ||||
| name | ΣC | 0..1 | string | Official name | ||||
| alias | 0..* | string | Alternate names | |||||
| period | 0..1 | Period | When the product is available | |||||
| ownedBy | Σ | 0..1 | Reference(Organization) | Plan issuer | ||||
| administeredBy | Σ | 0..1 | Reference(Organization) | Product administrator | ||||
| coverageArea | Σ | 0..* | Reference(Location) | Where product applies | ||||
| contact | 0..* | BackboneElement | Contact for the product | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| purpose | 0..1 | CodeableConcept | The type of contact Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party. | |||||
| name | 0..1 | HumanName | A name associated with the contact | |||||
| telecom | 0..* | ContactPoint | Contact details (telephone, email, etc.) for a contact | |||||
| address | 0..1 | Address | Visiting or postal addresses for the contact | |||||
| endpoint | 0..* | Reference(Endpoint) | Technical endpoint | |||||
| network | 0..* | Reference(Organization) | What networks are Included | |||||
| coverage | 0..* | BackboneElement | Coverage details | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 1..1 | CodeableConcept | Type of coverage Binding: Insurance Plan Type Value Set (extensible) | |||||
| network | 0..* | Reference(Organization) | What networks provide coverage | |||||
| benefit | 1..* | BackboneElement | List of benefits | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 1..1 | CodeableConcept | Type of benefit | |||||
| requirement | 0..1 | string | Referral requirements | |||||
| limit | 0..* | BackboneElement | Benefit limits | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| value | 0..1 | Quantity | Maximum value allowed | |||||
| code | 0..1 | CodeableConcept | Benefit limit details | |||||
| plan | 0..* | BackboneElement | Plan details | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| acaHealthInsuranceOversightSystemPlan | 0..1 | CodeableConcept | Code for Affordable Care Act (ACA) HIOS plan URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/aca-health-insurance-oversight-system-plan | |||||
| acaHealthInsuranceOversightSystemProduct | 0..1 | CodeableConcept | Code for Affordable Care Act (ACA) HIOS product ID and component code of the associated plan URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/aca-health-insurance-oversight-system-product | |||||
| acaMarketType | 0..1 | CodeableConcept | Code for Affordable Care Act (ACA) market type of the associated plan URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/aca-market-type | |||||
| acaMetalTier | 0..1 | CodeableConcept | Code for Affordable Care Act (ACA) metal tier of the associated plan URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/aca-metal-tier | |||||
| capitationArrangement | 0..1 | CodeableConcept | Code for the capitation arrangement URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/capitation-arrangement | |||||
| carveOut | 0..1 | CodeableConcept | Code for the carveout group URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/carve-out | |||||
| costSharingReductionVariant | 0..1 | CodeableConcept | Code for Affordable Care Act (ACA) cost sharing reduction variant of the associated plan URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/cost-sharing-reduction-variant | |||||
| fundingArrangement | 0..1 | CodeableConcept | Code for the funding arrangement URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/funding-arrangement | |||||
| levelOfCare | 0..1 | CodeableConcept | Code for the level of care URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/level-of-care | |||||
| longtermCareDuration | 0..1 | integer | Number of weeks for which the employee is eligible for long-term disability (LTD) benefits URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/long-term-care-duration | |||||
| longtermCareWaitingPeriod | 0..1 | integer | Elimination or waiting period for the long-term disability (LTD) benefit (for example, 90, 180 or 365 days). URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/long-term-care-waiting-period | |||||
| ratingArea | 0..1 | CodeableConcept | Code for the geographic insurance rating area of the associated plan URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/rating-area | |||||
| shorttermCareDuration | 0..1 | integer | Number of weeks for which the employee is eligible for short-term disability (STD) benefits URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/short-term-care-duration | |||||
| shorttermCareWaitingPeriod | 0..1 | integer | Elimination or waiting period for the short-term disability (STD) benefit (for example, 90, 180 or 365 days). URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/short-term-care-waiting-period | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| identifier | Σ | 0..* | Identifier | Business Identifier for Product | ||||
| type | 0..1 | CodeableConcept | Type of plan | |||||
| coverageArea | Σ | 0..* | Reference(Location) | Where product applies | ||||
| network | 0..* | Reference(Organization) | What networks provide coverage | |||||
| generalCost | 0..* | BackboneElement | Overall costs | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 0..1 | CodeableConcept | Type of cost | |||||
| groupSize | 0..1 | positiveInt | Number of enrollees | |||||
| cost | 0..1 | Money | Cost value | |||||
| comment | 0..1 | string | Additional cost information | |||||
| specificCost | 0..* | BackboneElement | Specific costs | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| category | 1..1 | CodeableConcept | General category of benefit | |||||
| benefit | 0..* | BackboneElement | Benefits list | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 1..1 | CodeableConcept | Type of specific benefit | |||||
| cost | 0..* | BackboneElement | List of the costs | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 1..1 | CodeableConcept | Type of cost | |||||
| applicability | 0..1 | CodeableConcept | in-network | out-of-network | other Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers. | |||||
| qualifiers | 0..* | CodeableConcept | Additional information about the cost | |||||
| value | 0..1 | Quantity | The actual cost value | |||||
| Documentation for this format | ||||||||
| Path | Conformance | ValueSet | ||||
| InsurancePlan.language | preferred | CommonLanguages
| ||||
| InsurancePlan.extension:IndustryClassification.value[x]:valueCodeableConcept | example | PayerJobTitleValueSet | ||||
| InsurancePlan.status | required | PublicationStatus | ||||
| InsurancePlan.type | extensible | InsurancePlanTypeValueSet | ||||
| InsurancePlan.contact.purpose | extensible | ContactEntityType | ||||
| InsurancePlan.coverage.type | extensible | InsurancePlanTypeValueSet | ||||
| InsurancePlan.plan.specificCost.benefit.cost.applicability | required | BenefitCostApplicability |
This structure is derived from InsurancePlan
Summary
Prohibited: 1 element
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Other representations of profile: CSV, Excel, Schematron
