InsurancePlan
Full Profile Definition: | Profile: Insurance Plan |
Resource Content:
Differential
InsurancePlan | I | InsurancePlan | There are no (further) constraints on this element Element idInsurancePlan Details of a Health Insurance product/plan provided by an organization DefinitionDetails of a Health Insurance product/plan provided by an organization.
| |
id | Σ | 0..1 | string | There are no (further) constraints on this element Element idInsurancePlan.id Logical id of this artifact DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation. |
meta | Σ | 1..1 | Meta | There are no (further) constraints on this element Element idInsurancePlan.meta Metadata about the resource DefinitionThe metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
|
id | 0..1 | string | There are no (further) constraints on this element Element idInsurancePlan.meta.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.meta.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
versionId | Σ | 0..1 | id | There are no (further) constraints on this element Element idInsurancePlan.meta.versionId Version specific identifier DefinitionThe version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted. The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.
|
lastUpdated | Σ | 0..1 | instant | There are no (further) constraints on this element Element idInsurancePlan.meta.lastUpdated When the resource version last changed DefinitionWhen the resource last changed - e.g. when the version changed. This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.
|
meta-source | Σ | 1..1 | uri | Element idInsurancePlan.meta.source:meta-source uri of the data source DefinitionTypically the data owner's URL followed by a source/file description mandatory for all resources in bWell's FHIR Server In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.
example of meta.source https://www.icanbwell.com/provider-directory Mappings
|
profile | Σ | 0..* | canonical(StructureDefinition) | There are no (further) constraints on this element Element idInsurancePlan.meta.profile Profiles this resource claims to conform to DefinitionA list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url. It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set. canonical(StructureDefinition) Constraints
|
meta-security | Σ | 1..* | CodingBinding | Element idInsurancePlan.meta.security:meta-security security tags representing the data's owner, vendor, and accessibility Definitiondata owner: data vendor: data access: /owner & /access are mandatory for all resources in bWell's FHIR Server The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored. Security Labels from the Healthcare Privacy and Security Classification System.
example of data owner security tag { "system": "https://www.icanbwell.com/owner", "code": "bwell" } example of data access security tag { "system": "https://www.icanbwell.com/access", "code": "bwell" } example of data vendor security tag { "system": "https://www.icanbwell.com/vendor", "code": "bwell" } Mappings
|
tag | Σ | 0..* | Coding | There are no (further) constraints on this element Element idInsurancePlan.meta.tag Tags applied to this resource DefinitionTags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource. The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored. Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
|
implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idInsurancePlan.implicitRules A set of rules under which this content was created DefinitionA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
|
language | 0..1 | codeBinding | There are no (further) constraints on this element Element idInsurancePlan.language Language of the resource content DefinitionThe base language in which the resource is written. Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). A human language.
| |
text | 0..1 | Narrative | There are no (further) constraints on this element Element idInsurancePlan.text Text summary of the resource, for human interpretation Alternate namesnarrative, html, xhtml, display DefinitionA human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
| |
contained | 0..* | Resource | There are no (further) constraints on this element Element idInsurancePlan.contained Contained, inline Resources Alternate namesinline resources, anonymous resources, contained resources DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
modifierExtension | ?! I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
identifier | Σ I | 0..* | Identifier | Element idInsurancePlan.identifier a value to identify the resource by DefinitionBusiness identifiers assigned to this health insurance product which remain constant as the resource is updated and propagates from server to server. Unordered, Open, by slice by types Constraints
|
(All Slices) | There are no (further) constraints on this element | |||
id | 1..1 | string | Element idInsurancePlan.identifier.id set case-by-case DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.identifier.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
use | Σ ?! | 0..1 | codeBinding | There are no (further) constraints on this element Element idInsurancePlan.identifier.use usual | official | temp | secondary | old (If known) DefinitionThe purpose of this identifier. Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. Identifies the purpose for this identifier, if known .
|
type | Σ | 1..1 | CodeableConceptBinding | Element idInsurancePlan.identifier.type Description of identifier DefinitionA coded type for the identifier that can be used to determine which identifier to use for a specific purpose. Needs binding valueset This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type. A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
|
system | Σ | 1..1 | uri | Element idInsurancePlan.identifier.system The system which created the identifier DefinitionValues may be an oid, uri, url, or canonical There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers. for mapped data, this is frequently a canonical url
General http://www.acme.com/identifiers/patient a client's unknown system https://www.health.org/person-identifier Mappings
|
value | Σ | 1..1 | string | Element idInsurancePlan.identifier.value The unique value DefinitionThe raw identifier value that represents a resource This should be the raw value, as it exists in the source data (ie without prefix) If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
General 123456 Mappings
|
period | Σ I | 0..1 | Period | There are no (further) constraints on this element Element idInsurancePlan.identifier.period Time period when id is/was valid for use DefinitionTime period during which identifier is/was valid for use. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration.
|
assigner | Σ I | 0..1 | Reference(Organization) | There are no (further) constraints on this element Element idInsurancePlan.identifier.assigner Organization that issued id (may be just text) DefinitionOrganization that issued/manages the identifier. The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
|
status | S Σ ?! | 1..1 | codeBinding | There are no (further) constraints on this element Element idInsurancePlan.status draft | active | retired | unknown DefinitionThe current state of the health insurance product. Need a flag to indicate a record is no longer to be used and should generally be hidden for the user in the UI. Note that FHIR strings SHALL NOT exceed 1MB in size Default interpretation is active. The lifecycle status of an artifact.
|
type | S Σ | 1..* | CodeableConceptPattern | Element idInsurancePlan.type insurance plan type DefinitionThe kind of health insurance product. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Used to categorize the product/plan.
{ "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/insurance-plan-type" } ] }
|
name | S Σ I | 1..1 | string | Element idInsurancePlan.name Official name DefinitionOfficial name of the health insurance product as designated by the owner. If the name of the product/plan changes, consider putting the old name in the alias column so that it can still be located through searches.
insurance plan name Unity Point Direct Contracting Plan Mappings
|
alias | 0..* | string | There are no (further) constraints on this element Element idInsurancePlan.alias Alternate names DefinitionA list of alternate names that the product is known as, or was known as in the past. Over time products/plans go through many changes and can be known by different names. For searching knowing previous names that the product/plan was known by can be very useful. There are no dates associated with the alias/historic names, as this is not intended to track when names were used, but to assist in searching so that older names can still result in identifying the product/plan.
| |
period | I | 0..1 | Period | There are no (further) constraints on this element Element idInsurancePlan.period When the product is available DefinitionThe period of time that the health insurance product is available. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration.
|
ownedBy | Σ I | 1..1 | Reference(Profile: Healthcare Organization) | Element idInsurancePlan.ownedBy Plan issuer Alternate namesPayer DefinitionThe entity that is providing the health insurance product and underwriting the risk. This is typically an insurance carriers, other third-party payers, or health plan sponsors comonly referred to as 'payers'. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Profile: Healthcare Organization) Constraints
|
administeredBy | Σ I | 1..1 | Reference(Profile: Healthcare Organization) | Element idInsurancePlan.administeredBy Product administrator DefinitionAn organization which administer other services such as underwriting, customer service and/or claims processing on behalf of the health insurance product owner. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Profile: Healthcare Organization) Constraints
|
coverageArea | Σ I | 1..* | Reference(https://fhir.icanbwell.com/4_0_0/StructureDefinition/pr-location-area) | Element idInsurancePlan.coverageArea Where product applies Alternate nameszip code, state DefinitionThe geographic region in which a health insurance product's benefits apply. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(https://fhir.icanbwell.com/4_0_0/StructureDefinition/pr-location-area) Constraints
|
contact | 0..* | BackboneElement | There are no (further) constraints on this element Element idInsurancePlan.contact Contact for the product DefinitionThe contact for the health insurance product for a certain purpose. Need to keep track of assigned contact points within bigger organization. Where multiple contacts for the same purpose are provided there is a standard extension that can be used to determine which one is the preferred contact to use.
| |
id | 0..1 | string | There are no (further) constraints on this element Element idInsurancePlan.contact.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.contact.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.contact.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
|
purpose | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idInsurancePlan.contact.purpose The type of contact DefinitionIndicates a purpose for which the contact can be reached. Need to distinguish between multiple contact persons. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The purpose for which you would contact a contact party.
| |
name | 0..1 | HumanName | There are no (further) constraints on this element Element idInsurancePlan.contact.name A name associated with the contact DefinitionA name associated with the contact. Need to be able to track the person by name. Names may be changed, or repudiated, or people may have different names in different contexts. Names may be divided into parts of different type that have variable significance depending on context, though the division into parts does not always matter. With personal names, the different parts might or might not be imbued with some implicit meaning; various cultures associate different importance with the name parts and the degree to which systems must care about name parts around the world varies widely.
| |
telecom | I | 0..* | ContactPoint | There are no (further) constraints on this element Element idInsurancePlan.contact.telecom Contact details (telephone, email, etc.) for a contact DefinitionA contact detail (e.g. a telephone number or an email address) by which the party may be contacted. People have (primary) ways to contact them in some way such as phone, email.
|
address | 0..1 | Address | There are no (further) constraints on this element Element idInsurancePlan.contact.address Visiting or postal addresses for the contact DefinitionVisiting or postal addresses for the contact. May need to keep track of a contact party's address for contacting, billing or reporting requirements. Note: address is intended to describe postal addresses for administrative purposes, not to describe absolute geographical coordinates. Postal addresses are often used as proxies for physical locations (also see the Location resource).
| |
endpoint | I | 0..* | Reference(Endpoint) | There are no (further) constraints on this element Element idInsurancePlan.endpoint Technical endpoint DefinitionThe technical endpoints providing access to services operated for the health insurance product. Organizations have multiple systems that provide various services and need to be able to define the technical connection details for how to connect to them, and for what purpose. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
|
network | I | 1..1 | Reference(https://fhir.icanbwell.com/4_0_0/StructureDefinition/pr-healthcare-network) | Element idInsurancePlan.network What networks are Included DefinitionReference to the network included in the health insurance product. Networks are represented as a hierarchy of organization resources. Reference(https://fhir.icanbwell.com/4_0_0/StructureDefinition/pr-healthcare-network) Constraints
|
coverage | 0..* | BackboneElement | There are no (further) constraints on this element Element idInsurancePlan.coverage Coverage details DefinitionDetails about the coverage offered by the insurance product.
| |
id | 0..1 | string | There are no (further) constraints on this element Element idInsurancePlan.coverage.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.coverage.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.coverage.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
|
type | 1..1 | CodeableConcept | There are no (further) constraints on this element Element idInsurancePlan.coverage.type Type of coverage DefinitionType of coverage (Medical; Dental; Mental Health; Substance Abuse; Vision; Drug; Short Term; Long Term Care; Hospice; Home Health). Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
| |
network | I | 0..* | Reference(Organization) | There are no (further) constraints on this element Element idInsurancePlan.coverage.network What networks provide coverage DefinitionReference to the network that providing the type of coverage. Networks are represented as a hierarchy of organization resources.
|
benefit | 1..* | BackboneElement | There are no (further) constraints on this element Element idInsurancePlan.coverage.benefit List of benefits DefinitionSpecific benefits under this type of coverage.
| |
id | 0..1 | string | There are no (further) constraints on this element Element idInsurancePlan.coverage.benefit.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.coverage.benefit.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.coverage.benefit.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
|
type | 1..1 | CodeableConcept | There are no (further) constraints on this element Element idInsurancePlan.coverage.benefit.type Type of benefit DefinitionType of benefit (primary care; speciality care; inpatient; outpatient). Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
| |
requirement | 0..1 | string | There are no (further) constraints on this element Element idInsurancePlan.coverage.benefit.requirement Referral requirements DefinitionThe referral requirements to have access/coverage for this benefit. Note that FHIR strings SHALL NOT exceed 1MB in size
| |
limit | 0..* | BackboneElement | There are no (further) constraints on this element Element idInsurancePlan.coverage.benefit.limit Benefit limits DefinitionThe specific limits on the benefit.
| |
id | 0..1 | string | There are no (further) constraints on this element Element idInsurancePlan.coverage.benefit.limit.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.coverage.benefit.limit.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.coverage.benefit.limit.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
|
value | I | 0..1 | Quantity | There are no (further) constraints on this element Element idInsurancePlan.coverage.benefit.limit.value Maximum value allowed DefinitionThe maximum amount of a service item a plan will pay for a covered benefit. For examples. wellness visits, or eyeglasses. May also be called “eligible expense,” “payment allowance,” or “negotiated rate.”.
|
code | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idInsurancePlan.coverage.benefit.limit.code Benefit limit details DefinitionThe specific limit on the benefit. Use
| |
plan | 0..* | BackboneElement | There are no (further) constraints on this element Element idInsurancePlan.plan Plan details DefinitionDetails about an insurance plan.
| |
id | 0..1 | string | There are no (further) constraints on this element Element idInsurancePlan.plan.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.plan.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.plan.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
|
identifier | Σ | 0..* | Identifier | There are no (further) constraints on this element Element idInsurancePlan.plan.identifier Business Identifier for Product DefinitionBusiness identifiers assigned to this health insurance plan which remain constant as the resource is updated and propagates from server to server.
|
type | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idInsurancePlan.plan.type Type of plan DefinitionType of plan. For example, "Platinum" or "High Deductable". Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
| |
coverageArea | Σ I | 0..* | Reference(Location) | There are no (further) constraints on this element Element idInsurancePlan.plan.coverageArea Where product applies DefinitionThe geographic region in which a health insurance plan's benefits apply. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
|
network | I | 0..* | Reference(Organization) | There are no (further) constraints on this element Element idInsurancePlan.plan.network What networks provide coverage DefinitionReference to the network that providing the type of coverage. Networks are represented as a hierarchy of organization resources.
|
generalCost | 0..* | BackboneElement | There are no (further) constraints on this element Element idInsurancePlan.plan.generalCost Overall costs DefinitionOverall costs associated with the plan.
| |
id | 0..1 | string | There are no (further) constraints on this element Element idInsurancePlan.plan.generalCost.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.plan.generalCost.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.plan.generalCost.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
|
type | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idInsurancePlan.plan.generalCost.type Type of cost DefinitionType of cost. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
| |
groupSize | 0..1 | positiveInt | There are no (further) constraints on this element Element idInsurancePlan.plan.generalCost.groupSize Number of enrollees DefinitionNumber of participants enrolled in the plan. 32 bit number; for values larger than this, use decimal
| |
cost | 0..1 | Money | There are no (further) constraints on this element Element idInsurancePlan.plan.generalCost.cost Cost value DefinitionValue of the cost.
| |
comment | 0..1 | string | There are no (further) constraints on this element Element idInsurancePlan.plan.generalCost.comment Additional cost information DefinitionAdditional information about the general costs associated with this plan. Note that FHIR strings SHALL NOT exceed 1MB in size
| |
specificCost | 0..* | BackboneElement | There are no (further) constraints on this element Element idInsurancePlan.plan.specificCost Specific costs DefinitionCosts associated with the coverage provided by the product.
| |
id | 0..1 | string | There are no (further) constraints on this element Element idInsurancePlan.plan.specificCost.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.plan.specificCost.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.plan.specificCost.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
|
category | 1..1 | CodeableConcept | There are no (further) constraints on this element Element idInsurancePlan.plan.specificCost.category General category of benefit DefinitionGeneral category of benefit (Medical; Dental; Vision; Drug; Mental Health; Substance Abuse; Hospice, Home Health). Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
| |
benefit | 0..* | BackboneElement | There are no (further) constraints on this element Element idInsurancePlan.plan.specificCost.benefit Benefits list DefinitionList of the specific benefits under this category of benefit.
| |
id | 0..1 | string | There are no (further) constraints on this element Element idInsurancePlan.plan.specificCost.benefit.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.plan.specificCost.benefit.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.plan.specificCost.benefit.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
|
type | 1..1 | CodeableConcept | There are no (further) constraints on this element Element idInsurancePlan.plan.specificCost.benefit.type Type of specific benefit DefinitionType of specific benefit (preventative; primary care office visit; speciality office visit; hospitalization; emergency room; urgent care). Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
| |
cost | 0..* | BackboneElement | There are no (further) constraints on this element Element idInsurancePlan.plan.specificCost.benefit.cost List of the costs DefinitionList of the costs associated with a specific benefit.
| |
id | 0..1 | string | There are no (further) constraints on this element Element idInsurancePlan.plan.specificCost.benefit.cost.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.plan.specificCost.benefit.cost.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.plan.specificCost.benefit.cost.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
|
type | 1..1 | CodeableConcept | There are no (further) constraints on this element Element idInsurancePlan.plan.specificCost.benefit.cost.type Type of cost DefinitionType of cost (copay; individual cap; family cap; coinsurance; deductible). Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
| |
applicability | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idInsurancePlan.plan.specificCost.benefit.cost.applicability in-network | out-of-network | other DefinitionWhether the cost applies to in-network or out-of-network providers (in-network; out-of-network; other). Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Whether the cost applies to in-network or out-of-network providers.
| |
qualifiers | 0..* | CodeableConcept | There are no (further) constraints on this element Element idInsurancePlan.plan.specificCost.benefit.cost.qualifiers Additional information about the cost DefinitionAdditional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA). Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
| |
value | I | 0..1 | Quantity | There are no (further) constraints on this element Element idInsurancePlan.plan.specificCost.benefit.cost.value The actual cost value DefinitionThe actual cost value. (some of the costs may be represented as percentages rather than currency, e.g. 10% coinsurance). The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
|
Hybrid
InsurancePlan | I | InsurancePlan | There are no (further) constraints on this element Element idInsurancePlan Details of a Health Insurance product/plan provided by an organization DefinitionDetails of a Health Insurance product/plan provided by an organization.
| |
id | Σ | 0..1 | string | There are no (further) constraints on this element Element idInsurancePlan.id Logical id of this artifact DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation. |
meta | Σ | 1..1 | Meta | There are no (further) constraints on this element Element idInsurancePlan.meta Metadata about the resource DefinitionThe metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
|
id | 0..1 | string | There are no (further) constraints on this element Element idInsurancePlan.meta.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.meta.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
versionId | Σ | 0..1 | id | There are no (further) constraints on this element Element idInsurancePlan.meta.versionId Version specific identifier DefinitionThe version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted. The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.
|
lastUpdated | Σ | 0..1 | instant | There are no (further) constraints on this element Element idInsurancePlan.meta.lastUpdated When the resource version last changed DefinitionWhen the resource last changed - e.g. when the version changed. This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.
|
meta-source | Σ | 1..1 | uri | Element idInsurancePlan.meta.source:meta-source uri of the data source DefinitionTypically the data owner's URL followed by a source/file description mandatory for all resources in bWell's FHIR Server In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.
example of meta.source https://www.icanbwell.com/provider-directory Mappings
|
profile | Σ | 0..* | canonical(StructureDefinition) | There are no (further) constraints on this element Element idInsurancePlan.meta.profile Profiles this resource claims to conform to DefinitionA list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url. It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set. canonical(StructureDefinition) Constraints
|
meta-security | Σ | 1..* | CodingBinding | Element idInsurancePlan.meta.security:meta-security security tags representing the data's owner, vendor, and accessibility Definitiondata owner: data vendor: data access: /owner & /access are mandatory for all resources in bWell's FHIR Server The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored. Security Labels from the Healthcare Privacy and Security Classification System.
example of data owner security tag { "system": "https://www.icanbwell.com/owner", "code": "bwell" } example of data access security tag { "system": "https://www.icanbwell.com/access", "code": "bwell" } example of data vendor security tag { "system": "https://www.icanbwell.com/vendor", "code": "bwell" } Mappings
|
tag | Σ | 0..* | Coding | There are no (further) constraints on this element Element idInsurancePlan.meta.tag Tags applied to this resource DefinitionTags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource. The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored. Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
|
implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idInsurancePlan.implicitRules A set of rules under which this content was created DefinitionA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
|
language | 0..1 | codeBinding | There are no (further) constraints on this element Element idInsurancePlan.language Language of the resource content DefinitionThe base language in which the resource is written. Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). A human language.
| |
text | 0..1 | Narrative | There are no (further) constraints on this element Element idInsurancePlan.text Text summary of the resource, for human interpretation Alternate namesnarrative, html, xhtml, display DefinitionA human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
| |
contained | 0..* | Resource | There are no (further) constraints on this element Element idInsurancePlan.contained Contained, inline Resources Alternate namesinline resources, anonymous resources, contained resources DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
modifierExtension | ?! I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
identifier | Σ I | 0..* | Identifier | Element idInsurancePlan.identifier a value to identify the resource by DefinitionBusiness identifiers assigned to this health insurance product which remain constant as the resource is updated and propagates from server to server. Unordered, Open, by slice by types Constraints
|
(All Slices) | There are no (further) constraints on this element | |||
id | 1..1 | string | Element idInsurancePlan.identifier.id set case-by-case DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.identifier.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
use | Σ ?! | 0..1 | codeBinding | There are no (further) constraints on this element Element idInsurancePlan.identifier.use usual | official | temp | secondary | old (If known) DefinitionThe purpose of this identifier. Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. Identifies the purpose for this identifier, if known .
|
type | Σ | 1..1 | CodeableConceptBinding | Element idInsurancePlan.identifier.type Description of identifier DefinitionA coded type for the identifier that can be used to determine which identifier to use for a specific purpose. Needs binding valueset This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type. A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
|
system | Σ | 1..1 | uri | Element idInsurancePlan.identifier.system The system which created the identifier DefinitionValues may be an oid, uri, url, or canonical There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers. for mapped data, this is frequently a canonical url
General http://www.acme.com/identifiers/patient a client's unknown system https://www.health.org/person-identifier Mappings
|
value | Σ | 1..1 | string | Element idInsurancePlan.identifier.value The unique value DefinitionThe raw identifier value that represents a resource This should be the raw value, as it exists in the source data (ie without prefix) If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
General 123456 Mappings
|
period | Σ I | 0..1 | Period | There are no (further) constraints on this element Element idInsurancePlan.identifier.period Time period when id is/was valid for use DefinitionTime period during which identifier is/was valid for use. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration.
|
assigner | Σ I | 0..1 | Reference(Organization) | There are no (further) constraints on this element Element idInsurancePlan.identifier.assigner Organization that issued id (may be just text) DefinitionOrganization that issued/manages the identifier. The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
|
status | S Σ ?! | 1..1 | codeBinding | There are no (further) constraints on this element Element idInsurancePlan.status draft | active | retired | unknown DefinitionThe current state of the health insurance product. Need a flag to indicate a record is no longer to be used and should generally be hidden for the user in the UI. Note that FHIR strings SHALL NOT exceed 1MB in size Default interpretation is active. The lifecycle status of an artifact.
|
type | S Σ | 1..* | CodeableConceptPattern | Element idInsurancePlan.type insurance plan type DefinitionThe kind of health insurance product. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Used to categorize the product/plan.
{ "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/insurance-plan-type" } ] }
|
name | S Σ I | 1..1 | string | Element idInsurancePlan.name Official name DefinitionOfficial name of the health insurance product as designated by the owner. If the name of the product/plan changes, consider putting the old name in the alias column so that it can still be located through searches.
insurance plan name Unity Point Direct Contracting Plan Mappings
|
alias | 0..* | string | There are no (further) constraints on this element Element idInsurancePlan.alias Alternate names DefinitionA list of alternate names that the product is known as, or was known as in the past. Over time products/plans go through many changes and can be known by different names. For searching knowing previous names that the product/plan was known by can be very useful. There are no dates associated with the alias/historic names, as this is not intended to track when names were used, but to assist in searching so that older names can still result in identifying the product/plan.
| |
period | I | 0..1 | Period | There are no (further) constraints on this element Element idInsurancePlan.period When the product is available DefinitionThe period of time that the health insurance product is available. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration.
|
ownedBy | Σ I | 1..1 | Reference(Profile: Healthcare Organization) | Element idInsurancePlan.ownedBy Plan issuer Alternate namesPayer DefinitionThe entity that is providing the health insurance product and underwriting the risk. This is typically an insurance carriers, other third-party payers, or health plan sponsors comonly referred to as 'payers'. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Profile: Healthcare Organization) Constraints
|
administeredBy | Σ I | 1..1 | Reference(Profile: Healthcare Organization) | Element idInsurancePlan.administeredBy Product administrator DefinitionAn organization which administer other services such as underwriting, customer service and/or claims processing on behalf of the health insurance product owner. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Profile: Healthcare Organization) Constraints
|
coverageArea | Σ I | 1..* | Reference(https://fhir.icanbwell.com/4_0_0/StructureDefinition/pr-location-area) | Element idInsurancePlan.coverageArea Where product applies Alternate nameszip code, state DefinitionThe geographic region in which a health insurance product's benefits apply. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(https://fhir.icanbwell.com/4_0_0/StructureDefinition/pr-location-area) Constraints
|
contact | 0..* | BackboneElement | There are no (further) constraints on this element Element idInsurancePlan.contact Contact for the product DefinitionThe contact for the health insurance product for a certain purpose. Need to keep track of assigned contact points within bigger organization. Where multiple contacts for the same purpose are provided there is a standard extension that can be used to determine which one is the preferred contact to use.
| |
id | 0..1 | string | There are no (further) constraints on this element Element idInsurancePlan.contact.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.contact.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.contact.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
|
purpose | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idInsurancePlan.contact.purpose The type of contact DefinitionIndicates a purpose for which the contact can be reached. Need to distinguish between multiple contact persons. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The purpose for which you would contact a contact party.
| |
name | 0..1 | HumanName | There are no (further) constraints on this element Element idInsurancePlan.contact.name A name associated with the contact DefinitionA name associated with the contact. Need to be able to track the person by name. Names may be changed, or repudiated, or people may have different names in different contexts. Names may be divided into parts of different type that have variable significance depending on context, though the division into parts does not always matter. With personal names, the different parts might or might not be imbued with some implicit meaning; various cultures associate different importance with the name parts and the degree to which systems must care about name parts around the world varies widely.
| |
telecom | I | 0..* | ContactPoint | There are no (further) constraints on this element Element idInsurancePlan.contact.telecom Contact details (telephone, email, etc.) for a contact DefinitionA contact detail (e.g. a telephone number or an email address) by which the party may be contacted. People have (primary) ways to contact them in some way such as phone, email.
|
address | 0..1 | Address | There are no (further) constraints on this element Element idInsurancePlan.contact.address Visiting or postal addresses for the contact DefinitionVisiting or postal addresses for the contact. May need to keep track of a contact party's address for contacting, billing or reporting requirements. Note: address is intended to describe postal addresses for administrative purposes, not to describe absolute geographical coordinates. Postal addresses are often used as proxies for physical locations (also see the Location resource).
| |
endpoint | I | 0..* | Reference(Endpoint) | There are no (further) constraints on this element Element idInsurancePlan.endpoint Technical endpoint DefinitionThe technical endpoints providing access to services operated for the health insurance product. Organizations have multiple systems that provide various services and need to be able to define the technical connection details for how to connect to them, and for what purpose. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
|
network | I | 1..1 | Reference(https://fhir.icanbwell.com/4_0_0/StructureDefinition/pr-healthcare-network) | Element idInsurancePlan.network What networks are Included DefinitionReference to the network included in the health insurance product. Networks are represented as a hierarchy of organization resources. Reference(https://fhir.icanbwell.com/4_0_0/StructureDefinition/pr-healthcare-network) Constraints
|
coverage | 0..* | BackboneElement | There are no (further) constraints on this element Element idInsurancePlan.coverage Coverage details DefinitionDetails about the coverage offered by the insurance product.
| |
id | 0..1 | string | There are no (further) constraints on this element Element idInsurancePlan.coverage.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.coverage.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.coverage.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
|
type | 1..1 | CodeableConcept | There are no (further) constraints on this element Element idInsurancePlan.coverage.type Type of coverage DefinitionType of coverage (Medical; Dental; Mental Health; Substance Abuse; Vision; Drug; Short Term; Long Term Care; Hospice; Home Health). Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
| |
network | I | 0..* | Reference(Organization) | There are no (further) constraints on this element Element idInsurancePlan.coverage.network What networks provide coverage DefinitionReference to the network that providing the type of coverage. Networks are represented as a hierarchy of organization resources.
|
benefit | 1..* | BackboneElement | There are no (further) constraints on this element Element idInsurancePlan.coverage.benefit List of benefits DefinitionSpecific benefits under this type of coverage.
| |
id | 0..1 | string | There are no (further) constraints on this element Element idInsurancePlan.coverage.benefit.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.coverage.benefit.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.coverage.benefit.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
|
type | 1..1 | CodeableConcept | There are no (further) constraints on this element Element idInsurancePlan.coverage.benefit.type Type of benefit DefinitionType of benefit (primary care; speciality care; inpatient; outpatient). Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
| |
requirement | 0..1 | string | There are no (further) constraints on this element Element idInsurancePlan.coverage.benefit.requirement Referral requirements DefinitionThe referral requirements to have access/coverage for this benefit. Note that FHIR strings SHALL NOT exceed 1MB in size
| |
limit | 0..* | BackboneElement | There are no (further) constraints on this element Element idInsurancePlan.coverage.benefit.limit Benefit limits DefinitionThe specific limits on the benefit.
| |
id | 0..1 | string | There are no (further) constraints on this element Element idInsurancePlan.coverage.benefit.limit.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.coverage.benefit.limit.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.coverage.benefit.limit.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
|
value | I | 0..1 | Quantity | There are no (further) constraints on this element Element idInsurancePlan.coverage.benefit.limit.value Maximum value allowed DefinitionThe maximum amount of a service item a plan will pay for a covered benefit. For examples. wellness visits, or eyeglasses. May also be called “eligible expense,” “payment allowance,” or “negotiated rate.”.
|
code | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idInsurancePlan.coverage.benefit.limit.code Benefit limit details DefinitionThe specific limit on the benefit. Use
| |
plan | 0..* | BackboneElement | There are no (further) constraints on this element Element idInsurancePlan.plan Plan details DefinitionDetails about an insurance plan.
| |
id | 0..1 | string | There are no (further) constraints on this element Element idInsurancePlan.plan.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.plan.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.plan.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
|
identifier | Σ | 0..* | Identifier | There are no (further) constraints on this element Element idInsurancePlan.plan.identifier Business Identifier for Product DefinitionBusiness identifiers assigned to this health insurance plan which remain constant as the resource is updated and propagates from server to server.
|
type | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idInsurancePlan.plan.type Type of plan DefinitionType of plan. For example, "Platinum" or "High Deductable". Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
| |
coverageArea | Σ I | 0..* | Reference(Location) | There are no (further) constraints on this element Element idInsurancePlan.plan.coverageArea Where product applies DefinitionThe geographic region in which a health insurance plan's benefits apply. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
|
network | I | 0..* | Reference(Organization) | There are no (further) constraints on this element Element idInsurancePlan.plan.network What networks provide coverage DefinitionReference to the network that providing the type of coverage. Networks are represented as a hierarchy of organization resources.
|
generalCost | 0..* | BackboneElement | There are no (further) constraints on this element Element idInsurancePlan.plan.generalCost Overall costs DefinitionOverall costs associated with the plan.
| |
id | 0..1 | string | There are no (further) constraints on this element Element idInsurancePlan.plan.generalCost.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.plan.generalCost.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.plan.generalCost.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
|
type | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idInsurancePlan.plan.generalCost.type Type of cost DefinitionType of cost. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
| |
groupSize | 0..1 | positiveInt | There are no (further) constraints on this element Element idInsurancePlan.plan.generalCost.groupSize Number of enrollees DefinitionNumber of participants enrolled in the plan. 32 bit number; for values larger than this, use decimal
| |
cost | 0..1 | Money | There are no (further) constraints on this element Element idInsurancePlan.plan.generalCost.cost Cost value DefinitionValue of the cost.
| |
comment | 0..1 | string | There are no (further) constraints on this element Element idInsurancePlan.plan.generalCost.comment Additional cost information DefinitionAdditional information about the general costs associated with this plan. Note that FHIR strings SHALL NOT exceed 1MB in size
| |
specificCost | 0..* | BackboneElement | There are no (further) constraints on this element Element idInsurancePlan.plan.specificCost Specific costs DefinitionCosts associated with the coverage provided by the product.
| |
id | 0..1 | string | There are no (further) constraints on this element Element idInsurancePlan.plan.specificCost.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.plan.specificCost.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.plan.specificCost.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
|
category | 1..1 | CodeableConcept | There are no (further) constraints on this element Element idInsurancePlan.plan.specificCost.category General category of benefit DefinitionGeneral category of benefit (Medical; Dental; Vision; Drug; Mental Health; Substance Abuse; Hospice, Home Health). Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
| |
benefit | 0..* | BackboneElement | There are no (further) constraints on this element Element idInsurancePlan.plan.specificCost.benefit Benefits list DefinitionList of the specific benefits under this category of benefit.
| |
id | 0..1 | string | There are no (further) constraints on this element Element idInsurancePlan.plan.specificCost.benefit.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.plan.specificCost.benefit.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.plan.specificCost.benefit.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
|
type | 1..1 | CodeableConcept | There are no (further) constraints on this element Element idInsurancePlan.plan.specificCost.benefit.type Type of specific benefit DefinitionType of specific benefit (preventative; primary care office visit; speciality office visit; hospitalization; emergency room; urgent care). Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
| |
cost | 0..* | BackboneElement | There are no (further) constraints on this element Element idInsurancePlan.plan.specificCost.benefit.cost List of the costs DefinitionList of the costs associated with a specific benefit.
| |
id | 0..1 | string | There are no (further) constraints on this element Element idInsurancePlan.plan.specificCost.benefit.cost.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.plan.specificCost.benefit.cost.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idInsurancePlan.plan.specificCost.benefit.cost.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
|
type | 1..1 | CodeableConcept | There are no (further) constraints on this element Element idInsurancePlan.plan.specificCost.benefit.cost.type Type of cost DefinitionType of cost (copay; individual cap; family cap; coinsurance; deductible). Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
| |
applicability | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idInsurancePlan.plan.specificCost.benefit.cost.applicability in-network | out-of-network | other DefinitionWhether the cost applies to in-network or out-of-network providers (in-network; out-of-network; other). Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Whether the cost applies to in-network or out-of-network providers.
| |
qualifiers | 0..* | CodeableConcept | There are no (further) constraints on this element Element idInsurancePlan.plan.specificCost.benefit.cost.qualifiers Additional information about the cost DefinitionAdditional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA). Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
| |
value | I | 0..1 | Quantity | There are no (further) constraints on this element Element idInsurancePlan.plan.specificCost.benefit.cost.value The actual cost value DefinitionThe actual cost value. (some of the costs may be represented as percentages rather than currency, e.g. 10% coinsurance). The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
|
Examples:
TB