{ "resourceType": "StructureDefinition", "id": "InsurancePlan", "meta": { "lastUpdated": "2022-05-28T02:47:40.239+00:00" }, "text": { "status": "generated", "div": "
\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n\n \n \n \n \n \n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n\n \n \n \n \n \n \n\n \n \n \n \n \n \n\n \n \n \n \n \n \n\n \n \n \n \n \n \n\n \n \n \n \n \n \n\n \n \n \n \n \n \n\n \n \n \n \n \n \n\n \n \n \n \n \n \n\n \n \n \n \n \n \n\n \n \n \n \n \n \n\n \n \n \n \n \n \n\n \n \n \n \n \n \n\n \n \n \n \n \n \n\n \n \n \n \n \n \n\n \n \n \n \n \n \n\n \n \n \n \n \n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n\n \n \n \n \n \n \n\n \n \n \n \n \n \n\n \n \n \n \n \n \n\n \n \n \n \n \n \n\n \n \n \n \n \n \n\n \n \n \n \n \n \n\n \n \n \n \n \n \n\n \n \n \n \n \n \n\n \n \n \n \n \n \n\n \n \n \n \n \n \n\n \n \n \n \n \n \n\n \n \n \n \n \n \n\n \n \n \n \n \n \n\n \n \n \n \n \n \n\n \n \n \n
\n Name\n \n Flags\n \n Card.\n \n Type\n \n Description & Constraints\n \n \n \"doco\"\n \n \n
\n \".\"\n \".\" \n InsurancePlan\n \n \n TU\n \n \n DomainResource\n Details of a Health Insurance product/plan provided by an organization\n
\n + Rule: The organization SHALL at least have a name or an idendtifier, and possibly more than one\n
Elements defined in Ancestors: \n id, \n meta, \n implicitRules, \n language, \n text, \n contained, \n extension, \n modifierExtension\n
\n \".\"\n \".\"\n \".\" \n identifier\n \n \n Σ\n I\n 0..*\n Identifier\n Business Identifier for Product\n
\n
\n \".\"\n \".\"\n \".\" \n status\n \n \n ?!\n Σ\n 0..1\n code\n draft | active | retired | unknown\n
\n PublicationStatus (\n Required)\n
\n \".\"\n \".\"\n \".\" \n type\n \n \n Σ\n 0..*\n CodeableConcept\n Kind of product\n
\n InsurancePlanType (\n Example)\n
\n
\n \".\"\n \".\"\n \".\" \n name\n \n \n Σ\n I\n 0..1\n string\n Official name
\n \".\"\n \".\"\n \".\" \n alias\n \n \n 0..*\n string\n Alternate names\n
\n
\n \".\"\n \".\"\n \".\" \n period\n \n \n 0..1\n Period\n When the product is available
\n \".\"\n \".\"\n \".\" \n ownedBy\n \n \n Σ\n 0..1\n Reference(\n Organization)\n Plan issuer
\n \".\"\n \".\"\n \".\" \n administeredBy\n \n \n Σ\n 0..1\n Reference(\n Organization)\n Product administrator
\n \".\"\n \".\"\n \".\" \n coverageArea\n \n \n Σ\n 0..*\n Reference(\n Location)\n Where product applies\n
\n
\n \".\"\n \".\"\n \".\" \n contact\n \n \n 0..*\n BackboneElement\n Contact for the product\n
\n
\n \".\"\n \".\"\n \".\"\n \".\" \n purpose\n \n \n 0..1\n CodeableConcept\n The type of contact\n
\n ContactEntityType (\n Extensible)\n
\n \".\"\n \".\"\n \".\"\n \".\" \n name\n \n \n 0..1\n HumanName\n A name associated with the contact
\n \".\"\n \".\"\n \".\"\n \".\" \n telecom\n \n \n 0..*\n ContactPoint\n Contact details (telephone, email, etc.) for a contact\n
\n
\n \".\"\n \".\"\n \".\"\n \".\" \n address\n \n \n 0..1\n Address\n Visiting or postal addresses for the contact
\n \".\"\n \".\"\n \".\" \n endpoint\n \n \n 0..*\n Reference(\n Endpoint)\n Technical endpoint\n
\n
\n \".\"\n \".\"\n \".\" \n network\n \n \n 0..*\n Reference(\n Organization)\n What networks are Included\n
\n
\n \".\"\n \".\"\n \".\" \n coverage\n \n \n 0..*\n BackboneElement\n Coverage details\n
\n
\n \".\"\n \".\"\n \".\"\n \".\" \n type\n \n \n 1..1\n CodeableConcept\n Type of coverage
\n \".\"\n \".\"\n \".\"\n \".\" \n network\n \n \n 0..*\n Reference(\n Organization)\n What networks provide coverage\n
\n
\n \".\"\n \".\"\n \".\"\n \".\" \n benefit\n \n \n 1..*\n BackboneElement\n List of benefits\n
\n
\n \".\"\n \".\"\n \".\"\n \".\"\n \".\" \n type\n \n \n 1..1\n CodeableConcept\n Type of benefit
\n \".\"\n \".\"\n \".\"\n \".\"\n \".\" \n requirement\n \n \n 0..1\n string\n Referral requirements
\n \".\"\n \".\"\n \".\"\n \".\"\n \".\" \n limit\n \n \n 0..*\n BackboneElement\n Benefit limits\n
\n
\n \".\"\n \".\"\n \".\"\n \".\"\n \".\"\n \".\" \n value\n \n \n 0..1\n Quantity\n Maximum value allowed
\n \".\"\n \".\"\n \".\"\n \".\"\n \".\"\n \".\" \n code\n \n \n 0..1\n CodeableConcept\n Benefit limit details
\n \".\"\n \".\"\n \".\" \n plan\n \n \n 0..*\n BackboneElement\n Plan details\n
\n
\n \".\"\n \".\"\n \".\"\n \".\" \n identifier\n \n \n Σ\n 0..*\n Identifier\n Business Identifier for Product\n
\n
\n \".\"\n \".\"\n \".\"\n \".\" \n type\n \n \n 0..1\n CodeableConcept\n Type of plan
\n \".\"\n \".\"\n \".\"\n \".\" \n coverageArea\n \n \n Σ\n 0..*\n Reference(\n Location)\n Where product applies\n
\n
\n \".\"\n \".\"\n \".\"\n \".\" \n network\n \n \n 0..*\n Reference(\n Organization)\n What networks provide coverage\n
\n
\n \".\"\n \".\"\n \".\"\n \".\" \n generalCost\n \n \n 0..*\n BackboneElement\n Overall costs\n
\n
\n \".\"\n \".\"\n \".\"\n \".\"\n \".\" \n type\n \n \n 0..1\n CodeableConcept\n Type of cost
\n \".\"\n \".\"\n \".\"\n \".\"\n \".\" \n groupSize\n \n \n 0..1\n positiveInt\n Number of enrollees
\n \".\"\n \".\"\n \".\"\n \".\"\n \".\" \n cost\n \n \n 0..1\n Money\n Cost value
\n \".\"\n \".\"\n \".\"\n \".\"\n \".\" \n comment\n \n \n 0..1\n string\n Additional cost information
\n \".\"\n \".\"\n \".\"\n \".\" \n specificCost\n \n \n 0..*\n BackboneElement\n Specific costs\n
\n
\n \".\"\n \".\"\n \".\"\n \".\"\n \".\" \n category\n \n \n 1..1\n CodeableConcept\n General category of benefit
\n \".\"\n \".\"\n \".\"\n \".\"\n \".\" \n benefit\n \n \n 0..*\n BackboneElement\n Benefits list\n
\n
\n \".\"\n \".\"\n \".\"\n \".\"\n \".\"\n \".\" \n type\n \n \n 1..1\n CodeableConcept\n Type of specific benefit
\n \".\"\n \".\"\n \".\"\n \".\"\n \".\"\n \".\" \n cost\n \n \n 0..*\n BackboneElement\n List of the costs\n
\n
\n \".\"\n \".\"\n \".\"\n \".\"\n \".\"\n \".\"\n \".\" \n type\n \n \n 1..1\n CodeableConcept\n Type of cost
\n \".\"\n \".\"\n \".\"\n \".\"\n \".\"\n \".\"\n \".\" \n applicability\n \n \n 0..1\n CodeableConcept\n in-network | out-of-network | other\n
\n BenefitCostApplicability (\n Required)\n
\n \".\"\n \".\"\n \".\"\n \".\"\n \".\"\n \".\"\n \".\" \n qualifiers\n \n \n 0..*\n CodeableConcept\n Additional information about the cost\n
\n
\n \".\"\n \".\"\n \".\"\n \".\"\n \".\"\n \".\"\n \".\" \n value\n \n \n 0..1\n Quantity\n The actual cost value
\n
\n \n \"doco\" Documentation for this format\n \n
\n
" }, "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-category", "valueString": "Financial.General" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "trial-use" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm", "valueInteger": 0 }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-security-category", "valueCode": "business" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg", "valueCode": "pa" } ], "url": "http://hl7.org/fhir/StructureDefinition/InsurancePlan", "version": "4.3.0", "name": "InsurancePlan", "status": "draft", "experimental": false, "date": "2022-05-28T02:47:40+00:00", "publisher": "Health Level Seven International (Patient Administration)", "contact": [ { "telecom": [ { "system": "url", "value": "http://hl7.org/fhir" } ] }, { "telecom": [ { "system": "url", "value": "http://www.hl7.org/Special/committees/pafm/index.cfm" } ] } ], "description": "Details of a Health Insurance product/plan provided by an organization.", "fhirVersion": "4.3.0", "mapping": [ { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" } ], "kind": "resource", "abstract": false, "type": "InsurancePlan", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/DomainResource", "derivation": "specialization", "snapshot": { "element": [ { "id": "InsurancePlan", "path": "InsurancePlan", "short": "Details of a Health Insurance product/plan provided by an organization", "definition": "Details of a Health Insurance product/plan provided by an organization.", "min": 0, "max": "*", "base": { "path": "InsurancePlan", "min": 0, "max": "*" }, "constraint": [ { "key": "dom-2", "severity": "error", "human": "If the resource is contained in another resource, it SHALL NOT contain nested Resources", "expression": "contained.contained.empty()", "xpath": "not(parent::f:contained and f:contained)", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-4", "severity": "error", "human": "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated", "expression": "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()", "xpath": "not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-3", "severity": "error", "human": "If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource", "expression": "contained.where(((id.exists() and ('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url)))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(uri) = '#').exists()).not()).trace('unmatched', id).empty()", "xpath": "not(exists(for $contained in f:contained return $contained[not(exists(parent::*/descendant::f:reference/@value=concat('#', $contained/*/f:id/@value)) or exists(descendant::f:reference[@value='#']))]))", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice", "valueBoolean": true }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation", "valueMarkdown": "When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time." } ], "key": "dom-6", "severity": "warning", "human": "A resource should have narrative for robust management", "expression": "text.`div`.exists()", "xpath": "exists(f:text/h:div)", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-5", "severity": "error", "human": "If a resource is contained in another resource, it SHALL NOT have a security label", "expression": "contained.meta.security.empty()", "xpath": "not(exists(f:contained/*/f:meta/f:security))", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "ipn-1", "severity": "error", "human": "The organization SHALL at least have a name or an idendtifier, and possibly more than one", "expression": "(identifier.count() + name.count()) > 0", "xpath": "count(f:identifier | f:name) > 0", "source": "http://hl7.org/fhir/StructureDefinition/InsurancePlan" } ], "mustSupport": false, "isModifier": false, "mapping": [ { "identity": "rim", "map": "Entity. Role, or Act" }, { "identity": "w5", "map": "administrative.entity" } ] }, { "id": "InsurancePlan.id", "path": "InsurancePlan.id", "short": "Logical id of this artifact", "definition": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.", "comment": "The only time that a resource does not have an id is when it is being submitted to the server using a create operation.", "min": 0, "max": "1", "base": { "path": "Resource.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mustSupport": false, "isModifier": false, "isSummary": true }, { "id": "InsurancePlan.meta", "path": "InsurancePlan.meta", "short": "Metadata about the resource", "definition": "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.", "min": 0, "max": "1", "base": { "path": "Resource.meta", "min": 0, "max": "1" }, "type": [ { "code": "Meta" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "InsurancePlan.implicitRules", "path": "InsurancePlan.implicitRules", "short": "A set of rules under which this content was created", "definition": "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.", "comment": "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.", "min": 0, "max": "1", "base": { "path": "Resource.implicitRules", "min": 0, "max": "1" }, "type": [ { "code": "uri" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": true, "isModifierReason": "This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "InsurancePlan.language", "path": "InsurancePlan.language", "short": "Language of the resource content", "definition": "The base language in which the resource is written.", "comment": "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).", "min": 0, "max": "1", "base": { "path": "Resource.language", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet", "valueCanonical": "http://hl7.org/fhir/ValueSet/all-languages" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Language" } ], "strength": "preferred", "description": "IETF language tag", "valueSet": "http://hl7.org/fhir/ValueSet/languages" }, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "InsurancePlan.text", "path": "InsurancePlan.text", "short": "Text summary of the resource, for human interpretation", "definition": "A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it \"clinically safe\" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.", "comment": "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.", "alias": [ "narrative", "html", "xhtml", "display" ], "min": 0, "max": "1", "base": { "path": "DomainResource.text", "min": 0, "max": "1" }, "type": [ { "code": "Narrative" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" }, { "identity": "rim", "map": "Act.text?" } ] }, { "id": "InsurancePlan.contained", "path": "InsurancePlan.contained", "short": "Contained, inline Resources", "definition": "These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.", "comment": "This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.", "alias": [ "inline resources", "anonymous resources", "contained resources" ], "min": 0, "max": "*", "base": { "path": "DomainResource.contained", "min": 0, "max": "*" }, "type": [ { "code": "Resource" } ], "constraint": [ { "key": "dom-r4b", "severity": "warning", "human": "Containing new R4B resources within R4 resources may cause interoperability issues if instances are shared with R4 systems", "expression": "($this is Citation or $this is Evidence or $this is EvidenceReport or $this is EvidenceVariable or $this is MedicinalProductDefinition or $this is PackagedProductDefinition or $this is AdministrableProductDefinition or $this is Ingredient or $this is ClinicalUseDefinition or $this is RegulatedAuthorization or $this is SubstanceDefinition or $this is SubscriptionStatus or $this is SubscriptionTopic) implies (%resource is Citation or %resource is Evidence or %resource is EvidenceReport or %resource is EvidenceVariable or %resource is MedicinalProductDefinition or %resource is PackagedProductDefinition or %resource is AdministrableProductDefinition or %resource is Ingredient or %resource is ClinicalUseDefinition or %resource is RegulatedAuthorization or %resource is SubstanceDefinition or %resource is SubscriptionStatus or %resource is SubscriptionTopic)", "xpath": "not(f:Citation|f:Evidence|f:EvidenceReport|f:EvidenceVariable|f:MedicinalProductDefinition|f:PackagedProductDefinition|f:AdministrableProductDefinition|f:Ingredient|f:ClinicalUseDefinition|f:RegulatedAuthorization|f:SubstanceDefinition|f:SubscriptionStatus|f:SubscriptionTopic) or not(parent::f:Citation|parent::f:Evidence|parent::f:EvidenceReport|parent::f:EvidenceVariable|parent::f:MedicinalProductDefinition|parent::f:PackagedProductDefinition|parent::f:AdministrableProductDefinition|parent::f:Ingredient|parent::f:ClinicalUseDefinition|parent::f:RegulatedAuthorization|parent::f:SubstanceDefinition|f:SubscriptionStatus|f:SubscriptionTopic)", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "Entity. Role, or Act" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "InsurancePlan.extension", "path": "InsurancePlan.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "DomainResource.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "InsurancePlan.modifierExtension", "path": "InsurancePlan.modifierExtension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Extensions that cannot be ignored", "definition": "May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "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.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "DomainResource.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": false, "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them", "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "InsurancePlan.identifier", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "InsurancePlan.identifier", "short": "Business Identifier for Product", "definition": "Business identifiers assigned to this health insurance product which remain constant as the resource is updated and propagates from server to server.", "min": 0, "max": "*", "base": { "path": "InsurancePlan.identifier", "min": 0, "max": "*" }, "type": [ { "code": "Identifier" } ], "condition": [ "ele-1", "ipn-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)" }, { "identity": "rim", "map": "II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]" }, { "identity": "servd", "map": "Identifier" }, { "identity": "w5", "map": "FiveWs.identifier" }, { "identity": "rim", "map": ".scopes[Role](classCode=IDENT)" } ] }, { "id": "InsurancePlan.status", "path": "InsurancePlan.status", "short": "draft | active | retired | unknown", "definition": "The current state of the health insurance product.", "comment": "Note that FHIR strings SHALL NOT exceed 1MB in size", "requirements": "Need a flag to indicate a record is no longer to be used and should generally be hidden for the user in the UI.", "min": 0, "max": "1", "base": { "path": "InsurancePlan.status", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "meaningWhenMissing": "Default interpretation is active.", "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": true, "isModifierReason": "This element is labeled as a modifier because it is a status element that contains codes which means that the resource should not be treated as valid", "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "PublicationStatus" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "required", "description": "The lifecycle status of an artifact.", "valueSet": "http://hl7.org/fhir/ValueSet/publication-status|4.3.0" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "w5", "map": "FiveWs.status" }, { "identity": "rim", "map": ".status" } ] }, { "id": "InsurancePlan.type", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "InsurancePlan.type", "short": "Kind of product", "definition": "The kind of health insurance product.", "comment": "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.", "min": 0, "max": "*", "base": { "path": "InsurancePlan.type", "min": 0, "max": "*" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "InsurancePlanType" } ], "strength": "example", "description": "Used to categorize the product/plan.", "valueSet": "http://hl7.org/fhir/ValueSet/insuranceplan-type" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "w5", "map": "FiveWs.class" }, { "identity": "rim", "map": ".code" } ] }, { "id": "InsurancePlan.name", "path": "InsurancePlan.name", "short": "Official name", "definition": "Official name of the health insurance product as designated by the owner.", "comment": "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.", "min": 0, "max": "1", "base": { "path": "InsurancePlan.name", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1", "ipn-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": ".name" } ] }, { "id": "InsurancePlan.alias", "path": "InsurancePlan.alias", "short": "Alternate names", "definition": "A list of alternate names that the product is known as, or was known as in the past.", "comment": "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.", "requirements": "Over time products/plans go through many changes and can be known by different names.\n\nFor searching knowing previous names that the product/plan was known by can be very useful.", "min": 0, "max": "*", "base": { "path": "InsurancePlan.alias", "min": 0, "max": "*" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": ".name" } ] }, { "id": "InsurancePlan.period", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "InsurancePlan.period", "short": "When the product is available", "definition": "The period of time that the health insurance product is available.", "comment": "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\").\n\nPeriod is not used for a duration (a measure of elapsed time). See [Duration](datatypes.html#Duration).", "min": 0, "max": "1", "base": { "path": "InsurancePlan.period", "min": 0, "max": "1" }, "type": [ { "code": "Period" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "per-1", "severity": "error", "human": "If present, start SHALL have a lower value than end", "expression": "start.hasValue().not() or end.hasValue().not() or (start <= end)", "xpath": "not(exists(f:start/@value)) or not(exists(f:end/@value)) or (xs:dateTime(f:start/@value) <= xs:dateTime(f:end/@value))", "source": "http://hl7.org/fhir/StructureDefinition/Period" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "DR" }, { "identity": "rim", "map": "IVL[lowClosed=\"true\" and highClosed=\"true\"] or URG[lowClosed=\"true\" and highClosed=\"true\"]" } ] }, { "id": "InsurancePlan.ownedBy", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "InsurancePlan.ownedBy", "short": "Plan issuer", "definition": "The entity that is providing the health insurance product and underwriting the risk. This is typically an insurance carriers, other third-party payers, or health plan sponsors comonly referred to as 'payers'.", "comment": "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.", "alias": [ "Payer" ], "min": 0, "max": "1", "base": { "path": "InsurancePlan.ownedBy", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Organization" ] } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource)", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" } ] }, { "id": "InsurancePlan.administeredBy", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "InsurancePlan.administeredBy", "short": "Product administrator", "definition": "An organization which administer other services such as underwriting, customer service and/or claims processing on behalf of the health insurance product owner.", "comment": "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.", "min": 0, "max": "1", "base": { "path": "InsurancePlan.administeredBy", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Organization" ] } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource)", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" } ] }, { "id": "InsurancePlan.coverageArea", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "InsurancePlan.coverageArea", "short": "Where product applies", "definition": "The geographic region in which a health insurance product's benefits apply.", "comment": "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.", "min": 0, "max": "*", "base": { "path": "InsurancePlan.coverageArea", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Location" ] } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource)", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" } ] }, { "id": "InsurancePlan.contact", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "InsurancePlan.contact", "short": "Contact for the product", "definition": "The contact for the health insurance product for a certain purpose.", "comment": "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.", "requirements": "Need to keep track of assigned contact points within bigger organization.", "min": 0, "max": "*", "base": { "path": "InsurancePlan.contact", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": ".contactParty" } ] }, { "id": "InsurancePlan.contact.id", "path": "InsurancePlan.contact.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "InsurancePlan.contact.extension", "path": "InsurancePlan.contact.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "InsurancePlan.contact.modifierExtension", "path": "InsurancePlan.contact.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "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.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "InsurancePlan.contact.purpose", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "InsurancePlan.contact.purpose", "short": "The type of contact", "definition": "Indicates a purpose for which the contact can be reached.", "comment": "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.", "requirements": "Need to distinguish between multiple contact persons.", "min": 0, "max": "1", "base": { "path": "InsurancePlan.contact.purpose", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ContactPartyType" } ], "strength": "extensible", "description": "The purpose for which you would contact a contact party.", "valueSet": "http://hl7.org/fhir/ValueSet/contactentity-type" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "rim", "map": "./type" } ] }, { "id": "InsurancePlan.contact.name", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "InsurancePlan.contact.name", "short": "A name associated with the contact", "definition": "A name associated with the contact.", "comment": "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.", "requirements": "Need to be able to track the person by name.", "min": 0, "max": "1", "base": { "path": "InsurancePlan.contact.name", "min": 0, "max": "1" }, "type": [ { "code": "HumanName" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "XPN" }, { "identity": "rim", "map": "EN (actually, PN)" }, { "identity": "servd", "map": "ProviderName" }, { "identity": "rim", "map": "./name" } ] }, { "id": "InsurancePlan.contact.telecom", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "InsurancePlan.contact.telecom", "short": "Contact details (telephone, email, etc.) for a contact", "definition": "A contact detail (e.g. a telephone number or an email address) by which the party may be contacted.", "requirements": "People have (primary) ways to contact them in some way such as phone, email.", "min": 0, "max": "*", "base": { "path": "InsurancePlan.contact.telecom", "min": 0, "max": "*" }, "type": [ { "code": "ContactPoint" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "cpt-2", "severity": "error", "human": "A system is required if a value is provided.", "expression": "value.empty() or system.exists()", "xpath": "not(exists(f:value)) or exists(f:system)", "source": "http://hl7.org/fhir/StructureDefinition/ContactPoint" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "XTN" }, { "identity": "rim", "map": "TEL" }, { "identity": "servd", "map": "ContactPoint" }, { "identity": "rim", "map": "./telecom" } ] }, { "id": "InsurancePlan.contact.address", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "InsurancePlan.contact.address", "short": "Visiting or postal addresses for the contact", "definition": "Visiting or postal addresses for the contact.", "comment": "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](location.html#) resource).", "requirements": "May need to keep track of a contact party's address for contacting, billing or reporting requirements.", "min": 0, "max": "1", "base": { "path": "InsurancePlan.contact.address", "min": 0, "max": "1" }, "type": [ { "code": "Address" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "XAD" }, { "identity": "rim", "map": "AD" }, { "identity": "servd", "map": "Address" }, { "identity": "rim", "map": "./addr" } ] }, { "id": "InsurancePlan.endpoint", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "InsurancePlan.endpoint", "short": "Technical endpoint", "definition": "The technical endpoints providing access to services operated for the health insurance product.", "comment": "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.", "requirements": "Organizations have multiple systems that provide various services and need to be able to define the technical connection details for how to connect to them, and for what purpose.", "min": 0, "max": "*", "base": { "path": "InsurancePlan.endpoint", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Endpoint" ] } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource)", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" } ] }, { "id": "InsurancePlan.network", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "InsurancePlan.network", "short": "What networks are Included", "definition": "Reference to the network included in the health insurance product.", "comment": "Networks are represented as a hierarchy of organization resources.", "min": 0, "max": "*", "base": { "path": "InsurancePlan.network", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Organization" ] } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource)", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" } ] }, { "id": "InsurancePlan.coverage", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "InsurancePlan.coverage", "short": "Coverage details", "definition": "Details about the coverage offered by the insurance product.", "min": 0, "max": "*", "base": { "path": "InsurancePlan.coverage", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "InsurancePlan.coverage.id", "path": "InsurancePlan.coverage.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "InsurancePlan.coverage.extension", "path": "InsurancePlan.coverage.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "InsurancePlan.coverage.modifierExtension", "path": "InsurancePlan.coverage.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "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.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "InsurancePlan.coverage.type", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "InsurancePlan.coverage.type", "short": "Type of coverage", "definition": "Type of coverage (Medical; Dental; Mental Health; Substance Abuse; Vision; Drug; Short Term; Long Term Care; Hospice; Home Health).", "comment": "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.", "min": 1, "max": "1", "base": { "path": "InsurancePlan.coverage.type", "min": 1, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "InsurancePlan.coverage.network", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "InsurancePlan.coverage.network", "short": "What networks provide coverage", "definition": "Reference to the network that providing the type of coverage.", "comment": "Networks are represented as a hierarchy of organization resources.", "min": 0, "max": "*", "base": { "path": "InsurancePlan.coverage.network", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Organization" ] } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource)", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" } ] }, { "id": "InsurancePlan.coverage.benefit", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "CoverageBenefit" } ], "path": "InsurancePlan.coverage.benefit", "short": "List of benefits", "definition": "Specific benefits under this type of coverage.", "min": 1, "max": "*", "base": { "path": "InsurancePlan.coverage.benefit", "min": 1, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "InsurancePlan.coverage.benefit.id", "path": "InsurancePlan.coverage.benefit.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "InsurancePlan.coverage.benefit.extension", "path": "InsurancePlan.coverage.benefit.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "InsurancePlan.coverage.benefit.modifierExtension", "path": "InsurancePlan.coverage.benefit.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "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.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "InsurancePlan.coverage.benefit.type", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "InsurancePlan.coverage.benefit.type", "short": "Type of benefit", "definition": "Type of benefit (primary care; speciality care; inpatient; outpatient).", "comment": "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.", "min": 1, "max": "1", "base": { "path": "InsurancePlan.coverage.benefit.type", "min": 1, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "InsurancePlan.coverage.benefit.requirement", "path": "InsurancePlan.coverage.benefit.requirement", "short": "Referral requirements", "definition": "The referral requirements to have access/coverage for this benefit.", "comment": "Note that FHIR strings SHALL NOT exceed 1MB in size", "min": 0, "max": "1", "base": { "path": "InsurancePlan.coverage.benefit.requirement", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "InsurancePlan.coverage.benefit.limit", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "InsurancePlan.coverage.benefit.limit", "short": "Benefit limits", "definition": "The specific limits on the benefit.", "min": 0, "max": "*", "base": { "path": "InsurancePlan.coverage.benefit.limit", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "InsurancePlan.coverage.benefit.limit.id", "path": "InsurancePlan.coverage.benefit.limit.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "InsurancePlan.coverage.benefit.limit.extension", "path": "InsurancePlan.coverage.benefit.limit.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "InsurancePlan.coverage.benefit.limit.modifierExtension", "path": "InsurancePlan.coverage.benefit.limit.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "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.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "InsurancePlan.coverage.benefit.limit.value", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "InsurancePlan.coverage.benefit.limit.value", "short": "Maximum value allowed", "definition": "The maximum amount of a service item a plan will pay for a covered benefit. For examples. wellness visits, or eyeglasses.", "comment": "May also be called “eligible expense,” “payment allowance,” or “negotiated rate.”.", "min": 0, "max": "1", "base": { "path": "InsurancePlan.coverage.benefit.limit.value", "min": 0, "max": "1" }, "type": [ { "code": "Quantity" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "qty-3", "severity": "error", "human": "If a code for the unit is present, the system SHALL also be present", "expression": "code.empty() or system.exists()", "xpath": "not(exists(f:code)) or exists(f:system)", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "SN (see also Range) or CQ" }, { "identity": "rim", "map": "PQ, IVL, MO, CO, depending on the values" } ] }, { "id": "InsurancePlan.coverage.benefit.limit.code", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "InsurancePlan.coverage.benefit.limit.code", "short": "Benefit limit details", "definition": "The specific limit on the benefit.", "comment": "Use `CodeableConcept.text` element if the data is free (uncoded) text.", "min": 0, "max": "1", "base": { "path": "InsurancePlan.coverage.benefit.limit.code", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "InsurancePlan.plan", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "InsurancePlan.plan", "short": "Plan details", "definition": "Details about an insurance plan.", "min": 0, "max": "*", "base": { "path": "InsurancePlan.plan", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "InsurancePlan.plan.id", "path": "InsurancePlan.plan.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "InsurancePlan.plan.extension", "path": "InsurancePlan.plan.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "InsurancePlan.plan.modifierExtension", "path": "InsurancePlan.plan.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "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.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "InsurancePlan.plan.identifier", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "InsurancePlan.plan.identifier", "short": "Business Identifier for Product", "definition": "Business identifiers assigned to this health insurance plan which remain constant as the resource is updated and propagates from server to server.", "min": 0, "max": "*", "base": { "path": "InsurancePlan.plan.identifier", "min": 0, "max": "*" }, "type": [ { "code": "Identifier" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)" }, { "identity": "rim", "map": "II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]" }, { "identity": "servd", "map": "Identifier" }, { "identity": "w5", "map": "FiveWs.identifier" }, { "identity": "rim", "map": ".scopes[Role](classCode=IDENT)" } ] }, { "id": "InsurancePlan.plan.type", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "InsurancePlan.plan.type", "short": "Type of plan", "definition": "Type of plan. For example, \"Platinum\" or \"High Deductable\".", "comment": "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.", "min": 0, "max": "1", "base": { "path": "InsurancePlan.plan.type", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "InsurancePlan.plan.coverageArea", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "InsurancePlan.plan.coverageArea", "short": "Where product applies", "definition": "The geographic region in which a health insurance plan's benefits apply.", "comment": "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.", "min": 0, "max": "*", "base": { "path": "InsurancePlan.plan.coverageArea", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Location" ] } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource)", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" } ] }, { "id": "InsurancePlan.plan.network", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "InsurancePlan.plan.network", "short": "What networks provide coverage", "definition": "Reference to the network that providing the type of coverage.", "comment": "Networks are represented as a hierarchy of organization resources.", "min": 0, "max": "*", "base": { "path": "InsurancePlan.plan.network", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Organization" ] } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource)", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" } ] }, { "id": "InsurancePlan.plan.generalCost", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "InsurancePlan.plan.generalCost", "short": "Overall costs", "definition": "Overall costs associated with the plan.", "min": 0, "max": "*", "base": { "path": "InsurancePlan.plan.generalCost", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "InsurancePlan.plan.generalCost.id", "path": "InsurancePlan.plan.generalCost.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "InsurancePlan.plan.generalCost.extension", "path": "InsurancePlan.plan.generalCost.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "InsurancePlan.plan.generalCost.modifierExtension", "path": "InsurancePlan.plan.generalCost.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "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.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "InsurancePlan.plan.generalCost.type", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "InsurancePlan.plan.generalCost.type", "short": "Type of cost", "definition": "Type of cost.", "comment": "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.", "min": 0, "max": "1", "base": { "path": "InsurancePlan.plan.generalCost.type", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "InsurancePlan.plan.generalCost.groupSize", "path": "InsurancePlan.plan.generalCost.groupSize", "short": "Number of enrollees", "definition": "Number of participants enrolled in the plan.", "comment": "32 bit number; for values larger than this, use decimal", "min": 0, "max": "1", "base": { "path": "InsurancePlan.plan.generalCost.groupSize", "min": 0, "max": "1" }, "type": [ { "code": "positiveInt" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "InsurancePlan.plan.generalCost.cost", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "InsurancePlan.plan.generalCost.cost", "short": "Cost value", "definition": "Value of the cost.", "min": 0, "max": "1", "base": { "path": "InsurancePlan.plan.generalCost.cost", "min": 0, "max": "1" }, "type": [ { "code": "Money" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "MO" } ] }, { "id": "InsurancePlan.plan.generalCost.comment", "path": "InsurancePlan.plan.generalCost.comment", "short": "Additional cost information", "definition": "Additional information about the general costs associated with this plan.", "comment": "Note that FHIR strings SHALL NOT exceed 1MB in size", "min": 0, "max": "1", "base": { "path": "InsurancePlan.plan.generalCost.comment", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "InsurancePlan.plan.specificCost", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "InsurancePlan.plan.specificCost", "short": "Specific costs", "definition": "Costs associated with the coverage provided by the product.", "min": 0, "max": "*", "base": { "path": "InsurancePlan.plan.specificCost", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "InsurancePlan.plan.specificCost.id", "path": "InsurancePlan.plan.specificCost.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "InsurancePlan.plan.specificCost.extension", "path": "InsurancePlan.plan.specificCost.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "InsurancePlan.plan.specificCost.modifierExtension", "path": "InsurancePlan.plan.specificCost.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "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.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "InsurancePlan.plan.specificCost.category", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "InsurancePlan.plan.specificCost.category", "short": "General category of benefit", "definition": "General category of benefit (Medical; Dental; Vision; Drug; Mental Health; Substance Abuse; Hospice, Home Health).", "comment": "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.", "min": 1, "max": "1", "base": { "path": "InsurancePlan.plan.specificCost.category", "min": 1, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "InsurancePlan.plan.specificCost.benefit", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "PlanBenefit" } ], "path": "InsurancePlan.plan.specificCost.benefit", "short": "Benefits list", "definition": "List of the specific benefits under this category of benefit.", "min": 0, "max": "*", "base": { "path": "InsurancePlan.plan.specificCost.benefit", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "InsurancePlan.plan.specificCost.benefit.id", "path": "InsurancePlan.plan.specificCost.benefit.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "InsurancePlan.plan.specificCost.benefit.extension", "path": "InsurancePlan.plan.specificCost.benefit.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "InsurancePlan.plan.specificCost.benefit.modifierExtension", "path": "InsurancePlan.plan.specificCost.benefit.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "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.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "InsurancePlan.plan.specificCost.benefit.type", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "InsurancePlan.plan.specificCost.benefit.type", "short": "Type of specific benefit", "definition": "Type of specific benefit (preventative; primary care office visit; speciality office visit; hospitalization; emergency room; urgent care).", "comment": "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.", "min": 1, "max": "1", "base": { "path": "InsurancePlan.plan.specificCost.benefit.type", "min": 1, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "InsurancePlan.plan.specificCost.benefit.cost", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "InsurancePlan.plan.specificCost.benefit.cost", "short": "List of the costs", "definition": "List of the costs associated with a specific benefit.", "min": 0, "max": "*", "base": { "path": "InsurancePlan.plan.specificCost.benefit.cost", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "InsurancePlan.plan.specificCost.benefit.cost.id", "path": "InsurancePlan.plan.specificCost.benefit.cost.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "InsurancePlan.plan.specificCost.benefit.cost.extension", "path": "InsurancePlan.plan.specificCost.benefit.cost.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "InsurancePlan.plan.specificCost.benefit.cost.modifierExtension", "path": "InsurancePlan.plan.specificCost.benefit.cost.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "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.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "InsurancePlan.plan.specificCost.benefit.cost.type", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "InsurancePlan.plan.specificCost.benefit.cost.type", "short": "Type of cost", "definition": "Type of cost (copay; individual cap; family cap; coinsurance; deductible).", "comment": "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.", "min": 1, "max": "1", "base": { "path": "InsurancePlan.plan.specificCost.benefit.cost.type", "min": 1, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "InsurancePlan.plan.specificCost.benefit.cost.applicability", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "InsurancePlan.plan.specificCost.benefit.cost.applicability", "short": "in-network | out-of-network | other", "definition": "Whether the cost applies to in-network or out-of-network providers (in-network; out-of-network; other).", "comment": "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.", "min": 0, "max": "1", "base": { "path": "InsurancePlan.plan.specificCost.benefit.cost.applicability", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "BenefitCostApplicability" } ], "strength": "required", "description": "Whether the cost applies to in-network or out-of-network providers.", "valueSet": "http://hl7.org/fhir/ValueSet/insuranceplan-applicability|4.3.0" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "InsurancePlan.plan.specificCost.benefit.cost.qualifiers", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "InsurancePlan.plan.specificCost.benefit.cost.qualifiers", "short": "Additional information about the cost", "definition": "Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA).", "comment": "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.", "min": 0, "max": "*", "base": { "path": "InsurancePlan.plan.specificCost.benefit.cost.qualifiers", "min": 0, "max": "*" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "InsurancePlan.plan.specificCost.benefit.cost.value", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "InsurancePlan.plan.specificCost.benefit.cost.value", "short": "The actual cost value", "definition": "The actual cost value. (some of the costs may be represented as percentages rather than currency, e.g. 10% coinsurance).", "comment": "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.", "min": 0, "max": "1", "base": { "path": "InsurancePlan.plan.specificCost.benefit.cost.value", "min": 0, "max": "1" }, "type": [ { "code": "Quantity" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "qty-3", "severity": "error", "human": "If a code for the unit is present, the system SHALL also be present", "expression": "code.empty() or system.exists()", "xpath": "not(exists(f:code)) or exists(f:system)", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "SN (see also Range) or CQ" }, { "identity": "rim", "map": "PQ, IVL, MO, CO, depending on the values" } ] } ] }, "differential": { "element": [ { "id": "InsurancePlan", "path": "InsurancePlan", "short": "Details of a Health Insurance product/plan provided by an organization", "definition": "Details of a Health Insurance product/plan provided by an organization.", "min": 0, "max": "*", "constraint": [ { "key": "ipn-1", "severity": "error", "human": "The organization SHALL at least have a name or an idendtifier, and possibly more than one", "expression": "(identifier.count() + name.count()) > 0", "xpath": "count(f:identifier | f:name) > 0", "source": "http://hl7.org/fhir/StructureDefinition/InsurancePlan" } ], "mustSupport": false, "isModifier": false, "mapping": [ { "identity": "w5", "map": "administrative.entity" } ] }, { "id": "InsurancePlan.identifier", "path": "InsurancePlan.identifier", "short": "Business Identifier for Product", "definition": "Business identifiers assigned to this health insurance product which remain constant as the resource is updated and propagates from server to server.", "min": 0, "max": "*", "type": [ { "code": "Identifier" } ], "condition": [ "ipn-1" ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "w5", "map": "FiveWs.identifier" }, { "identity": "rim", "map": ".scopes[Role](classCode=IDENT)" } ] }, { "id": "InsurancePlan.status", "path": "InsurancePlan.status", "short": "draft | active | retired | unknown", "definition": "The current state of the health insurance product.", "requirements": "Need a flag to indicate a record is no longer to be used and should generally be hidden for the user in the UI.", "min": 0, "max": "1", "type": [ { "code": "code" } ], "meaningWhenMissing": "Default interpretation is active.", "mustSupport": false, "isModifier": true, "isModifierReason": "This element is labeled as a modifier because it is a status element that contains codes which means that the resource should not be treated as valid", "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "PublicationStatus" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "required", "description": "The lifecycle status of an artifact.", "valueSet": "http://hl7.org/fhir/ValueSet/publication-status|4.3.0" }, "mapping": [ { "identity": "w5", "map": "FiveWs.status" }, { "identity": "rim", "map": ".status" } ] }, { "id": "InsurancePlan.type", "path": "InsurancePlan.type", "short": "Kind of product", "definition": "The kind of health insurance product.", "min": 0, "max": "*", "type": [ { "code": "CodeableConcept" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "InsurancePlanType" } ], "strength": "example", "description": "Used to categorize the product/plan.", "valueSet": "http://hl7.org/fhir/ValueSet/insuranceplan-type" }, "mapping": [ { "identity": "w5", "map": "FiveWs.class" }, { "identity": "rim", "map": ".code" } ] }, { "id": "InsurancePlan.name", "path": "InsurancePlan.name", "short": "Official name", "definition": "Official name of the health insurance product as designated by the owner.", "comment": "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.", "min": 0, "max": "1", "type": [ { "code": "string" } ], "condition": [ "ipn-1" ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": ".name" } ] }, { "id": "InsurancePlan.alias", "path": "InsurancePlan.alias", "short": "Alternate names", "definition": "A list of alternate names that the product is known as, or was known as in the past.", "comment": "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.", "requirements": "Over time products/plans go through many changes and can be known by different names.\n\nFor searching knowing previous names that the product/plan was known by can be very useful.", "min": 0, "max": "*", "type": [ { "code": "string" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": ".name" } ] }, { "id": "InsurancePlan.period", "path": "InsurancePlan.period", "short": "When the product is available", "definition": "The period of time that the health insurance product is available.", "min": 0, "max": "1", "type": [ { "code": "Period" } ], "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "InsurancePlan.ownedBy", "path": "InsurancePlan.ownedBy", "short": "Plan issuer", "definition": "The entity that is providing the health insurance product and underwriting the risk. This is typically an insurance carriers, other third-party payers, or health plan sponsors comonly referred to as 'payers'.", "alias": [ "Payer" ], "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Organization" ] } ], "mustSupport": false, "isModifier": false, "isSummary": true }, { "id": "InsurancePlan.administeredBy", "path": "InsurancePlan.administeredBy", "short": "Product administrator", "definition": "An organization which administer other services such as underwriting, customer service and/or claims processing on behalf of the health insurance product owner.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Organization" ] } ], "mustSupport": false, "isModifier": false, "isSummary": true }, { "id": "InsurancePlan.coverageArea", "path": "InsurancePlan.coverageArea", "short": "Where product applies", "definition": "The geographic region in which a health insurance product's benefits apply.", "min": 0, "max": "*", "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Location" ] } ], "mustSupport": false, "isModifier": false, "isSummary": true }, { "id": "InsurancePlan.contact", "path": "InsurancePlan.contact", "short": "Contact for the product", "definition": "The contact for the health insurance product for a certain purpose.", "comment": "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.", "requirements": "Need to keep track of assigned contact points within bigger organization.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": ".contactParty" } ] }, { "id": "InsurancePlan.contact.purpose", "path": "InsurancePlan.contact.purpose", "short": "The type of contact", "definition": "Indicates a purpose for which the contact can be reached.", "requirements": "Need to distinguish between multiple contact persons.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ContactPartyType" } ], "strength": "extensible", "description": "The purpose for which you would contact a contact party.", "valueSet": "http://hl7.org/fhir/ValueSet/contactentity-type" }, "mapping": [ { "identity": "rim", "map": "./type" } ] }, { "id": "InsurancePlan.contact.name", "path": "InsurancePlan.contact.name", "short": "A name associated with the contact", "definition": "A name associated with the contact.", "requirements": "Need to be able to track the person by name.", "min": 0, "max": "1", "type": [ { "code": "HumanName" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "./name" } ] }, { "id": "InsurancePlan.contact.telecom", "path": "InsurancePlan.contact.telecom", "short": "Contact details (telephone, email, etc.) for a contact", "definition": "A contact detail (e.g. a telephone number or an email address) by which the party may be contacted.", "requirements": "People have (primary) ways to contact them in some way such as phone, email.", "min": 0, "max": "*", "type": [ { "code": "ContactPoint" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "./telecom" } ] }, { "id": "InsurancePlan.contact.address", "path": "InsurancePlan.contact.address", "short": "Visiting or postal addresses for the contact", "definition": "Visiting or postal addresses for the contact.", "requirements": "May need to keep track of a contact party's address for contacting, billing or reporting requirements.", "min": 0, "max": "1", "type": [ { "code": "Address" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "./addr" } ] }, { "id": "InsurancePlan.endpoint", "path": "InsurancePlan.endpoint", "short": "Technical endpoint", "definition": "The technical endpoints providing access to services operated for the health insurance product.", "requirements": "Organizations have multiple systems that provide various services and need to be able to define the technical connection details for how to connect to them, and for what purpose.", "min": 0, "max": "*", "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Endpoint" ] } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "InsurancePlan.network", "path": "InsurancePlan.network", "short": "What networks are Included", "definition": "Reference to the network included in the health insurance product.", "comment": "Networks are represented as a hierarchy of organization resources.", "min": 0, "max": "*", "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Organization" ] } ], "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "InsurancePlan.coverage", "path": "InsurancePlan.coverage", "short": "Coverage details", "definition": "Details about the coverage offered by the insurance product.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ], "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "InsurancePlan.coverage.type", "path": "InsurancePlan.coverage.type", "short": "Type of coverage", "definition": "Type of coverage (Medical; Dental; Mental Health; Substance Abuse; Vision; Drug; Short Term; Long Term Care; Hospice; Home Health).", "min": 1, "max": "1", "type": [ { "code": "CodeableConcept" } ], "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "InsurancePlan.coverage.network", "path": "InsurancePlan.coverage.network", "short": "What networks provide coverage", "definition": "Reference to the network that providing the type of coverage.", "comment": "Networks are represented as a hierarchy of organization resources.", "min": 0, "max": "*", "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Organization" ] } ], "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "InsurancePlan.coverage.benefit", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "CoverageBenefit" } ], "path": "InsurancePlan.coverage.benefit", "short": "List of benefits", "definition": "Specific benefits under this type of coverage.", "min": 1, "max": "*", "type": [ { "code": "BackboneElement" } ], "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "InsurancePlan.coverage.benefit.type", "path": "InsurancePlan.coverage.benefit.type", "short": "Type of benefit", "definition": "Type of benefit (primary care; speciality care; inpatient; outpatient).", "min": 1, "max": "1", "type": [ { "code": "CodeableConcept" } ], "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "InsurancePlan.coverage.benefit.requirement", "path": "InsurancePlan.coverage.benefit.requirement", "short": "Referral requirements", "definition": "The referral requirements to have access/coverage for this benefit.", "min": 0, "max": "1", "type": [ { "code": "string" } ], "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "InsurancePlan.coverage.benefit.limit", "path": "InsurancePlan.coverage.benefit.limit", "short": "Benefit limits", "definition": "The specific limits on the benefit.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ], "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "InsurancePlan.coverage.benefit.limit.value", "path": "InsurancePlan.coverage.benefit.limit.value", "short": "Maximum value allowed", "definition": "The maximum amount of a service item a plan will pay for a covered benefit. For examples. wellness visits, or eyeglasses.", "comment": "May also be called “eligible expense,” “payment allowance,” or “negotiated rate.”.", "min": 0, "max": "1", "type": [ { "code": "Quantity" } ], "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "InsurancePlan.coverage.benefit.limit.code", "path": "InsurancePlan.coverage.benefit.limit.code", "short": "Benefit limit details", "definition": "The specific limit on the benefit.", "comment": "Use `CodeableConcept.text` element if the data is free (uncoded) text.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "InsurancePlan.plan", "path": "InsurancePlan.plan", "short": "Plan details", "definition": "Details about an insurance plan.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ], "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "InsurancePlan.plan.identifier", "path": "InsurancePlan.plan.identifier", "short": "Business Identifier for Product", "definition": "Business identifiers assigned to this health insurance plan which remain constant as the resource is updated and propagates from server to server.", "min": 0, "max": "*", "type": [ { "code": "Identifier" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "w5", "map": "FiveWs.identifier" }, { "identity": "rim", "map": ".scopes[Role](classCode=IDENT)" } ] }, { "id": "InsurancePlan.plan.type", "path": "InsurancePlan.plan.type", "short": "Type of plan", "definition": "Type of plan. For example, \"Platinum\" or \"High Deductable\".", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "InsurancePlan.plan.coverageArea", "path": "InsurancePlan.plan.coverageArea", "short": "Where product applies", "definition": "The geographic region in which a health insurance plan's benefits apply.", "min": 0, "max": "*", "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Location" ] } ], "mustSupport": false, "isModifier": false, "isSummary": true }, { "id": "InsurancePlan.plan.network", "path": "InsurancePlan.plan.network", "short": "What networks provide coverage", "definition": "Reference to the network that providing the type of coverage.", "comment": "Networks are represented as a hierarchy of organization resources.", "min": 0, "max": "*", "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Organization" ] } ], "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "InsurancePlan.plan.generalCost", "path": "InsurancePlan.plan.generalCost", "short": "Overall costs", "definition": "Overall costs associated with the plan.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ], "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "InsurancePlan.plan.generalCost.type", "path": "InsurancePlan.plan.generalCost.type", "short": "Type of cost", "definition": "Type of cost.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "InsurancePlan.plan.generalCost.groupSize", "path": "InsurancePlan.plan.generalCost.groupSize", "short": "Number of enrollees", "definition": "Number of participants enrolled in the plan.", "min": 0, "max": "1", "type": [ { "code": "positiveInt" } ], "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "InsurancePlan.plan.generalCost.cost", "path": "InsurancePlan.plan.generalCost.cost", "short": "Cost value", "definition": "Value of the cost.", "min": 0, "max": "1", "type": [ { "code": "Money" } ], "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "InsurancePlan.plan.generalCost.comment", "path": "InsurancePlan.plan.generalCost.comment", "short": "Additional cost information", "definition": "Additional information about the general costs associated with this plan.", "min": 0, "max": "1", "type": [ { "code": "string" } ], "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "InsurancePlan.plan.specificCost", "path": "InsurancePlan.plan.specificCost", "short": "Specific costs", "definition": "Costs associated with the coverage provided by the product.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ], "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "InsurancePlan.plan.specificCost.category", "path": "InsurancePlan.plan.specificCost.category", "short": "General category of benefit", "definition": "General category of benefit (Medical; Dental; Vision; Drug; Mental Health; Substance Abuse; Hospice, Home Health).", "min": 1, "max": "1", "type": [ { "code": "CodeableConcept" } ], "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "InsurancePlan.plan.specificCost.benefit", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "PlanBenefit" } ], "path": "InsurancePlan.plan.specificCost.benefit", "short": "Benefits list", "definition": "List of the specific benefits under this category of benefit.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ], "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "InsurancePlan.plan.specificCost.benefit.type", "path": "InsurancePlan.plan.specificCost.benefit.type", "short": "Type of specific benefit", "definition": "Type of specific benefit (preventative; primary care office visit; speciality office visit; hospitalization; emergency room; urgent care).", "min": 1, "max": "1", "type": [ { "code": "CodeableConcept" } ], "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "InsurancePlan.plan.specificCost.benefit.cost", "path": "InsurancePlan.plan.specificCost.benefit.cost", "short": "List of the costs", "definition": "List of the costs associated with a specific benefit.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ], "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "InsurancePlan.plan.specificCost.benefit.cost.type", "path": "InsurancePlan.plan.specificCost.benefit.cost.type", "short": "Type of cost", "definition": "Type of cost (copay; individual cap; family cap; coinsurance; deductible).", "min": 1, "max": "1", "type": [ { "code": "CodeableConcept" } ], "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "InsurancePlan.plan.specificCost.benefit.cost.applicability", "path": "InsurancePlan.plan.specificCost.benefit.cost.applicability", "short": "in-network | out-of-network | other", "definition": "Whether the cost applies to in-network or out-of-network providers (in-network; out-of-network; other).", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "BenefitCostApplicability" } ], "strength": "required", "description": "Whether the cost applies to in-network or out-of-network providers.", "valueSet": "http://hl7.org/fhir/ValueSet/insuranceplan-applicability|4.3.0" } }, { "id": "InsurancePlan.plan.specificCost.benefit.cost.qualifiers", "path": "InsurancePlan.plan.specificCost.benefit.cost.qualifiers", "short": "Additional information about the cost", "definition": "Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA).", "min": 0, "max": "*", "type": [ { "code": "CodeableConcept" } ], "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "InsurancePlan.plan.specificCost.benefit.cost.value", "path": "InsurancePlan.plan.specificCost.benefit.cost.value", "short": "The actual cost value", "definition": "The actual cost value. (some of the costs may be represented as percentages rather than currency, e.g. 10% coinsurance).", "min": 0, "max": "1", "type": [ { "code": "Quantity" } ], "mustSupport": false, "isModifier": false, "isSummary": false } ] } }