<StructureDefinition xmlns="http://hl7.org/fhir">
  <id value="InsurancePlan" />
  <meta>
    <lastUpdated value="2021-01-02T08:58:31.578+11:00" />
  </meta>
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-category">
    <valueString value="Financial.General" />
  </extension>
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
    <valueCode value="trial-use" />
  </extension>
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
    <valueInteger value="0" />
  </extension>
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-security-category">
    <valueCode value="business" />
  </extension>
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="pa" />
  </extension>
  <extension url="http://hl7.org/fhir/build/StructureDefinition/entered-in-error-status">
    <valueCode value=".status = retired" />
  </extension>
  <url value="http://hl7.org/fhir/StructureDefinition/InsurancePlan" />
  <version value="4.6.0" />
  <name value="InsurancePlan" />
  <status value="draft" />
  <date value="2021-01-02T08:58:31+11:00" />
  <publisher value="Health Level Seven International (Patient Administration)" />
  <contact>
    <telecom>
      <system value="url" />
      <value value="http://hl7.org/fhir" />
    </telecom>
  </contact>
  <contact>
    <telecom>
      <system value="url" />
      <value value="http://www.hl7.org/Special/committees/pafm/index.cfm" />
    </telecom>
  </contact>
  <description value="Details of a Health Insurance product/plan provided by an organization." />
  <fhirVersion value="4.6.0" />
  <mapping>
    <identity value="w5" />
    <uri value="http://hl7.org/fhir/fivews" />
    <name value="FiveWs Pattern Mapping" />
  </mapping>
  <mapping>
    <identity value="rim" />
    <uri value="http://hl7.org/v3" />
    <name value="RIM Mapping" />
  </mapping>
  <kind value="resource" />
  <abstract value="false" />
  <type value="InsurancePlan" />
  <baseDefinition value="http://hl7.org/fhir/StructureDefinition/DomainResource" />
  <derivation value="specialization" />
  <differential>
    <element id="InsurancePlan">
      <path value="InsurancePlan" />
      <short value="Details of a Health Insurance product/plan provided by an organization" />
      <definition value="Details of a Health Insurance product/plan provided by an organization." />
      <min value="0" />
      <max value="*" />
      <constraint>
        <key value="ipn-1" />
        <severity value="error" />
        <human value="The organization SHALL at least have a name or an identifier, and possibly more than one" />
        <expression value="(identifier.count() + name.count()) &gt; 0" />
        <xpath value="count(f:identifier | f:name) &gt; 0" />
        <source value="http://hl7.org/fhir/StructureDefinition/InsurancePlan" />
      </constraint>
      <mapping>
        <identity value="w5" />
        <map value="administrative.entity" />
      </mapping>
    </element>
    <element id="InsurancePlan.identifier">
      <path value="InsurancePlan.identifier" />
      <short value="Business Identifier for Product" />
      <definition value="Business identifiers assigned to this health insurance product which remain constant as the resource is updated and propagates from server to server." />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="Identifier" />
      </type>
      <condition value="ipn-1" />
      <isSummary value="true" />
      <mapping>
        <identity value="w5" />
        <map value="FiveWs.identifier" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".scopes[Role](classCode=IDENT)" />
      </mapping>
    </element>
    <element id="InsurancePlan.status">
      <path value="InsurancePlan.status" />
      <short value="draft | active | retired | unknown" />
      <definition value="The current state of the health insurance product." />
      <requirements value="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 value="0" />
      <max value="1" />
      <type>
        <code value="code" />
      </type>
      <meaningWhenMissing value="Default interpretation is active." />
      <isModifier value="true" />
      <isModifierReason value="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 value="true" />
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="PublicationStatus" />
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding">
          <valueBoolean value="true" />
        </extension>
        <strength value="required" />
        <description value="The lifecycle status of an artifact." />
        <valueSet value="http://hl7.org/fhir/ValueSet/publication-status" />
      </binding>
      <mapping>
        <identity value="w5" />
        <map value="FiveWs.status" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".status" />
      </mapping>
    </element>
    <element id="InsurancePlan.type">
      <path value="InsurancePlan.type" />
      <short value="Kind of product" />
      <definition value="The kind of health insurance product." />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="CodeableConcept" />
      </type>
      <isSummary value="true" />
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="InsurancePlanType" />
        </extension>
        <strength value="example" />
        <description value="Used to categorize the product/plan." />
        <valueSet value="http://hl7.org/fhir/ValueSet/insuranceplan-type" />
      </binding>
      <mapping>
        <identity value="w5" />
        <map value="FiveWs.class" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".code" />
      </mapping>
    </element>
    <element id="InsurancePlan.name">
      <path value="InsurancePlan.name" />
      <short value="Official name" />
      <definition value="Official name of the health insurance product as designated by the owner." />
      <comment value="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 value="0" />
      <max value="1" />
      <type>
        <code value="string" />
      </type>
      <condition value="ipn-1" />
      <isSummary value="true" />
      <mapping>
        <identity value="rim" />
        <map value=".name" />
      </mapping>
    </element>
    <element id="InsurancePlan.alias">
      <extension url="http://hl7.org/fhir/build/StructureDefinition/committee-notes">
        <valueString value="This is used in many registries, and is often very important in searching." />
      </extension>
      <path value="InsurancePlan.alias" />
      <short value="Alternate names" />
      <definition value="A list of alternate names that the product is known as, or was known as in the past." />
      <comment value="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 value="Over time products/plans go through many changes and can be known by different names.&#xA;&#xA;For searching knowing previous names that the product/plan was known by can be very useful." />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="string" />
      </type>
      <mapping>
        <identity value="rim" />
        <map value=".name" />
      </mapping>
    </element>
    <element id="InsurancePlan.period">
      <path value="InsurancePlan.period" />
      <short value="When the product is available" />
      <definition value="The period of time that the health insurance product is available." />
      <min value="0" />
      <max value="1" />
      <type>
        <code value="Period" />
      </type>
    </element>
    <element id="InsurancePlan.ownedBy">
      <path value="InsurancePlan.ownedBy" />
      <short value="Plan issuer" />
      <definition value="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 value="Payer" />
      <min value="0" />
      <max value="1" />
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization" />
      </type>
      <isSummary value="true" />
    </element>
    <element id="InsurancePlan.administeredBy">
      <path value="InsurancePlan.administeredBy" />
      <short value="Product administrator" />
      <definition value="An organization which administer other services such as underwriting, customer service and/or claims processing on behalf of the health insurance product owner." />
      <min value="0" />
      <max value="1" />
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization" />
      </type>
      <isSummary value="true" />
    </element>
    <element id="InsurancePlan.coverageArea">
      <path value="InsurancePlan.coverageArea" />
      <short value="Where product applies" />
      <definition value="The geographic region in which a health insurance product's benefits apply." />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Location" />
      </type>
      <isSummary value="true" />
    </element>
    <element id="InsurancePlan.contact">
      <path value="InsurancePlan.contact" />
      <short value="Official contact details relevant to the health insurance plan/product" />
      <definition value="The contact details of communication devices available relevant to the specific Insurance Plan/Product. This can include addresses, phone numbers, fax numbers, mobile numbers, email addresses and web sites." />
      <requirements value="Need to keep track of both simple contact details and also assigned contacts within larger organizations." />
      <comment value="The address/telecom use code 'home' are not to be used." />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="ExtendedContactDetail" />
      </type>
      <mapping>
        <identity value="rim" />
        <map value=".contactParty" />
      </mapping>
    </element>
    <element id="InsurancePlan.endpoint">
      <path value="InsurancePlan.endpoint" />
      <short value="Technical endpoint" />
      <definition value="The technical endpoints providing access to services operated for the health insurance product." />
      <requirements value="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 value="0" />
      <max value="*" />
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Endpoint" />
      </type>
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
    </element>
    <element id="InsurancePlan.network">
      <path value="InsurancePlan.network" />
      <short value="What networks are Included" />
      <definition value="Reference to the network included in the health insurance product." />
      <comment value="Networks are represented as a hierarchy of organization resources." />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization" />
      </type>
    </element>
    <element id="InsurancePlan.coverage">
      <path value="InsurancePlan.coverage" />
      <short value="Coverage details" />
      <definition value="Details about the coverage offered by the insurance product." />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="BackboneElement" />
      </type>
    </element>
    <element id="InsurancePlan.coverage.type">
      <path value="InsurancePlan.coverage.type" />
      <short value="Type of coverage" />
      <definition value="Type of coverage  (Medical; Dental; Mental Health; Substance Abuse; Vision; Drug; Short Term; Long Term Care; Hospice; Home Health)." />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="CodeableConcept" />
      </type>
    </element>
    <element id="InsurancePlan.coverage.network">
      <path value="InsurancePlan.coverage.network" />
      <short value="What networks provide coverage" />
      <definition value="Reference to the network that providing the type of coverage." />
      <comment value="Networks are represented as a hierarchy of organization resources." />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization" />
      </type>
    </element>
    <element id="InsurancePlan.coverage.benefit">
      <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name">
        <valueString value="CoverageBenefit" />
      </extension>
      <path value="InsurancePlan.coverage.benefit" />
      <short value="List of benefits" />
      <definition value="Specific benefits under this type of coverage." />
      <min value="1" />
      <max value="*" />
      <type>
        <code value="BackboneElement" />
      </type>
    </element>
    <element id="InsurancePlan.coverage.benefit.type">
      <path value="InsurancePlan.coverage.benefit.type" />
      <short value="Type of benefit" />
      <definition value="Type of benefit (primary care; speciality care; inpatient; outpatient)." />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="CodeableConcept" />
      </type>
    </element>
    <element id="InsurancePlan.coverage.benefit.requirement">
      <path value="InsurancePlan.coverage.benefit.requirement" />
      <short value="Referral requirements" />
      <definition value="The referral requirements to have access/coverage for this benefit." />
      <min value="0" />
      <max value="1" />
      <type>
        <code value="string" />
      </type>
    </element>
    <element id="InsurancePlan.coverage.benefit.limit">
      <path value="InsurancePlan.coverage.benefit.limit" />
      <short value="Benefit limits" />
      <definition value="The specific limits on the benefit." />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="BackboneElement" />
      </type>
    </element>
    <element id="InsurancePlan.coverage.benefit.limit.value">
      <path value="InsurancePlan.coverage.benefit.limit.value" />
      <short value="Maximum value allowed" />
      <definition value="The maximum amount of a service item a plan will pay for a covered benefit.  For examples. wellness visits, or eyeglasses." />
      <comment value="May also be called “eligible expense,” “payment allowance,” or “negotiated rate.”." />
      <min value="0" />
      <max value="1" />
      <type>
        <code value="Quantity" />
      </type>
    </element>
    <element id="InsurancePlan.coverage.benefit.limit.code">
      <path value="InsurancePlan.coverage.benefit.limit.code" />
      <short value="Benefit limit details" />
      <definition value="The specific limit on the benefit." />
      <comment value="Use `CodeableConcept.text` element if the data is free (uncoded) text." />
      <min value="0" />
      <max value="1" />
      <type>
        <code value="CodeableConcept" />
      </type>
    </element>
    <element id="InsurancePlan.plan">
      <path value="InsurancePlan.plan" />
      <short value="Plan details" />
      <definition value="Details about an insurance plan." />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="BackboneElement" />
      </type>
    </element>
    <element id="InsurancePlan.plan.identifier">
      <path value="InsurancePlan.plan.identifier" />
      <short value="Business Identifier for Product" />
      <definition value="Business identifiers assigned to this health insurance plan which remain constant as the resource is updated and propagates from server to server." />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="Identifier" />
      </type>
      <isSummary value="true" />
      <mapping>
        <identity value="w5" />
        <map value="FiveWs.identifier" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".scopes[Role](classCode=IDENT)" />
      </mapping>
    </element>
    <element id="InsurancePlan.plan.type">
      <path value="InsurancePlan.plan.type" />
      <short value="Type of plan" />
      <definition value="Type of plan. For example, &quot;Platinum&quot; or &quot;High Deductable&quot;." />
      <min value="0" />
      <max value="1" />
      <type>
        <code value="CodeableConcept" />
      </type>
    </element>
    <element id="InsurancePlan.plan.coverageArea">
      <path value="InsurancePlan.plan.coverageArea" />
      <short value="Where product applies" />
      <definition value="The geographic region in which a health insurance plan's benefits apply." />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Location" />
      </type>
      <isSummary value="true" />
    </element>
    <element id="InsurancePlan.plan.network">
      <path value="InsurancePlan.plan.network" />
      <short value="What networks provide coverage" />
      <definition value="Reference to the network that providing the type of coverage." />
      <comment value="Networks are represented as a hierarchy of organization resources." />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization" />
      </type>
    </element>
    <element id="InsurancePlan.plan.generalCost">
      <path value="InsurancePlan.plan.generalCost" />
      <short value="Overall costs" />
      <definition value="Overall costs associated with the plan." />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="BackboneElement" />
      </type>
    </element>
    <element id="InsurancePlan.plan.generalCost.type">
      <path value="InsurancePlan.plan.generalCost.type" />
      <short value="Type of cost" />
      <definition value="Type of cost." />
      <min value="0" />
      <max value="1" />
      <type>
        <code value="CodeableConcept" />
      </type>
    </element>
    <element id="InsurancePlan.plan.generalCost.groupSize">
      <path value="InsurancePlan.plan.generalCost.groupSize" />
      <short value="Number of enrollees" />
      <definition value="Number of participants enrolled in the plan." />
      <min value="0" />
      <max value="1" />
      <type>
        <code value="positiveInt" />
      </type>
    </element>
    <element id="InsurancePlan.plan.generalCost.cost">
      <path value="InsurancePlan.plan.generalCost.cost" />
      <short value="Cost value" />
      <definition value="Value of the cost." />
      <min value="0" />
      <max value="1" />
      <type>
        <code value="Money" />
      </type>
    </element>
    <element id="InsurancePlan.plan.generalCost.comment">
      <path value="InsurancePlan.plan.generalCost.comment" />
      <short value="Additional cost information" />
      <definition value="Additional information about the general costs associated with this plan." />
      <min value="0" />
      <max value="1" />
      <type>
        <code value="string" />
      </type>
    </element>
    <element id="InsurancePlan.plan.specificCost">
      <path value="InsurancePlan.plan.specificCost" />
      <short value="Specific costs" />
      <definition value="Costs associated with the coverage provided by the product." />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="BackboneElement" />
      </type>
    </element>
    <element id="InsurancePlan.plan.specificCost.category">
      <path value="InsurancePlan.plan.specificCost.category" />
      <short value="General category of benefit" />
      <definition value="General category of benefit (Medical; Dental; Vision; Drug; Mental Health; Substance Abuse; Hospice, Home Health)." />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="CodeableConcept" />
      </type>
    </element>
    <element id="InsurancePlan.plan.specificCost.benefit">
      <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name">
        <valueString value="PlanBenefit" />
      </extension>
      <path value="InsurancePlan.plan.specificCost.benefit" />
      <short value="Benefits list" />
      <definition value="List of the specific benefits under this category of benefit." />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="BackboneElement" />
      </type>
    </element>
    <element id="InsurancePlan.plan.specificCost.benefit.type">
      <path value="InsurancePlan.plan.specificCost.benefit.type" />
      <short value="Type of specific benefit" />
      <definition value="Type of specific benefit (preventative; primary care office visit; speciality office visit; hospitalization; emergency room; urgent care)." />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="CodeableConcept" />
      </type>
    </element>
    <element id="InsurancePlan.plan.specificCost.benefit.cost">
      <path value="InsurancePlan.plan.specificCost.benefit.cost" />
      <short value="List of the costs" />
      <definition value="List of the costs associated with a specific benefit." />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="BackboneElement" />
      </type>
    </element>
    <element id="InsurancePlan.plan.specificCost.benefit.cost.type">
      <path value="InsurancePlan.plan.specificCost.benefit.cost.type" />
      <short value="Type of cost" />
      <definition value="Type of cost (copay; individual cap; family cap; coinsurance; deductible)." />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="CodeableConcept" />
      </type>
    </element>
    <element id="InsurancePlan.plan.specificCost.benefit.cost.applicability">
      <path value="InsurancePlan.plan.specificCost.benefit.cost.applicability" />
      <short value="in-network | out-of-network | other" />
      <definition value="Whether the cost applies to in-network or out-of-network providers (in-network; out-of-network; other)." />
      <min value="0" />
      <max value="1" />
      <type>
        <code value="CodeableConcept" />
      </type>
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="BenefitCostApplicability" />
        </extension>
        <strength value="required" />
        <description value="Whether the cost applies to in-network or out-of-network providers." />
        <valueSet value="http://hl7.org/fhir/ValueSet/insuranceplan-applicability" />
      </binding>
    </element>
    <element id="InsurancePlan.plan.specificCost.benefit.cost.qualifiers">
      <path value="InsurancePlan.plan.specificCost.benefit.cost.qualifiers" />
      <short value="Additional information about the cost" />
      <definition value="Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA)." />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="CodeableConcept" />
      </type>
    </element>
    <element id="InsurancePlan.plan.specificCost.benefit.cost.value">
      <path value="InsurancePlan.plan.specificCost.benefit.cost.value" />
      <short value="The actual cost value" />
      <definition value="The actual cost value. (some of the costs may be represented as percentages rather than currency, e.g. 10% coinsurance)." />
      <min value="0" />
      <max value="1" />
      <type>
        <code value="Quantity" />
      </type>
    </element>
  </differential>
</StructureDefinition>