InsurancePlan describes the costs to the subscriber or beneficiary associated with benefits, as well as additional information about the offering, such as who administers the plan, a coverage area, contact information, etc. The specific benefits covered by the plan are described in the InsuranceProduct referenced in InsurancePlan.product.

Identifiers, such as the plan ID and/or group ID associated with the insurance plan.

In some markets, the combination of a plan ID and a group ID are needed to uniquely identify an InsurancePlan. For example, if a single plan (Bronze) is offered to two employer groups (Boilermakers and Aviation), you would represent that using two InsurancePlan resources, as shown below:

InsurancePlan.identifier  0..*  (Boilermakers)   InsurancePlan/bm
     [0].value = 1234   (bronze plan)
     [0].type = Plan
     [0].system = https://insurance-payer.com/plan-numbers

     [1].value = Boilermakers
     [1].type = Group
     [1].system = https:// insurance-payer.com /group-numbers

InsurancePlan.identifier  0..*  (Aviation)   InsurancePlan/av
     [0].value = 1234  (bronze plan)
     [0].type = Plan
     [0].system = https:// insurance-payer.com /plan-numbers

     [1].value = Aviation
     [1].type = Group
     [1].system = https:// insurance-payer.com /group-numbers

Type of plan. For example, "Platinum" or "High Deductable".

The product that this plan is available under.

The geographic region in which a health insurance plan's benefits apply.

Reference to the network that providing the type of coverage.

Networks are represented as a hierarchy of organization resources.

Overall costs associated with the plan.

Type of cost.

Number of participants enrolled in the plan.

Value of the cost.

Additional information about the general costs associated with this plan.

Costs associated with the coverage provided by the product-plan.

General category of benefit (Medical; Dental; Vision; Drug; Mental Health; Substance Abuse; Hospice, Home Health).

List of the specific benefits under this category of benefit.

Type of specific benefit (preventative; primary care office visit; speciality office visit; hospitalization; emergency room; urgent care).

List of the costs associated with a specific benefit.

Type of cost (copay; individual cap; family cap; coinsurance; deductible).

Whether the cost applies to in-network or out-of-network providers (in-network; out-of-network; other).

Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA).

The actual cost value. (some of the costs may be represented as percentages rather than currency, e.g. 10% coinsurance).