Validated Healthcare Directory
0.2.0 - CI Build
Validated Healthcare Directory
0.2.0 - CI Build
Validated Healthcare Directory, published by HL7 International - Patient Administration Work Group. This is not an authorized publication; it is the continuous build for version 0.2.0). This version is based on the current content of https://github.com/HL7/VhDir/ and changes regularly. See the Directory of published versions
{
"resourceType" : "InsurancePlan",
"id" : "insuranceplan1",
"text" : // describes a fictional Qualified Health Plan (QHP) in the Washington, DC metro area
{
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: InsurancePlan</b><a name=\"insuranceplan1\"> </a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource InsurancePlan "insuranceplan1" </p></div><p><b>identifier</b>: HIOS product ID:\u00a01234567891\u00a0(use:\u00a0OFFICIAL)</p><p><b>status</b>: active</p><p><b>type</b>: Bronze <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-payercharacteristics.html\">VhDir Payer Characteristics Code System</a>#bronze)</span></p><p><b>name</b>: Patriot PPO Standard</p><p><b>alias</b>: Patriot Plus</p><p><b>period</b>: 2018-06-06 --> 2019-01-01</p><p><b>ownedBy</b>: <a href=\"Organization-homeland.html\">Organization/homeland: Homeland Health Insurance</a> "Homeland Health Insurance"</p><p><b>administeredBy</b>: <a href=\"Organization-homeland.html\">Organization/homeland: Homeland Health Insurance</a> "Homeland Health Insurance"</p><p><b>coverageArea</b>: <a href=\"Location-wash-dc-metro.html\">Location/wash-dc-metro: Washington, DC metro area</a> "Washington, DC metro area"</p><h3>Contacts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Purpose</b></td><td><b>Telecom</b></td></tr><tr><td style=\"display: none\">*</td><td>General information <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-contactentity-type.html\">Contact entity type</a>#PATINF "Patient")</span></td><td>ph: 202-123-5555, <a href=\"mailto:info@homelandinc.org\">info@homelandinc.org</a></td></tr></table><p><b>endpoint</b>: <span>: patriot plan endpoint hub</span></p><p><b>network</b>: </p><ul><li><a href=\"Organization-patriotppo.html\">Organization/patriotppo: Patriot Preferred Provider Network</a> "Patriot Preferred Provider Network"</li><li><a href=\"Organization-patriotdental.html\">Organization/patriotdental: Patriot Dental Provider Network</a> "Patriot Dental Provider Network"</li></ul><blockquote><p><b>coverage</b></p><p><b>type</b>: Coverage related to medical inpatient, outpatient, diagnostic, and preventive care <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (coverage-type#medical "Medical")</span></p><p><b>network</b>: <a href=\"Organization-patriotppo.html\">Organization/patriotppo: Patriot Preferred Provider Network</a> "Patriot Preferred Provider Network"</p><blockquote><p><b>benefit</b></p><p><b>type</b>: Primary care visit to treat an injury or illness <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (benefit-type#001)</span></p><p><b>requirement</b>: N/A</p><h3>Limits</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Code</b></td></tr><tr><td style=\"display: none\">*</td><td>unlimited <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ()</span></td></tr></table></blockquote></blockquote><blockquote><p><b>coverage</b></p><p><b>type</b>: Coverage related to dental care <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (coverage-type#dental "Dental")</span></p><p><b>network</b>: <a href=\"Organization-patriotdental.html\">Organization/patriotdental: Patriot Dental Provider Network</a> "Patriot Dental Provider Network"</p><blockquote><p><b>benefit</b></p><p><b>type</b>: Periodic oral checkup <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (benefit-type#052 "Basic Dental Care – Adult")</span></p><p><b>requirement</b>: N/A</p><h3>Limits</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Code</b></td></tr><tr><td style=\"display: none\">*</td><td>2 visit/yr<span style=\"background: LightGoldenRodYellow\"> (Details: UCUM code {visit}/a = '{visit}/a')</span></td><td>biannual oral checkup <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ()</span></td></tr></table></blockquote></blockquote><blockquote><p><b>plan</b></p><p><b>identifier</b>: HIOS plan ID:\u00a0123456789101112\u00a0(use:\u00a0OFFICIAL)</p><p><b>type</b>: Bronze <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (planlevel#bronze)</span></p><p><b>coverageArea</b>: <a href=\"Location-wash-dc-metro.html\">Location/wash-dc-metro: Washington, DC metro area</a> "Washington, DC metro area"</p><p><b>network</b>: <a href=\"Organization-patriotdental.html\">Organization/patriotdental: Patriot Dental Provider Network</a> "Patriot Dental Provider Network"</p><blockquote><p><b>generalCost</b></p><p><b>type</b>: Deductible <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (cost-type#deductible)</span></p><p><b>groupSize</b>: 1</p><h3>Costs</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>6200</td><td>USD</td></tr></table><p><b>comment</b>: Includes all prescription and medical costs for in-network providers</p></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: Medical <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (cost-category#medical)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Primary care visit to treat an injury or illness <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (benefit-type#001)</span></p><h3>Costs</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Applicability</b></td><td><b>Qualifiers</b></td><td><b>Value</b></td></tr><tr><td style=\"display: none\">*</td><td>Copay <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (cost-type#copay)</span></td><td>In Network <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-applicability.html\">Benefit cost applicability</a>#in-network)</span></td><td>in-network preferred provider <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ()</span></td><td>50 dollars<span style=\"background: LightGoldenRodYellow\"> (Details: urn:iso:std:iso:4217 code USD = 'USD')</span></td></tr></table></blockquote></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: Dental <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (cost-category#dental)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Basic Dental Care – Adult <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (cost-type#052)</span></p><h3>Costs</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Applicability</b></td><td><b>Qualifiers</b></td><td><b>Value</b></td></tr><tr><td style=\"display: none\">*</td><td>Coinsurance <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (costing#coinsurance)</span></td><td>In Network <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-applicability.html\">Benefit cost applicability</a>#in-network)</span></td><td>in-network provider <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ()</span></td><td>10 percent</td></tr></table></blockquote></blockquote></blockquote></div>"
},
"identifier" : [
{
"use" : "official",
"type" : // Official HIOS product ID assigned by CMS
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "NIIP",
"display" : "National Insurance Payor Identifier (Payor)",
"userSelected" : true
}
],
"text" : "HIOS product ID"
},
"system" : "https://www.cms.gov/CCIIO/",
"value" : "1234567891",
"assigner" : {
"display" : "Centers for Medicare and Medicaid Services"
}
}
],
"status" : "active",
"type" : [
// This record is active
{
"coding" : [
{
"system" : "http://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristics",
"code" : "bronze",
"display" : "Bronze"
}
]
}
],
"name" : "Patriot PPO Standard",
"alias" : [
"Patriot Plus"
],
"period" : // Name of the product is Patriot PPO Standard
{
"start" : "2018-06-06",
"end" : "2019-01-01"
},
"ownedBy" : {
"reference" : "Organization/homeland",
"display" : "Homeland Health Insurance"
},
"administeredBy" : // Reference to the owner of the product, Homeland Health Insurance
{
"reference" : "Organization/homeland",
"display" : "Homeland Health Insurance"
},
"coverageArea" : [
{
"reference" : "Location/wash-dc-metro",
"display" : "Washington, DC metro area"
}
],
"contact" : [
// Reference to the product's coverage area, the Washington, DC metro area
{
"purpose" : // Contact information for consumers
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/contactentity-type",
"code" : "PATINF",
"display" : "Patient"
}
],
"text" : "General information"
},
"telecom" : [
{
"system" : "phone",
"value" : "202-123-5555"
},
{
"system" : "email",
"value" : "info@homelandinc.org"
}
]
}
],
"endpoint" : [
{
"display" : "patriot plan endpoint hub"
}
],
"network" : [
// A reference to the technical endpoints providing access to services operated for the health insurance product.
<reference value=""/>
{
"reference" : "Organization/patriotppo",
"display" : "Patriot Preferred Provider Network"
},
// A reference to the medical provider network associated with this product
{
"reference" : "Organization/patriotdental",
"display" : "Patriot Dental Provider Network"
}
],
"coverage" : [
// A reference to the dental provider network associated with this product
{
"type" : // describes medical benefits
{
"coding" : [
{
"system" : "http://example.org/coverage-type",
"code" : "medical",
"display" : "Medical"
}
],
"text" : "Coverage related to medical inpatient, outpatient, diagnostic, and preventive care"
},
"network" : [
{
"reference" : "Organization/patriotppo",
"display" : "Patriot Preferred Provider Network"
}
],
"benefit" : [
{
"type" : // basic primary care visit
{
"coding" : [
{
"system" : "http://example.org/benefit-type",
"code" : "001",
"display" : "Primary care visit to treat an injury or illness"
}
]
},
"requirement" : "N/A",
"limit" : [
{
"code" : {
"text" : "unlimited"
}
}
]
}
]
},
{
"type" : // describes dental benefits
{
"coding" : [
{
"system" : "http://example.org/coverage-type",
"code" : "dental",
"display" : "Dental"
}
],
"text" : "Coverage related to dental care"
},
"network" : [
{
"reference" : "Organization/patriotdental",
"display" : "Patriot Dental Provider Network"
}
],
"benefit" : [
// Specific benefits under this type of coverage.
{
"type" : // biannual oral checkup
{
"coding" : [
{
"system" : "http://example.org/benefit-type",
"code" : "052",
"display" : "Basic Dental Care – Adult"
}
],
"text" : "Periodic oral checkup"
},
"requirement" : "N/A",
"limit" : [
{
"value" : {
"value" : 2,
"unit" : "visit/yr",
"system" : "http://unitsofmeasure.org",
"code" : "{visit}/a"
},
"code" : {
"text" : "biannual oral checkup"
}
}
]
}
]
}
],
"plan" : [
{
"identifier" : [
// Information about the cost sharing features of the product
{
"use" : "official",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "NIIP",
"display" : "National Insurance Payor Identifier (Payor)",
"userSelected" : true
}
],
"text" : "HIOS plan ID"
},
"system" : "https://www.cms.gov/CCIIO/",
"value" : "123456789101112",
"assigner" : {
"display" : "Centers for Medicare and Medicaid Services"
}
}
],
"type" : {
"coding" : [
{
"system" : "http://example.org/planlevel",
"code" : "bronze",
"display" : "Bronze"
}
],
"text" : "Bronze"
},
"coverageArea" : [
{
"reference" : "Location/wash-dc-metro",
"display" : "Washington, DC metro area"
}
],
"network" : [
// Reference to the product's coverage area, the Washington, DC metro area
{
"reference" : "Organization/patriotdental",
"display" : "Patriot Dental Provider Network"
}
],
"generalCost" : [
{
"type" : // Describes the plan's deductible
{
"coding" : [
{
"system" : "http://example.org/cost-type",
"code" : "deductible",
"display" : "Deductible"
}
],
"text" : "Deductible"
},
"groupSize" : 1,
"cost" : {
"value" : 6200,
"currency" : "USD"
},
"comment" : "Includes all prescription and medical costs for in-network providers"
}
],
"specificCost" : [
{
"category" : // Describes the costs associated with the medical coverage options
{
"coding" : [
{
"system" : "http://example.org/cost-category",
"code" : "medical",
"display" : "Medical"
}
]
},
"benefit" : [
{
"type" : // $50 copay for primary care visits with an in-network preferred provider
{
"coding" : [
{
"system" : "http://example.org/benefit-type",
"code" : "001",
"display" : "Primary care visit to treat an injury or illness"
}
]
},
"cost" : [
{
"type" : {
"coding" : [
{
"system" : "http://example.org/cost-type",
"code" : "copay",
"display" : "Copay"
}
]
},
"applicability" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/applicability",
"code" : "in-network",
"display" : "In Network"
}
]
},
"qualifiers" : [
{
"text" : "in-network preferred provider"
}
],
"value" : {
"value" : 50,
"unit" : "dollars",
"system" : "urn:iso:std:iso:4217",
"code" : "USD"
}
}
]
}
]
},
{
"category" : // describes the costs associated with dental coverage
{
"coding" : [
{
"system" : "http://example.org/cost-category",
"code" : "dental",
"display" : "Dental"
}
]
},
"benefit" : [
{
"type" : // 10% coinsurance for routine oral checkup with an in-network dental provider
{
"coding" : [
{
"system" : "http://example.org/cost-type",
"code" : "052",
"display" : "Basic Dental Care – Adult"
}
]
},
"cost" : [
{
"type" : {
"coding" : [
{
"system" : "http://example.org/costing",
"code" : "coinsurance",
"display" : "Coinsurance"
}
]
},
"applicability" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/applicability",
"code" : "in-network",
"display" : "In Network"
}
]
},
"qualifiers" : [
{
"text" : "in-network provider"
}
],
"value" : {
"value" : 10,
"unit" : "percent"
}
}
]
}
]
}
]
}
]
}
IG © 2022+ HL7 International - Patient Administration Work Group. Package hl7.fhir.uv.vhdir#0.2.0 based on FHIR 4.0.1. Generated 2023-09-12
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