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
<InsurancePlan xmlns="http://hl7.org/fhir">
<!-- describes a fictional Qualified Health Plan (QHP) in the Washington, DC metro area -->
<id value="insuranceplan1"/>
<text>
<status value="generated"/>
<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: 1234567891 (use: OFFICIAL)</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: 123456789101112 (use: OFFICIAL)</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>
</text>
<identifier>
<!-- Official HIOS product ID assigned by CMS -->
<use value="official"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
<code value="NIIP"/>
<display value="National Insurance Payor Identifier (Payor)"/>
<userSelected value="true"/>
</coding>
<text value="HIOS product ID"/>
</type>
<system value="https://www.cms.gov/CCIIO/"/>
<value value="1234567891"/>
<assigner>
<display value="Centers for Medicare and Medicaid Services"/>
</assigner>
</identifier>
<status value="active"/>
<!-- This record is active -->
<type>
<coding>
<system
value="http://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristics"/>
<code value="bronze"/>
<display value="Bronze"/>
</coding>
</type>
<name value="Patriot PPO Standard"/>
<!-- Name of the product is Patriot PPO Standard -->
<alias value="Patriot Plus"/>
<period>
<start value="2018-06-06"/>
<end value="2019-01-01"/>
</period>
<ownedBy>
<!-- Reference to the owner of the product, Homeland Health Insurance -->
<reference value="Organization/homeland"/>
<display value="Homeland Health Insurance"/>
</ownedBy>
<administeredBy>
<reference value="Organization/homeland"/>
<display value="Homeland Health Insurance"/>
</administeredBy>
<coverageArea>
<!-- Reference to the product's coverage area, the Washington, DC metro area -->
<reference value="Location/wash-dc-metro"/>
<display value="Washington, DC metro area"/>
</coverageArea>
<contact>
<!-- Contact information for consumers -->
<purpose>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/contactentity-type"/>
<code value="PATINF"/>
<display value="Patient"/>
</coding>
<text value="General information"/>
</purpose>
<telecom>
<system value="phone"/>
<value value="202-123-5555"/>
</telecom>
<telecom>
<system value="email"/>
<value value="info@homelandinc.org"/>
</telecom>
</contact>
<endpoint>
<!-- A reference to the technical endpoints providing access to services operated for the health insurance product.
<reference value=""/> -->
<display value="patriot plan endpoint hub"/>
</endpoint>
<network>
<!-- A reference to the medical provider network associated with this product -->
<reference value="Organization/patriotppo"/>
<display value="Patriot Preferred Provider Network"/>
</network>
<network>
<!-- A reference to the dental provider network associated with this product -->
<reference value="Organization/patriotdental"/>
<display value="Patriot Dental Provider Network"/>
</network>
<coverage>
<!-- describes medical benefits -->
<type>
<coding>
<system value="http://example.org/coverage-type"/>
<code value="medical"/>
<display value="Medical"/>
</coding>
<text
value="Coverage related to medical inpatient, outpatient, diagnostic, and preventive care"/>
</type>
<network>
<reference value="Organization/patriotppo"/>
<display value="Patriot Preferred Provider Network"/>
</network>
<benefit>
<!-- basic primary care visit -->
<type>
<coding>
<system value="http://example.org/benefit-type"/>
<code value="001"/>
<display value="Primary care visit to treat an injury or illness"/>
</coding>
</type>
<requirement value="N/A"/>
<limit>
<code>
<text value="unlimited"/>
</code>
</limit>
</benefit>
</coverage>
<coverage>
<!-- describes dental benefits -->
<type>
<coding>
<system value="http://example.org/coverage-type"/>
<code value="dental"/>
<display value="Dental"/>
</coding>
<text value="Coverage related to dental care"/>
</type>
<network>
<reference value="Organization/patriotdental"/>
<display value="Patriot Dental Provider Network"/>
</network>
<!-- Specific benefits under this type of coverage. -->
<benefit>
<!-- biannual oral checkup -->
<type>
<coding>
<system value="http://example.org/benefit-type"/>
<code value="052"/>
<display value="Basic Dental Care – Adult"/>
</coding>
<text value="Periodic oral checkup"/>
</type>
<requirement value="N/A"/>
<limit>
<value>
<value value="2"/>
<unit value="visit/yr"/>
<system value="http://unitsofmeasure.org"/>
<code value="{visit}/a"/>
</value>
<code>
<text value="biannual oral checkup"/>
</code>
</limit>
</benefit>
</coverage>
<plan>
<!-- Information about the cost sharing features of the product -->
<identifier>
<use value="official"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
<code value="NIIP"/>
<display value="National Insurance Payor Identifier (Payor)"/>
<userSelected value="true"/>
</coding>
<text value="HIOS plan ID"/>
</type>
<system value="https://www.cms.gov/CCIIO/"/>
<value value="123456789101112"/>
<assigner>
<display value="Centers for Medicare and Medicaid Services"/>
</assigner>
</identifier>
<type>
<coding>
<system value="http://example.org/planlevel"/>
<code value="bronze"/>
<display value="Bronze"/>
</coding>
<text value="Bronze"/>
</type>
<coverageArea>
<!-- Reference to the product's coverage area, the Washington, DC metro area -->
<reference value="Location/wash-dc-metro"/>
<display value="Washington, DC metro area"/>
</coverageArea>
<network>
<reference value="Organization/patriotdental"/>
<display value="Patriot Dental Provider Network"/>
</network>
<generalCost>
<!-- Describes the plan's deductible -->
<type>
<coding>
<system value="http://example.org/cost-type"/>
<code value="deductible"/>
<display value="Deductible"/>
</coding>
<text value="Deductible"/>
</type>
<groupSize value="1"/>
<cost>
<value value="6200"/>
<currency value="USD"/>
</cost>
<comment
value="Includes all prescription and medical costs for in-network providers"/>
</generalCost>
<specificCost>
<!-- Describes the costs associated with the medical coverage options -->
<category>
<coding>
<system value="http://example.org/cost-category"/>
<code value="medical"/>
<display value="Medical"/>
</coding>
</category>
<benefit>
<!-- $50 copay for primary care visits with an in-network preferred provider -->
<type>
<coding>
<system value="http://example.org/benefit-type"/>
<code value="001"/>
<display
value="Primary care visit to treat an injury or illness"/>
</coding>
</type>
<cost>
<type>
<coding>
<system value="http://example.org/cost-type"/>
<code value="copay"/>
<display value="Copay"/>
</coding>
</type>
<applicability>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/applicability"/>
<code value="in-network"/>
<display value="In Network"/>
</coding>
</applicability>
<qualifiers>
<text value="in-network preferred provider"/>
</qualifiers>
<value>
<value value="50"/>
<unit value="dollars"/>
<system value="urn:iso:std:iso:4217"/>
<code value="USD"/>
</value>
</cost>
</benefit>
</specificCost>
<specificCost>
<!-- describes the costs associated with dental coverage -->
<category>
<coding>
<system value="http://example.org/cost-category"/>
<code value="dental"/>
<display value="Dental"/>
</coding>
</category>
<benefit>
<!-- 10% coinsurance for routine oral checkup with an in-network dental provider -->
<type>
<coding>
<system value="http://example.org/cost-type"/>
<code value="052"/>
<display value="Basic Dental Care – Adult"/>
</coding>
</type>
<cost>
<type>
<coding>
<system value="http://example.org/costing"/>
<code value="coinsurance"/>
<display value="Coinsurance"/>
</coding>
</type>
<applicability>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/applicability"/>
<code value="in-network"/>
<display value="In Network"/>
</coding>
</applicability>
<qualifiers>
<text value="in-network provider"/>
</qualifiers>
<value>
<value value="10"/>
<unit value="percent"/>
</value>
</cost>
</benefit>
</specificCost>
</plan>
</InsurancePlan>
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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