HL7 FHIR® Validated Healthcare Directory Implementation Guide STU 1

Validated Healthcare Directory, published by HL7 International - Patient Admistration Working 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

StructureDefinition-vhdir-insuranceplan

This profile sets minimum expectations for searching for and fetching information associated with a health insurance product/plan. It identifies which core elements, extensions, vocabularies and value sets SHALL be present in the InsurancePlan resource when using this profile.

Background & Scope

A product is a discrete package of health insurance coverage benefits that are offered under a particular network type. A given payer’s products typically differ by network type and/or covered benefits. A plan pairs a product’s covered benefits with the particular cost sharing structure offered to a consumer. A given product may comprise multiple plans (i.e. each plan offers different cost sharing requirements for the same set of covered benefits).

InsurancePlan describes a health insurance offering comprised of a list of covered benefits (i.e. the product), costs associated with those benefits (i.e. the plan), and additional information about the offering, such as who it is owned and administered by, a coverage area, contact information, etc.

This profile modifies the base InsurancePlan resource in the following manner:

  • Constrains the cardinality of InsurancePlan.status (1..1), InsurancePlan.ownedBy (1..1), InsurancePlan.administeredBy (1..1), InsurancePlan.contact.name.family (1..1), InsurancePlan.contact.name.given (1..*), InsurancePlan.contact.telecom.system (1..1), and InsurancePlan.contact.telecom.value (1..1)

  • All references SHALL conform to the appropriate Validated Healthcare Directory Implementation Guide profile

  • Adds extensions:

  1. Identifier status (1..1) - indicates the status of a product or plan’s identifier
  2. Via intermediary (0..1) - a reference to an alternative point of contact for this InsurancePlan
  3. Available time (0..*) - indicates when the point of contact for an InsurancePlan is available
  4. Restriction (0..*) - indicates whether disclosure of any data associated with a service is restricted

Examples:

The following are example uses for the vhdir-insuranceplan profile:

Mandatory Data Elements

The following data-elements are mandatory (i.e data MUST be present). These are presented below in a simple human-readable explanation. The Formal Profile Definition below provides the formal summary, definitions, and terminology requirements.

Each insurancePlan resource must have:

  1. A coded value in InsurancePlan.status
  2. A reference to an organization that issues the product/plan in InsurancePlan.ownedBy
  3. A reference to an organization that administers the product/plan in InsurancePlan.administeredBy
  4. For each set of coverage details, one coded type of coverage in InsurancePlan.coverage.type
  5. For each set of coverage details, at least one covered benefit in InsurancePlan.coverage.benefit, including a coded type of benefit in InsurancePlan.coverage.benefit.type
  6. For each set of specific costs associated with a Plan, a coded value indicating the general category of benefit the cost applies to in InsurancePlan.plan.specificCost.category
  7. For each set specific costs associated with a covered benefit, a coded type of benefit in InsurancePlan.plan.specificCost.benefit.type
  8. For each set of specific costs associated with covered benefits, a coded type of cost in InsurancePlan.plan.specificCost.benefit.cost.type

Formal Views of Profile Content

Description of Profiles, Differentials, and Snapshots.

The official URL for this profile is: http://hl7.org/fhir/uv/vhdir/StructureDefinition/vhdir-insuranceplan

Published on Tue Dec 05 17:38:42 UTC 2017 as a active by .

This profile builds on InsurancePlan


NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan 0..*
... extension 0..*ExtensionSlice: Unordered, Open by value:url
... usage-restriction S0..*Reference(VhDir Restriction)Restriction
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/usage-restriction
... identifier S0..*Identifier
.... extension 0..*ExtensionSlice: Unordered, Open by value:url
.... identifier-status S1..1codeStatus
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/identifier-status
Binding: VhDir Identifier Status Value Set (required)
.... use S0..1code
.... type S0..1CodeableConcept
.... system S0..1uri
.... value S0..1string
.... period S0..1Period
.... assigner S0..1Reference(VhDir Organization)
... status S1..1code
... type S0..*CodeableConcept
... name S0..1string
... alias S0..*string
... period S0..1Period
... ownedBy S1..1Reference(VhDir Organization)
... administeredBy S1..1Reference(VhDir Organization)
... coverageArea S0..*Reference(VhDir Location)
... contact S0..*BackboneElement
.... purpose S0..1CodeableConcept
.... name S0..1HumanName
..... use S0..1code
..... text S0..1string
..... family S1..1string
..... given S1..*string
..... prefix S0..*string
..... suffix S0..*string
..... period S0..1Period
.... telecom S0..*ContactPoint
..... extension 0..*ExtensionSlice: Unordered, Open by value:url
..... contactpoint-viaintermediary S0..1Reference(VhDir Practitioner Role | VhDir Organization | VhDir Organization Affiliation | VhDir Location)viaintermediary
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/contactpoint-viaintermediary
..... contactpoint-availabletime S0..*(Complex)Available time
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/contactpoint-availabletime
..... system S1..1code
..... value S1..1string
..... use S0..1code
..... rank S0..1positiveInt
..... period S0..1Period
.... address S0..1Address
... endpoint S0..*Reference(VhDir Endpoint)
... network S0..*Reference(VhDir Network)
... coverage S0..*BackboneElement
.... type S1..1CodeableConceptBinding: VhDir Coverage Type (example)
.... network S0..*Reference(VhDir Network)
.... benefit S1..*BackboneElement
..... type S1..1CodeableConceptBinding: VhDir Benefit Type (example)
..... requirement S0..1string
..... limit S0..*BackboneElement
...... value S0..1Quantity
...... code S0..1CodeableConceptBinding: VhDir Limit Unit (example)
... plan S0..*BackboneElement
.... identifier S0..*IdentifierBusiness identifier for plan
..... extension 0..*ExtensionSlice: Unordered, Open by value:url
..... identifier-status S0..1codeStatus
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/identifier-status
Binding: VhDir Identifier Status Value Set (required)
..... use S0..1code
..... type S0..1CodeableConcept
..... system S0..1uri
..... value S0..1string
..... period S0..1Period
..... assigner S0..1Reference(VhDir Organization)
.... type S0..1CodeableConceptBinding: VhDir Plan Type (example)
.... coverageArea S0..*Reference(VhDir Location)Where plan applies
.... network S0..*Reference(VhDir Network)
.... generalCost S0..*BackboneElement
..... type S0..1CodeableConceptBinding: VhDir Insurance Plan Cost Type (example)
..... groupSize S0..1positiveInt
..... cost S0..1Money
..... comment S0..1string
.... specificCost S0..*BackboneElement
..... category S1..1CodeableConceptBinding: VhDir Insurance Plan Cost Category (example)
..... benefit S0..*BackboneElement
...... type S1..1CodeableConceptBinding: VhDir Insurance Plan Benefit Type (example)
...... cost S0..*BackboneElement
....... type S1..1CodeableConceptBinding: VhDir Insurance Plan Benefit Cost Type (example)
....... applicability S0..1CodeableConcept
....... qualifiers S0..*CodeableConceptBinding: VhDir Insurance Plan Cost Qualifier (example)
....... value S0..1Quantity

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan I0..*Details of a Health Insurance product/plan provided by an organization
... id Σ0..1stringLogical id of this artifact
... meta ΣI0..1MetaMetadata about the resource
... implicitRules ?!ΣI0..1uriA set of rules under which this content was created
... language I0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension I0..*ExtensionExtension
Slice: Unordered, Open by value:url
... usage-restriction SI0..*Reference(VhDir Restriction)Restriction
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/usage-restriction
... modifierExtension ?!I0..*ExtensionExtensions that cannot be ignored
... identifier SΣI0..*IdentifierBusiness Identifier for Product
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... identifier-status SI1..1codeStatus
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/identifier-status
Binding: VhDir Identifier Status Value Set (required)
.... use ?!SΣI0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required)
.... type SΣI0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible)
.... system SΣI0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value SΣI0..1stringThe value that is unique
Example General: 123456
.... period SΣI0..1PeriodTime period when id is/was valid for use
.... assigner SΣI0..1Reference(VhDir Organization)Organization that issued id (may be just text)
... status ?!SΣI1..1codedraft | active | retired | unknown
Binding: PublicationStatus (required)
... type SΣI0..*CodeableConceptKind of product
Binding: InsurancePlanType (example)
... name SΣI0..1stringOfficial name
... alias SI0..*stringAlternate names
... period SI0..1PeriodWhen the product is available
... ownedBy SΣI1..1Reference(VhDir Organization)Plan issuer
... administeredBy SΣI1..1Reference(VhDir Organization)Product administrator
... coverageArea SΣI0..*Reference(VhDir Location)Where product applies
... contact SI0..*BackboneElementContact for the product
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... purpose SI0..1CodeableConceptThe type of contact
Binding: ContactEntityType (extensible)
.... name SI0..1HumanNameA name associated with the contact
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!SΣI0..1codeusual | official | temp | nickname | anonymous | old | maiden
Binding: NameUse (required)
..... text SΣI0..1stringText representation of the full name
..... family SΣI1..1stringFamily name (often called 'Surname')
..... given SΣI1..*stringGiven names (not always 'first'). Includes middle names
This repeating element order: Given Names appear in the correct order for presenting the name
..... prefix SΣI0..*stringParts that come before the name
This repeating element order: Prefixes appear in the correct order for presenting the name
..... suffix SΣI0..*stringParts that come after the name
This repeating element order: Suffixes appear in the correct order for presenting the name
..... period SΣI0..1PeriodTime period when name was/is in use
.... telecom SI0..*ContactPointContact details (telephone, email, etc.) for a contact
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionExtension
Slice: Unordered, Open by value:url
..... contactpoint-viaintermediary SI0..1Reference(VhDir Practitioner Role | VhDir Organization | VhDir Organization Affiliation | VhDir Location)viaintermediary
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/contactpoint-viaintermediary
..... contactpoint-availabletime SI0..*(Complex)Available time
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/contactpoint-availabletime
..... system SΣI1..1codephone | fax | email | pager | url | sms | other
Binding: ContactPointSystem (required)
..... value SΣI1..1stringThe actual contact point details
..... use ?!SΣI0..1codehome | work | temp | old | mobile - purpose of this contact point
Binding: ContactPointUse (required)
..... rank SΣI0..1positiveIntSpecify preferred order of use (1 = highest)
..... period SΣI0..1PeriodTime period when the contact point was/is in use
.... address SI0..1AddressVisiting or postal addresses for the contact
... endpoint SI0..*Reference(VhDir Endpoint)Technical endpoint
... network SI0..*Reference(VhDir Network)What networks are Included
... coverage SI0..*BackboneElementCoverage details
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type SI1..1CodeableConceptType of coverage
Binding: VhDir Coverage Type (example)
.... network SI0..*Reference(VhDir Network)What networks provide coverage
.... benefit SI1..*BackboneElementList of benefits
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type SI1..1CodeableConceptType of benefit
Binding: VhDir Benefit Type (example)
..... requirement SI0..1stringReferral requirements
..... limit SI0..*BackboneElementBenefit limits
...... id 0..1stringUnique id for inter-element referencing
...... extension I0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... value SI0..1QuantityMaximum value allowed
...... code SI0..1CodeableConceptBenefit limit details
Binding: VhDir Limit Unit (example)
... plan SI0..*BackboneElementPlan details
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... identifier SΣI0..*IdentifierBusiness identifier for plan
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionExtension
Slice: Unordered, Open by value:url
..... identifier-status SI0..1codeStatus
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/identifier-status
Binding: VhDir Identifier Status Value Set (required)
..... use ?!SΣI0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required)
..... type SΣI0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible)
..... system SΣI0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value SΣI0..1stringThe value that is unique
Example General: 123456
..... period SΣI0..1PeriodTime period when id is/was valid for use
..... assigner SΣI0..1Reference(VhDir Organization)Organization that issued id (may be just text)
.... type SI0..1CodeableConceptType of plan
Binding: VhDir Plan Type (example)
.... coverageArea SΣI0..*Reference(VhDir Location)Where plan applies
.... network SI0..*Reference(VhDir Network)What networks provide coverage
.... generalCost SI0..*BackboneElementOverall costs
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type SI0..1CodeableConceptType of cost
Binding: VhDir Insurance Plan Cost Type (example)
..... groupSize SI0..1positiveIntNumber of enrollees
..... cost SI0..1MoneyCost value
..... comment SI0..1stringAdditional cost information
.... specificCost SI0..*BackboneElementSpecific costs
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... category SI1..1CodeableConceptGeneral category of benefit
Binding: VhDir Insurance Plan Cost Category (example)
..... benefit SI0..*BackboneElementBenefits list
...... id 0..1stringUnique id for inter-element referencing
...... extension I0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... type SI1..1CodeableConceptType of specific benefit
Binding: VhDir Insurance Plan Benefit Type (example)
...... cost SI0..*BackboneElementList of the costs
....... id 0..1stringUnique id for inter-element referencing
....... extension I0..*ExtensionAdditional content defined by implementations
....... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
....... type SI1..1CodeableConceptType of cost
Binding: VhDir Insurance Plan Benefit Cost Type (example)
....... applicability SI0..1CodeableConceptin-network | out-of-network | other
Binding: BenefitCostApplicability (required)
....... qualifiers SI0..*CodeableConceptAdditional information about the cost
Binding: VhDir Insurance Plan Cost Qualifier (example)
....... value SI0..1QuantityThe actual cost value

doco Documentation for this format

Differential View

NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan 0..*
... extension 0..*ExtensionSlice: Unordered, Open by value:url
... usage-restriction S0..*Reference(VhDir Restriction)Restriction
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/usage-restriction
... identifier S0..*Identifier
.... extension 0..*ExtensionSlice: Unordered, Open by value:url
.... identifier-status S1..1codeStatus
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/identifier-status
Binding: VhDir Identifier Status Value Set (required)
.... use S0..1code
.... type S0..1CodeableConcept
.... system S0..1uri
.... value S0..1string
.... period S0..1Period
.... assigner S0..1Reference(VhDir Organization)
... status S1..1code
... type S0..*CodeableConcept
... name S0..1string
... alias S0..*string
... period S0..1Period
... ownedBy S1..1Reference(VhDir Organization)
... administeredBy S1..1Reference(VhDir Organization)
... coverageArea S0..*Reference(VhDir Location)
... contact S0..*BackboneElement
.... purpose S0..1CodeableConcept
.... name S0..1HumanName
..... use S0..1code
..... text S0..1string
..... family S1..1string
..... given S1..*string
..... prefix S0..*string
..... suffix S0..*string
..... period S0..1Period
.... telecom S0..*ContactPoint
..... extension 0..*ExtensionSlice: Unordered, Open by value:url
..... contactpoint-viaintermediary S0..1Reference(VhDir Practitioner Role | VhDir Organization | VhDir Organization Affiliation | VhDir Location)viaintermediary
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/contactpoint-viaintermediary
..... contactpoint-availabletime S0..*(Complex)Available time
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/contactpoint-availabletime
..... system S1..1code
..... value S1..1string
..... use S0..1code
..... rank S0..1positiveInt
..... period S0..1Period
.... address S0..1Address
... endpoint S0..*Reference(VhDir Endpoint)
... network S0..*Reference(VhDir Network)
... coverage S0..*BackboneElement
.... type S1..1CodeableConceptBinding: VhDir Coverage Type (example)
.... network S0..*Reference(VhDir Network)
.... benefit S1..*BackboneElement
..... type S1..1CodeableConceptBinding: VhDir Benefit Type (example)
..... requirement S0..1string
..... limit S0..*BackboneElement
...... value S0..1Quantity
...... code S0..1CodeableConceptBinding: VhDir Limit Unit (example)
... plan S0..*BackboneElement
.... identifier S0..*IdentifierBusiness identifier for plan
..... extension 0..*ExtensionSlice: Unordered, Open by value:url
..... identifier-status S0..1codeStatus
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/identifier-status
Binding: VhDir Identifier Status Value Set (required)
..... use S0..1code
..... type S0..1CodeableConcept
..... system S0..1uri
..... value S0..1string
..... period S0..1Period
..... assigner S0..1Reference(VhDir Organization)
.... type S0..1CodeableConceptBinding: VhDir Plan Type (example)
.... coverageArea S0..*Reference(VhDir Location)Where plan applies
.... network S0..*Reference(VhDir Network)
.... generalCost S0..*BackboneElement
..... type S0..1CodeableConceptBinding: VhDir Insurance Plan Cost Type (example)
..... groupSize S0..1positiveInt
..... cost S0..1Money
..... comment S0..1string
.... specificCost S0..*BackboneElement
..... category S1..1CodeableConceptBinding: VhDir Insurance Plan Cost Category (example)
..... benefit S0..*BackboneElement
...... type S1..1CodeableConceptBinding: VhDir Insurance Plan Benefit Type (example)
...... cost S0..*BackboneElement
....... type S1..1CodeableConceptBinding: VhDir Insurance Plan Benefit Cost Type (example)
....... applicability S0..1CodeableConcept
....... qualifiers S0..*CodeableConceptBinding: VhDir Insurance Plan Cost Qualifier (example)
....... value S0..1Quantity

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan I0..*Details of a Health Insurance product/plan provided by an organization
... id Σ0..1stringLogical id of this artifact
... meta ΣI0..1MetaMetadata about the resource
... implicitRules ?!ΣI0..1uriA set of rules under which this content was created
... language I0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension I0..*ExtensionExtension
Slice: Unordered, Open by value:url
... usage-restriction SI0..*Reference(VhDir Restriction)Restriction
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/usage-restriction
... modifierExtension ?!I0..*ExtensionExtensions that cannot be ignored
... identifier SΣI0..*IdentifierBusiness Identifier for Product
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... identifier-status SI1..1codeStatus
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/identifier-status
Binding: VhDir Identifier Status Value Set (required)
.... use ?!SΣI0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required)
.... type SΣI0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible)
.... system SΣI0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value SΣI0..1stringThe value that is unique
Example General: 123456
.... period SΣI0..1PeriodTime period when id is/was valid for use
.... assigner SΣI0..1Reference(VhDir Organization)Organization that issued id (may be just text)
... status ?!SΣI1..1codedraft | active | retired | unknown
Binding: PublicationStatus (required)
... type SΣI0..*CodeableConceptKind of product
Binding: InsurancePlanType (example)
... name SΣI0..1stringOfficial name
... alias SI0..*stringAlternate names
... period SI0..1PeriodWhen the product is available
... ownedBy SΣI1..1Reference(VhDir Organization)Plan issuer
... administeredBy SΣI1..1Reference(VhDir Organization)Product administrator
... coverageArea SΣI0..*Reference(VhDir Location)Where product applies
... contact SI0..*BackboneElementContact for the product
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... purpose SI0..1CodeableConceptThe type of contact
Binding: ContactEntityType (extensible)
.... name SI0..1HumanNameA name associated with the contact
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!SΣI0..1codeusual | official | temp | nickname | anonymous | old | maiden
Binding: NameUse (required)
..... text SΣI0..1stringText representation of the full name
..... family SΣI1..1stringFamily name (often called 'Surname')
..... given SΣI1..*stringGiven names (not always 'first'). Includes middle names
This repeating element order: Given Names appear in the correct order for presenting the name
..... prefix SΣI0..*stringParts that come before the name
This repeating element order: Prefixes appear in the correct order for presenting the name
..... suffix SΣI0..*stringParts that come after the name
This repeating element order: Suffixes appear in the correct order for presenting the name
..... period SΣI0..1PeriodTime period when name was/is in use
.... telecom SI0..*ContactPointContact details (telephone, email, etc.) for a contact
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionExtension
Slice: Unordered, Open by value:url
..... contactpoint-viaintermediary SI0..1Reference(VhDir Practitioner Role | VhDir Organization | VhDir Organization Affiliation | VhDir Location)viaintermediary
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/contactpoint-viaintermediary
..... contactpoint-availabletime SI0..*(Complex)Available time
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/contactpoint-availabletime
..... system SΣI1..1codephone | fax | email | pager | url | sms | other
Binding: ContactPointSystem (required)
..... value SΣI1..1stringThe actual contact point details
..... use ?!SΣI0..1codehome | work | temp | old | mobile - purpose of this contact point
Binding: ContactPointUse (required)
..... rank SΣI0..1positiveIntSpecify preferred order of use (1 = highest)
..... period SΣI0..1PeriodTime period when the contact point was/is in use
.... address SI0..1AddressVisiting or postal addresses for the contact
... endpoint SI0..*Reference(VhDir Endpoint)Technical endpoint
... network SI0..*Reference(VhDir Network)What networks are Included
... coverage SI0..*BackboneElementCoverage details
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type SI1..1CodeableConceptType of coverage
Binding: VhDir Coverage Type (example)
.... network SI0..*Reference(VhDir Network)What networks provide coverage
.... benefit SI1..*BackboneElementList of benefits
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type SI1..1CodeableConceptType of benefit
Binding: VhDir Benefit Type (example)
..... requirement SI0..1stringReferral requirements
..... limit SI0..*BackboneElementBenefit limits
...... id 0..1stringUnique id for inter-element referencing
...... extension I0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... value SI0..1QuantityMaximum value allowed
...... code SI0..1CodeableConceptBenefit limit details
Binding: VhDir Limit Unit (example)
... plan SI0..*BackboneElementPlan details
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... identifier SΣI0..*IdentifierBusiness identifier for plan
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionExtension
Slice: Unordered, Open by value:url
..... identifier-status SI0..1codeStatus
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/identifier-status
Binding: VhDir Identifier Status Value Set (required)
..... use ?!SΣI0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required)
..... type SΣI0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible)
..... system SΣI0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value SΣI0..1stringThe value that is unique
Example General: 123456
..... period SΣI0..1PeriodTime period when id is/was valid for use
..... assigner SΣI0..1Reference(VhDir Organization)Organization that issued id (may be just text)
.... type SI0..1CodeableConceptType of plan
Binding: VhDir Plan Type (example)
.... coverageArea SΣI0..*Reference(VhDir Location)Where plan applies
.... network SI0..*Reference(VhDir Network)What networks provide coverage
.... generalCost SI0..*BackboneElementOverall costs
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type SI0..1CodeableConceptType of cost
Binding: VhDir Insurance Plan Cost Type (example)
..... groupSize SI0..1positiveIntNumber of enrollees
..... cost SI0..1MoneyCost value
..... comment SI0..1stringAdditional cost information
.... specificCost SI0..*BackboneElementSpecific costs
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... category SI1..1CodeableConceptGeneral category of benefit
Binding: VhDir Insurance Plan Cost Category (example)
..... benefit SI0..*BackboneElementBenefits list
...... id 0..1stringUnique id for inter-element referencing
...... extension I0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... type SI1..1CodeableConceptType of specific benefit
Binding: VhDir Insurance Plan Benefit Type (example)
...... cost SI0..*BackboneElementList of the costs
....... id 0..1stringUnique id for inter-element referencing
....... extension I0..*ExtensionAdditional content defined by implementations
....... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
....... type SI1..1CodeableConceptType of cost
Binding: VhDir Insurance Plan Benefit Cost Type (example)
....... applicability SI0..1CodeableConceptin-network | out-of-network | other
Binding: BenefitCostApplicability (required)
....... qualifiers SI0..*CodeableConceptAdditional information about the cost
Binding: VhDir Insurance Plan Cost Qualifier (example)
....... value SI0..1QuantityThe actual cost value

doco Documentation for this format

Downloads: StructureDefinition: (XML, JSON), Schema: XML Schematron


Terminology Bindings

PathConformanceValueSet
InsurancePlan.languagepreferredCommonLanguages
Max Binding: AllLanguages
InsurancePlan.identifier.userequiredIdentifierUse
InsurancePlan.identifier.typeextensibleIdentifier Type Codes
InsurancePlan.statusrequiredPublicationStatus
InsurancePlan.typeexampleInsurancePlanType
InsurancePlan.contact.purposeextensibleContactEntityType
InsurancePlan.contact.name.userequiredNameUse
InsurancePlan.contact.telecom.systemrequiredContactPointSystem
InsurancePlan.contact.telecom.userequiredContactPointUse
InsurancePlan.coverage.typeexampleVhDirCoverageType
InsurancePlan.coverage.benefit.typeexampleVhDirBenefitType
InsurancePlan.coverage.benefit.limit.codeexampleVhDirLimitUnit
InsurancePlan.plan.identifier.userequiredIdentifierUse
InsurancePlan.plan.identifier.typeextensibleIdentifier Type Codes
InsurancePlan.plan.typeexampleVhDirPlanType
InsurancePlan.plan.generalCost.typeexampleVhDirPlanType
InsurancePlan.plan.specificCost.categoryexampleVhDirInsPlanCostCategory
InsurancePlan.plan.specificCost.benefit.typeexampleVhDirInsPlanBenefitType
InsurancePlan.plan.specificCost.benefit.cost.typeexampleVhDirInsPlanBenefitCostType
InsurancePlan.plan.specificCost.benefit.cost.applicabilityrequiredBenefitCostApplicability
InsurancePlan.plan.specificCost.benefit.cost.qualifiersexampleVhDirInsPlanQualifier

Quick Start

Below is an overview of the required set of RESTful FHIR interactions - for example, search and read operations - for this profile. See the Conformance requirements for a complete list of supported RESTful interactions for this IG.

Supported Searches

  1. GET [base]/InsurancePlan?administered-by=[id]

    Support: SHOULD support search by the administered-by parameter

    • with a target type: Organization
    • including the modifiers: above, below
    • including these search paramaters which may be chained: administered-by.identifier, administered-by.name, administered-by.partof

  1. GET [base]/InsurancePlan?coverage-benefit-type=[code]

    Support: SHALL support search by the coverage-benefit-type parameter

    • including the modifiers: text

  1. GET [base]/InsurancePlan?coverage-limit-value=[prefix][number]|[system]|[code]

    Support: MAY support search by the coverage-limit-value parameter

    • including the comparators: eq, gt, lt, ge, le, sa, eb

  1. GET [base]/InsurancePlan?coverage-network=[id]

    Support: SHALL support search by the coverage-network parameter

    • with a target type: Organization
    • including these search paramaters which may be chained: coverage-network.identifier, coverage-network.name, coverage-network.partof

  1. GET [base]/InsurancePlan?coverage-type=[code]

    Support: SHALL support search by the coverage-type parameter

    • including the modifiers: text

  1. GET [base]/InsurancePlan?endpoint=[id]

    Support: SHOULD support search by the endpoint parameter

    • with a target type: Endpoint
    • including these search paramaters which may be chained: endpoint.identifier, endpoint.connection-type, endpoint.organization

  1. GET [base]/InsurancePlan?general-cost-groupsize=[number]

    Support: MAY support search by the general-cost-groupsize parameter

    • including the comparators: eq, gt, lt, ge, le, sa, eb

  1. GET [base]/InsurancePlan?general-cost-type=[code]

    Support: MAY support search by the general-cost-type parameter

    • including the modifiers: text

  1. GET [base]/InsurancePlan?general-cost-value=[prefix][number]|[system]|[code]

    Support: MAY support search by the general-cost-value parameter

    • including the comparators: eq, gt, lt, ge, le, sa, eb

  1. GET [base]/InsurancePlan?name=[string]

    Support: SHOULD support search by the name parameter

    • including the modifiers: exact, contains

  1. GET [base]/InsurancePlan?owned-by=[id]

    Support: SHALL support search by the owned-by parameter

    • with a target type: Organization
    • including the modifiers: above, below
    • including these search paramaters which may be chained: owned-by.identifier, owned-by.name, owned-by.partof

  1. GET [base]/InsurancePlan?plan-coverage-area=[id]

    Support: SHOULD support search by the plan-coverage-area parameter

    • with a target type: Location
    • including these search paramaters which may be chained: plan-coverage-area.identifier, plan-coverage-area.contains

  1. GET [base]/InsurancePlan?plan-identifier=[code]

    Support: SHALL support search by the plan-identifier parameter

    • including the modifiers: text, ofType

  1. GET [base]/InsurancePlan?plan-network=[id]

    Support: SHALL support search by the plan-network parameter

    • with a target type: Organization
    • including these search paramaters which may be chained: plan-network.identifier, plan-network.name, plan-network.partof

  1. GET [base]/InsurancePlan?plan-type=[code]

    Support: SHALL support search by the plan-type parameter

    • including the modifiers: text

  1. GET [base]/InsurancePlan?coverage-area=[id]

    Support: SHOULD support search by the coverage-area parameter

    • with a target type: Location
    • including these search paramaters which may be chained: coverage-area.identifier, coverage-area.contains

  1. `GET [base]/InsurancePlan?identifier=[code]

    Support: SHALL support search by the identifier parameter


  1. GET [base]/InsurancePlan?network=[id]

    Support: SHALL support search by the network parameter

    • with a target type: Organization
    • including these search paramaters which may be chained: network.identifier, network.name, network.partof

  1. GET [base]/InsurancePlan?type=[code]

    Support: SHALL support search by the type parameter

    • including the modifiers: text

  1. GET [base]/InsurancePlan?specific-cost-benefit-type=[code]

    Support: SHOULD support search by the specific-cost-benefit-type parameter

    • including the modifiers: text

  1. GET [base]/InsurancePlan?specific-cost-category=[code]

    Support: SHOULD support search by the specific-cost-category parameter

    • including the modifiers: text

  1. GET [base]/InsurancePlan?specific-cost-cost-type=[code]

    Support: MAY support search by the specific-cost-cost-type parameter

    • including the modifiers: text

  1. GET [base]/InsurancePlan?specific-cost-value=[prefix][number]|[system]|[code]

    Support: MAY support search by the specific-cost-value parameter

    • including the comparators: eq, gt, lt, ge, le, sa, eb

  1. GET [base]/InsurancePlan?status=[code]

    Support: SHALL support search by the status parameter