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

Resource Profile: VhDir Insurance Plan

Defining URL:http://hl7.org/fhir/uv/vhdir/StructureDefinition/vhdir-insuranceplan
Version:0.2.0
Name:VhdirInsurancePlan
Title:VhDir Insurance Plan
Status:Active as of 2017-12-05 12:38:42-0500
Definition:

The details of a health insurance product/plan

Publisher:HL7 International - Patient Administration Work Group
Copyright:

Used by permission of HL7 International all rights reserved Creative Commons License

Source Resource:XML / JSON / Turtle

The official URL for this profile is:

http://hl7.org/fhir/uv/vhdir/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, Snapshots and how the different presentations work.

This structure is derived from InsurancePlan

NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan 0..*InsurancePlanDetails of a Health Insurance product/plan provided by an organization
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... usage-restriction S0..*Reference(VhDir Restriction)Restriction
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/usage-restriction
... identifier S0..*IdentifierBusiness Identifier for Product
.... Slices for extension 0..*ExtensionExtension
Slice: 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..1codeusual | official | temp | secondary | old (If known)
.... type S0..1CodeableConceptDescription of identifier
.... system S0..1uriThe namespace for the identifier value
.... value S0..1stringThe value that is unique
.... period S0..1PeriodTime period when id is/was valid for use
.... assigner S0..1Reference(VhDir Organization)Organization that issued id (may be just text)
... status S1..1codedraft | active | retired | unknown
... type S0..*CodeableConceptKind of product
... name S0..1stringOfficial name
... alias S0..*stringAlternate names
... period S0..1PeriodWhen the product is available
... ownedBy S1..1Reference(VhDir Organization)Plan issuer
... administeredBy S1..1Reference(VhDir Organization)Product administrator
... coverageArea S0..*Reference(VhDir Location)Where product applies
... contact S0..*BackboneElementContact for the product
.... purpose S0..1CodeableConceptThe type of contact
.... name S0..1HumanNameA name associated with the contact
..... use S0..1codeusual | official | temp | nickname | anonymous | old | maiden
..... text S0..1stringText representation of the full name
..... family S1..1stringFamily name (often called 'Surname')
..... given S1..*stringGiven names (not always 'first'). Includes middle names
..... prefix S0..*stringParts that come before the name
..... suffix S0..*stringParts that come after the name
..... period S0..1PeriodTime period when name was/is in use
.... telecom S0..*ContactPointContact details (telephone, email, etc.) for a contact
..... Slices for extension 0..*ExtensionExtension
Slice: 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..1codephone | fax | email | pager | url | sms | other
..... value S1..1stringThe actual contact point details
..... use S0..1codehome | work | temp | old | mobile - purpose of this contact point
..... rank S0..1positiveIntSpecify preferred order of use (1 = highest)
..... period S0..1PeriodTime period when the contact point was/is in use
.... address S0..1AddressVisiting or postal addresses for the contact
... endpoint S0..*Reference(VhDir Endpoint)Technical endpoint
... network S0..*Reference(VhDir Network)What networks are Included
... coverage S0..*BackboneElementCoverage details
.... type S1..1CodeableConceptType of coverage
Binding: VhDir Coverage Type (example)
.... network S0..*Reference(VhDir Network)What networks provide coverage
.... benefit S1..*BackboneElementList of benefits
..... type S1..1CodeableConceptType of benefit
Binding: VhDir Benefit Type (example)
..... requirement S0..1stringReferral requirements
..... limit S0..*BackboneElementBenefit limits
...... value S0..1QuantityMaximum value allowed
...... code S0..1CodeableConceptBenefit limit details
Binding: VhDir Limit Unit (example)
... plan S0..*BackboneElementPlan details
.... identifier S0..*IdentifierBusiness identifier for plan
..... Slices for extension 0..*ExtensionExtension
Slice: 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..1codeusual | official | temp | secondary | old (If known)
..... type S0..1CodeableConceptDescription of identifier
..... system S0..1uriThe namespace for the identifier value
..... value S0..1stringThe value that is unique
..... period S0..1PeriodTime period when id is/was valid for use
..... assigner S0..1Reference(VhDir Organization)Organization that issued id (may be just text)
.... type S0..1CodeableConceptType of plan
Binding: VhDir Plan Type (example)
.... coverageArea S0..*Reference(VhDir Location)Where plan applies
.... network S0..*Reference(VhDir Network)What networks provide coverage
.... generalCost S0..*BackboneElementOverall costs
..... type S0..1CodeableConceptType of cost
Binding: VhDir Insurance Plan Cost Type (example)
..... groupSize S0..1positiveIntNumber of enrollees
..... cost S0..1MoneyCost value
..... comment S0..1stringAdditional cost information
.... specificCost S0..*BackboneElementSpecific costs
..... category S1..1CodeableConceptGeneral category of benefit
Binding: VhDir Insurance Plan Cost Category (example)
..... benefit S0..*BackboneElementBenefits list
...... type S1..1CodeableConceptType of specific benefit
Binding: VhDir Insurance Plan Benefit Type (example)
...... cost S0..*BackboneElementList of the costs
....... type S1..1CodeableConceptType of cost
Binding: VhDir Insurance Plan Benefit Cost Type (example)
....... applicability S0..1CodeableConceptin-network | out-of-network | other
....... qualifiers S0..*CodeableConceptAdditional information about the cost
Binding: VhDir Insurance Plan Cost Qualifier (example)
....... value S0..1QuantityThe actual cost value

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan I0..*InsurancePlanDetails of a Health Insurance product/plan provided by an organization
... id Σ0..1stringLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages: A human language.

... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... usage-restriction S0..*Reference(VhDir Restriction)Restriction
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/usage-restriction
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier SΣI0..*IdentifierBusiness Identifier for Product
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionExtension
Slice: 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 ?!SΣ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

.... type SΣ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

.... system SΣ0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value SΣ0..1stringThe value that is unique
Example General: 123456
.... period SΣ0..1PeriodTime period when id is/was valid for use
.... assigner SΣ0..1Reference(VhDir Organization)Organization that issued id (may be just text)
... status ?!SΣ1..1codedraft | active | retired | unknown
Binding: PublicationStatus (required): The lifecycle status of an artifact.

... type SΣ0..*CodeableConceptKind of product
Binding: InsurancePlanType (example): Used to categorize the product/plan.


... name SΣI0..1stringOfficial name
... alias S0..*stringAlternate names
... period S0..1PeriodWhen the product is available
... ownedBy SΣ1..1Reference(VhDir Organization)Plan issuer
... administeredBy SΣ1..1Reference(VhDir Organization)Product administrator
... coverageArea SΣ0..*Reference(VhDir Location)Where product applies
... contact S0..*BackboneElementContact for the product
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... purpose S0..1CodeableConceptThe type of contact
Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party.

.... name S0..1HumanNameA name associated with the contact
..... id 0..1stringUnique id for inter-element referencing
..... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!SΣ0..1codeusual | official | temp | nickname | anonymous | old | maiden
Binding: NameUse (required): The use of a human name.

..... text SΣ0..1stringText representation of the full name
..... family SΣ1..1stringFamily name (often called 'Surname')
..... given SΣ1..*stringGiven names (not always 'first'). Includes middle names
This repeating element order: Given Names appear in the correct order for presenting the name
..... prefix SΣ0..*stringParts that come before the name
This repeating element order: Prefixes appear in the correct order for presenting the name
..... suffix SΣ0..*stringParts that come after the name
This repeating element order: Suffixes appear in the correct order for presenting the name
..... period SΣ0..1PeriodTime period when name was/is in use
.... telecom S0..*ContactPointContact details (telephone, email, etc.) for a contact
..... id 0..1stringUnique id for inter-element referencing
..... Slices for extension 0..*ExtensionExtension
Slice: 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 SΣI1..1codephone | fax | email | pager | url | sms | other
Binding: ContactPointSystem (required): Telecommunications form for contact point.

..... value SΣ1..1stringThe actual contact point details
..... use ?!SΣ0..1codehome | work | temp | old | mobile - purpose of this contact point
Binding: ContactPointUse (required): Use of contact point.

..... rank SΣ0..1positiveIntSpecify preferred order of use (1 = highest)
..... period SΣ0..1PeriodTime period when the contact point was/is in use
.... address S0..1AddressVisiting or postal addresses for the contact
... endpoint S0..*Reference(VhDir Endpoint)Technical endpoint
... network S0..*Reference(VhDir Network)What networks are Included
... coverage S0..*BackboneElementCoverage details
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type S1..1CodeableConceptType of coverage
Binding: VhDir Coverage Type (example)
.... network S0..*Reference(VhDir Network)What networks provide coverage
.... benefit S1..*BackboneElementList of benefits
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type S1..1CodeableConceptType of benefit
Binding: VhDir Benefit Type (example)
..... requirement S0..1stringReferral requirements
..... limit S0..*BackboneElementBenefit limits
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... value S0..1QuantityMaximum value allowed
...... code S0..1CodeableConceptBenefit limit details
Binding: VhDir Limit Unit (example)
... plan S0..*BackboneElementPlan details
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... identifier SΣ0..*IdentifierBusiness identifier for plan
..... id 0..1stringUnique id for inter-element referencing
..... Slices for extension 0..*ExtensionExtension
Slice: 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 ?!SΣ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type SΣ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

..... system SΣ0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value SΣ0..1stringThe value that is unique
Example General: 123456
..... period SΣ0..1PeriodTime period when id is/was valid for use
..... assigner SΣ0..1Reference(VhDir Organization)Organization that issued id (may be just text)
.... type S0..1CodeableConceptType of plan
Binding: VhDir Plan Type (example)
.... coverageArea SΣ0..*Reference(VhDir Location)Where plan applies
.... network S0..*Reference(VhDir Network)What networks provide coverage
.... generalCost S0..*BackboneElementOverall costs
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type S0..1CodeableConceptType of cost
Binding: VhDir Insurance Plan Cost Type (example)
..... groupSize S0..1positiveIntNumber of enrollees
..... cost S0..1MoneyCost value
..... comment S0..1stringAdditional cost information
.... specificCost S0..*BackboneElementSpecific costs
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... category S1..1CodeableConceptGeneral category of benefit
Binding: VhDir Insurance Plan Cost Category (example)
..... benefit S0..*BackboneElementBenefits list
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... type S1..1CodeableConceptType of specific benefit
Binding: VhDir Insurance Plan Benefit Type (example)
...... cost S0..*BackboneElementList of the costs
....... id 0..1stringUnique id for inter-element referencing
....... extension 0..*ExtensionAdditional content defined by implementations
....... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
....... type S1..1CodeableConceptType of cost
Binding: VhDir Insurance Plan Benefit Cost Type (example)
....... applicability S0..1CodeableConceptin-network | out-of-network | other
Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.

....... qualifiers S0..*CodeableConceptAdditional information about the cost
Binding: VhDir Insurance Plan Cost Qualifier (example)
....... value S0..1QuantityThe actual cost value

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan I0..*InsurancePlanDetails of a Health Insurance product/plan provided by an organization
... usage-restriction 0..*Reference(VhDir Restriction)Restriction
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/usage-restriction
... identifier ΣI0..*IdentifierBusiness Identifier for Product
.... identifier-status 1..1codeStatus
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/identifier-status
Binding: VhDir Identifier Status Value Set (required)
.... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

.... type Σ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

.... system Σ0..1uriThe namespace for the identifier value
.... value Σ0..1stringThe value that is unique
.... period Σ0..1PeriodTime period when id is/was valid for use
.... assigner Σ0..1Reference(VhDir Organization)Organization that issued id (may be just text)
... status ?!Σ1..1codedraft | active | retired | unknown
Binding: PublicationStatus (required): The lifecycle status of an artifact.

... type Σ0..*CodeableConceptKind of product
Binding: InsurancePlanType (example): Used to categorize the product/plan.


... name ΣI0..1stringOfficial name
... alias 0..*stringAlternate names
... period 0..1PeriodWhen the product is available
... ownedBy Σ1..1Reference(VhDir Organization)Plan issuer
... administeredBy Σ1..1Reference(VhDir Organization)Product administrator
... coverageArea Σ0..*Reference(VhDir Location)Where product applies
... contact 0..*BackboneElementContact for the product
.... purpose 0..1CodeableConceptThe type of contact
Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party.

.... name 0..1HumanNameA name associated with the contact
..... use ?!Σ0..1codeusual | official | temp | nickname | anonymous | old | maiden
Binding: NameUse (required): The use of a human name.

..... text Σ0..1stringText representation of the full name
..... family Σ1..1stringFamily name (often called 'Surname')
..... given Σ1..*stringGiven names (not always 'first'). Includes middle names
This repeating element order: Given Names appear in the correct order for presenting the name
..... prefix Σ0..*stringParts that come before the name
This repeating element order: Prefixes appear in the correct order for presenting the name
..... suffix Σ0..*stringParts that come after the name
This repeating element order: Suffixes appear in the correct order for presenting the name
..... period Σ0..1PeriodTime period when name was/is in use
.... telecom 0..*ContactPointContact details (telephone, email, etc.) for a contact
..... contactpoint-viaintermediary 0..1Reference(VhDir Practitioner Role | VhDir Organization | VhDir Organization Affiliation | VhDir Location)viaintermediary
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/contactpoint-viaintermediary
..... contactpoint-availabletime 0..*(Complex)Available time
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/contactpoint-availabletime
..... system ΣI1..1codephone | fax | email | pager | url | sms | other
Binding: ContactPointSystem (required): Telecommunications form for contact point.

..... value Σ1..1stringThe actual contact point details
..... use ?!Σ0..1codehome | work | temp | old | mobile - purpose of this contact point
Binding: ContactPointUse (required): Use of contact point.

..... rank Σ0..1positiveIntSpecify preferred order of use (1 = highest)
..... period Σ0..1PeriodTime period when the contact point was/is in use
.... address 0..1AddressVisiting or postal addresses for the contact
... endpoint 0..*Reference(VhDir Endpoint)Technical endpoint
... network 0..*Reference(VhDir Network)What networks are Included
... coverage 0..*BackboneElementCoverage details
.... type 1..1CodeableConceptType of coverage
Binding: VhDir Coverage Type (example)
.... network 0..*Reference(VhDir Network)What networks provide coverage
.... benefit 1..*BackboneElementList of benefits
..... type 1..1CodeableConceptType of benefit
Binding: VhDir Benefit Type (example)
..... requirement 0..1stringReferral requirements
..... limit 0..*BackboneElementBenefit limits
...... value 0..1QuantityMaximum value allowed
...... code 0..1CodeableConceptBenefit limit details
Binding: VhDir Limit Unit (example)
... plan 0..*BackboneElementPlan details
.... identifier Σ0..*IdentifierBusiness identifier for plan
..... identifier-status 0..1codeStatus
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/identifier-status
Binding: VhDir Identifier Status Value Set (required)
..... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type Σ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

..... system Σ0..1uriThe namespace for the identifier value
..... value Σ0..1stringThe value that is unique
..... period Σ0..1PeriodTime period when id is/was valid for use
..... assigner Σ0..1Reference(VhDir Organization)Organization that issued id (may be just text)
.... type 0..1CodeableConceptType of plan
Binding: VhDir Plan Type (example)
.... coverageArea Σ0..*Reference(VhDir Location)Where plan applies
.... network 0..*Reference(VhDir Network)What networks provide coverage
.... generalCost 0..*BackboneElementOverall costs
..... type 0..1CodeableConceptType of cost
Binding: VhDir Insurance Plan Cost Type (example)
..... groupSize 0..1positiveIntNumber of enrollees
..... cost 0..1MoneyCost value
..... comment 0..1stringAdditional cost information
.... specificCost 0..*BackboneElementSpecific costs
..... category 1..1CodeableConceptGeneral category of benefit
Binding: VhDir Insurance Plan Cost Category (example)
..... benefit 0..*BackboneElementBenefits list
...... type 1..1CodeableConceptType of specific benefit
Binding: VhDir Insurance Plan Benefit Type (example)
...... cost 0..*BackboneElementList of the costs
....... type 1..1CodeableConceptType of cost
Binding: VhDir Insurance Plan Benefit Cost Type (example)
....... applicability 0..1CodeableConceptin-network | out-of-network | other
Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.

....... qualifiers 0..*CodeableConceptAdditional information about the cost
Binding: VhDir Insurance Plan Cost Qualifier (example)
....... value 0..1QuantityThe actual cost value

doco Documentation for this format

Differential View

This structure is derived from InsurancePlan

NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan 0..*InsurancePlanDetails of a Health Insurance product/plan provided by an organization
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... usage-restriction S0..*Reference(VhDir Restriction)Restriction
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/usage-restriction
... identifier S0..*IdentifierBusiness Identifier for Product
.... Slices for extension 0..*ExtensionExtension
Slice: 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..1codeusual | official | temp | secondary | old (If known)
.... type S0..1CodeableConceptDescription of identifier
.... system S0..1uriThe namespace for the identifier value
.... value S0..1stringThe value that is unique
.... period S0..1PeriodTime period when id is/was valid for use
.... assigner S0..1Reference(VhDir Organization)Organization that issued id (may be just text)
... status S1..1codedraft | active | retired | unknown
... type S0..*CodeableConceptKind of product
... name S0..1stringOfficial name
... alias S0..*stringAlternate names
... period S0..1PeriodWhen the product is available
... ownedBy S1..1Reference(VhDir Organization)Plan issuer
... administeredBy S1..1Reference(VhDir Organization)Product administrator
... coverageArea S0..*Reference(VhDir Location)Where product applies
... contact S0..*BackboneElementContact for the product
.... purpose S0..1CodeableConceptThe type of contact
.... name S0..1HumanNameA name associated with the contact
..... use S0..1codeusual | official | temp | nickname | anonymous | old | maiden
..... text S0..1stringText representation of the full name
..... family S1..1stringFamily name (often called 'Surname')
..... given S1..*stringGiven names (not always 'first'). Includes middle names
..... prefix S0..*stringParts that come before the name
..... suffix S0..*stringParts that come after the name
..... period S0..1PeriodTime period when name was/is in use
.... telecom S0..*ContactPointContact details (telephone, email, etc.) for a contact
..... Slices for extension 0..*ExtensionExtension
Slice: 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..1codephone | fax | email | pager | url | sms | other
..... value S1..1stringThe actual contact point details
..... use S0..1codehome | work | temp | old | mobile - purpose of this contact point
..... rank S0..1positiveIntSpecify preferred order of use (1 = highest)
..... period S0..1PeriodTime period when the contact point was/is in use
.... address S0..1AddressVisiting or postal addresses for the contact
... endpoint S0..*Reference(VhDir Endpoint)Technical endpoint
... network S0..*Reference(VhDir Network)What networks are Included
... coverage S0..*BackboneElementCoverage details
.... type S1..1CodeableConceptType of coverage
Binding: VhDir Coverage Type (example)
.... network S0..*Reference(VhDir Network)What networks provide coverage
.... benefit S1..*BackboneElementList of benefits
..... type S1..1CodeableConceptType of benefit
Binding: VhDir Benefit Type (example)
..... requirement S0..1stringReferral requirements
..... limit S0..*BackboneElementBenefit limits
...... value S0..1QuantityMaximum value allowed
...... code S0..1CodeableConceptBenefit limit details
Binding: VhDir Limit Unit (example)
... plan S0..*BackboneElementPlan details
.... identifier S0..*IdentifierBusiness identifier for plan
..... Slices for extension 0..*ExtensionExtension
Slice: 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..1codeusual | official | temp | secondary | old (If known)
..... type S0..1CodeableConceptDescription of identifier
..... system S0..1uriThe namespace for the identifier value
..... value S0..1stringThe value that is unique
..... period S0..1PeriodTime period when id is/was valid for use
..... assigner S0..1Reference(VhDir Organization)Organization that issued id (may be just text)
.... type S0..1CodeableConceptType of plan
Binding: VhDir Plan Type (example)
.... coverageArea S0..*Reference(VhDir Location)Where plan applies
.... network S0..*Reference(VhDir Network)What networks provide coverage
.... generalCost S0..*BackboneElementOverall costs
..... type S0..1CodeableConceptType of cost
Binding: VhDir Insurance Plan Cost Type (example)
..... groupSize S0..1positiveIntNumber of enrollees
..... cost S0..1MoneyCost value
..... comment S0..1stringAdditional cost information
.... specificCost S0..*BackboneElementSpecific costs
..... category S1..1CodeableConceptGeneral category of benefit
Binding: VhDir Insurance Plan Cost Category (example)
..... benefit S0..*BackboneElementBenefits list
...... type S1..1CodeableConceptType of specific benefit
Binding: VhDir Insurance Plan Benefit Type (example)
...... cost S0..*BackboneElementList of the costs
....... type S1..1CodeableConceptType of cost
Binding: VhDir Insurance Plan Benefit Cost Type (example)
....... applicability S0..1CodeableConceptin-network | out-of-network | other
....... qualifiers S0..*CodeableConceptAdditional information about the cost
Binding: VhDir Insurance Plan Cost Qualifier (example)
....... value S0..1QuantityThe actual cost value

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan I0..*InsurancePlanDetails of a Health Insurance product/plan provided by an organization
... id Σ0..1stringLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages: A human language.

... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... usage-restriction S0..*Reference(VhDir Restriction)Restriction
URL: http://hl7.org/fhir/uv/vhdir/StructureDefinition/usage-restriction
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier SΣI0..*IdentifierBusiness Identifier for Product
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionExtension
Slice: 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 ?!SΣ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

.... type SΣ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

.... system SΣ0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value SΣ0..1stringThe value that is unique
Example General: 123456
.... period SΣ0..1PeriodTime period when id is/was valid for use
.... assigner SΣ0..1Reference(VhDir Organization)Organization that issued id (may be just text)
... status ?!SΣ1..1codedraft | active | retired | unknown
Binding: PublicationStatus (required): The lifecycle status of an artifact.

... type SΣ0..*CodeableConceptKind of product
Binding: InsurancePlanType (example): Used to categorize the product/plan.


... name SΣI0..1stringOfficial name
... alias S0..*stringAlternate names
... period S0..1PeriodWhen the product is available
... ownedBy SΣ1..1Reference(VhDir Organization)Plan issuer
... administeredBy SΣ1..1Reference(VhDir Organization)Product administrator
... coverageArea SΣ0..*Reference(VhDir Location)Where product applies
... contact S0..*BackboneElementContact for the product
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... purpose S0..1CodeableConceptThe type of contact
Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party.

.... name S0..1HumanNameA name associated with the contact
..... id 0..1stringUnique id for inter-element referencing
..... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!SΣ0..1codeusual | official | temp | nickname | anonymous | old | maiden
Binding: NameUse (required): The use of a human name.

..... text SΣ0..1stringText representation of the full name
..... family SΣ1..1stringFamily name (often called 'Surname')
..... given SΣ1..*stringGiven names (not always 'first'). Includes middle names
This repeating element order: Given Names appear in the correct order for presenting the name
..... prefix SΣ0..*stringParts that come before the name
This repeating element order: Prefixes appear in the correct order for presenting the name
..... suffix SΣ0..*stringParts that come after the name
This repeating element order: Suffixes appear in the correct order for presenting the name
..... period SΣ0..1PeriodTime period when name was/is in use
.... telecom S0..*ContactPointContact details (telephone, email, etc.) for a contact
..... id 0..1stringUnique id for inter-element referencing
..... Slices for extension 0..*ExtensionExtension
Slice: 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 SΣI1..1codephone | fax | email | pager | url | sms | other
Binding: ContactPointSystem (required): Telecommunications form for contact point.

..... value SΣ1..1stringThe actual contact point details
..... use ?!SΣ0..1codehome | work | temp | old | mobile - purpose of this contact point
Binding: ContactPointUse (required): Use of contact point.

..... rank SΣ0..1positiveIntSpecify preferred order of use (1 = highest)
..... period SΣ0..1PeriodTime period when the contact point was/is in use
.... address S0..1AddressVisiting or postal addresses for the contact
... endpoint S0..*Reference(VhDir Endpoint)Technical endpoint
... network S0..*Reference(VhDir Network)What networks are Included
... coverage S0..*BackboneElementCoverage details
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type S1..1CodeableConceptType of coverage
Binding: VhDir Coverage Type (example)
.... network S0..*Reference(VhDir Network)What networks provide coverage
.... benefit S1..*BackboneElementList of benefits
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type S1..1CodeableConceptType of benefit
Binding: VhDir Benefit Type (example)
..... requirement S0..1stringReferral requirements
..... limit S0..*BackboneElementBenefit limits
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... value S0..1QuantityMaximum value allowed
...... code S0..1CodeableConceptBenefit limit details
Binding: VhDir Limit Unit (example)
... plan S0..*BackboneElementPlan details
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... identifier SΣ0..*IdentifierBusiness identifier for plan
..... id 0..1stringUnique id for inter-element referencing
..... Slices for extension 0..*ExtensionExtension
Slice: 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 ?!SΣ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type SΣ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

..... system SΣ0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value SΣ0..1stringThe value that is unique
Example General: 123456
..... period SΣ0..1PeriodTime period when id is/was valid for use
..... assigner SΣ0..1Reference(VhDir Organization)Organization that issued id (may be just text)
.... type S0..1CodeableConceptType of plan
Binding: VhDir Plan Type (example)
.... coverageArea SΣ0..*Reference(VhDir Location)Where plan applies
.... network S0..*Reference(VhDir Network)What networks provide coverage
.... generalCost S0..*BackboneElementOverall costs
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type S0..1CodeableConceptType of cost
Binding: VhDir Insurance Plan Cost Type (example)
..... groupSize S0..1positiveIntNumber of enrollees
..... cost S0..1MoneyCost value
..... comment S0..1stringAdditional cost information
.... specificCost S0..*BackboneElementSpecific costs
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... category S1..1CodeableConceptGeneral category of benefit
Binding: VhDir Insurance Plan Cost Category (example)
..... benefit S0..*BackboneElementBenefits list
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... type S1..1CodeableConceptType of specific benefit
Binding: VhDir Insurance Plan Benefit Type (example)
...... cost S0..*BackboneElementList of the costs
....... id 0..1stringUnique id for inter-element referencing
....... extension 0..*ExtensionAdditional content defined by implementations
....... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
....... type S1..1CodeableConceptType of cost
Binding: VhDir Insurance Plan Benefit Cost Type (example)
....... applicability S0..1CodeableConceptin-network | out-of-network | other
Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.

....... qualifiers S0..*CodeableConceptAdditional information about the cost
Binding: VhDir Insurance Plan Cost Qualifier (example)
....... value S0..1QuantityThe actual cost value

doco Documentation for this format