CARIN Digital Insurance Card
2.0.0 - STU 2.0 United States of America flag

CARIN Digital Insurance Card, published by HL7 International / Payer/Provider Information Exchange Work Group. This guide is not an authorized publication; it is the continuous build for version 2.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/carin-digital-insurance-card/ and changes regularly. See the Directory of published versions

Extension: Benefit Limitation Extension (Experimental)

Official URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/benefit-limitation Version: 2.0.0
Standards status: Informative Computable Name: BenefitLimitation

Extension for documenting limitations and exceptions that apply to specific benefits in the SBC, carrying the limitation text as displayed along with an optional structured representation of the limit (type, value, and period)

Context of Use

This extension may be used on the following element(s):

  • Element ID InsurancePlan.coverage.benefit
  • Element ID InsurancePlan.plan.specificCost.benefit

Usage info

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Extension Content

Description of Profiles, Differentials, Snapshots, and how the XML and JSON presentations work.

This structure is derived from Extension

Summary

Complex Extension: Extension for documenting limitations and exceptions that apply to specific benefits in the SBC, carrying the limitation text as displayed along with an optional structured representation of the limit (type, value, and period)

  • limitText: string: Text describing limitations, exceptions, or additional requirements that apply to this benefit, as displayed in the SBC
  • limitType: CodeableConcept: The unit of measure for the limit, such as visits, days, or dollars
  • limitValue: Quantity: The numeric value of the limit
  • limitPeriod: CodeableConcept: The period over which the limit accrues, such as plan year, calendar year, benefit period, or lifetime

This structure is derived from Extension

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Extension 0..* Extension Benefit Limitation Extension
... Slices for extension Content/Rules for all slices
.... extension:limitText 0..1 Extension Limitation or Exception
..... extension 0..0 Extension
..... url 1..1 uri "limitText"
..... value[x] 0..1 string Value of extension
.... extension:limitType 0..1 Extension What the limit counts
..... extension 0..0 Extension
..... url 1..1 uri "limitType"
..... value[x] 0..1 CodeableConcept Value of extension
Binding: Limit Type Value Set (extensible)
.... extension:limitValue 0..1 Extension Limit amount
..... extension 0..0 Extension
..... url 1..1 uri "limitValue"
..... value[x] 0..1 Quantity Value of extension
.... extension:limitPeriod 0..1 Extension Period over which the limit applies
..... extension 0..0 Extension
..... url 1..1 uri "limitPeriod"
..... value[x] 0..1 CodeableConcept Value of extension
Binding: Limit Period Value Set (extensible)
... url 1..1 uri "http://hl7.org/fhir/us/insurance-card/StructureDefinition/benefit-limitation"
... value[x] 0..0 Value of extension

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Extension 0..* Extension Benefit Limitation Extension
... id 0..1 string Unique id for inter-element referencing
... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... extension:limitText 0..1 Extension Limitation or Exception
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "limitText"
..... value[x] 0..1 string Value of extension
.... extension:limitType 0..1 Extension What the limit counts
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "limitType"
..... value[x] 0..1 CodeableConcept Value of extension
Binding: Limit Type Value Set (extensible)
.... extension:limitValue 0..1 Extension Limit amount
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "limitValue"
..... value[x] 0..1 Quantity Value of extension
.... extension:limitPeriod 0..1 Extension Period over which the limit applies
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "limitPeriod"
..... value[x] 0..1 CodeableConcept Value of extension
Binding: Limit Period Value Set (extensible)
... url 1..1 uri "http://hl7.org/fhir/us/insurance-card/StructureDefinition/benefit-limitation"

doco Documentation for this format

This structure is derived from Extension

Summary

Complex Extension: Extension for documenting limitations and exceptions that apply to specific benefits in the SBC, carrying the limitation text as displayed along with an optional structured representation of the limit (type, value, and period)

  • limitText: string: Text describing limitations, exceptions, or additional requirements that apply to this benefit, as displayed in the SBC
  • limitType: CodeableConcept: The unit of measure for the limit, such as visits, days, or dollars
  • limitValue: Quantity: The numeric value of the limit
  • limitPeriod: CodeableConcept: The period over which the limit accrues, such as plan year, calendar year, benefit period, or lifetime

Differential View

This structure is derived from Extension

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Extension 0..* Extension Benefit Limitation Extension
... Slices for extension Content/Rules for all slices
.... extension:limitText 0..1 Extension Limitation or Exception
..... extension 0..0 Extension
..... url 1..1 uri "limitText"
..... value[x] 0..1 string Value of extension
.... extension:limitType 0..1 Extension What the limit counts
..... extension 0..0 Extension
..... url 1..1 uri "limitType"
..... value[x] 0..1 CodeableConcept Value of extension
Binding: Limit Type Value Set (extensible)
.... extension:limitValue 0..1 Extension Limit amount
..... extension 0..0 Extension
..... url 1..1 uri "limitValue"
..... value[x] 0..1 Quantity Value of extension
.... extension:limitPeriod 0..1 Extension Period over which the limit applies
..... extension 0..0 Extension
..... url 1..1 uri "limitPeriod"
..... value[x] 0..1 CodeableConcept Value of extension
Binding: Limit Period Value Set (extensible)
... url 1..1 uri "http://hl7.org/fhir/us/insurance-card/StructureDefinition/benefit-limitation"
... value[x] 0..0 Value of extension

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Extension 0..* Extension Benefit Limitation Extension
... id 0..1 string Unique id for inter-element referencing
... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... extension:limitText 0..1 Extension Limitation or Exception
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "limitText"
..... value[x] 0..1 string Value of extension
.... extension:limitType 0..1 Extension What the limit counts
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "limitType"
..... value[x] 0..1 CodeableConcept Value of extension
Binding: Limit Type Value Set (extensible)
.... extension:limitValue 0..1 Extension Limit amount
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "limitValue"
..... value[x] 0..1 Quantity Value of extension
.... extension:limitPeriod 0..1 Extension Period over which the limit applies
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "limitPeriod"
..... value[x] 0..1 CodeableConcept Value of extension
Binding: Limit Period Value Set (extensible)
... url 1..1 uri "http://hl7.org/fhir/us/insurance-card/StructureDefinition/benefit-limitation"

doco Documentation for this format

 

Other representations of profile: CSV, Excel, Schematron

Terminology Bindings

Path Status Usage ValueSet Version Source
Extension.extension:limitType.​value[x] Base extensible Limit Type Value Set 📦2.0.0 This IG
Extension.extension:limitPeriod.​value[x] Base extensible Limit Period Value Set 📦2.0.0 This IG

Constraints

Id Grade Path(s) Description Expression
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()