DaVinci Payer Data Exchange (PDex) US Drug Formulary, published by HL7 International / Pharmacy. This guide is not an authorized publication; it is the continuous build for version 2.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-pdex-formulary/ and changes regularly. See the Directory of published versions
Page standards status: Trial-use |
Definitions for the usdf-PayerInsurancePlan resource profile.
Guidance on how to interpret the contents of this table can be found here
0. InsurancePlan | |
2. InsurancePlan.meta | |
4. InsurancePlan.meta.lastUpdated | |
Control | 1..? |
Must Support | true |
6. InsurancePlan.identifier | |
Short | The business identifier for the plan. The same InsurancePlan may be present in multiple directories and if they have the same identifier they are assumed to be the same plan. |
Note | This is a business identifier, not a resource identifier (see discussion) |
Control | 1..? |
Must Support | true |
8. InsurancePlan.status | |
Control | 1..? |
Must Support | true |
10. InsurancePlan.type | |
Short | Product type |
Control | 1..1 |
Binding | Unless not suitable, these codes SHALL be taken from Insurance Product Type VS (extensible to http://hl7.org/fhir/us/davinci-pdex-plan-net/ValueSet/InsuranceProductTypeVS ) |
Must Support | true |
12. InsurancePlan.name | |
Must Support | true |
14. InsurancePlan.period | |
Must Support | true |
16. InsurancePlan.coverageArea | |
Type | Reference(Insurance Plan Location) |
Must Support | true |
18. InsurancePlan.contact | |
Short | Contact information for the Insurance Plan including URLs for brochure and formulary information |
20. InsurancePlan.contact.purpose | |
Binding | Unless not suitable, these codes SHALL be taken from Type of plan contact (extensible to http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/PlanContactTypeVS ) |
22. InsurancePlan.contact.name | |
Must Support | true |
24. InsurancePlan.contact.name.text | |
Must Support | true |
26. InsurancePlan.contact.telecom | |
Must Support | true |
28. InsurancePlan.contact.telecom.system | |
Must Support | true |
30. InsurancePlan.contact.telecom.value | |
Must Support | true |
32. InsurancePlan.coverage | |
Control | 1..? |
Must Support | true |
Slicing | This element introduces a set of slices on InsurancePlan.coverage . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
34. InsurancePlan.coverage.type | |
Must Support | true |
36. InsurancePlan.coverage:drug-coverage | |
Slice Name | drug-coverage |
Control | 1..* |
Must Support | true |
38. InsurancePlan.coverage:drug-coverage.extension | |
Control | 1..? |
Must Support | true |
Slicing | This element introduces a set of slices on InsurancePlan.coverage.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
40. InsurancePlan.coverage:drug-coverage.extension:usdf-FormularyReference-extension | |
Slice Name | usdf-FormularyReference-extension |
Control | 1..* |
Type | Extension(Formulary Reference) (Extension Type: Reference(Formulary)) |
Must Support | true |
42. InsurancePlan.coverage:drug-coverage.type | |
Pattern Value | { |
44. InsurancePlan.coverage:drug-coverage.benefit | |
Slicing | This element introduces a set of slices on InsurancePlan.coverage.benefit . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
46. InsurancePlan.coverage:drug-coverage.benefit.type | |
Binding | Unless not suitable, these codes SHALL be taken from Insurance plan type (extensible to http://terminology.hl7.org/ValueSet/insuranceplan-type ) |
48. InsurancePlan.coverage:drug-coverage.benefit:drug-plan | |
Slice Name | drug-plan |
Control | 1..* |
Must Support | true |
50. InsurancePlan.coverage:drug-coverage.benefit:drug-plan.type | |
Pattern Value | { |
52. InsurancePlan.plan | |
Control | 1..? |
Must Support | true |
Slicing | This element introduces a set of slices on InsurancePlan.plan . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
54. InsurancePlan.plan.type | |
Binding | Unless not suitable, these codes SHALL be taken from Insurance plan type (extensible to http://terminology.hl7.org/ValueSet/insuranceplan-type ) |
56. InsurancePlan.plan:drug-plan | |
Slice Name | drug-plan |
Short | Drug plan |
Control | 1..* |
Must Support | true |
58. InsurancePlan.plan:drug-plan.type | |
Control | 1..? |
Pattern Value | { |
60. InsurancePlan.plan:drug-plan.network | |
Short | Pharmacy benefit types that are part of the drug plan |
62. InsurancePlan.plan:drug-plan.specificCost | |
Short | Pharmacy benefit type specific cost |
Control | 1..? |
Must Support | true |
64. InsurancePlan.plan:drug-plan.specificCost.category | |
Short | Pharmacy Benefit Type |
Binding | Unless not suitable, these codes SHALL be taken from Pharmacy benefit types (extensible to http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/PharmacyBenefitTypeVS ) |
Must Support | true |
66. InsurancePlan.plan:drug-plan.specificCost.benefit | |
Short | Drug tier benefit |
Control | 1..? |
Must Support | true |
68. InsurancePlan.plan:drug-plan.specificCost.benefit.type | |
Binding | Unless not suitable, these codes SHALL be taken from Drug tier of medication in health plan (extensible to http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/DrugTierVS ) |
Must Support | true |
70. InsurancePlan.plan:drug-plan.specificCost.benefit.cost | |
Control | 1..? |
Must Support | true |
Slicing | This element introduces a set of slices on InsurancePlan.plan.specificCost.benefit.cost . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
72. InsurancePlan.plan:drug-plan.specificCost.benefit.cost.type | |
Binding | Unless not suitable, these codes SHALL be taken from Benefit type of cost (extensible to http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/BenefitCostTypeVS ) |
74. InsurancePlan.plan:drug-plan.specificCost.benefit.cost.qualifiers | |
Control | 1..1 |
Must Support | true |
76. InsurancePlan.plan:drug-plan.specificCost.benefit.cost.value | |
Must Support | true |
78. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay | |
Slice Name | copay |
Short | Copay costs |
Control | 0..1 |
Must Support | true |
80. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.type | |
Pattern Value | { |
82. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.qualifiers | |
Binding | The codes SHALL be taken from Qualifier of copay amount (required to http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/CopayOptionVS ) |
84. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.value | |
Control | 1..? |
Type | Quantity(MoneyQuantity) |
86. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.value.value | |
Control | 1..? |
Must Support | true |
88. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.value.system | |
Pattern Value | urn:iso:std:iso:4217 |
90. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.value.code | |
Pattern Value | USD |
92. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance | |
Slice Name | coinsurance |
Short | Coinsurance costs |
Control | 0..1 |
Must Support | true |
94. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.type | |
Pattern Value | { |
96. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.qualifiers | |
Binding | The codes SHALL be taken from Qualifier for coinsurance rate (required to http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/CoinsuranceOptionVS ) |
98. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.value | |
Control | 1..? |
100. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.value.value | |
Control | 1..? |
Must Support | true |
102. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.value.system | |
Pattern Value | http://unitsofmeasure.org |
104. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.value.code | |
Pattern Value | % |
Guidance on how to interpret the contents of this table can be found here
0. InsurancePlan | |
Definition | Details of a Health Insurance product/plan provided by an organization. |
Short | Details of a Health Insurance product/plan provided by an organization |
Control | 0..* |
Is Modifier | false |
Summary | false |
Invariants | dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty()) dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()) dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()) dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty()) dom-6: A resource should have narrative for robust management (text.`div`.exists()) ipn-1: The organization SHALL at least have a name or an idendtifier, and possibly more than one ( (identifier.count() + name.count()) > 0 )ipn-1: The organization SHALL at least have a name or an idendtifier, and possibly more than one ((identifier.count() + name.count()) > 0) |
2. InsurancePlan.meta | |
Definition | The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource. |
Short | Metadata about the resource |
Control | 0..1 |
Type | Meta |
Is Modifier | false |
Summary | true |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
4. InsurancePlan.meta.lastUpdated | |
Definition | When the resource last changed - e.g. when the version changed. |
Short | When the resource version last changed |
Comments | This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction. |
Control | 10..1 |
Type | instant |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | true |
Summary | true |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
6. InsurancePlan.implicitRules | |
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. |
Short | A set of rules under which this content was created |
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. |
Control | 0..1 |
Type | uri |
Is Modifier | true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
8. InsurancePlan.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them |
Summary | false |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
10. InsurancePlan.identifier | |
Definition | Business identifiers assigned to this health insurance product which remain constant as the resource is updated and propagates from server to server. |
Short | The business identifier for the plan. The same InsurancePlan may be present in multiple directories and if they have the same identifier they are assumed to be the same plan.Business Identifier for Product |
Note | This is a business identifier, not a resource identifier (see discussion) |
Control | 10..* This element is affected by the following invariants: ipn-1 |
Type | Identifier |
Is Modifier | false |
Must Support | true |
Summary | true |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
12. InsurancePlan.status | |
Definition | The current state of the health insurance product. |
Short | draft | active | retired | unknown |
Control | 10..1 |
Binding | The codes SHALL be taken from PublicationStatushttp://hl7.org/fhir/ValueSet/publication-status|4.0.1 (required to http://hl7.org/fhir/ValueSet/publication-status|4.0.1 )The lifecycle status of an artifact. |
Type | code |
Is Modifier | true because This element is labeled as a modifier because it is a status element that contains codes which means that the resource should not be treated as valid |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | true |
Summary | true |
Requirements | Need a flag to indicate a record is no longer to be used and should generally be hidden for the user in the UI. |
Meaning if Missing | Default interpretation is active. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
14. InsurancePlan.type | |
Definition | The kind of health insurance product. |
Short | Product typeKind of product |
Control | 10..1* |
Binding | Unless not suitable, these codes SHALL be taken from For example codes, see Insurance Product Type VShttp://hl7.org/fhir/ValueSet/insuranceplan-type (extensible to http://hl7.org/fhir/us/davinci-pdex-plan-net/ValueSet/InsuranceProductTypeVS ) |
Type | CodeableConcept |
Is Modifier | false |
Must Support | true |
Summary | true |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
16. InsurancePlan.name | |
Definition | Official name of the health insurance product as designated by the owner. |
Short | Official name |
Comments | If the name of the product/plan changes, consider putting the old name in the alias column so that it can still be located through searches. |
Control | 0..1 This element is affected by the following invariants: ipn-1 |
Type | string |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | true |
Summary | true |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
18. InsurancePlan.period | |
Definition | The period of time that the health insurance product is available. |
Short | When the product is available |
Control | 0..1 |
Type | Period |
Is Modifier | false |
Must Support | true |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
20. InsurancePlan.coverageArea | |
Definition | The geographic region in which a health insurance product's benefits apply. |
Short | Where product applies |
Control | 0..* |
Type | Reference(Insurance Plan Location, Location) |
Is Modifier | false |
Must Support | true |
Summary | true |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
22. InsurancePlan.contact | |
Definition | The contact for the health insurance product for a certain purpose. |
Short | Contact information for the Insurance Plan including URLs for brochure and formulary informationContact for the product |
Comments | Where multiple contacts for the same purpose are provided there is a standard extension that can be used to determine which one is the preferred contact to use. |
Control | 0..* |
Type | BackboneElement |
Is Modifier | false |
Summary | false |
Requirements | Need to keep track of assigned contact points within bigger organization. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
24. InsurancePlan.contact.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
26. InsurancePlan.contact.purpose | |
Definition | Indicates a purpose for which the contact can be reached. |
Short | The type of contact |
Control | 0..1 |
Binding | Unless not suitable, these codes SHALL be taken from Type of plan contacthttp://hl7.org/fhir/ValueSet/contactentity-type (extensible to http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/PlanContactTypeVS ) |
Type | CodeableConcept |
Is Modifier | false |
Summary | false |
Requirements | Need to distinguish between multiple contact persons. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
28. InsurancePlan.contact.name | |
Definition | A name associated with the contact. |
Short | A name associated with the contact |
Control | 0..1 |
Type | HumanName |
Is Modifier | false |
Must Support | true |
Summary | false |
Requirements | Need to be able to track the person by name. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
30. InsurancePlan.contact.name.use | |
Definition | Identifies the purpose for this name. |
Short | usual | official | temp | nickname | anonymous | old | maiden |
Comments | Applications can assume that a name is current unless it explicitly says that it is temporary or old. |
Control | 0..1 |
Binding | The codes SHALL be taken from NameUsehttp://hl7.org/fhir/ValueSet/name-use|4.0.1 (required to http://hl7.org/fhir/ValueSet/name-use|4.0.1 )The use of a human name. |
Type | code |
Is Modifier | true because This is labeled as "Is Modifier" because applications should not mistake a temporary or old name etc.for a current/permanent one |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
Requirements | Allows the appropriate name for a particular context of use to be selected from among a set of names. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
32. InsurancePlan.contact.name.text | |
Definition | Specifies the entire name as it should be displayed e.g. on an application UI. This may be provided instead of or as well as the specific parts. |
Short | Text representation of the full name |
Comments | Can provide both a text representation and parts. Applications updating a name SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part. |
Control | 0..1 |
Type | string |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | true |
Summary | true |
Requirements | A renderable, unencoded form. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
34. InsurancePlan.contact.telecom | |
Definition | A contact detail (e.g. a telephone number or an email address) by which the party may be contacted. |
Short | Contact details (telephone, email, etc.) for a contact |
Control | 0..* |
Type | ContactPoint |
Is Modifier | false |
Must Support | true |
Summary | false |
Requirements | People have (primary) ways to contact them in some way such as phone, email. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
36. InsurancePlan.contact.telecom.system | |
Definition | Telecommunications form for contact point - what communications system is required to make use of the contact. |
Short | phone | fax | email | pager | url | sms | other |
Control | 0..1 This element is affected by the following invariants: cpt-2 |
Binding | The codes SHALL be taken from ContactPointSystemhttp://hl7.org/fhir/ValueSet/contact-point-system|4.0.1 (required to http://hl7.org/fhir/ValueSet/contact-point-system|4.0.1 )Telecommunications form for contact point. |
Type | code |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | true |
Summary | true |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
38. InsurancePlan.contact.telecom.value | |
Definition | The actual contact point details, in a form that is meaningful to the designated communication system (i.e. phone number or email address). |
Short | The actual contact point details |
Comments | Additional text data such as phone extension numbers, or notes about use of the contact are sometimes included in the value. |
Control | 0..1 |
Type | string |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | true |
Summary | true |
Requirements | Need to support legacy numbers that are not in a tightly controlled format. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
40. InsurancePlan.contact.telecom.use | |
Definition | Identifies the purpose for the contact point. |
Short | home | work | temp | old | mobile - purpose of this contact point |
Comments | Applications can assume that a contact is current unless it explicitly says that it is temporary or old. |
Control | 0..1 |
Binding | The codes SHALL be taken from ContactPointUsehttp://hl7.org/fhir/ValueSet/contact-point-use|4.0.1 (required to http://hl7.org/fhir/ValueSet/contact-point-use|4.0.1 )Use of contact point. |
Type | code |
Is Modifier | true because This is labeled as "Is Modifier" because applications should not mistake a temporary or old contact etc.for a current/permanent one |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
Requirements | Need to track the way a person uses this contact, so a user can choose which is appropriate for their purpose. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
42. InsurancePlan.coverage | |
Definition | Details about the coverage offered by the insurance product. |
Short | Coverage details |
Control | 10..* |
Type | BackboneElement |
Is Modifier | false |
Must Support | true |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
Slicing | This element introduces a set of slices on InsurancePlan.coverage . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
44. InsurancePlan.coverage.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
46. InsurancePlan.coverage.type | |
Definition | Type of coverage (Medical; Dental; Mental Health; Substance Abuse; Vision; Drug; Short Term; Long Term Care; Hospice; Home Health). |
Short | Type of coverage |
Control | 1..1 |
Type | CodeableConcept |
Is Modifier | false |
Must Support | true |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
48. InsurancePlan.coverage.benefit | |
Definition | Specific benefits under this type of coverage. |
Short | List of benefits |
Control | 1..* |
Type | BackboneElement |
Is Modifier | false |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
50. InsurancePlan.coverage.benefit.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
52. InsurancePlan.coverage.benefit.type | |
Definition | Type of benefit (primary care; speciality care; inpatient; outpatient). |
Short | Type of benefit |
Control | 1..1 |
Type | CodeableConcept |
Is Modifier | false |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
54. InsurancePlan.coverage:drug-coverage | |
Slice Name | drug-coverage |
Definition | Details about the coverage offered by the insurance product. |
Short | Coverage details |
Control | 10..* |
Type | BackboneElement |
Is Modifier | false |
Must Support | true |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
56. InsurancePlan.coverage:drug-coverage.extension | |
Definition | An Extension May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Short | ExtensionAdditional content defined by implementations |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 10..* |
Type | Extension |
Is Modifier | false |
Must Support | true |
Summary | false |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
Slicing | This element introduces a set of slices on InsurancePlan.coverage.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
58. InsurancePlan.coverage:drug-coverage.extension:usdf-FormularyReference-extension | |
Slice Name | usdf-FormularyReference-extension |
Definition | Reference to the formulary this item belongs to. |
Short | Formulary Reference |
Control | 1..* This element is affected by the following invariants: ele-1 |
Type | Extension(Formulary Reference) (Extension Type: Reference(Formulary)) |
Is Modifier | false |
Must Support | true |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() )ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
60. InsurancePlan.coverage:drug-coverage.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
62. InsurancePlan.coverage:drug-coverage.type | |
Definition | Type of coverage (Medical; Dental; Mental Health; Substance Abuse; Vision; Drug; Short Term; Long Term Care; Hospice; Home Health). |
Short | Type of coverage |
Control | 1..1 |
Type | CodeableConcept |
Is Modifier | false |
Summary | false |
Pattern Value | { |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
64. InsurancePlan.coverage:drug-coverage.benefit | |
Definition | Specific benefits under this type of coverage. |
Short | List of benefits |
Control | 1..* |
Type | BackboneElement |
Is Modifier | false |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
Slicing | This element introduces a set of slices on InsurancePlan.coverage.benefit . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
66. InsurancePlan.coverage:drug-coverage.benefit.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
68. InsurancePlan.coverage:drug-coverage.benefit.type | |
Definition | Type of benefit (primary care; speciality care; inpatient; outpatient). |
Short | Type of benefit |
Control | 1..1 |
Binding | Unless not suitable, these codes SHALL be taken from For codes, see Insurance plan type (extensible to http://terminology.hl7.org/ValueSet/insuranceplan-type ) |
Type | CodeableConcept |
Is Modifier | false |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
70. InsurancePlan.coverage:drug-coverage.benefit:drug-plan | |
Slice Name | drug-plan |
Definition | Specific benefits under this type of coverage. |
Short | List of benefits |
Control | 1..* |
Type | BackboneElement |
Is Modifier | false |
Must Support | true |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
72. InsurancePlan.coverage:drug-coverage.benefit:drug-plan.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
74. InsurancePlan.coverage:drug-coverage.benefit:drug-plan.type | |
Definition | Type of benefit (primary care; speciality care; inpatient; outpatient). |
Short | Type of benefit |
Control | 1..1 |
Type | CodeableConcept |
Is Modifier | false |
Summary | false |
Pattern Value | { |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
76. InsurancePlan.plan | |
Definition | Details about an insurance plan. |
Short | Plan details |
Control | 10..* |
Type | BackboneElement |
Is Modifier | false |
Must Support | true |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
Slicing | This element introduces a set of slices on InsurancePlan.plan . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
78. InsurancePlan.plan.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
80. InsurancePlan.plan.type | |
Definition | Type of plan. For example, "Platinum" or "High Deductable". |
Short | Type of plan |
Control | 0..1 |
Binding | Unless not suitable, these codes SHALL be taken from For codes, see Insurance plan type (extensible to http://terminology.hl7.org/ValueSet/insuranceplan-type ) |
Type | CodeableConcept |
Is Modifier | false |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
82. InsurancePlan.plan:drug-plan | |
Slice Name | drug-plan |
Definition | Details about an insurance plan. |
Short | Drug planPlan details |
Control | 10..* |
Type | BackboneElement |
Is Modifier | false |
Must Support | true |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
84. InsurancePlan.plan:drug-plan.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
86. InsurancePlan.plan:drug-plan.type | |
Definition | Type of plan. For example, "Platinum" or "High Deductable". |
Short | Type of plan |
Control | 10..1 |
Type | CodeableConcept |
Is Modifier | false |
Summary | false |
Pattern Value | { |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
88. InsurancePlan.plan:drug-plan.network | |
Definition | Reference to the network that providing the type of coverage. |
Short | Pharmacy benefit types that are part of the drug planWhat networks provide coverage |
Comments | Networks are represented as a hierarchy of organization resources. |
Control | 0..* |
Type | Reference(Organization) |
Is Modifier | false |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
90. InsurancePlan.plan:drug-plan.specificCost | |
Definition | Costs associated with the coverage provided by the product. |
Short | Pharmacy benefit type specific costSpecific costs |
Control | 10..* |
Type | BackboneElement |
Is Modifier | false |
Must Support | true |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
92. InsurancePlan.plan:drug-plan.specificCost.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
94. InsurancePlan.plan:drug-plan.specificCost.category | |
Definition | General category of benefit (Medical; Dental; Vision; Drug; Mental Health; Substance Abuse; Hospice, Home Health). |
Short | Pharmacy Benefit TypeGeneral category of benefit |
Control | 1..1 |
Binding | Unless not suitable, these codes SHALL be taken from For codes, see Pharmacy benefit types (extensible to http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/PharmacyBenefitTypeVS ) |
Type | CodeableConcept |
Is Modifier | false |
Must Support | true |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
96. InsurancePlan.plan:drug-plan.specificCost.benefit | |
Definition | List of the specific benefits under this category of benefit. |
Short | Drug tier benefitBenefits list |
Control | 10..* |
Type | BackboneElement |
Is Modifier | false |
Must Support | true |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
98. InsurancePlan.plan:drug-plan.specificCost.benefit.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
100. InsurancePlan.plan:drug-plan.specificCost.benefit.type | |
Definition | Type of specific benefit (preventative; primary care office visit; speciality office visit; hospitalization; emergency room; urgent care). |
Short | Type of specific benefit |
Control | 1..1 |
Binding | Unless not suitable, these codes SHALL be taken from For codes, see Drug tier of medication in health plan (extensible to http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/DrugTierVS ) |
Type | CodeableConcept |
Is Modifier | false |
Must Support | true |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
102. InsurancePlan.plan:drug-plan.specificCost.benefit.cost | |
Definition | List of the costs associated with a specific benefit. |
Short | List of the costs |
Control | 10..* |
Type | BackboneElement |
Is Modifier | false |
Must Support | true |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
Slicing | This element introduces a set of slices on InsurancePlan.plan.specificCost.benefit.cost . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
104. InsurancePlan.plan:drug-plan.specificCost.benefit.cost.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
106. InsurancePlan.plan:drug-plan.specificCost.benefit.cost.type | |
Definition | Type of cost (copay; individual cap; family cap; coinsurance; deductible). |
Short | Type of cost |
Control | 1..1 |
Binding | Unless not suitable, these codes SHALL be taken from For codes, see Benefit type of cost (extensible to http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/BenefitCostTypeVS ) |
Type | CodeableConcept |
Is Modifier | false |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
108. InsurancePlan.plan:drug-plan.specificCost.benefit.cost.qualifiers | |
Definition | Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA). |
Short | Additional information about the cost |
Control | 10..1* |
Type | CodeableConcept |
Is Modifier | false |
Must Support | true |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
110. InsurancePlan.plan:drug-plan.specificCost.benefit.cost.value | |
Definition | The actual cost value. (some of the costs may be represented as percentages rather than currency, e.g. 10% coinsurance). |
Short | The actual cost value |
Control | 0..1 |
Type | Quantity |
Is Modifier | false |
Must Support | true |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
112. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay | |
Slice Name | copay |
Definition | List of the costs associated with a specific benefit. |
Short | Copay costsList of the costs |
Control | 0..1* |
Type | BackboneElement |
Is Modifier | false |
Must Support | true |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
114. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
116. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.type | |
Definition | Type of cost (copay; individual cap; family cap; coinsurance; deductible). |
Short | Type of cost |
Control | 1..1 |
Type | CodeableConcept |
Is Modifier | false |
Summary | false |
Pattern Value | { |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
118. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.qualifiers | |
Definition | Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA). |
Short | Additional information about the cost |
Control | 0..* |
Binding | The codes SHALL be taken from For codes, see Qualifier of copay amount (required to http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/CopayOptionVS ) |
Type | CodeableConcept |
Is Modifier | false |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
120. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.value | |
Definition | There SHALL be a code if there is a value and it SHALL be an expression of currency. If system is present, it SHALL be ISO 4217 (system = "urn:iso:std:iso:4217" - currency). The actual cost value. (some of the costs may be represented as percentages rather than currency, e.g. 10% coinsurance). |
Short | An amount of money. With regard to precision, see [Decimal Precision](datatypes.html#precision)The actual cost value |
Comments | The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator. |
Control | 10..1 This element is affected by the following invariants: ele-1 |
Type | Quantity(MoneyQuantity) |
Is Modifier | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) mqty-1: There SHALL be a code if there is a value and it SHALL be an expression of currency. If system is present, it SHALL be ISO 4217 (system = "urn:iso:std:iso:4217" - currency). ( (code.exists() or value.empty()) and (system.empty() or system = 'urn:iso:std:iso:4217') )qty-3: If a code for the unit is present, the system SHALL also be present ( code.empty() or system.exists() ) |
122. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.value.value | |
Definition | The value of the measured amount. The value includes an implicit precision in the presentation of the value. |
Short | Numerical value (with implicit precision) |
Comments | The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books). |
Control | 10..1 |
Type | decimal |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | true |
Summary | true |
Requirements | Precision is handled implicitly in almost all cases of measurement. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
124. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.value.comparator | |
Definition | How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value. |
Short | < | <= | >= | > - how to understand the value |
Control | 0..1 |
Binding | The codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1 (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1 )How the Quantity should be understood and represented. |
Type | code |
Is Modifier | true because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
Requirements | Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology. |
Meaning if Missing | If there is no comparator, then there is no modification of the value |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
126. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.value.system | |
Definition | The identification of the system that provides the coded form of the unit. |
Short | System that defines coded unit form |
Control | 0..1 This element is affected by the following invariants: qty-3 |
Type | uri |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
Requirements | Need to know the system that defines the coded form of the unit. |
Pattern Value | urn:iso:std:iso:4217 |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
128. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.value.code | |
Definition | A computer processable form of the unit in some unit representation system. |
Short | Coded form of the unit |
Comments | The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system. |
Control | 0..1 |
Type | code |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
Requirements | Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest. |
Pattern Value | USD |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
130. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance | |
Slice Name | coinsurance |
Definition | List of the costs associated with a specific benefit. |
Short | Coinsurance costsList of the costs |
Control | 0..1* |
Type | BackboneElement |
Is Modifier | false |
Must Support | true |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
132. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
134. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.type | |
Definition | Type of cost (copay; individual cap; family cap; coinsurance; deductible). |
Short | Type of cost |
Control | 1..1 |
Type | CodeableConcept |
Is Modifier | false |
Summary | false |
Pattern Value | { |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
136. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.qualifiers | |
Definition | Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA). |
Short | Additional information about the cost |
Control | 0..* |
Binding | The codes SHALL be taken from For codes, see Qualifier for coinsurance rate (required to http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/CoinsuranceOptionVS ) |
Type | CodeableConcept |
Is Modifier | false |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
138. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.value | |
Definition | The actual cost value. (some of the costs may be represented as percentages rather than currency, e.g. 10% coinsurance). |
Short | The actual cost value |
Control | 10..1 |
Type | Quantity |
Is Modifier | false |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
140. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.value.value | |
Definition | The value of the measured amount. The value includes an implicit precision in the presentation of the value. |
Short | Numerical value (with implicit precision) |
Comments | The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books). |
Control | 10..1 |
Type | decimal |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | true |
Summary | true |
Requirements | Precision is handled implicitly in almost all cases of measurement. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
142. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.value.comparator | |
Definition | How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value. |
Short | < | <= | >= | > - how to understand the value |
Control | 0..1 |
Binding | The codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1 (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1 )How the Quantity should be understood and represented. |
Type | code |
Is Modifier | true because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
Requirements | Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology. |
Meaning if Missing | If there is no comparator, then there is no modification of the value |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
144. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.value.system | |
Definition | The identification of the system that provides the coded form of the unit. |
Short | System that defines coded unit form |
Control | 0..1 This element is affected by the following invariants: qty-3 |
Type | uri |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
Requirements | Need to know the system that defines the coded form of the unit. |
Pattern Value | http://unitsofmeasure.org |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
146. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.value.code | |
Definition | A computer processable form of the unit in some unit representation system. |
Short | Coded form of the unit |
Comments | The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system. |
Control | 0..1 |
Type | code |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
Requirements | Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest. |
Pattern Value | % |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
Guidance on how to interpret the contents of this table can be found here
0. InsurancePlan | |||||
Definition | Details of a Health Insurance product/plan provided by an organization. | ||||
Short | Details of a Health Insurance product/plan provided by an organization | ||||
Control | 0..* | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty() )dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource ( contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() )dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated ( contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() )dom-5: If a resource is contained in another resource, it SHALL NOT have a security label ( contained.meta.security.empty() )dom-6: A resource should have narrative for robust management ( text.`div`.exists() )ipn-1: The organization SHALL at least have a name or an idendtifier, and possibly more than one ( (identifier.count() + name.count()) > 0 ) | ||||
2. InsurancePlan.id | |||||
Definition | The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. | ||||
Short | Logical id of this artifact | ||||
Comments | The only time that a resource does not have an id is when it is being submitted to the server using a create operation. | ||||
Control | 0..1 | ||||
Type | id | ||||
Is Modifier | false | ||||
Summary | true | ||||
4. InsurancePlan.meta | |||||
Definition | The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource. | ||||
Short | Metadata about the resource | ||||
Control | 0..1 | ||||
Type | Meta | ||||
Is Modifier | false | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
6. InsurancePlan.meta.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
8. InsurancePlan.meta.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
Slicing | This element introduces a set of slices on InsurancePlan.meta.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
10. InsurancePlan.meta.versionId | |||||
Definition | The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted. | ||||
Short | Version specific identifier | ||||
Comments | The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes. | ||||
Control | 0..1 | ||||
Type | id | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
12. InsurancePlan.meta.lastUpdated | |||||
Definition | When the resource last changed - e.g. when the version changed. | ||||
Short | When the resource version last changed | ||||
Comments | This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction. | ||||
Control | 1..1 | ||||
Type | instant | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Must Support | true | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
14. InsurancePlan.meta.source | |||||
Definition | A uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc. | ||||
Short | Identifies where the resource comes from | ||||
Comments | In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL. | ||||
Control | 0..1 | ||||
Type | uri | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
16. InsurancePlan.meta.profile | |||||
Definition | A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url. | ||||
Short | Profiles this resource claims to conform to | ||||
Comments | It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set. | ||||
Control | 0..* | ||||
Type | canonical(StructureDefinition) | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
18. InsurancePlan.meta.security | |||||
Definition | Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure. | ||||
Short | Security Labels applied to this resource | ||||
Comments | The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored. | ||||
Control | 0..* | ||||
Binding | Unless not suitable, these codes SHALL be taken from All Security Labels (extensible to http://hl7.org/fhir/ValueSet/security-labels )Security Labels from the Healthcare Privacy and Security Classification System. | ||||
Type | Coding | ||||
Is Modifier | false | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
20. InsurancePlan.meta.tag | |||||
Definition | Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource. | ||||
Short | Tags applied to this resource | ||||
Comments | The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored. | ||||
Control | 0..* | ||||
Binding | For example codes, see CommonTags (example to http://hl7.org/fhir/ValueSet/common-tags )Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". | ||||
Type | Coding | ||||
Is Modifier | false | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
22. InsurancePlan.implicitRules | |||||
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. | ||||
Short | A set of rules under which this content was created | ||||
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. | ||||
Control | 0..1 | ||||
Type | uri | ||||
Is Modifier | true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
24. InsurancePlan.language | |||||
Definition | The base language in which the resource is written. | ||||
Short | Language of the resource content | ||||
Comments | Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). | ||||
Control | 0..1 | ||||
Binding | The codes SHOULD be taken from CommonLanguages (preferred to http://hl7.org/fhir/ValueSet/languages )A human language.
| ||||
Type | code | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
26. InsurancePlan.text | |||||
Definition | A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. | ||||
Short | Text summary of the resource, for human interpretation | ||||
Comments | Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later. | ||||
Control | 0..1 | ||||
Type | Narrative | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | narrative, html, xhtml, display | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
28. InsurancePlan.contained | |||||
Definition | These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. | ||||
Short | Contained, inline Resources | ||||
Comments | This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels. | ||||
Control | 0..* | ||||
Type | Resource | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | inline resources, anonymous resources, contained resources | ||||
30. InsurancePlan.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
32. InsurancePlan.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them | ||||
Summary | false | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
34. InsurancePlan.identifier | |||||
Definition | Business identifiers assigned to this health insurance product which remain constant as the resource is updated and propagates from server to server. | ||||
Short | The business identifier for the plan. The same InsurancePlan may be present in multiple directories and if they have the same identifier they are assumed to be the same plan. | ||||
Note | This is a business identifier, not a resource identifier (see discussion) | ||||
Control | 1..* This element is affected by the following invariants: ipn-1 | ||||
Type | Identifier | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
36. InsurancePlan.status | |||||
Definition | The current state of the health insurance product. | ||||
Short | draft | active | retired | unknown | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from PublicationStatus (required to http://hl7.org/fhir/ValueSet/publication-status|4.0.1 )The lifecycle status of an artifact. | ||||
Type | code | ||||
Is Modifier | true because This element is labeled as a modifier because it is a status element that contains codes which means that the resource should not be treated as valid | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Must Support | true | ||||
Summary | true | ||||
Requirements | Need a flag to indicate a record is no longer to be used and should generally be hidden for the user in the UI. | ||||
Meaning if Missing | Default interpretation is active. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
38. InsurancePlan.type | |||||
Definition | The kind of health insurance product. | ||||
Short | Product type | ||||
Control | 1..1 | ||||
Binding | Unless not suitable, these codes SHALL be taken from Insurance Product Type VS (extensible to http://hl7.org/fhir/us/davinci-pdex-plan-net/ValueSet/InsuranceProductTypeVS ) | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
40. InsurancePlan.name | |||||
Definition | Official name of the health insurance product as designated by the owner. | ||||
Short | Official name | ||||
Comments | If the name of the product/plan changes, consider putting the old name in the alias column so that it can still be located through searches. | ||||
Control | 0..1 This element is affected by the following invariants: ipn-1 | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Must Support | true | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
42. InsurancePlan.alias | |||||
Definition | A list of alternate names that the product is known as, or was known as in the past. | ||||
Short | Alternate names | ||||
Comments | There are no dates associated with the alias/historic names, as this is not intended to track when names were used, but to assist in searching so that older names can still result in identifying the product/plan. | ||||
Control | 0..* | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | Over time products/plans go through many changes and can be known by different names. For searching knowing previous names that the product/plan was known by can be very useful. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
44. InsurancePlan.period | |||||
Definition | The period of time that the health insurance product is available. | ||||
Short | When the product is available | ||||
Control | 0..1 | ||||
Type | Period | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
46. InsurancePlan.ownedBy | |||||
Definition | The entity that is providing the health insurance product and underwriting the risk. This is typically an insurance carriers, other third-party payers, or health plan sponsors comonly referred to as 'payers'. | ||||
Short | Plan issuer | ||||
Control | 0..1 | ||||
Type | Reference(Organization) | ||||
Is Modifier | false | ||||
Summary | true | ||||
Alternate Names | Payer | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
48. InsurancePlan.administeredBy | |||||
Definition | An organization which administer other services such as underwriting, customer service and/or claims processing on behalf of the health insurance product owner. | ||||
Short | Product administrator | ||||
Control | 0..1 | ||||
Type | Reference(Organization) | ||||
Is Modifier | false | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
50. InsurancePlan.coverageArea | |||||
Definition | The geographic region in which a health insurance product's benefits apply. | ||||
Short | Where product applies | ||||
Control | 0..* | ||||
Type | Reference(Insurance Plan Location) | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
52. InsurancePlan.contact | |||||
Definition | The contact for the health insurance product for a certain purpose. | ||||
Short | Contact information for the Insurance Plan including URLs for brochure and formulary information | ||||
Comments | Where multiple contacts for the same purpose are provided there is a standard extension that can be used to determine which one is the preferred contact to use. | ||||
Control | 0..* | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Need to keep track of assigned contact points within bigger organization. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
54. InsurancePlan.contact.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
56. InsurancePlan.contact.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
58. InsurancePlan.contact.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
60. InsurancePlan.contact.purpose | |||||
Definition | Indicates a purpose for which the contact can be reached. | ||||
Short | The type of contact | ||||
Control | 0..1 | ||||
Binding | Unless not suitable, these codes SHALL be taken from Type of plan contact (extensible to http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/PlanContactTypeVS ) | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Need to distinguish between multiple contact persons. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
62. InsurancePlan.contact.name | |||||
Definition | A name associated with the contact. | ||||
Short | A name associated with the contact | ||||
Control | 0..1 | ||||
Type | HumanName | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Requirements | Need to be able to track the person by name. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
64. InsurancePlan.contact.name.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
66. InsurancePlan.contact.name.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
Slicing | This element introduces a set of slices on InsurancePlan.contact.name.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
68. InsurancePlan.contact.name.use | |||||
Definition | Identifies the purpose for this name. | ||||
Short | usual | official | temp | nickname | anonymous | old | maiden | ||||
Comments | Applications can assume that a name is current unless it explicitly says that it is temporary or old. | ||||
Control | 0..1 | ||||
Binding | The codes SHALL be taken from NameUse (required to http://hl7.org/fhir/ValueSet/name-use|4.0.1 )The use of a human name. | ||||
Type | code | ||||
Is Modifier | true because This is labeled as "Is Modifier" because applications should not mistake a temporary or old name etc.for a current/permanent one | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Requirements | Allows the appropriate name for a particular context of use to be selected from among a set of names. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
70. InsurancePlan.contact.name.text | |||||
Definition | Specifies the entire name as it should be displayed e.g. on an application UI. This may be provided instead of or as well as the specific parts. | ||||
Short | Text representation of the full name | ||||
Comments | Can provide both a text representation and parts. Applications updating a name SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part. | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Must Support | true | ||||
Summary | true | ||||
Requirements | A renderable, unencoded form. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
72. InsurancePlan.contact.name.family | |||||
Definition | The part of a name that links to the genealogy. In some cultures (e.g. Eritrea) the family name of a son is the first name of his father. | ||||
Short | Family name (often called 'Surname') | ||||
Comments | Family Name may be decomposed into specific parts using extensions (de, nl, es related cultures). | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Alternate Names | surname | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
74. InsurancePlan.contact.name.given | |||||
Definition | Given name. | ||||
Short | Given names (not always 'first'). Includes middle names | ||||
Comments | If only initials are recorded, they may be used in place of the full name parts. Initials may be separated into multiple given names but often aren't due to paractical limitations. This element is not called "first name" since given names do not always come first. | ||||
Control | 0..* | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Alternate Names | first name, middle name | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
76. InsurancePlan.contact.name.prefix | |||||
Definition | Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the start of the name. | ||||
Short | Parts that come before the name | ||||
Control | 0..* | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
78. InsurancePlan.contact.name.suffix | |||||
Definition | Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the end of the name. | ||||
Short | Parts that come after the name | ||||
Control | 0..* | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
80. InsurancePlan.contact.name.period | |||||
Definition | Indicates the period of time when this name was valid for the named person. | ||||
Short | Time period when name was/is in use | ||||
Control | 0..1 | ||||
Type | Period | ||||
Is Modifier | false | ||||
Summary | true | ||||
Requirements | Allows names to be placed in historical context. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
82. InsurancePlan.contact.telecom | |||||
Definition | A contact detail (e.g. a telephone number or an email address) by which the party may be contacted. | ||||
Short | Contact details (telephone, email, etc.) for a contact | ||||
Control | 0..* | ||||
Type | ContactPoint | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Requirements | People have (primary) ways to contact them in some way such as phone, email. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
84. InsurancePlan.contact.telecom.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
86. InsurancePlan.contact.telecom.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
Slicing | This element introduces a set of slices on InsurancePlan.contact.telecom.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
88. InsurancePlan.contact.telecom.system | |||||
Definition | Telecommunications form for contact point - what communications system is required to make use of the contact. | ||||
Short | phone | fax | email | pager | url | sms | other | ||||
Control | 0..1 This element is affected by the following invariants: cpt-2 | ||||
Binding | The codes SHALL be taken from ContactPointSystem (required to http://hl7.org/fhir/ValueSet/contact-point-system|4.0.1 )Telecommunications form for contact point. | ||||
Type | code | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Must Support | true | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
90. InsurancePlan.contact.telecom.value | |||||
Definition | The actual contact point details, in a form that is meaningful to the designated communication system (i.e. phone number or email address). | ||||
Short | The actual contact point details | ||||
Comments | Additional text data such as phone extension numbers, or notes about use of the contact are sometimes included in the value. | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Must Support | true | ||||
Summary | true | ||||
Requirements | Need to support legacy numbers that are not in a tightly controlled format. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
92. InsurancePlan.contact.telecom.use | |||||
Definition | Identifies the purpose for the contact point. | ||||
Short | home | work | temp | old | mobile - purpose of this contact point | ||||
Comments | Applications can assume that a contact is current unless it explicitly says that it is temporary or old. | ||||
Control | 0..1 | ||||
Binding | The codes SHALL be taken from ContactPointUse (required to http://hl7.org/fhir/ValueSet/contact-point-use|4.0.1 )Use of contact point. | ||||
Type | code | ||||
Is Modifier | true because This is labeled as "Is Modifier" because applications should not mistake a temporary or old contact etc.for a current/permanent one | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Requirements | Need to track the way a person uses this contact, so a user can choose which is appropriate for their purpose. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
94. InsurancePlan.contact.telecom.rank | |||||
Definition | Specifies a preferred order in which to use a set of contacts. ContactPoints with lower rank values are more preferred than those with higher rank values. | ||||
Short | Specify preferred order of use (1 = highest) | ||||
Comments | Note that rank does not necessarily follow the order in which the contacts are represented in the instance. | ||||
Control | 0..1 | ||||
Type | positiveInt | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
96. InsurancePlan.contact.telecom.period | |||||
Definition | Time period when the contact point was/is in use. | ||||
Short | Time period when the contact point was/is in use | ||||
Control | 0..1 | ||||
Type | Period | ||||
Is Modifier | false | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
98. InsurancePlan.contact.address | |||||
Definition | Visiting or postal addresses for the contact. | ||||
Short | Visiting or postal addresses for the contact | ||||
Control | 0..1 | ||||
Type | Address | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | May need to keep track of a contact party's address for contacting, billing or reporting requirements. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
100. InsurancePlan.endpoint | |||||
Definition | The technical endpoints providing access to services operated for the health insurance product. | ||||
Short | Technical endpoint | ||||
Control | 0..* | ||||
Type | Reference(Endpoint) | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Organizations have multiple systems that provide various services and need to be able to define the technical connection details for how to connect to them, and for what purpose. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
102. InsurancePlan.network | |||||
Definition | Reference to the network included in the health insurance product. | ||||
Short | What networks are Included | ||||
Comments | Networks are represented as a hierarchy of organization resources. | ||||
Control | 0..* | ||||
Type | Reference(Organization) | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
104. InsurancePlan.coverage | |||||
Definition | Details about the coverage offered by the insurance product. | ||||
Short | Coverage details | ||||
Control | 1..* | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
Slicing | This element introduces a set of slices on InsurancePlan.coverage . The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
106. InsurancePlan.coverage.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
108. InsurancePlan.coverage.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
110. InsurancePlan.coverage.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
112. InsurancePlan.coverage.type | |||||
Definition | Type of coverage (Medical; Dental; Mental Health; Substance Abuse; Vision; Drug; Short Term; Long Term Care; Hospice; Home Health). | ||||
Short | Type of coverage | ||||
Control | 1..1 | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
114. InsurancePlan.coverage.network | |||||
Definition | Reference to the network that providing the type of coverage. | ||||
Short | What networks provide coverage | ||||
Comments | Networks are represented as a hierarchy of organization resources. | ||||
Control | 0..* | ||||
Type | Reference(Organization) | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
116. InsurancePlan.coverage.benefit | |||||
Definition | Specific benefits under this type of coverage. | ||||
Short | List of benefits | ||||
Control | 1..* | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
118. InsurancePlan.coverage.benefit.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
120. InsurancePlan.coverage.benefit.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
122. InsurancePlan.coverage.benefit.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
124. InsurancePlan.coverage.benefit.type | |||||
Definition | Type of benefit (primary care; speciality care; inpatient; outpatient). | ||||
Short | Type of benefit | ||||
Control | 1..1 | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
126. InsurancePlan.coverage.benefit.requirement | |||||
Definition | The referral requirements to have access/coverage for this benefit. | ||||
Short | Referral requirements | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
128. InsurancePlan.coverage.benefit.limit | |||||
Definition | The specific limits on the benefit. | ||||
Short | Benefit limits | ||||
Control | 0..* | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
130. InsurancePlan.coverage.benefit.limit.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
132. InsurancePlan.coverage.benefit.limit.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
134. InsurancePlan.coverage.benefit.limit.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
136. InsurancePlan.coverage.benefit.limit.value | |||||
Definition | The maximum amount of a service item a plan will pay for a covered benefit. For examples. wellness visits, or eyeglasses. | ||||
Short | Maximum value allowed | ||||
Comments | May also be called “eligible expense,” “payment allowance,” or “negotiated rate.”. | ||||
Control | 0..1 | ||||
Type | Quantity | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
138. InsurancePlan.coverage.benefit.limit.code | |||||
Definition | The specific limit on the benefit. | ||||
Short | Benefit limit details | ||||
Comments | Use | ||||
Control | 0..1 | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
140. InsurancePlan.coverage:drug-coverage | |||||
Slice Name | drug-coverage | ||||
Definition | Details about the coverage offered by the insurance product. | ||||
Short | Coverage details | ||||
Control | 1..* | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
142. InsurancePlan.coverage:drug-coverage.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
144. InsurancePlan.coverage:drug-coverage.extension | |||||
Definition | An Extension | ||||
Short | Extension | ||||
Control | 1..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
Slicing | This element introduces a set of slices on InsurancePlan.coverage.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
146. InsurancePlan.coverage:drug-coverage.extension:usdf-FormularyReference-extension | |||||
Slice Name | usdf-FormularyReference-extension | ||||
Definition | Reference to the formulary this item belongs to. | ||||
Short | Formulary Reference | ||||
Control | 1..* This element is affected by the following invariants: ele-1 | ||||
Type | Extension(Formulary Reference) (Extension Type: Reference(Formulary)) | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
148. InsurancePlan.coverage:drug-coverage.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
150. InsurancePlan.coverage:drug-coverage.type | |||||
Definition | Type of coverage (Medical; Dental; Mental Health; Substance Abuse; Vision; Drug; Short Term; Long Term Care; Hospice; Home Health). | ||||
Short | Type of coverage | ||||
Control | 1..1 | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Pattern Value | { | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
152. InsurancePlan.coverage:drug-coverage.network | |||||
Definition | Reference to the network that providing the type of coverage. | ||||
Short | What networks provide coverage | ||||
Comments | Networks are represented as a hierarchy of organization resources. | ||||
Control | 0..* | ||||
Type | Reference(Organization) | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
154. InsurancePlan.coverage:drug-coverage.benefit | |||||
Definition | Specific benefits under this type of coverage. | ||||
Short | List of benefits | ||||
Control | 1..* | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
Slicing | This element introduces a set of slices on InsurancePlan.coverage.benefit . The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
156. InsurancePlan.coverage:drug-coverage.benefit.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
158. InsurancePlan.coverage:drug-coverage.benefit.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
160. InsurancePlan.coverage:drug-coverage.benefit.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
162. InsurancePlan.coverage:drug-coverage.benefit.type | |||||
Definition | Type of benefit (primary care; speciality care; inpatient; outpatient). | ||||
Short | Type of benefit | ||||
Control | 1..1 | ||||
Binding | Unless not suitable, these codes SHALL be taken from Insurance plan type (extensible to http://terminology.hl7.org/ValueSet/insuranceplan-type ) | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
164. InsurancePlan.coverage:drug-coverage.benefit.requirement | |||||
Definition | The referral requirements to have access/coverage for this benefit. | ||||
Short | Referral requirements | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
166. InsurancePlan.coverage:drug-coverage.benefit.limit | |||||
Definition | The specific limits on the benefit. | ||||
Short | Benefit limits | ||||
Control | 0..* | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
168. InsurancePlan.coverage:drug-coverage.benefit.limit.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
170. InsurancePlan.coverage:drug-coverage.benefit.limit.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
172. InsurancePlan.coverage:drug-coverage.benefit.limit.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
174. InsurancePlan.coverage:drug-coverage.benefit.limit.value | |||||
Definition | The maximum amount of a service item a plan will pay for a covered benefit. For examples. wellness visits, or eyeglasses. | ||||
Short | Maximum value allowed | ||||
Comments | May also be called “eligible expense,” “payment allowance,” or “negotiated rate.”. | ||||
Control | 0..1 | ||||
Type | Quantity | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
176. InsurancePlan.coverage:drug-coverage.benefit.limit.code | |||||
Definition | The specific limit on the benefit. | ||||
Short | Benefit limit details | ||||
Comments | Use | ||||
Control | 0..1 | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
178. InsurancePlan.coverage:drug-coverage.benefit:drug-plan | |||||
Slice Name | drug-plan | ||||
Definition | Specific benefits under this type of coverage. | ||||
Short | List of benefits | ||||
Control | 1..* | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
180. InsurancePlan.coverage:drug-coverage.benefit:drug-plan.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
182. InsurancePlan.coverage:drug-coverage.benefit:drug-plan.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
184. InsurancePlan.coverage:drug-coverage.benefit:drug-plan.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
186. InsurancePlan.coverage:drug-coverage.benefit:drug-plan.type | |||||
Definition | Type of benefit (primary care; speciality care; inpatient; outpatient). | ||||
Short | Type of benefit | ||||
Control | 1..1 | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Pattern Value | { | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
188. InsurancePlan.coverage:drug-coverage.benefit:drug-plan.requirement | |||||
Definition | The referral requirements to have access/coverage for this benefit. | ||||
Short | Referral requirements | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
190. InsurancePlan.coverage:drug-coverage.benefit:drug-plan.limit | |||||
Definition | The specific limits on the benefit. | ||||
Short | Benefit limits | ||||
Control | 0..* | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
192. InsurancePlan.coverage:drug-coverage.benefit:drug-plan.limit.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
194. InsurancePlan.coverage:drug-coverage.benefit:drug-plan.limit.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
196. InsurancePlan.coverage:drug-coverage.benefit:drug-plan.limit.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
198. InsurancePlan.coverage:drug-coverage.benefit:drug-plan.limit.value | |||||
Definition | The maximum amount of a service item a plan will pay for a covered benefit. For examples. wellness visits, or eyeglasses. | ||||
Short | Maximum value allowed | ||||
Comments | May also be called “eligible expense,” “payment allowance,” or “negotiated rate.”. | ||||
Control | 0..1 | ||||
Type | Quantity | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
200. InsurancePlan.coverage:drug-coverage.benefit:drug-plan.limit.code | |||||
Definition | The specific limit on the benefit. | ||||
Short | Benefit limit details | ||||
Comments | Use | ||||
Control | 0..1 | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
202. InsurancePlan.plan | |||||
Definition | Details about an insurance plan. | ||||
Short | Plan details | ||||
Control | 1..* | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
Slicing | This element introduces a set of slices on InsurancePlan.plan . The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
204. InsurancePlan.plan.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
206. InsurancePlan.plan.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
208. InsurancePlan.plan.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
210. InsurancePlan.plan.identifier | |||||
Definition | Business identifiers assigned to this health insurance plan which remain constant as the resource is updated and propagates from server to server. | ||||
Short | Business Identifier for Product | ||||
Note | This is a business identifier, not a resource identifier (see discussion) | ||||
Control | 0..* | ||||
Type | Identifier | ||||
Is Modifier | false | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
212. InsurancePlan.plan.type | |||||
Definition | Type of plan. For example, "Platinum" or "High Deductable". | ||||
Short | Type of plan | ||||
Control | 0..1 | ||||
Binding | Unless not suitable, these codes SHALL be taken from Insurance plan type (extensible to http://terminology.hl7.org/ValueSet/insuranceplan-type ) | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
214. InsurancePlan.plan.coverageArea | |||||
Definition | The geographic region in which a health insurance plan's benefits apply. | ||||
Short | Where product applies | ||||
Control | 0..* | ||||
Type | Reference(Location) | ||||
Is Modifier | false | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
216. InsurancePlan.plan.network | |||||
Definition | Reference to the network that providing the type of coverage. | ||||
Short | What networks provide coverage | ||||
Comments | Networks are represented as a hierarchy of organization resources. | ||||
Control | 0..* | ||||
Type | Reference(Organization) | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
218. InsurancePlan.plan.generalCost | |||||
Definition | Overall costs associated with the plan. | ||||
Short | Overall costs | ||||
Control | 0..* | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
220. InsurancePlan.plan.generalCost.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
222. InsurancePlan.plan.generalCost.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
224. InsurancePlan.plan.generalCost.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
226. InsurancePlan.plan.generalCost.type | |||||
Definition | Type of cost. | ||||
Short | Type of cost | ||||
Control | 0..1 | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
228. InsurancePlan.plan.generalCost.groupSize | |||||
Definition | Number of participants enrolled in the plan. | ||||
Short | Number of enrollees | ||||
Control | 0..1 | ||||
Type | positiveInt | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
230. InsurancePlan.plan.generalCost.cost | |||||
Definition | Value of the cost. | ||||
Short | Cost value | ||||
Control | 0..1 | ||||
Type | Money | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
232. InsurancePlan.plan.generalCost.comment | |||||
Definition | Additional information about the general costs associated with this plan. | ||||
Short | Additional cost information | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
234. InsurancePlan.plan.specificCost | |||||
Definition | Costs associated with the coverage provided by the product. | ||||
Short | Specific costs | ||||
Control | 0..* | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
236. InsurancePlan.plan.specificCost.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
238. InsurancePlan.plan.specificCost.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
240. InsurancePlan.plan.specificCost.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
242. InsurancePlan.plan.specificCost.category | |||||
Definition | General category of benefit (Medical; Dental; Vision; Drug; Mental Health; Substance Abuse; Hospice, Home Health). | ||||
Short | General category of benefit | ||||
Control | 1..1 | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
244. InsurancePlan.plan.specificCost.benefit | |||||
Definition | List of the specific benefits under this category of benefit. | ||||
Short | Benefits list | ||||
Control | 0..* | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
246. InsurancePlan.plan.specificCost.benefit.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
248. InsurancePlan.plan.specificCost.benefit.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
250. InsurancePlan.plan.specificCost.benefit.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
252. InsurancePlan.plan.specificCost.benefit.type | |||||
Definition | Type of specific benefit (preventative; primary care office visit; speciality office visit; hospitalization; emergency room; urgent care). | ||||
Short | Type of specific benefit | ||||
Control | 1..1 | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
254. InsurancePlan.plan.specificCost.benefit.cost | |||||
Definition | List of the costs associated with a specific benefit. | ||||
Short | List of the costs | ||||
Control | 0..* | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
256. InsurancePlan.plan.specificCost.benefit.cost.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
258. InsurancePlan.plan.specificCost.benefit.cost.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
260. InsurancePlan.plan.specificCost.benefit.cost.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
262. InsurancePlan.plan.specificCost.benefit.cost.type | |||||
Definition | Type of cost (copay; individual cap; family cap; coinsurance; deductible). | ||||
Short | Type of cost | ||||
Control | 1..1 | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
264. InsurancePlan.plan.specificCost.benefit.cost.applicability | |||||
Definition | Whether the cost applies to in-network or out-of-network providers (in-network; out-of-network; other). | ||||
Short | in-network | out-of-network | other | ||||
Control | 0..1 | ||||
Binding | The codes SHALL be taken from BenefitCostApplicability (required to http://hl7.org/fhir/ValueSet/insuranceplan-applicability|4.0.1 )Whether the cost applies to in-network or out-of-network providers. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
266. InsurancePlan.plan.specificCost.benefit.cost.qualifiers | |||||
Definition | Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA). | ||||
Short | Additional information about the cost | ||||
Control | 0..* | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
268. InsurancePlan.plan.specificCost.benefit.cost.value | |||||
Definition | The actual cost value. (some of the costs may be represented as percentages rather than currency, e.g. 10% coinsurance). | ||||
Short | The actual cost value | ||||
Control | 0..1 | ||||
Type | Quantity | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
270. InsurancePlan.plan:drug-plan | |||||
Slice Name | drug-plan | ||||
Definition | Details about an insurance plan. | ||||
Short | Drug plan | ||||
Control | 1..* | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
272. InsurancePlan.plan:drug-plan.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
274. InsurancePlan.plan:drug-plan.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
276. InsurancePlan.plan:drug-plan.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
278. InsurancePlan.plan:drug-plan.identifier | |||||
Definition | Business identifiers assigned to this health insurance plan which remain constant as the resource is updated and propagates from server to server. | ||||
Short | Business Identifier for Product | ||||
Note | This is a business identifier, not a resource identifier (see discussion) | ||||
Control | 0..* | ||||
Type | Identifier | ||||
Is Modifier | false | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
280. InsurancePlan.plan:drug-plan.type | |||||
Definition | Type of plan. For example, "Platinum" or "High Deductable". | ||||
Short | Type of plan | ||||
Control | 1..1 | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Pattern Value | { | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
282. InsurancePlan.plan:drug-plan.coverageArea | |||||
Definition | The geographic region in which a health insurance plan's benefits apply. | ||||
Short | Where product applies | ||||
Control | 0..* | ||||
Type | Reference(Location) | ||||
Is Modifier | false | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
284. InsurancePlan.plan:drug-plan.network | |||||
Definition | Reference to the network that providing the type of coverage. | ||||
Short | Pharmacy benefit types that are part of the drug plan | ||||
Comments | Networks are represented as a hierarchy of organization resources. | ||||
Control | 0..* | ||||
Type | Reference(Organization) | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
286. InsurancePlan.plan:drug-plan.generalCost | |||||
Definition | Overall costs associated with the plan. | ||||
Short | Overall costs | ||||
Control | 0..* | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
288. InsurancePlan.plan:drug-plan.generalCost.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
290. InsurancePlan.plan:drug-plan.generalCost.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
292. InsurancePlan.plan:drug-plan.generalCost.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
294. InsurancePlan.plan:drug-plan.generalCost.type | |||||
Definition | Type of cost. | ||||
Short | Type of cost | ||||
Control | 0..1 | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
296. InsurancePlan.plan:drug-plan.generalCost.groupSize | |||||
Definition | Number of participants enrolled in the plan. | ||||
Short | Number of enrollees | ||||
Control | 0..1 | ||||
Type | positiveInt | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
298. InsurancePlan.plan:drug-plan.generalCost.cost | |||||
Definition | Value of the cost. | ||||
Short | Cost value | ||||
Control | 0..1 | ||||
Type | Money | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
300. InsurancePlan.plan:drug-plan.generalCost.comment | |||||
Definition | Additional information about the general costs associated with this plan. | ||||
Short | Additional cost information | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
302. InsurancePlan.plan:drug-plan.specificCost | |||||
Definition | Costs associated with the coverage provided by the product. | ||||
Short | Pharmacy benefit type specific cost | ||||
Control | 1..* | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
304. InsurancePlan.plan:drug-plan.specificCost.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
306. InsurancePlan.plan:drug-plan.specificCost.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
308. InsurancePlan.plan:drug-plan.specificCost.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
310. InsurancePlan.plan:drug-plan.specificCost.category | |||||
Definition | General category of benefit (Medical; Dental; Vision; Drug; Mental Health; Substance Abuse; Hospice, Home Health). | ||||
Short | Pharmacy Benefit Type | ||||
Control | 1..1 | ||||
Binding | Unless not suitable, these codes SHALL be taken from Pharmacy benefit types (extensible to http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/PharmacyBenefitTypeVS ) | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
312. InsurancePlan.plan:drug-plan.specificCost.benefit | |||||
Definition | List of the specific benefits under this category of benefit. | ||||
Short | Drug tier benefit | ||||
Control | 1..* | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
314. InsurancePlan.plan:drug-plan.specificCost.benefit.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
316. InsurancePlan.plan:drug-plan.specificCost.benefit.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
318. InsurancePlan.plan:drug-plan.specificCost.benefit.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
320. InsurancePlan.plan:drug-plan.specificCost.benefit.type | |||||
Definition | Type of specific benefit (preventative; primary care office visit; speciality office visit; hospitalization; emergency room; urgent care). | ||||
Short | Type of specific benefit | ||||
Control | 1..1 | ||||
Binding | Unless not suitable, these codes SHALL be taken from Drug tier of medication in health plan (extensible to http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/DrugTierVS ) | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
322. InsurancePlan.plan:drug-plan.specificCost.benefit.cost | |||||
Definition | List of the costs associated with a specific benefit. | ||||
Short | List of the costs | ||||
Control | 1..* | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
Slicing | This element introduces a set of slices on InsurancePlan.plan.specificCost.benefit.cost . The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
324. InsurancePlan.plan:drug-plan.specificCost.benefit.cost.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
326. InsurancePlan.plan:drug-plan.specificCost.benefit.cost.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
328. InsurancePlan.plan:drug-plan.specificCost.benefit.cost.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
330. InsurancePlan.plan:drug-plan.specificCost.benefit.cost.type | |||||
Definition | Type of cost (copay; individual cap; family cap; coinsurance; deductible). | ||||
Short | Type of cost | ||||
Control | 1..1 | ||||
Binding | Unless not suitable, these codes SHALL be taken from Benefit type of cost (extensible to http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/BenefitCostTypeVS ) | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
332. InsurancePlan.plan:drug-plan.specificCost.benefit.cost.applicability | |||||
Definition | Whether the cost applies to in-network or out-of-network providers (in-network; out-of-network; other). | ||||
Short | in-network | out-of-network | other | ||||
Control | 0..1 | ||||
Binding | The codes SHALL be taken from BenefitCostApplicability (required to http://hl7.org/fhir/ValueSet/insuranceplan-applicability|4.0.1 )Whether the cost applies to in-network or out-of-network providers. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
334. InsurancePlan.plan:drug-plan.specificCost.benefit.cost.qualifiers | |||||
Definition | Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA). | ||||
Short | Additional information about the cost | ||||
Control | 1..1 | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
336. InsurancePlan.plan:drug-plan.specificCost.benefit.cost.value | |||||
Definition | The actual cost value. (some of the costs may be represented as percentages rather than currency, e.g. 10% coinsurance). | ||||
Short | The actual cost value | ||||
Control | 0..1 | ||||
Type | Quantity | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
338. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay | |||||
Slice Name | copay | ||||
Definition | List of the costs associated with a specific benefit. | ||||
Short | Copay costs | ||||
Control | 0..1 | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
340. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
342. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
344. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
346. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.type | |||||
Definition | Type of cost (copay; individual cap; family cap; coinsurance; deductible). | ||||
Short | Type of cost | ||||
Control | 1..1 | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Pattern Value | { | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
348. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.applicability | |||||
Definition | Whether the cost applies to in-network or out-of-network providers (in-network; out-of-network; other). | ||||
Short | in-network | out-of-network | other | ||||
Control | 0..1 | ||||
Binding | The codes SHALL be taken from BenefitCostApplicability (required to http://hl7.org/fhir/ValueSet/insuranceplan-applicability|4.0.1 )Whether the cost applies to in-network or out-of-network providers. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
350. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.qualifiers | |||||
Definition | Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA). | ||||
Short | Additional information about the cost | ||||
Control | 0..* | ||||
Binding | The codes SHALL be taken from Qualifier of copay amount (required to http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/CopayOptionVS ) | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
352. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.value | |||||
Definition | There SHALL be a code if there is a value and it SHALL be an expression of currency. If system is present, it SHALL be ISO 4217 (system = "urn:iso:std:iso:4217" - currency). | ||||
Short | An amount of money. With regard to precision, see [Decimal Precision](datatypes.html#precision) | ||||
Comments | The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator. | ||||
Control | 1..1 This element is affected by the following invariants: ele-1 | ||||
Type | Quantity(MoneyQuantity) | ||||
Is Modifier | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )mqty-1: There SHALL be a code if there is a value and it SHALL be an expression of currency. If system is present, it SHALL be ISO 4217 (system = "urn:iso:std:iso:4217" - currency). ( (code.exists() or value.empty()) and (system.empty() or system = 'urn:iso:std:iso:4217') )qty-3: If a code for the unit is present, the system SHALL also be present ( code.empty() or system.exists() ) | ||||
354. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.value.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
356. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.value.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
Slicing | This element introduces a set of slices on InsurancePlan.plan.specificCost.benefit.cost.value.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
358. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.value.value | |||||
Definition | The value of the measured amount. The value includes an implicit precision in the presentation of the value. | ||||
Short | Numerical value (with implicit precision) | ||||
Comments | The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books). | ||||
Control | 1..1 | ||||
Type | decimal | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Must Support | true | ||||
Summary | true | ||||
Requirements | Precision is handled implicitly in almost all cases of measurement. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
360. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.value.comparator | |||||
Definition | How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value. | ||||
Short | < | <= | >= | > - how to understand the value | ||||
Control | 0..1 | ||||
Binding | The codes SHALL be taken from QuantityComparator (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1 )How the Quantity should be understood and represented. | ||||
Type | code | ||||
Is Modifier | true because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Requirements | Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology. | ||||
Meaning if Missing | If there is no comparator, then there is no modification of the value | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
362. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.value.unit | |||||
Definition | A human-readable form of the unit. | ||||
Short | Unit representation | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Requirements | There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
364. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.value.system | |||||
Definition | The identification of the system that provides the coded form of the unit. | ||||
Short | System that defines coded unit form | ||||
Control | 0..1 This element is affected by the following invariants: qty-3 | ||||
Type | uri | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Requirements | Need to know the system that defines the coded form of the unit. | ||||
Pattern Value | urn:iso:std:iso:4217 | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
366. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.value.code | |||||
Definition | A computer processable form of the unit in some unit representation system. | ||||
Short | Coded form of the unit | ||||
Comments | The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system. | ||||
Control | 0..1 | ||||
Type | code | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Requirements | Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest. | ||||
Pattern Value | USD | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
368. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance | |||||
Slice Name | coinsurance | ||||
Definition | List of the costs associated with a specific benefit. | ||||
Short | Coinsurance costs | ||||
Control | 0..1 | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
370. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
372. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
374. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
376. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.type | |||||
Definition | Type of cost (copay; individual cap; family cap; coinsurance; deductible). | ||||
Short | Type of cost | ||||
Control | 1..1 | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Pattern Value | { | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
378. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.applicability | |||||
Definition | Whether the cost applies to in-network or out-of-network providers (in-network; out-of-network; other). | ||||
Short | in-network | out-of-network | other | ||||
Control | 0..1 | ||||
Binding | The codes SHALL be taken from BenefitCostApplicability (required to http://hl7.org/fhir/ValueSet/insuranceplan-applicability|4.0.1 )Whether the cost applies to in-network or out-of-network providers. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
380. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.qualifiers | |||||
Definition | Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA). | ||||
Short | Additional information about the cost | ||||
Control | 0..* | ||||
Binding | The codes SHALL be taken from Qualifier for coinsurance rate (required to http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/CoinsuranceOptionVS ) | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
382. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.value | |||||
Definition | The actual cost value. (some of the costs may be represented as percentages rather than currency, e.g. 10% coinsurance). | ||||
Short | The actual cost value | ||||
Control | 1..1 | ||||
Type | Quantity | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
384. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.value.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
386. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.value.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
Slicing | This element introduces a set of slices on InsurancePlan.plan.specificCost.benefit.cost.value.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
388. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.value.value | |||||
Definition | The value of the measured amount. The value includes an implicit precision in the presentation of the value. | ||||
Short | Numerical value (with implicit precision) | ||||
Comments | The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books). | ||||
Control | 1..1 | ||||
Type | decimal | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Must Support | true | ||||
Summary | true | ||||
Requirements | Precision is handled implicitly in almost all cases of measurement. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
390. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.value.comparator | |||||
Definition | How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value. | ||||
Short | < | <= | >= | > - how to understand the value | ||||
Control | 0..1 | ||||
Binding | The codes SHALL be taken from QuantityComparator (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1 )How the Quantity should be understood and represented. | ||||
Type | code | ||||
Is Modifier | true because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Requirements | Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology. | ||||
Meaning if Missing | If there is no comparator, then there is no modification of the value | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
392. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.value.unit | |||||
Definition | A human-readable form of the unit. | ||||
Short | Unit representation | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Requirements | There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
394. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.value.system | |||||
Definition | The identification of the system that provides the coded form of the unit. | ||||
Short | System that defines coded unit form | ||||
Control | 0..1 This element is affected by the following invariants: qty-3 | ||||
Type | uri | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Requirements | Need to know the system that defines the coded form of the unit. | ||||
Pattern Value | http://unitsofmeasure.org | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
396. InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.value.code | |||||
Definition | A computer processable form of the unit in some unit representation system. | ||||
Short | Coded form of the unit | ||||
Comments | The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system. | ||||
Control | 0..1 | ||||
Type | code | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Requirements | Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest. | ||||
Pattern Value | % | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |