abstractbaseDefinitioncopyrightdate- Values Differ
descriptionexperimentalfhirVersionjurisdiction
jurisdiction[0]kindnamepublisherpurposestatustitletypeurlversion- Values Differ
| Left: | Payer Insurance Plan (http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PayerInsurancePlan) |
| Right: | Payer Insurance Plan (http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PayerInsurancePlan) |
| Error | StructureDefinition.version | Values for version differ: '2.1.0' vs '3.0.0-ballot' |
| Information | StructureDefinition.date | Values for date differ: '2025-02-26T17:11:51+00:00' vs '2026-11-09T20:57:19+00:00' |
| Information | InsurancePlan.language | Example/preferred bindings differ at InsurancePlan.language using binding from PayerInsurancePlan |
| Name | Value | Comments | |
|---|---|---|---|
| abstract | false | ||
| baseDefinition | http://hl7.org/fhir/StructureDefinition/InsurancePlan | ||
| copyright | |||
| date | 2025-02-26T17:11:51+00:00 | 2026-11-09T20:57:19+00:00 |
|
| description | The Payer InsurancePlan that defines the health insurance product, which include coverage benefits that are offered, and additional information about the offering, such as a coverage area, contact information, brochure locations, etc. The health insurance product offers one or more types of coverage, each of which may define a plan of covered benefits with the particular cost sharing structure offered to a consumer. Health insurance plans that include drug coverage reference a formulary that provides details about drugs that are covered under the plan including requirements and limitations of the coverage specific to each drug. | ||
| experimental | |||
| fhirVersion | 4.0.1 | ||
| jurisdiction | |||
| jurisdiction[0] | urn:iso:std:iso:3166#US | ||
| kind | resource | ||
| name | PayerInsurancePlan | ||
| publisher | HL7 International / Pharmacy | ||
| purpose | |||
| status | active | ||
| title | Payer Insurance Plan | ||
| type | InsurancePlan | ||
| url | http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PayerInsurancePlan | ||
| version | 2.1.0 | 3.0.0-ballot |
|
| Name | L Flags | L Card. | L Type | L Description & Constraints | R Flags | R Card. | R Type | R Description & Constraints | Comments | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
 InsurancePlan | C | 0..* | InsurancePlan | Details of a Health Insurance product/plan provided by an organization | C | 0..* | InsurancePlan | Details of a Health Insurance product/plan provided by an organization | |||||||||
 id | 0..1 | id | Logical id of this artifact | 0..1 | id | Logical id of this artifact | |||||||||||
 meta | 0..1 | Meta | Metadata about the resource | 0..1 | Meta | Metadata about the resource | |||||||||||
 id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
 Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||||||
| versionId | 0..1 | id | Version specific identifier | 0..1 | id | Version specific identifier | |||||||||||
| lastUpdated | 1..1 | instant | When the resource version last changed | 1..1 | instant | When the resource version last changed | |||||||||||
| source | 0..1 | uri | Identifies where the resource comes from | 0..1 | uri | Identifies where the resource comes from | |||||||||||
| profile | 0..* | canonical(StructureDefinition) | Profiles this resource claims to conform to | 0..* | canonical(StructureDefinition) | Profiles this resource claims to conform to | |||||||||||
| security | 0..* | Coding | Security Labels applied to this resource Binding: ?? (extensible): Security Labels from the Healthcare Privacy and Security Classification System. | 0..* | Coding | Security Labels applied to this resource Binding: ?? (extensible): Security Labels from the Healthcare Privacy and Security Classification System. | |||||||||||
| tag | 0..* | Coding | Tags applied to this resource Binding: ?? (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". | 0..* | Coding | Tags applied to this resource Binding: ?? (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". | |||||||||||
| implicitRules | 0..1 | uri | A set of rules under which this content was created | 0..1 | uri | A set of rules under which this content was created | |||||||||||
| language | 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language.
| 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language.
|
| ||||||||||
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements | |||||||||||
| contained | 0..* | Resource | Contained, inline Resources | 0..* | Resource | Contained, inline Resources | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
 modifierExtension | 0..* | Extension | Extensions that cannot be ignored | 0..* | Extension | Extensions that cannot be ignored | |||||||||||
| identifier | C | 1..* | Identifier | 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. | C | 1..* | Identifier | 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. | |||||||||
| status | 1..1 | code | draft | active | retired | unknown Binding: ?? (required): The lifecycle status of an artifact. | 1..1 | code | draft | active | retired | unknown Binding: ?? (required): The lifecycle status of an artifact. | |||||||||||
| type | 1..1 | CodeableConcept | Product type Binding: ?? (extensible) | 1..1 | CodeableConcept | Product type Binding: ?? (extensible) | |||||||||||
| name | C | 0..1 | string | Official name | C | 0..1 | string | Official name | |||||||||
| alias | 0..* | string | Alternate names | 0..* | string | Alternate names | |||||||||||
| period | 0..1 | Period | When the product is available | 0..1 | Period | When the product is available | |||||||||||
| ownedBy | 0..1 | Reference(Organization) | Plan issuer | 0..1 | Reference(Organization) | Plan issuer | |||||||||||
| administeredBy | 0..1 | Reference(Organization) | Product administrator | 0..1 | Reference(Organization) | Product administrator | |||||||||||
| coverageArea | 0..* | Reference(Insurance Plan Location) | Where product applies | 0..* | Reference(Insurance Plan Location) | Where product applies | |||||||||||
| contact | 0..* | BackboneElement | Contact information for the Insurance Plan including URLs for brochure and formulary information | 0..* | BackboneElement | Contact information for the Insurance Plan including URLs for brochure and formulary information | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||||
| purpose | 0..1 | CodeableConcept | The type of contact Binding: ?? (extensible) | 0..1 | CodeableConcept | The type of contact Binding: ?? (extensible) | |||||||||||
| name | 0..1 | HumanName | A name associated with the contact | 0..1 | HumanName | A name associated with the contact | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||||||
| use | 0..1 | code | usual | official | temp | nickname | anonymous | old | maiden Binding: ?? (required): The use of a human name. | 0..1 | code | usual | official | temp | nickname | anonymous | old | maiden Binding: ?? (required): The use of a human name. | |||||||||||
| text | 0..1 | string | Text representation of the full name | 0..1 | string | Text representation of the full name | |||||||||||
| family | 0..1 | string | Family name (often called 'Surname') | 0..1 | string | Family name (often called 'Surname') | |||||||||||
| given | 0..* | string | Given names (not always 'first'). Includes middle names This repeating element order: Given Names appear in the correct order for presenting the name | 0..* | string | Given names (not always 'first'). Includes middle names This repeating element order: Given Names appear in the correct order for presenting the name | |||||||||||
| prefix | 0..* | string | Parts that come before the name This repeating element order: Prefixes appear in the correct order for presenting the name | 0..* | string | Parts that come before the name This repeating element order: Prefixes appear in the correct order for presenting the name | |||||||||||
| suffix | 0..* | string | Parts that come after the name This repeating element order: Suffixes appear in the correct order for presenting the name | 0..* | string | Parts that come after the name This repeating element order: Suffixes appear in the correct order for presenting the name | |||||||||||
| period | 0..1 | Period | Time period when name was/is in use | 0..1 | Period | Time period when name was/is in use | |||||||||||
| telecom | 0..* | ContactPoint | Contact details (telephone, email, etc.) for a contact | 0..* | ContactPoint | Contact details (telephone, email, etc.) for a contact | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||||||
| system | C | 0..1 | code | phone | fax | email | pager | url | sms | other Binding: ?? (required): Telecommunications form for contact point. | C | 0..1 | code | phone | fax | email | pager | url | sms | other Binding: ?? (required): Telecommunications form for contact point. | |||||||||
| value | 0..1 | string | The actual contact point details | 0..1 | string | The actual contact point details | |||||||||||
| use | 0..1 | code | home | work | temp | old | mobile - purpose of this contact point Binding: ?? (required): Use of contact point. | 0..1 | code | home | work | temp | old | mobile - purpose of this contact point Binding: ?? (required): Use of contact point. | |||||||||||
| rank | 0..1 | positiveInt | Specify preferred order of use (1 = highest) | 0..1 | positiveInt | Specify preferred order of use (1 = highest) | |||||||||||
| period | 0..1 | Period | Time period when the contact point was/is in use | 0..1 | Period | Time period when the contact point was/is in use | |||||||||||
| address | 0..1 | Address | Visiting or postal addresses for the contact | 0..1 | Address | Visiting or postal addresses for the contact | |||||||||||
| endpoint | 0..* | Reference(Endpoint) | Technical endpoint | 0..* | Reference(Endpoint) | Technical endpoint | |||||||||||
| network | 0..* | Reference(Organization) | What networks are Included | 0..* | Reference(Organization) | What networks are Included | |||||||||||
| Slices for coverage | 1..* | BackboneElement | Coverage details Slice: Unordered, Open by pattern:type Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | 1..* | BackboneElement | Coverage details Slice: Unordered, Open by pattern:type Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||||
| type | 1..1 | CodeableConcept | Type of coverage | 1..1 | CodeableConcept | Type of coverage | |||||||||||
| network | 0..* | Reference(Organization) | What networks provide coverage | 0..* | Reference(Organization) | What networks provide coverage | |||||||||||
 benefit | 1..* | BackboneElement | List of benefits | 1..* | BackboneElement | List of benefits | |||||||||||
 id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||||
| type | 1..1 | CodeableConcept | Type of benefit | 1..1 | CodeableConcept | Type of benefit | |||||||||||
| requirement | 0..1 | string | Referral requirements | 0..1 | string | Referral requirements | |||||||||||
| limit | 0..* | BackboneElement | Benefit limits | 0..* | BackboneElement | Benefit limits | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||||
| value | 0..1 | Quantity | Maximum value allowed | 0..1 | Quantity | Maximum value allowed | |||||||||||
| code | 0..1 | CodeableConcept | Benefit limit details | 0..1 | CodeableConcept | Benefit limit details | |||||||||||
| Slices for plan | 1..* | BackboneElement | Plan details Slice: Unordered, Open by pattern:type Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | 1..* | BackboneElement | Plan details Slice: Unordered, Open by pattern:type Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||||
| identifier | 0..* | Identifier | Business Identifier for Product | 0..* | Identifier | Business Identifier for Product | |||||||||||
| type | 0..1 | CodeableConcept | Type of plan Binding: ?? (extensible) | 0..1 | CodeableConcept | Type of plan Binding: ?? (extensible) | |||||||||||
| coverageArea | 0..* | Reference(Location) | Where product applies | 0..* | Reference(Location) | Where product applies | |||||||||||
| network | 0..* | Reference(Organization) | What networks provide coverage | 0..* | Reference(Organization) | What networks provide coverage | |||||||||||
| generalCost | 0..* | BackboneElement | Overall costs | 0..* | BackboneElement | Overall costs | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||||
| type | 0..1 | CodeableConcept | Type of cost | 0..1 | CodeableConcept | Type of cost | |||||||||||
| groupSize | 0..1 | positiveInt | Number of enrollees | 0..1 | positiveInt | Number of enrollees | |||||||||||
| cost | 0..1 | Money | Cost value | 0..1 | Money | Cost value | |||||||||||
| comment | 0..1 | string | Additional cost information | 0..1 | string | Additional cost information | |||||||||||
| specificCost | 0..* | BackboneElement | Specific costs | 0..* | BackboneElement | Specific costs | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||||
| category | 1..1 | CodeableConcept | General category of benefit | 1..1 | CodeableConcept | General category of benefit | |||||||||||
| benefit | 0..* | BackboneElement | Benefits list | 0..* | BackboneElement | Benefits list | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||||
| type | 1..1 | CodeableConcept | Type of specific benefit | 1..1 | CodeableConcept | Type of specific benefit | |||||||||||
| cost | 0..* | BackboneElement | List of the costs | 0..* | BackboneElement | List of the costs | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||||
| type | 1..1 | CodeableConcept | Type of cost | 1..1 | CodeableConcept | Type of cost | |||||||||||
| applicability | 0..1 | CodeableConcept | in-network | out-of-network | other Binding: ?? (required): Whether the cost applies to in-network or out-of-network providers. | 0..1 | CodeableConcept | in-network | out-of-network | other Binding: ?? (required): Whether the cost applies to in-network or out-of-network providers. | |||||||||||
| qualifiers | 0..* | CodeableConcept | Additional information about the cost | 0..* | CodeableConcept | Additional information about the cost | |||||||||||
| value | 0..1 | Quantity | The actual cost value | 0..1 | Quantity | The actual cost value | |||||||||||
| Documentation for this format | |||||||||||||||||