DaVinci Payer Data Exchange (PDex) US Drug Formulary
2.1.0 - STU2.1 United States of America flag

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

: InsurancePlanCoverageExample

Page standards status: Informative

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

<http://hl7.org/fhir/Coverage/InsurancePlanCoverageExample> a fhir:Coverage ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:Resource.id [ fhir:value "InsurancePlanCoverageExample"] ;
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/insurance-plan-coverage" ;
       fhir:index -1 ;
       fhir:link <http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/insurance-plan-coverage>
     ]
  ] ;
  fhir:Resource.language [ fhir:value "en"] ;
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "extensions" ] ;
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Coverage InsurancePlanCoverageExample</b></p><a name=\"InsurancePlanCoverageExample\"> </a><a name=\"hcInsurancePlanCoverageExample\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-insurance-plan-coverage.html\">Insurance Plan Coverage</a></p></div><p><b>R5: Insurance plan details (new)</b>: <a href=\"InsurancePlan-PayerInsurancePlanA1002.html\">InsurancePlan Sample Medicare Advantage Plan A1002</a></p><p><b>identifier</b>: Member Number/88800933501</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{https://nahdo.org/sopt 3712}, {http://terminology.hl7.org/CodeSystem/v3-ActCode PPO}\">PPO</span></p><p><b>subscriberId</b>: 888009335</p><p><b>beneficiary</b>: <a href=\"Patient-example.html\">Amy V. Baxter  Female, DoB: 1987-02-20 ( Medical Record Number: 1032702 (use: usual, ))</a></p><p><b>relationship</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship self}\">Self</span></p><p><b>period</b>: 2020-01-01 --&gt; (ongoing)</p><p><b>payor</b>: <a href=\"Organization-acme-payer.html\">Acme Health Plan</a></p><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/coverage-class group}\">An employee group</span></p><p><b>value</b>: xyz</p><p><b>name</b>: XYZ employee Group Plan</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/coverage-class plan}\">A specific suite of benefits.</span></p><p><b>value</b>: gold</p><p><b>name</b>: Acme Gold Plan</p></blockquote></div>"
  ] ;
  fhir:DomainResource.extension [
     fhir:index -1 ;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.insurancePlan" ] ;
     fhir:Extension.valueReference [
       fhir:link <http://hl7.org/fhir/InsurancePlan/PayerInsurancePlanA1002> ;
       fhir:Reference.reference [ fhir:value "InsurancePlan/PayerInsurancePlanA1002" ]
     ]
  ] ;
  fhir:Coverage.identifier [
     fhir:index -1 ;
     fhir:Identifier.type [
       fhir:CodeableConcept.coding [
         fhir:index -1 ;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v2-0203" ] ;
         fhir:Coding.code [ fhir:value "MB" ] ;
         fhir:Coding.display [ fhir:value "Member Number" ]
       ]
     ] ;
     fhir:Identifier.system [ fhir:value "http://example.org/fhir/memberidentifier" ] ;
     fhir:Identifier.value [ fhir:value "88800933501" ]
  ] ;
  fhir:Coverage.status [ fhir:value "active"] ;
  fhir:Coverage.type [
     fhir:CodeableConcept.coding [
       fhir:index -1 ;
       fhir:Coding.system [ fhir:value "https://nahdo.org/sopt" ] ;
       fhir:Coding.code [ fhir:value "3712" ] ;
       fhir:Coding.display [ fhir:value "PPO" ]
     ], [
       fhir:index -1 ;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v3-ActCode" ] ;
       fhir:Coding.code [ fhir:value "PPO" ] ;
       fhir:Coding.display [ fhir:value "preferred provider organization policy" ]
     ] ;
     fhir:CodeableConcept.text [ fhir:value "PPO" ]
  ] ;
  fhir:Coverage.subscriberId [ fhir:value "888009335"] ;
  fhir:Coverage.beneficiary [
     fhir:link <http://hl7.org/fhir/Patient/example> ;
     fhir:Reference.reference [ fhir:value "Patient/example" ]
  ] ;
  fhir:Coverage.relationship [
     fhir:CodeableConcept.coding [
       fhir:index -1 ;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/subscriber-relationship" ] ;
       fhir:Coding.code [ fhir:value "self" ]
     ] ;
     fhir:CodeableConcept.text [ fhir:value "Self" ]
  ] ;
  fhir:Coverage.period [
     fhir:Period.start [ fhir:value "2020-01-01"^^xsd:date ]
  ] ;
  fhir:Coverage.payor [
     fhir:index -1 ;
     fhir:link <http://hl7.org/fhir/Organization/acme-payer> ;
     fhir:Reference.reference [ fhir:value "Organization/acme-payer" ] ;
     fhir:Reference.display [ fhir:value "Acme Health Plan" ]
  ] ;
  fhir:Coverage.class [
     fhir:index -1 ;
     fhir:Coverage.class.type [
       fhir:CodeableConcept.coding [
         fhir:index -1 ;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ] ;
         fhir:Coding.code [ fhir:value "group" ] ;
         fhir:Coding.display [ fhir:value "Group" ]
       ] ;
       fhir:CodeableConcept.text [ fhir:value "An employee group" ]
     ] ;
     fhir:Coverage.class.value [ fhir:value "xyz" ] ;
     fhir:Coverage.class.name [ fhir:value "XYZ employee Group Plan" ]
  ], [
     fhir:index -1 ;
     fhir:Coverage.class.type [
       fhir:CodeableConcept.coding [
         fhir:index -1 ;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ] ;
         fhir:Coding.code [ fhir:value "plan" ] ;
         fhir:Coding.display [ fhir:value "Plan" ]
       ] ;
       fhir:CodeableConcept.text [ fhir:value "A specific suite of benefits." ]
     ] ;
     fhir:Coverage.class.value [ fhir:value "gold" ] ;
     fhir:Coverage.class.name [ fhir:value "Acme Gold Plan" ]
  ] .

<http://hl7.org/fhir/InsurancePlan/PayerInsurancePlanA1002> a fhir:InsurancePlan .

<http://hl7.org/fhir/Patient/example> a fhir:Patient .

<http://hl7.org/fhir/Organization/acme-payer> a fhir:Organization .

# - ontology header ------------------------------------------------------------

<http://hl7.org/fhir/Coverage/InsurancePlanCoverageExample.ttl> a owl:Ontology ;
  owl:imports fhir:fhir.ttl ;
  owl:versionIRI <http://build.fhir.org/Coverage/InsurancePlanCoverageExample.ttl> .