National Directory of Healthcare Providers & Services (NDH) Implementation Guide
1.0.0-ballot - ballot
National Directory of Healthcare Providers & Services (NDH) Implementation Guide
1.0.0-ballot - ballot
National Directory of Healthcare Providers & Services (NDH) Implementation Guide, published by HL7 International / Patient Administration. This guide is not an authorized publication; it is the continuous build for version 1.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-us-ndh/ and changes regularly. See the Directory of published versions
| Official URL: http://hl7.org/fhir/us/ndh/StructureDefinition/ndh-ndapi-InsurancePlan | Version: 1.0.0-ballot | |||
| Active as of 2024-03-28 | Computable Name: NdhNdApiInsurancePlan | |||
An InsurancePlan is a discrete package of health insurance coverage benefits that are offered under a particular network type. A given payer’s products typically differ by network type and/or covered benefits. A plan pairs a product’s covered benefits with the particular cost sharing structure offered to a consumer. A given product may comprise multiple plans (i.e. each plan offers different cost sharing requirements for the same set of covered benefits). InsurancePlan describes a health insurance offering comprised of a list of covered benefits (i.e. the product), costs associated with those benefits (i.e. the plan), and additional information about the offering, such as who it is owned and administered by, a coverage area, contact information, etc.
Usage:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from NdhInsurancePlan
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  InsurancePlan | NdhInsurancePlan | |||
  meta | S | 0..1 | Meta | Metadata about the resource |
  profile | 1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to | |
  extension | 1..* | Extension | Extension | |
 extension:verification-status | S | 1..1 | VerificationStatus | NDH Verification Status |
| identifier | ||||
| extension | 1..* | Extension | Extension | |
| extension:identifier-status | S | 1..1 | IdentifierStatus | NDH Identifier Status |
| use | S | 0..1 | code | usual | official | temp | secondary | old (If known) |
| type | S | 0..1 | CodeableConcept | Description of identifier |
| system | S | 0..1 | uri | The namespace for the identifier value |
| value | S | 0..1 | string | The value that is unique |
 assigner | S | 0..1 | Reference(National Directory API Organization Profile) | Organization that issued id (may be just text) |
| alias | S | 0..* | string | Alternate names |
| period | S | 0..1 | Period | When the product is available |
| ownedBy | S | 1..1 | Reference(National Directory API Organization Profile) | Plan issuer |
| administeredBy | S | 1..1 | Reference(National Directory API Organization Profile) | Product administrator |
| coverageArea | 0..* | Reference(National Directory API Location Profile) | Where product applies | |
| contact | S | 0..* | BackboneElement | Contact for the product |
| purpose | S | 0..1 | CodeableConcept | The type of contact |
| name | S | 0..1 | HumanName | A name associated with the contact |
| use | S | 0..1 | code | usual | official | temp | nickname | anonymous | old | maiden |
| text | S | 0..1 | string | Text representation of the full name |
| family | S | 0..1 | string | Family name (often called 'Surname') |
| given | S | 0..* | string | Given names (not always 'first'). Includes middle names |
| prefix | S | 0..* | string | Parts that come before the name |
| suffix | S | 0..* | string | Parts that come after the name |
| period | S | 0..1 | Period | Time period when name was/is in use |
 telecom | S | 0..* | ContactPoint | Contact details (telephone, email, etc.) for a contact |
 extension:contactpoint-availabletime | S | 0..* | ContactPointAvailableTime | NDH Contactpoint Availabletime |
| extension:via-intermediary | S | 0..1 | ViaIntermediary | NDH Via Intermediary |
| system | S | 0..1 | code | phone | fax | email | pager | url | sms | other |
| value | S | 0..1 | string | The actual contact point details |
| use | S | 0..1 | code | home | work | temp | old | mobile - purpose of this contact point |
| rank | S | 0..1 | positiveInt | Specify preferred order of use (1 = highest) |
| endpoint | S | 0..* | Reference(National Directory API Endpoint Profile) | Technical endpoint |
| network | 0..* | Reference(National Directory API Network Profile) | What networks are Included | |
| coverage | S | 0..* | BackboneElement | Coverage details |
| type | S | 1..1 | CodeableConcept | Type of coverage |
| network | 0..* | Reference(National Directory API Network Profile) | What networks provide coverage | |
| benefit | S | 1..* | BackboneElement | List of benefits |
| type | S | 1..1 | CodeableConcept | Type of benefit |
| requirement | S | 0..1 | string | Referral requirements |
| limit | S | 0..* | BackboneElement | Benefit limits |
| value | S | 0..1 | Quantity | Maximum value allowed |
| code | S | 0..1 | CodeableConcept | Benefit limit details |
| plan | S | 0..* | BackboneElement | Cost sharing details for the plan |
| identifier | S | 0..* | Identifier | Business Identifier for Product |
| extension:identifier-status | S | 0..1 | IdentifierStatus | NDH Identifier Status |
| use | S | 0..1 | code | usual | official | temp | secondary | old (If known) |
| type | S | 0..1 | CodeableConcept | Description of identifier |
| system | S | 0..1 | uri | The namespace for the identifier value |
| value | S | 0..1 | string | The value that is unique |
| period | S | 0..1 | Period | Time period when id is/was valid for use |
| assigner | S | 0..1 | Reference(National Directory API Organization Profile) | Organization that issued id (may be just text) |
| type | S | 0..1 | CodeableConcept | Categorization of the cost sharing for the plan |
| coverageArea | S | 0..* | Reference(National Directory API Location Profile) | Where product applies |
| network | S | 0..* | Reference(National Directory API Network Profile) | What networks provide coverage |
| generalCost | S | 0..* | BackboneElement | Overall costs |
| type | S | 0..1 | CodeableConcept | Type of cost |
| groupSize | S | 0..1 | positiveInt | Number of enrollees |
| cost | S | 0..1 | Money | Cost value |
| comment | S | 0..1 | string | Additional cost information |
| specificCost | S | 0..* | BackboneElement | Specific costs |
| category | S | 1..1 | CodeableConcept | General category of benefit |
| benefit | S | 0..* | BackboneElement | Benefits list |
| type | S | 1..1 | CodeableConcept | Type of specific benefit |
| cost | S | 0..* | BackboneElement | List of the costs |
| type | S | 1..1 | CodeableConcept | Type of cost |
| applicability | S | 0..1 | CodeableConcept | in-network | out-of-network | other |
| qualifiers | S | 0..* | CodeableConcept | Additional information about the cost |
| value | S | 0..1 | Quantity | The actual cost value |
| Documentation for this format | ||||
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| InsurancePlan | C | 0..* | NdhInsurancePlan | Details of a Health Insurance product/plan provided by an organization ipn-1: The organization SHALL at least have a name or an idendtifier, and possibly more than one network-or-NatlDirwork: If an insuranceplan does not define a network, then each plan must define one plan-type-is-distinct: Each InsurancePlan.plan should have a distinct plan.type. |
 meta | SΣ | 0..1 | Meta | Metadata about the resource |
 lastUpdated | Σ | 1..1 | instant | When the resource version last changed |
| profile | Σ | 1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to |
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
| Slices for extension | 1..* | Extension | Extension Slice: Unordered, Open by value:url | |
| usage-restriction | 0..* | Reference(NDH Base Restriction) {c} | Usage Restriction URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-usage-restriction | |
| verification-status | S | 1..1 | CodeableConcept | NDH Verification Status URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-verification-status Binding: NDH Verification Status Value Set (extensible) |
 modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
| identifier | SΣC | 0..* | Identifier | Business Identifier for Product |
| Slices for extension | 1..* | Extension | Extension Slice: Unordered, Open by value:url | |
| identifier-status | S | 1..1 | code | NDH Identifier Status URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-identifier-status Binding: Identifier Status Value Set (required) |
| use | ?!SΣ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . |
| type | SΣ | 0..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. |
| system | SΣ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient |
| value | SΣ | 0..1 | string | The value that is unique Example General: 123456 |
| assigner | SΣ | 0..1 | Reference(National Directory API Organization Profile) | Organization that issued id (may be just text) |
| status | ?!SΣ | 1..1 | code | draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact. Fixed Value: active |
| type | SΣ | 1..1 | CodeableConcept | Product Type Binding: Insurance Product Type Value Set (extensible) |
| name | SΣC | 0..1 | string | Official name |
| alias | S | 0..* | string | Alternate names |
| period | S | 0..1 | Period | When the product is available |
| ownedBy | SΣ | 1..1 | Reference(National Directory API Organization Profile) | Plan issuer |
| administeredBy | SΣ | 1..1 | Reference(National Directory API Organization Profile) | Product administrator |
| coverageArea | SΣ | 0..* | Reference(National Directory API Location Profile) | Where product applies |
| contact | S | 0..* | BackboneElement | Contact for the product |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| purpose | S | 0..1 | CodeableConcept | The type of contact Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party. |
| name | S | 0..1 | HumanName | A name associated with the contact |
| use | ?!SΣ | 0..1 | code | usual | official | temp | nickname | anonymous | old | maiden Binding: NameUse (required): The use of a human name. |
| text | SΣ | 0..1 | string | Text representation of the full name |
| family | SΣ | 0..1 | string | Family name (often called 'Surname') |
| given | SΣ | 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 | SΣ | 0..* | string | Parts that come before the name This repeating element order: Prefixes appear in the correct order for presenting the name |
| suffix | SΣ | 0..* | string | Parts that come after the name This repeating element order: Suffixes appear in the correct order for presenting the name |
| period | SΣ | 0..1 | Period | Time period when name was/is in use |
| telecom | S | 0..* | ContactPoint | Contact details (telephone, email, etc.) for a contact |
| contactpoint-availabletime | S | 0..* | (Complex) | NDH Contactpoint Availabletime URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-contactpoint-availabletime |
| via-intermediary | S | 0..1 | Reference(NDH Base PractitionerRole | NDH Base OrganizationAffiliation Profile | NDH Base Location Profile | NDH Base Organization Profile) | NDH Via Intermediary URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-via-intermediary |
| system | SΣC | 0..1 | code | phone | fax | email | pager | url | sms | other Binding: ContactPointSystem (required): Telecommunications form for contact point. |
| value | SΣ | 0..1 | string | The actual contact point details |
| use | ?!SΣ | 0..1 | code | home | work | temp | old | mobile - purpose of this contact point Binding: ContactPointUse (required): Use of contact point. |
| rank | SΣ | 0..1 | positiveInt | Specify preferred order of use (1 = highest) |
| endpoint | S | 0..* | Reference(National Directory API Endpoint Profile) | Technical endpoint |
| network | S | 0..* | Reference(National Directory API Network Profile) | What networks are Included |
| coverage | S | 0..* | BackboneElement | Coverage details |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | S | 1..1 | CodeableConcept | Type of coverage Binding: NDH Insurance Coverage Type Value Set (extensible) |
| network | S | 0..* | Reference(National Directory API Network Profile) | What networks provide coverage |
| benefit | S | 1..* | BackboneElement | List of benefits |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | S | 1..1 | CodeableConcept | Type of benefit Binding: NDH Benefit Type Value Set (extensible) |
| requirement | S | 0..1 | string | Referral requirements |
| limit | S | 0..* | BackboneElement | Benefit limits |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| value | S | 0..1 | Quantity | Maximum value allowed |
| code | S | 0..1 | CodeableConcept | Benefit limit details |
| plan | S | 0..* | BackboneElement | Cost sharing details for the plan |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| identifier | SΣ | 0..* | Identifier | Business Identifier for Product |
| identifier-status | S | 0..1 | code | NDH Identifier Status URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-identifier-status Binding: Identifier Status Value Set (required) |
| use | ?!SΣ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . |
| type | SΣ | 0..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. |
| system | SΣ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient |
| value | SΣ | 0..1 | string | The value that is unique Example General: 123456 |
| period | SΣ | 0..1 | Period | Time period when id is/was valid for use |
| assigner | SΣ | 0..1 | Reference(National Directory API Organization Profile) | Organization that issued id (may be just text) |
| type | S | 0..1 | CodeableConcept | Categorization of the cost sharing for the plan Binding: Insurance Plan Type Value Set (extensible) |
| coverageArea | SΣ | 0..* | Reference(National Directory API Location Profile) | Where product applies |
| network | S | 0..* | Reference(National Directory API Network Profile) | What networks provide coverage |
| generalCost | S | 0..* | BackboneElement | Overall costs |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | S | 0..1 | CodeableConcept | Type of cost |
| groupSize | S | 0..1 | positiveInt | Number of enrollees |
| cost | S | 0..1 | Money | Cost value |
| comment | S | 0..1 | string | Additional cost information |
| specificCost | S | 0..* | BackboneElement | Specific costs |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| category | S | 1..1 | CodeableConcept | General category of benefit |
| benefit | S | 0..* | BackboneElement | Benefits list |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | S | 1..1 | CodeableConcept | Type of specific benefit |
| cost | S | 0..* | BackboneElement | List of the costs |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | S | 1..1 | CodeableConcept | Type of cost |
| applicability | S | 0..1 | CodeableConcept | in-network | out-of-network | other Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers. |
| qualifiers | S | 0..* | CodeableConcept | Additional information about the cost |
| value | S | 0..1 | Quantity | The actual cost value |
| Documentation for this format | ||||
| Path | Conformance | ValueSet / Code | URI |
| InsurancePlan.identifier.use | required | IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1from the FHIR Standard | |
| InsurancePlan.identifier.type | extensible | Identifier Type Codeshttp://hl7.org/fhir/ValueSet/identifier-typefrom the FHIR Standard | |
| InsurancePlan.status | required | Fixed Value: activehttp://hl7.org/fhir/ValueSet/publication-status|4.0.1from the FHIR Standard | |
| InsurancePlan.type | extensible | InsuranceProductTypeVS (a valid code from Insurance Product Type Code System)http://hl7.org/fhir/us/ndh/ValueSet/InsuranceProductTypeVSfrom this IG | |
| InsurancePlan.contact.purpose | extensible | ContactEntityTypehttp://hl7.org/fhir/ValueSet/contactentity-typefrom the FHIR Standard | |
| InsurancePlan.contact.name.use | required | NameUsehttp://hl7.org/fhir/ValueSet/name-use|4.0.1from the FHIR Standard | |
| InsurancePlan.contact.telecom.system | required | ContactPointSystemhttp://hl7.org/fhir/ValueSet/contact-point-system|4.0.1from the FHIR Standard | |
| InsurancePlan.contact.telecom.use | required | ContactPointUsehttp://hl7.org/fhir/ValueSet/contact-point-use|4.0.1from the FHIR Standard | |
| InsurancePlan.coverage.type | extensible | NdhCoverageTypeVShttp://hl7.org/fhir/us/ndh/ValueSet/NdhCoverageTypeVSfrom this IG | |
| InsurancePlan.coverage.benefit.type | extensible | NdhBenefitTypeVShttp://hl7.org/fhir/us/ndh/ValueSet/NdhBenefitTypeVSfrom this IG | |
| InsurancePlan.plan.identifier.use | required | IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1from the FHIR Standard | |
| InsurancePlan.plan.identifier.type | extensible | Identifier Type Codeshttp://hl7.org/fhir/ValueSet/identifier-typefrom the FHIR Standard | |
| InsurancePlan.plan.type | extensible | InsurancePlanTypeVS (a valid code from Insurance Plan Type Code System)http://hl7.org/fhir/us/ndh/ValueSet/InsurancePlanTypeVSfrom this IG | |
| InsurancePlan.plan.specificCost.benefit.cost.applicability | required | BenefitCostApplicabilityhttp://hl7.org/fhir/ValueSet/insuranceplan-applicability|4.0.1from the FHIR Standard |
| Name | Flags | Card. | Type | Description & Constraints | ||||
|---|---|---|---|---|---|---|---|---|
| InsurancePlan | C | 0..* | NdhInsurancePlan | Details of a Health Insurance product/plan provided by an organization ipn-1: The organization SHALL at least have a name or an idendtifier, and possibly more than one network-or-NatlDirwork: If an insuranceplan does not define a network, then each plan must define one plan-type-is-distinct: Each InsurancePlan.plan should have a distinct plan.type. | ||||
| id | Σ | 0..1 | id | Logical id of this artifact | ||||
| meta | SΣ | 0..1 | Meta | Metadata about the resource | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| versionId | Σ | 0..1 | id | Version specific identifier | ||||
| lastUpdated | Σ | 1..1 | instant | When the resource version last changed | ||||
| source | Σ | 0..1 | uri | Identifies where the resource comes from | ||||
| profile | Σ | 1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to | ||||
| security | Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. | ||||
| tag | Σ | 0..* | Coding | Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". | ||||
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
| language | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
| contained | 0..* | Resource | Contained, inline Resources | |||||
| Slices for extension | 1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| usage-restriction | 0..* | Reference(NDH Base Restriction) {c} | Usage Restriction URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-usage-restriction | |||||
| verification-status | S | 1..1 | CodeableConcept | NDH Verification Status URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-verification-status Binding: NDH Verification Status Value Set (extensible) | ||||
| modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ||||
| identifier | SΣC | 0..* | Identifier | Business Identifier for Product | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension | 1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| identifier-status | S | 1..1 | code | NDH Identifier Status URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-identifier-status Binding: Identifier Status Value Set (required) | ||||
| use | ?!SΣ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
| type | SΣ | 0..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. | ||||
| system | SΣ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | ||||
| value | SΣ | 0..1 | string | The value that is unique Example General: 123456 | ||||
| period | Σ | 0..1 | Period | Time period when id is/was valid for use | ||||
| assigner | SΣ | 0..1 | Reference(National Directory API Organization Profile) | Organization that issued id (may be just text) | ||||
| status | ?!SΣ | 1..1 | code | draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact. Fixed Value: active | ||||
| type | SΣ | 1..1 | CodeableConcept | Product Type Binding: Insurance Product Type Value Set (extensible) | ||||
| name | SΣC | 0..1 | string | Official name | ||||
| alias | S | 0..* | string | Alternate names | ||||
| period | S | 0..1 | Period | When the product is available | ||||
| ownedBy | SΣ | 1..1 | Reference(National Directory API Organization Profile) | Plan issuer | ||||
| administeredBy | SΣ | 1..1 | Reference(National Directory API Organization Profile) | Product administrator | ||||
| coverageArea | SΣ | 0..* | Reference(National Directory API Location Profile) | Where product applies | ||||
| contact | S | 0..* | BackboneElement | Contact for the product | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| purpose | S | 0..1 | CodeableConcept | The type of contact Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party. | ||||
| name | S | 0..1 | HumanName | A name associated with the contact | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| use | ?!SΣ | 0..1 | code | usual | official | temp | nickname | anonymous | old | maiden Binding: NameUse (required): The use of a human name. | ||||
| text | SΣ | 0..1 | string | Text representation of the full name | ||||
| family | SΣ | 0..1 | string | Family name (often called 'Surname') | ||||
| given | SΣ | 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 | SΣ | 0..* | string | Parts that come before the name This repeating element order: Prefixes appear in the correct order for presenting the name | ||||
| suffix | SΣ | 0..* | string | Parts that come after the name This repeating element order: Suffixes appear in the correct order for presenting the name | ||||
| period | SΣ | 0..1 | Period | Time period when name was/is in use | ||||
| telecom | S | 0..* | ContactPoint | Contact details (telephone, email, etc.) for a contact | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| contactpoint-availabletime | S | 0..* | (Complex) | NDH Contactpoint Availabletime URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-contactpoint-availabletime | ||||
| via-intermediary | S | 0..1 | Reference(NDH Base PractitionerRole | NDH Base OrganizationAffiliation Profile | NDH Base Location Profile | NDH Base Organization Profile) | NDH Via Intermediary URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-via-intermediary | ||||
| system | SΣC | 0..1 | code | phone | fax | email | pager | url | sms | other Binding: ContactPointSystem (required): Telecommunications form for contact point. | ||||
| value | SΣ | 0..1 | string | The actual contact point details | ||||
| use | ?!SΣ | 0..1 | code | home | work | temp | old | mobile - purpose of this contact point Binding: ContactPointUse (required): Use of contact point. | ||||
| rank | SΣ | 0..1 | positiveInt | Specify preferred order of use (1 = highest) | ||||
| period | Σ | 0..1 | Period | Time period when the contact point was/is in use | ||||
| address | 0..1 | Address | Visiting or postal addresses for the contact | |||||
| endpoint | S | 0..* | Reference(National Directory API Endpoint Profile) | Technical endpoint | ||||
| network | S | 0..* | Reference(National Directory API Network Profile) | What networks are Included | ||||
| coverage | S | 0..* | BackboneElement | Coverage details | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | S | 1..1 | CodeableConcept | Type of coverage Binding: NDH Insurance Coverage Type Value Set (extensible) | ||||
| network | S | 0..* | Reference(National Directory API Network Profile) | What networks provide coverage | ||||
| benefit | S | 1..* | BackboneElement | List of benefits | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | S | 1..1 | CodeableConcept | Type of benefit Binding: NDH Benefit Type Value Set (extensible) | ||||
| requirement | S | 0..1 | string | Referral requirements | ||||
| limit | S | 0..* | BackboneElement | Benefit limits | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| value | S | 0..1 | Quantity | Maximum value allowed | ||||
| code | S | 0..1 | CodeableConcept | Benefit limit details | ||||
| plan | S | 0..* | BackboneElement | Cost sharing details for the plan | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| identifier | SΣ | 0..* | Identifier | Business Identifier for Product | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| identifier-status | S | 0..1 | code | NDH Identifier Status URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-identifier-status Binding: Identifier Status Value Set (required) | ||||
| use | ?!SΣ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
| type | SΣ | 0..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. | ||||
| system | SΣ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | ||||
| value | SΣ | 0..1 | string | The value that is unique Example General: 123456 | ||||
| period | SΣ | 0..1 | Period | Time period when id is/was valid for use | ||||
| assigner | SΣ | 0..1 | Reference(National Directory API Organization Profile) | Organization that issued id (may be just text) | ||||
| type | S | 0..1 | CodeableConcept | Categorization of the cost sharing for the plan Binding: Insurance Plan Type Value Set (extensible) | ||||
| coverageArea | SΣ | 0..* | Reference(National Directory API Location Profile) | Where product applies | ||||
| network | S | 0..* | Reference(National Directory API Network Profile) | What networks provide coverage | ||||
| generalCost | S | 0..* | BackboneElement | Overall costs | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | S | 0..1 | CodeableConcept | Type of cost | ||||
| groupSize | S | 0..1 | positiveInt | Number of enrollees | ||||
| cost | S | 0..1 | Money | Cost value | ||||
| comment | S | 0..1 | string | Additional cost information | ||||
| specificCost | S | 0..* | BackboneElement | Specific costs | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| category | S | 1..1 | CodeableConcept | General category of benefit | ||||
| benefit | S | 0..* | BackboneElement | Benefits list | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | S | 1..1 | CodeableConcept | Type of specific benefit | ||||
| cost | S | 0..* | BackboneElement | List of the costs | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | S | 1..1 | CodeableConcept | Type of cost | ||||
| applicability | S | 0..1 | CodeableConcept | in-network | out-of-network | other Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers. | ||||
| qualifiers | S | 0..* | CodeableConcept | Additional information about the cost | ||||
| value | S | 0..1 | Quantity | The actual cost value | ||||
| Documentation for this format | ||||||||
| Path | Conformance | ValueSet / Code | URI | |||
| InsurancePlan.meta.security | extensible | All Security Labelshttp://hl7.org/fhir/ValueSet/security-labelsfrom the FHIR Standard | ||||
| InsurancePlan.meta.tag | example | CommonTagshttp://hl7.org/fhir/ValueSet/common-tagsfrom the FHIR Standard | ||||
| InsurancePlan.language | preferred | CommonLanguages
http://hl7.org/fhir/ValueSet/languagesfrom the FHIR Standard | ||||
| InsurancePlan.identifier.use | required | IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1from the FHIR Standard | ||||
| InsurancePlan.identifier.type | extensible | Identifier Type Codeshttp://hl7.org/fhir/ValueSet/identifier-typefrom the FHIR Standard | ||||
| InsurancePlan.status | required | Fixed Value: activehttp://hl7.org/fhir/ValueSet/publication-status|4.0.1from the FHIR Standard | ||||
| InsurancePlan.type | extensible | InsuranceProductTypeVS (a valid code from Insurance Product Type Code System)http://hl7.org/fhir/us/ndh/ValueSet/InsuranceProductTypeVSfrom this IG | ||||
| InsurancePlan.contact.purpose | extensible | ContactEntityTypehttp://hl7.org/fhir/ValueSet/contactentity-typefrom the FHIR Standard | ||||
| InsurancePlan.contact.name.use | required | NameUsehttp://hl7.org/fhir/ValueSet/name-use|4.0.1from the FHIR Standard | ||||
| InsurancePlan.contact.telecom.system | required | ContactPointSystemhttp://hl7.org/fhir/ValueSet/contact-point-system|4.0.1from the FHIR Standard | ||||
| InsurancePlan.contact.telecom.use | required | ContactPointUsehttp://hl7.org/fhir/ValueSet/contact-point-use|4.0.1from the FHIR Standard | ||||
| InsurancePlan.coverage.type | extensible | NdhCoverageTypeVShttp://hl7.org/fhir/us/ndh/ValueSet/NdhCoverageTypeVSfrom this IG | ||||
| InsurancePlan.coverage.benefit.type | extensible | NdhBenefitTypeVShttp://hl7.org/fhir/us/ndh/ValueSet/NdhBenefitTypeVSfrom this IG | ||||
| InsurancePlan.plan.identifier.use | required | IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1from the FHIR Standard | ||||
| InsurancePlan.plan.identifier.type | extensible | Identifier Type Codeshttp://hl7.org/fhir/ValueSet/identifier-typefrom the FHIR Standard | ||||
| InsurancePlan.plan.type | extensible | InsurancePlanTypeVS (a valid code from Insurance Plan Type Code System)http://hl7.org/fhir/us/ndh/ValueSet/InsurancePlanTypeVSfrom this IG | ||||
| InsurancePlan.plan.specificCost.benefit.cost.applicability | required | BenefitCostApplicabilityhttp://hl7.org/fhir/ValueSet/insuranceplan-applicability|4.0.1from the FHIR Standard |
This structure is derived from NdhInsurancePlan
Summary
Mandatory: 4 elements (3 nested mandatory elements)
Must-Support: 64 elements
Structures
This structure refers to these other structures:
Differential View
This structure is derived from NdhInsurancePlan
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| InsurancePlan | NdhInsurancePlan | |||
| meta | S | 0..1 | Meta | Metadata about the resource |
| profile | 1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to | |
| extension | 1..* | Extension | Extension | |
| extension:verification-status | S | 1..1 | VerificationStatus | NDH Verification Status |
| identifier | ||||
| extension | 1..* | Extension | Extension | |
| extension:identifier-status | S | 1..1 | IdentifierStatus | NDH Identifier Status |
| use | S | 0..1 | code | usual | official | temp | secondary | old (If known) |
| type | S | 0..1 | CodeableConcept | Description of identifier |
| system | S | 0..1 | uri | The namespace for the identifier value |
| value | S | 0..1 | string | The value that is unique |
| assigner | S | 0..1 | Reference(National Directory API Organization Profile) | Organization that issued id (may be just text) |
| alias | S | 0..* | string | Alternate names |
| period | S | 0..1 | Period | When the product is available |
| ownedBy | S | 1..1 | Reference(National Directory API Organization Profile) | Plan issuer |
| administeredBy | S | 1..1 | Reference(National Directory API Organization Profile) | Product administrator |
| coverageArea | 0..* | Reference(National Directory API Location Profile) | Where product applies | |
| contact | S | 0..* | BackboneElement | Contact for the product |
| purpose | S | 0..1 | CodeableConcept | The type of contact |
| name | S | 0..1 | HumanName | A name associated with the contact |
| use | S | 0..1 | code | usual | official | temp | nickname | anonymous | old | maiden |
| text | S | 0..1 | string | Text representation of the full name |
| family | S | 0..1 | string | Family name (often called 'Surname') |
| given | S | 0..* | string | Given names (not always 'first'). Includes middle names |
| prefix | S | 0..* | string | Parts that come before the name |
| suffix | S | 0..* | string | Parts that come after the name |
| period | S | 0..1 | Period | Time period when name was/is in use |
| telecom | S | 0..* | ContactPoint | Contact details (telephone, email, etc.) for a contact |
| extension:contactpoint-availabletime | S | 0..* | ContactPointAvailableTime | NDH Contactpoint Availabletime |
| extension:via-intermediary | S | 0..1 | ViaIntermediary | NDH Via Intermediary |
| system | S | 0..1 | code | phone | fax | email | pager | url | sms | other |
| value | S | 0..1 | string | The actual contact point details |
| use | S | 0..1 | code | home | work | temp | old | mobile - purpose of this contact point |
| rank | S | 0..1 | positiveInt | Specify preferred order of use (1 = highest) |
| endpoint | S | 0..* | Reference(National Directory API Endpoint Profile) | Technical endpoint |
| network | 0..* | Reference(National Directory API Network Profile) | What networks are Included | |
| coverage | S | 0..* | BackboneElement | Coverage details |
| type | S | 1..1 | CodeableConcept | Type of coverage |
| network | 0..* | Reference(National Directory API Network Profile) | What networks provide coverage | |
| benefit | S | 1..* | BackboneElement | List of benefits |
| type | S | 1..1 | CodeableConcept | Type of benefit |
| requirement | S | 0..1 | string | Referral requirements |
| limit | S | 0..* | BackboneElement | Benefit limits |
| value | S | 0..1 | Quantity | Maximum value allowed |
| code | S | 0..1 | CodeableConcept | Benefit limit details |
| plan | S | 0..* | BackboneElement | Cost sharing details for the plan |
| identifier | S | 0..* | Identifier | Business Identifier for Product |
| extension:identifier-status | S | 0..1 | IdentifierStatus | NDH Identifier Status |
| use | S | 0..1 | code | usual | official | temp | secondary | old (If known) |
| type | S | 0..1 | CodeableConcept | Description of identifier |
| system | S | 0..1 | uri | The namespace for the identifier value |
| value | S | 0..1 | string | The value that is unique |
| period | S | 0..1 | Period | Time period when id is/was valid for use |
| assigner | S | 0..1 | Reference(National Directory API Organization Profile) | Organization that issued id (may be just text) |
| type | S | 0..1 | CodeableConcept | Categorization of the cost sharing for the plan |
| coverageArea | S | 0..* | Reference(National Directory API Location Profile) | Where product applies |
| network | S | 0..* | Reference(National Directory API Network Profile) | What networks provide coverage |
| generalCost | S | 0..* | BackboneElement | Overall costs |
| type | S | 0..1 | CodeableConcept | Type of cost |
| groupSize | S | 0..1 | positiveInt | Number of enrollees |
| cost | S | 0..1 | Money | Cost value |
| comment | S | 0..1 | string | Additional cost information |
| specificCost | S | 0..* | BackboneElement | Specific costs |
| category | S | 1..1 | CodeableConcept | General category of benefit |
| benefit | S | 0..* | BackboneElement | Benefits list |
| type | S | 1..1 | CodeableConcept | Type of specific benefit |
| cost | S | 0..* | BackboneElement | List of the costs |
| type | S | 1..1 | CodeableConcept | Type of cost |
| applicability | S | 0..1 | CodeableConcept | in-network | out-of-network | other |
| qualifiers | S | 0..* | CodeableConcept | Additional information about the cost |
| value | S | 0..1 | Quantity | The actual cost value |
| Documentation for this format | ||||
Key Elements View
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| InsurancePlan | C | 0..* | NdhInsurancePlan | Details of a Health Insurance product/plan provided by an organization ipn-1: The organization SHALL at least have a name or an idendtifier, and possibly more than one network-or-NatlDirwork: If an insuranceplan does not define a network, then each plan must define one plan-type-is-distinct: Each InsurancePlan.plan should have a distinct plan.type. |
| meta | SΣ | 0..1 | Meta | Metadata about the resource |
| lastUpdated | Σ | 1..1 | instant | When the resource version last changed |
| profile | Σ | 1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to |
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
| Slices for extension | 1..* | Extension | Extension Slice: Unordered, Open by value:url | |
| usage-restriction | 0..* | Reference(NDH Base Restriction) {c} | Usage Restriction URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-usage-restriction | |
| verification-status | S | 1..1 | CodeableConcept | NDH Verification Status URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-verification-status Binding: NDH Verification Status Value Set (extensible) |
| modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
| identifier | SΣC | 0..* | Identifier | Business Identifier for Product |
| Slices for extension | 1..* | Extension | Extension Slice: Unordered, Open by value:url | |
| identifier-status | S | 1..1 | code | NDH Identifier Status URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-identifier-status Binding: Identifier Status Value Set (required) |
| use | ?!SΣ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . |
| type | SΣ | 0..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. |
| system | SΣ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient |
| value | SΣ | 0..1 | string | The value that is unique Example General: 123456 |
| assigner | SΣ | 0..1 | Reference(National Directory API Organization Profile) | Organization that issued id (may be just text) |
| status | ?!SΣ | 1..1 | code | draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact. Fixed Value: active |
| type | SΣ | 1..1 | CodeableConcept | Product Type Binding: Insurance Product Type Value Set (extensible) |
| name | SΣC | 0..1 | string | Official name |
| alias | S | 0..* | string | Alternate names |
| period | S | 0..1 | Period | When the product is available |
| ownedBy | SΣ | 1..1 | Reference(National Directory API Organization Profile) | Plan issuer |
| administeredBy | SΣ | 1..1 | Reference(National Directory API Organization Profile) | Product administrator |
| coverageArea | SΣ | 0..* | Reference(National Directory API Location Profile) | Where product applies |
| contact | S | 0..* | BackboneElement | Contact for the product |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| purpose | S | 0..1 | CodeableConcept | The type of contact Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party. |
| name | S | 0..1 | HumanName | A name associated with the contact |
| use | ?!SΣ | 0..1 | code | usual | official | temp | nickname | anonymous | old | maiden Binding: NameUse (required): The use of a human name. |
| text | SΣ | 0..1 | string | Text representation of the full name |
| family | SΣ | 0..1 | string | Family name (often called 'Surname') |
| given | SΣ | 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 | SΣ | 0..* | string | Parts that come before the name This repeating element order: Prefixes appear in the correct order for presenting the name |
| suffix | SΣ | 0..* | string | Parts that come after the name This repeating element order: Suffixes appear in the correct order for presenting the name |
| period | SΣ | 0..1 | Period | Time period when name was/is in use |
| telecom | S | 0..* | ContactPoint | Contact details (telephone, email, etc.) for a contact |
| contactpoint-availabletime | S | 0..* | (Complex) | NDH Contactpoint Availabletime URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-contactpoint-availabletime |
| via-intermediary | S | 0..1 | Reference(NDH Base PractitionerRole | NDH Base OrganizationAffiliation Profile | NDH Base Location Profile | NDH Base Organization Profile) | NDH Via Intermediary URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-via-intermediary |
| system | SΣC | 0..1 | code | phone | fax | email | pager | url | sms | other Binding: ContactPointSystem (required): Telecommunications form for contact point. |
| value | SΣ | 0..1 | string | The actual contact point details |
| use | ?!SΣ | 0..1 | code | home | work | temp | old | mobile - purpose of this contact point Binding: ContactPointUse (required): Use of contact point. |
| rank | SΣ | 0..1 | positiveInt | Specify preferred order of use (1 = highest) |
| endpoint | S | 0..* | Reference(National Directory API Endpoint Profile) | Technical endpoint |
| network | S | 0..* | Reference(National Directory API Network Profile) | What networks are Included |
| coverage | S | 0..* | BackboneElement | Coverage details |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | S | 1..1 | CodeableConcept | Type of coverage Binding: NDH Insurance Coverage Type Value Set (extensible) |
| network | S | 0..* | Reference(National Directory API Network Profile) | What networks provide coverage |
| benefit | S | 1..* | BackboneElement | List of benefits |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | S | 1..1 | CodeableConcept | Type of benefit Binding: NDH Benefit Type Value Set (extensible) |
| requirement | S | 0..1 | string | Referral requirements |
| limit | S | 0..* | BackboneElement | Benefit limits |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| value | S | 0..1 | Quantity | Maximum value allowed |
| code | S | 0..1 | CodeableConcept | Benefit limit details |
| plan | S | 0..* | BackboneElement | Cost sharing details for the plan |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| identifier | SΣ | 0..* | Identifier | Business Identifier for Product |
| identifier-status | S | 0..1 | code | NDH Identifier Status URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-identifier-status Binding: Identifier Status Value Set (required) |
| use | ?!SΣ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . |
| type | SΣ | 0..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. |
| system | SΣ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient |
| value | SΣ | 0..1 | string | The value that is unique Example General: 123456 |
| period | SΣ | 0..1 | Period | Time period when id is/was valid for use |
| assigner | SΣ | 0..1 | Reference(National Directory API Organization Profile) | Organization that issued id (may be just text) |
| type | S | 0..1 | CodeableConcept | Categorization of the cost sharing for the plan Binding: Insurance Plan Type Value Set (extensible) |
| coverageArea | SΣ | 0..* | Reference(National Directory API Location Profile) | Where product applies |
| network | S | 0..* | Reference(National Directory API Network Profile) | What networks provide coverage |
| generalCost | S | 0..* | BackboneElement | Overall costs |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | S | 0..1 | CodeableConcept | Type of cost |
| groupSize | S | 0..1 | positiveInt | Number of enrollees |
| cost | S | 0..1 | Money | Cost value |
| comment | S | 0..1 | string | Additional cost information |
| specificCost | S | 0..* | BackboneElement | Specific costs |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| category | S | 1..1 | CodeableConcept | General category of benefit |
| benefit | S | 0..* | BackboneElement | Benefits list |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | S | 1..1 | CodeableConcept | Type of specific benefit |
| cost | S | 0..* | BackboneElement | List of the costs |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | S | 1..1 | CodeableConcept | Type of cost |
| applicability | S | 0..1 | CodeableConcept | in-network | out-of-network | other Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers. |
| qualifiers | S | 0..* | CodeableConcept | Additional information about the cost |
| value | S | 0..1 | Quantity | The actual cost value |
| Documentation for this format | ||||
| Path | Conformance | ValueSet / Code | URI |
| InsurancePlan.identifier.use | required | IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1from the FHIR Standard | |
| InsurancePlan.identifier.type | extensible | Identifier Type Codeshttp://hl7.org/fhir/ValueSet/identifier-typefrom the FHIR Standard | |
| InsurancePlan.status | required | Fixed Value: activehttp://hl7.org/fhir/ValueSet/publication-status|4.0.1from the FHIR Standard | |
| InsurancePlan.type | extensible | InsuranceProductTypeVS (a valid code from Insurance Product Type Code System)http://hl7.org/fhir/us/ndh/ValueSet/InsuranceProductTypeVSfrom this IG | |
| InsurancePlan.contact.purpose | extensible | ContactEntityTypehttp://hl7.org/fhir/ValueSet/contactentity-typefrom the FHIR Standard | |
| InsurancePlan.contact.name.use | required | NameUsehttp://hl7.org/fhir/ValueSet/name-use|4.0.1from the FHIR Standard | |
| InsurancePlan.contact.telecom.system | required | ContactPointSystemhttp://hl7.org/fhir/ValueSet/contact-point-system|4.0.1from the FHIR Standard | |
| InsurancePlan.contact.telecom.use | required | ContactPointUsehttp://hl7.org/fhir/ValueSet/contact-point-use|4.0.1from the FHIR Standard | |
| InsurancePlan.coverage.type | extensible | NdhCoverageTypeVShttp://hl7.org/fhir/us/ndh/ValueSet/NdhCoverageTypeVSfrom this IG | |
| InsurancePlan.coverage.benefit.type | extensible | NdhBenefitTypeVShttp://hl7.org/fhir/us/ndh/ValueSet/NdhBenefitTypeVSfrom this IG | |
| InsurancePlan.plan.identifier.use | required | IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1from the FHIR Standard | |
| InsurancePlan.plan.identifier.type | extensible | Identifier Type Codeshttp://hl7.org/fhir/ValueSet/identifier-typefrom the FHIR Standard | |
| InsurancePlan.plan.type | extensible | InsurancePlanTypeVS (a valid code from Insurance Plan Type Code System)http://hl7.org/fhir/us/ndh/ValueSet/InsurancePlanTypeVSfrom this IG | |
| InsurancePlan.plan.specificCost.benefit.cost.applicability | required | BenefitCostApplicabilityhttp://hl7.org/fhir/ValueSet/insuranceplan-applicability|4.0.1from the FHIR Standard |
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints | ||||
|---|---|---|---|---|---|---|---|---|
| InsurancePlan | C | 0..* | NdhInsurancePlan | Details of a Health Insurance product/plan provided by an organization ipn-1: The organization SHALL at least have a name or an idendtifier, and possibly more than one network-or-NatlDirwork: If an insuranceplan does not define a network, then each plan must define one plan-type-is-distinct: Each InsurancePlan.plan should have a distinct plan.type. | ||||
| id | Σ | 0..1 | id | Logical id of this artifact | ||||
| meta | SΣ | 0..1 | Meta | Metadata about the resource | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| versionId | Σ | 0..1 | id | Version specific identifier | ||||
| lastUpdated | Σ | 1..1 | instant | When the resource version last changed | ||||
| source | Σ | 0..1 | uri | Identifies where the resource comes from | ||||
| profile | Σ | 1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to | ||||
| security | Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. | ||||
| tag | Σ | 0..* | Coding | Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". | ||||
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
| language | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
| contained | 0..* | Resource | Contained, inline Resources | |||||
| Slices for extension | 1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| usage-restriction | 0..* | Reference(NDH Base Restriction) {c} | Usage Restriction URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-usage-restriction | |||||
| verification-status | S | 1..1 | CodeableConcept | NDH Verification Status URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-verification-status Binding: NDH Verification Status Value Set (extensible) | ||||
| modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ||||
| identifier | SΣC | 0..* | Identifier | Business Identifier for Product | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension | 1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| identifier-status | S | 1..1 | code | NDH Identifier Status URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-identifier-status Binding: Identifier Status Value Set (required) | ||||
| use | ?!SΣ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
| type | SΣ | 0..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. | ||||
| system | SΣ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | ||||
| value | SΣ | 0..1 | string | The value that is unique Example General: 123456 | ||||
| period | Σ | 0..1 | Period | Time period when id is/was valid for use | ||||
| assigner | SΣ | 0..1 | Reference(National Directory API Organization Profile) | Organization that issued id (may be just text) | ||||
| status | ?!SΣ | 1..1 | code | draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact. Fixed Value: active | ||||
| type | SΣ | 1..1 | CodeableConcept | Product Type Binding: Insurance Product Type Value Set (extensible) | ||||
| name | SΣC | 0..1 | string | Official name | ||||
| alias | S | 0..* | string | Alternate names | ||||
| period | S | 0..1 | Period | When the product is available | ||||
| ownedBy | SΣ | 1..1 | Reference(National Directory API Organization Profile) | Plan issuer | ||||
| administeredBy | SΣ | 1..1 | Reference(National Directory API Organization Profile) | Product administrator | ||||
| coverageArea | SΣ | 0..* | Reference(National Directory API Location Profile) | Where product applies | ||||
| contact | S | 0..* | BackboneElement | Contact for the product | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| purpose | S | 0..1 | CodeableConcept | The type of contact Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party. | ||||
| name | S | 0..1 | HumanName | A name associated with the contact | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| use | ?!SΣ | 0..1 | code | usual | official | temp | nickname | anonymous | old | maiden Binding: NameUse (required): The use of a human name. | ||||
| text | SΣ | 0..1 | string | Text representation of the full name | ||||
| family | SΣ | 0..1 | string | Family name (often called 'Surname') | ||||
| given | SΣ | 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 | SΣ | 0..* | string | Parts that come before the name This repeating element order: Prefixes appear in the correct order for presenting the name | ||||
| suffix | SΣ | 0..* | string | Parts that come after the name This repeating element order: Suffixes appear in the correct order for presenting the name | ||||
| period | SΣ | 0..1 | Period | Time period when name was/is in use | ||||
| telecom | S | 0..* | ContactPoint | Contact details (telephone, email, etc.) for a contact | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| contactpoint-availabletime | S | 0..* | (Complex) | NDH Contactpoint Availabletime URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-contactpoint-availabletime | ||||
| via-intermediary | S | 0..1 | Reference(NDH Base PractitionerRole | NDH Base OrganizationAffiliation Profile | NDH Base Location Profile | NDH Base Organization Profile) | NDH Via Intermediary URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-via-intermediary | ||||
| system | SΣC | 0..1 | code | phone | fax | email | pager | url | sms | other Binding: ContactPointSystem (required): Telecommunications form for contact point. | ||||
| value | SΣ | 0..1 | string | The actual contact point details | ||||
| use | ?!SΣ | 0..1 | code | home | work | temp | old | mobile - purpose of this contact point Binding: ContactPointUse (required): Use of contact point. | ||||
| rank | SΣ | 0..1 | positiveInt | Specify preferred order of use (1 = highest) | ||||
| period | Σ | 0..1 | Period | Time period when the contact point was/is in use | ||||
| address | 0..1 | Address | Visiting or postal addresses for the contact | |||||
| endpoint | S | 0..* | Reference(National Directory API Endpoint Profile) | Technical endpoint | ||||
| network | S | 0..* | Reference(National Directory API Network Profile) | What networks are Included | ||||
| coverage | S | 0..* | BackboneElement | Coverage details | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | S | 1..1 | CodeableConcept | Type of coverage Binding: NDH Insurance Coverage Type Value Set (extensible) | ||||
| network | S | 0..* | Reference(National Directory API Network Profile) | What networks provide coverage | ||||
| benefit | S | 1..* | BackboneElement | List of benefits | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | S | 1..1 | CodeableConcept | Type of benefit Binding: NDH Benefit Type Value Set (extensible) | ||||
| requirement | S | 0..1 | string | Referral requirements | ||||
| limit | S | 0..* | BackboneElement | Benefit limits | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| value | S | 0..1 | Quantity | Maximum value allowed | ||||
| code | S | 0..1 | CodeableConcept | Benefit limit details | ||||
| plan | S | 0..* | BackboneElement | Cost sharing details for the plan | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| identifier | SΣ | 0..* | Identifier | Business Identifier for Product | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| identifier-status | S | 0..1 | code | NDH Identifier Status URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-identifier-status Binding: Identifier Status Value Set (required) | ||||
| use | ?!SΣ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
| type | SΣ | 0..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. | ||||
| system | SΣ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | ||||
| value | SΣ | 0..1 | string | The value that is unique Example General: 123456 | ||||
| period | SΣ | 0..1 | Period | Time period when id is/was valid for use | ||||
| assigner | SΣ | 0..1 | Reference(National Directory API Organization Profile) | Organization that issued id (may be just text) | ||||
| type | S | 0..1 | CodeableConcept | Categorization of the cost sharing for the plan Binding: Insurance Plan Type Value Set (extensible) | ||||
| coverageArea | SΣ | 0..* | Reference(National Directory API Location Profile) | Where product applies | ||||
| network | S | 0..* | Reference(National Directory API Network Profile) | What networks provide coverage | ||||
| generalCost | S | 0..* | BackboneElement | Overall costs | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | S | 0..1 | CodeableConcept | Type of cost | ||||
| groupSize | S | 0..1 | positiveInt | Number of enrollees | ||||
| cost | S | 0..1 | Money | Cost value | ||||
| comment | S | 0..1 | string | Additional cost information | ||||
| specificCost | S | 0..* | BackboneElement | Specific costs | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| category | S | 1..1 | CodeableConcept | General category of benefit | ||||
| benefit | S | 0..* | BackboneElement | Benefits list | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | S | 1..1 | CodeableConcept | Type of specific benefit | ||||
| cost | S | 0..* | BackboneElement | List of the costs | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | S | 1..1 | CodeableConcept | Type of cost | ||||
| applicability | S | 0..1 | CodeableConcept | in-network | out-of-network | other Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers. | ||||
| qualifiers | S | 0..* | CodeableConcept | Additional information about the cost | ||||
| value | S | 0..1 | Quantity | The actual cost value | ||||
| Documentation for this format | ||||||||
| Path | Conformance | ValueSet / Code | URI | |||
| InsurancePlan.meta.security | extensible | All Security Labelshttp://hl7.org/fhir/ValueSet/security-labelsfrom the FHIR Standard | ||||
| InsurancePlan.meta.tag | example | CommonTagshttp://hl7.org/fhir/ValueSet/common-tagsfrom the FHIR Standard | ||||
| InsurancePlan.language | preferred | CommonLanguages
http://hl7.org/fhir/ValueSet/languagesfrom the FHIR Standard | ||||
| InsurancePlan.identifier.use | required | IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1from the FHIR Standard | ||||
| InsurancePlan.identifier.type | extensible | Identifier Type Codeshttp://hl7.org/fhir/ValueSet/identifier-typefrom the FHIR Standard | ||||
| InsurancePlan.status | required | Fixed Value: activehttp://hl7.org/fhir/ValueSet/publication-status|4.0.1from the FHIR Standard | ||||
| InsurancePlan.type | extensible | InsuranceProductTypeVS (a valid code from Insurance Product Type Code System)http://hl7.org/fhir/us/ndh/ValueSet/InsuranceProductTypeVSfrom this IG | ||||
| InsurancePlan.contact.purpose | extensible | ContactEntityTypehttp://hl7.org/fhir/ValueSet/contactentity-typefrom the FHIR Standard | ||||
| InsurancePlan.contact.name.use | required | NameUsehttp://hl7.org/fhir/ValueSet/name-use|4.0.1from the FHIR Standard | ||||
| InsurancePlan.contact.telecom.system | required | ContactPointSystemhttp://hl7.org/fhir/ValueSet/contact-point-system|4.0.1from the FHIR Standard | ||||
| InsurancePlan.contact.telecom.use | required | ContactPointUsehttp://hl7.org/fhir/ValueSet/contact-point-use|4.0.1from the FHIR Standard | ||||
| InsurancePlan.coverage.type | extensible | NdhCoverageTypeVShttp://hl7.org/fhir/us/ndh/ValueSet/NdhCoverageTypeVSfrom this IG | ||||
| InsurancePlan.coverage.benefit.type | extensible | NdhBenefitTypeVShttp://hl7.org/fhir/us/ndh/ValueSet/NdhBenefitTypeVSfrom this IG | ||||
| InsurancePlan.plan.identifier.use | required | IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1from the FHIR Standard | ||||
| InsurancePlan.plan.identifier.type | extensible | Identifier Type Codeshttp://hl7.org/fhir/ValueSet/identifier-typefrom the FHIR Standard | ||||
| InsurancePlan.plan.type | extensible | InsurancePlanTypeVS (a valid code from Insurance Plan Type Code System)http://hl7.org/fhir/us/ndh/ValueSet/InsurancePlanTypeVSfrom this IG | ||||
| InsurancePlan.plan.specificCost.benefit.cost.applicability | required | BenefitCostApplicabilityhttp://hl7.org/fhir/ValueSet/insuranceplan-applicability|4.0.1from the FHIR Standard |
This structure is derived from NdhInsurancePlan
Summary
Mandatory: 4 elements (3 nested mandatory elements)
Must-Support: 64 elements
Structures
This structure refers to these other structures:
Other representations of profile: CSV, Excel, Schematron
IG © 2023+ HL7 International / Patient Administration. Package hl7.fhir.us.ndh#1.0.0-ballot based on FHIR 4.0.1. Generated 2024-03-28
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