Current Build
Patient Administration Work GroupMaturity Level: 0 Draft Compartments: Not linked to any defined compartments

Detailed Descriptions for the elements in the ProductPlan resource.

ProductPlan
Element IdProductPlan
Definition

Details of a Health Insurance product/plan provided by an organization.

Control1..1
InvariantsDefined on this element
ppn-1: The organization SHALL at least have a name or an id, and possibly more than one (expression : (identifier.count() + name.count()) > 0, xpath: count(f:identifier | f:name) > 0)
ProductPlan.identifier
Element IdProductPlan.identifier
Definition

Identifier for the product/plan that is used to identify it across multiple disparate systems.

NoteThis is a business identifer, not a resource identifier (see discussion)
Control0..*
TypeIdentifier
Summarytrue
InvariantsAffect this element
ppn-1: The organization SHALL at least have a name or an id, and possibly more than one (expression : (identifier.count() + name.count()) > 0, xpath: count(f:identifier | f:name) > 0)
ProductPlan.status
Element IdProductPlan.status
Definition

Whether the organization's record is still in active use.

Control0..1
Terminology BindingPublicationStatus (Required)
Typecode
Is Modifiertrue (Reason: This element is labeled as a modifier because it is a status element that contains codes which means that the resource should not be treated as valid)
Meaning if MissingDefault interpretation is active.
Requirements

Need a flag to indicate a record is no longer to be used and should generally be hidden for the user in the UI.

Summarytrue
ProductPlan.type
Element IdProductPlan.type
Definition

The type of product/plan.

Control0..*
Terminology BindingProductPlanType (Example)
TypeCodeableConcept
Summarytrue
ProductPlan.name
Element IdProductPlan.name
Definition

Official name of the product/plan (as designated by the owner).

Control0..1
Typestring
Summarytrue
Comments

If the name of the product/plan changes, consider putting the old name in the alias column so that it can still be located through searches.

InvariantsAffect this element
ppn-1: The organization SHALL at least have a name or an id, and possibly more than one (expression : (identifier.count() + name.count()) > 0, xpath: count(f:identifier | f:name) > 0)
ProductPlan.alias
Element IdProductPlan.alias
Definition

A list of alternate names that the product/plan is known as, or was known as in the past.

Control0..*
Typestring
Requirements

Over time products/plans go through many changes and can be known by different names.

For searching knowing previous names that the product/plan was known by can be very useful.

Comments

There are no dates associated with the alias/historic names, as this is not intended to track when names were used, but to assist in searching so that older names can still result in identifying the product/plan.

ProductPlan.period
Element IdProductPlan.period
Definition

The period of time that the product is available.

Control0..1
TypePeriod
ProductPlan.ownedBy
Element IdProductPlan.ownedBy
Definition

Owner of the product/plan (typically a payer).

Control0..1
TypeReference(Organization)
Summarytrue
ProductPlan.administeredBy
Element IdProductPlan.administeredBy
Definition

Administrator of the product/plan (e.g. self-insured employer plan administered by a TPA).

Control0..1
TypeReference(Organization)
Summarytrue
ProductPlan.address
Element IdProductPlan.address
Definition

An address for the organization.

Control0..*
TypeAddress
Requirements

May need to keep track of the organization's addresses for contacting, billing or reporting requirements.

Comments

Organization may have multiple addresses with different uses or applicable periods. The use code home is not to be used.

InvariantsDefined on this element
ppn-2: An address of an organization can never be of use 'home' (expression : where(use = 'home').empty(), xpath: count(f:use[@value='home']) = 0)
Affect this element
ProductPlan.coverageArea
Element IdProductPlan.coverageArea
Definition

The geographic region in which this product/plan is available.

Control0..1
TypeReference(Location)
Summarytrue
ProductPlan.contact
Element IdProductPlan.contact
Definition

Contact for the product/plan for a certain purpose.

Control0..*
Requirements

Need to keep track of assigned contact points within bigger organization.

Comments

Where multiple contacts for the same purpose are provided there is a standard extension that can be used to determine which one is the preferred contact to use.

ProductPlan.contact.purpose
Element IdProductPlan.contact.purpose
Definition

Indicates a purpose for which the contact can be reached.

Control0..1
Terminology BindingContactEntityType (Extensible)
TypeCodeableConcept
Requirements

Need to distinguish between multiple contact persons.

ProductPlan.contact.name
Element IdProductPlan.contact.name
Definition

A name associated with the contact.

Control0..1
TypeHumanName
Requirements

Need to be able to track the person by name.

ProductPlan.contact.telecom
Element IdProductPlan.contact.telecom
Definition

A contact detail (e.g. a telephone number or an email address) by which the party may be contacted.

Control0..*
TypeContactPoint
Requirements

People have (primary) ways to contact them in some way such as phone, email.

ProductPlan.contact.address
Element IdProductPlan.contact.address
Definition

Visiting or postal addresses for the contact.

Control0..1
TypeAddress
Requirements

May need to keep track of a contact party's address for contacting, billing or reporting requirements.

ProductPlan.coverage
Element IdProductPlan.coverage
Definition

Details about the coverage offered by the insurance product.

Control0..*
ProductPlan.coverage.type
Element IdProductPlan.coverage.type
Definition

Type of coverage (Medical; Dental; Mental Health; Substance Abuse; Vision; Drug; Short Term; Long Term Care; Hospice; Home Health).

Control1..1
TypeCodeableConcept
ProductPlan.coverage.benefit
Element IdProductPlan.coverage.benefit
Definition

Specific benefits under this type of coverage.

Control1..*
ProductPlan.coverage.benefit.type
Element IdProductPlan.coverage.benefit.type
Definition

Type of benefit (primary care; speciality care; inpatient; outpatient).

Control1..1
TypeCodeableConcept
ProductPlan.coverage.benefit.item
Element IdProductPlan.coverage.benefit.item
Definition

Specific benefit and related value.

Control1..*
ProductPlan.coverage.benefit.item.code
Element IdProductPlan.coverage.benefit.item.code
Definition

Coded Details of the specific benefit (days; visits).

Control1..1
TypeCodeableConcept
ProductPlan.coverage.benefit.item.benefitValue
Element IdProductPlan.coverage.benefit.item.benefitValue
Definition

Value of the specific benefit.

Control0..1
TypeQuantity
ProductPlan.plan
Element IdProductPlan.plan
Definition

Details about an insurance plan.

Control0..*
ProductPlan.plan.type
Element IdProductPlan.plan.type
Definition

Type of plan (Platinum; Gold; Silver; Bronze; High Deductable; Low Deductable).

Control0..1
TypeCodeableConcept
ProductPlan.plan.description
Element IdProductPlan.plan.description
Definition

Additional descriptive content about the plan.

Control0..1
Typestring
ProductPlan.plan.premium
Element IdProductPlan.plan.premium
Definition

Plan premium.

Control0..1
TypeMoney
ProductPlan.plan.category
Element IdProductPlan.plan.category
Definition

List of the costs associated with plan benefits.

Control0..*
ProductPlan.plan.category.code
Element IdProductPlan.plan.category.code
Definition

General category of benefit (Medical; Dental; Vision; Drug; Mental Health; Substance Abuse; Hospice, Home Health).

Control0..1
TypeCodeableConcept
ProductPlan.plan.category.benefit
Element IdProductPlan.plan.category.benefit
Definition

List of the specific benefits under this category of benefit.

Control0..*
ProductPlan.plan.category.benefit.type
Element IdProductPlan.plan.category.benefit.type
Definition

Type of specific benefit (preventative; primary care office visit; speciality office visit; hospitalization; emergency room; urgent care).

Control1..1
TypeCodeableConcept
ProductPlan.plan.category.benefit.cost
Element IdProductPlan.plan.category.benefit.cost
Definition

List of the costs associated with a specific benefit.

Control0..*
ProductPlan.plan.category.benefit.cost.type
Element IdProductPlan.plan.category.benefit.cost.type
Definition

Type of cost (copay; individual cap; family cap; coinsurance; deductible).

Control1..1
TypeCodeableConcept
ProductPlan.plan.category.benefit.cost.applicability
Element IdProductPlan.plan.category.benefit.cost.applicability
Definition

Whether the cost applies to in-network or out-of-network providers (in-network; out-of-network; other).

Control0..*
TypeCoding
ProductPlan.plan.category.benefit.cost.qualifiers
Element IdProductPlan.plan.category.benefit.cost.qualifiers
Definition

Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA).

Control0..*
Typestring
ProductPlan.plan.category.benefit.cost.value
Element IdProductPlan.plan.category.benefit.cost.value
Definition

The actual cost value.

Control0..1
TypeQuantity
ProductPlan.endpoint
Element IdProductPlan.endpoint
Definition

Technical endpoints providing access to services operated for the organization.

Control0..*
TypeReference(Endpoint)
Requirements

Organizations have multiple systems that provide various services and need to be able to define the technical connection details for how to connect to them, and for what purpose.