Validated Healthcare Directory
1.0.0 - STU1 International flag

Validated Healthcare Directory, published by HL7 International / Patient Administration. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/VhDir/ and changes regularly. See the Directory of published versions

: InsurancePlan/insuranceplan1 - TTL Representation

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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 -------------------------------------------------------------------

 a fhir:InsurancePlan ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "insuranceplan1"] ; #  describes a fictional Qualified Health Plan (QHP) in the Washington, DC metro area 
  fhir:meta [
    ( fhir:profile [
fhir:v "http://hl7.org/fhir/uv/vhdir/StructureDefinition/vhdir-insuranceplan"^^xsd:anyURI ;
fhir:link <http://hl7.org/fhir/uv/vhdir/StructureDefinition/vhdir-insuranceplan>     ] )
  ] ; # 
  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: InsurancePlan insuranceplan1</b></p><a name=\"insuranceplan1\"> </a><a name=\"hcinsuranceplan1\"> </a><a name=\"insuranceplan1-en-US\"> </a><p><b>identifier</b>: HIOS product ID/1234567891 (use: official, )</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristics bronze}\">Bronze</span></p><p><b>name</b>: Patriot PPO Standard</p><p><b>alias</b>: Patriot Plus</p><p><b>period</b>: 2018-06-06 --&gt; 2019-01-01</p><p><b>ownedBy</b>: <a href=\"Organization-homeland.html\">Homeland Health Insurance</a></p><p><b>administeredBy</b>: <a href=\"Organization-homeland.html\">Homeland Health Insurance</a></p><p><b>coverageArea</b>: <a href=\"Location-wash-dc-metro.html\">Washington, DC metro area</a></p><blockquote><p><b>contact</b></p><p><b>purpose</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/contactentity-type PATINF}\">General information</span></p><p><b>telecom</b>: ph: 202-123-5555, <a href=\"mailto:info@homelandinc.org\">info@homelandinc.org</a></p></blockquote><p><b>endpoint</b>: patriot plan endpoint hub</p><p><b>network</b>: </p><ul><li><a href=\"Organization-patriotppo.html\">Patriot Preferred Provider Network</a></li><li><a href=\"Organization-patriotdental.html\">Patriot Dental Provider Network</a></li></ul><blockquote><p><b>coverage</b></p><p><b>type</b>: <span title=\"Codes:{http://example.org/coverage-type medical}\">Coverage related to medical inpatient, outpatient, diagnostic, and preventive care</span></p><p><b>network</b>: <a href=\"Organization-patriotppo.html\">Patriot Preferred Provider Network</a></p><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://example.org/benefit-type 001}\">Primary care visit to treat an injury or illness</span></p><p><b>requirement</b>: N/A</p><h3>Limits</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Code</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:\">unlimited</span></td></tr></table></blockquote></blockquote><blockquote><p><b>coverage</b></p><p><b>type</b>: <span title=\"Codes:{http://example.org/coverage-type dental}\">Coverage related to dental care</span></p><p><b>network</b>: <a href=\"Organization-patriotdental.html\">Patriot Dental Provider Network</a></p><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://example.org/benefit-type 052}\">Periodic oral checkup</span></p><p><b>requirement</b>: N/A</p><h3>Limits</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Code</b></td></tr><tr><td style=\"display: none\">*</td><td>2 visit/yr</td><td><span title=\"Codes:\">biannual oral checkup</span></td></tr></table></blockquote></blockquote><blockquote><p><b>plan</b></p><p><b>identifier</b>: HIOS plan ID/123456789101112 (use: official, )</p><p><b>type</b>: <span title=\"Codes:{http://example.org/planlevel bronze}\">Bronze</span></p><p><b>coverageArea</b>: <a href=\"Location-wash-dc-metro.html\">Washington, DC metro area</a></p><p><b>network</b>: <a href=\"Organization-patriotdental.html\">Patriot Dental Provider Network</a></p><blockquote><p><b>generalCost</b></p><p><b>type</b>: <span title=\"Codes:{http://example.org/cost-type deductible}\">Deductible</span></p><p><b>groupSize</b>: 1</p><h3>Costs</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>6200</td><td>United States dollar</td></tr></table><p><b>comment</b>: Includes all prescription and medical costs for in-network providers</p></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: <span title=\"Codes:{http://example.org/cost-category medical}\">Medical</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://example.org/benefit-type 001}\">Primary care visit to treat an injury or illness</span></p><h3>Costs</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Applicability</b></td><td><b>Qualifiers</b></td><td><b>Value</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://example.org/cost-type copay}\">Copay</span></td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/applicability in-network}\">In Network</span></td><td><span title=\"Codes:\">in-network preferred provider</span></td><td>50 dollars<span style=\"background: LightGoldenRodYellow\"> (Details: unknown  codeUSD = 'United States dollar')</span></td></tr></table></blockquote></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: <span title=\"Codes:{http://example.org/cost-category dental}\">Dental</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://example.org/cost-type 052}\">Basic Dental Care – Adult</span></p><h3>Costs</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Applicability</b></td><td><b>Qualifiers</b></td><td><b>Value</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://example.org/costing coinsurance}\">Coinsurance</span></td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/applicability in-network}\">In Network</span></td><td><span title=\"Codes:\">in-network provider</span></td><td>10 percent</td></tr></table></blockquote></blockquote></blockquote></div>"
  ] ; # 
  fhir:identifier ( [
    ( fhir:extension [
fhir:url [ fhir:v "http://hl7.org/fhir/uv/vhdir/StructureDefinition/identifier-status"^^xsd:anyURI ] ;
fhir:value [ fhir:v "active" ]     ] ) ; #  Official HIOS product ID assigned by CMS 
fhir:use [ fhir:v "official" ] ;
fhir:type [
      ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ] ;
fhir:code [ fhir:v "NIIP" ] ;
fhir:display [ fhir:v "National Insurance Payor Identifier (Payor)" ] ;
fhir:userSelected [ fhir:v "true"^^xsd:boolean ]       ] ) ;
fhir:text [ fhir:v "HIOS product ID" ]     ] ;
fhir:system [ fhir:v "https://www.cms.gov/CCIIO/"^^xsd:anyURI ] ;
fhir:value [ fhir:v "1234567891" ] ;
fhir:assigner [
fhir:display [ fhir:v "Centers for Medicare and Medicaid Services" ]     ]
  ] ) ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:type ( [
    ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristics"^^xsd:anyURI ] ;
fhir:code [ fhir:v "bronze" ] ;
fhir:display [ fhir:v "Bronze" ]     ] )
  ] ) ; #  This record is active 
  fhir:name [ fhir:v "Patriot PPO Standard"] ; # 
  fhir:alias ( [ fhir:v "Patriot Plus"] ) ; #  Name of the product is Patriot PPO Standard 
  fhir:period [
fhir:start [ fhir:v "2018-06-06"^^xsd:date ] ;
fhir:end [ fhir:v "2019-01-01"^^xsd:date ]
  ] ; # 
  fhir:ownedBy [
fhir:reference [ fhir:v "Organization/homeland" ] ; #  Reference to the owner of the product, Homeland Health Insurance 
fhir:display [ fhir:v "Homeland Health Insurance" ]
  ] ; # 
  fhir:administeredBy [
fhir:reference [ fhir:v "Organization/homeland" ] ;
fhir:display [ fhir:v "Homeland Health Insurance" ]
  ] ; # 
  fhir:coverageArea ( [
fhir:reference [ fhir:v "Location/wash-dc-metro" ] ; #  Reference to the product's coverage area, the Washington, DC metro area 
fhir:display [ fhir:v "Washington, DC metro area" ]
  ] ) ; # 
  fhir:contact ( [
fhir:purpose [
      ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/contactentity-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "PATINF" ] ;
fhir:display [ fhir:v "Patient" ]       ] ) ;
fhir:text [ fhir:v "General information" ]     ] ; #  Contact information for consumers 
    ( fhir:telecom [
fhir:system [ fhir:v "phone" ] ;
fhir:value [ fhir:v "202-123-5555" ]     ] [
fhir:system [ fhir:v "email" ] ;
fhir:value [ fhir:v "info@homelandinc.org" ]     ] )
  ] ) ; # 
  fhir:endpoint ( [
fhir:display [ fhir:v "patriot plan endpoint hub" ] #  A reference to the technical endpoints providing access to services operated for the health insurance product.\n		<reference value=\"\"\/> 
  ] ) ; # 
  fhir:network ( [
fhir:reference [ fhir:v "Organization/patriotppo" ] ; #  A reference to the medical provider network associated with this product 
fhir:display [ fhir:v "Patriot Preferred Provider Network" ]
  ] [
fhir:reference [ fhir:v "Organization/patriotdental" ] ; #  A reference to the dental provider network associated with this product 
fhir:display [ fhir:v "Patriot Dental Provider Network" ]
  ] ) ; # 
  fhir:coverage ( [
fhir:type [
      ( fhir:coding [
fhir:system [ fhir:v "http://example.org/coverage-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "medical" ] ;
fhir:display [ fhir:v "Medical" ]       ] ) ;
fhir:text [ fhir:v "Coverage related to medical inpatient, outpatient, diagnostic, and preventive care" ]     ] ; #  describes medical benefits 
    ( fhir:network [
fhir:reference [ fhir:v "Organization/patriotppo" ] ;
fhir:display [ fhir:v "Patriot Preferred Provider Network" ]     ] ) ;
    ( fhir:benefit [
fhir:type [
        ( fhir:coding [
fhir:system [ fhir:v "http://example.org/benefit-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "001" ] ;
fhir:display [ fhir:v "Primary care visit to treat an injury or illness" ]         ] )       ] ; #  basic primary care visit 
fhir:requirement [ fhir:v "N/A" ] ;
      ( fhir:limit [
fhir:code [
fhir:text [ fhir:v "unlimited" ]         ]       ] )     ] )
  ] [
fhir:type [
      ( fhir:coding [
fhir:system [ fhir:v "http://example.org/coverage-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "dental" ] ;
fhir:display [ fhir:v "Dental" ]       ] ) ;
fhir:text [ fhir:v "Coverage related to dental care" ]     ] ; #  describes dental benefits 
    ( fhir:network [
fhir:reference [ fhir:v "Organization/patriotdental" ] ;
fhir:display [ fhir:v "Patriot Dental Provider Network" ]     ] ) ;
    ( fhir:benefit [
fhir:type [
        ( fhir:coding [
fhir:system [ fhir:v "http://example.org/benefit-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "052" ] ;
fhir:display [ fhir:v "Basic Dental Care – Adult" ]         ] ) ;
fhir:text [ fhir:v "Periodic oral checkup" ]       ] ; #  biannual oral checkup 
fhir:requirement [ fhir:v "N/A" ] ;
      ( fhir:limit [
fhir:value [
fhir:value [ fhir:v "2"^^xsd:decimal ] ;
fhir:unit [ fhir:v "visit/yr" ] ;
fhir:system [ fhir:v "http://unitsofmeasure.org"^^xsd:anyURI ]         ] ;
fhir:code [
fhir:text [ fhir:v "biannual oral checkup" ]         ]       ] )     ] ) # Specific benefits under this type of coverage.
  ] ) ; # 
  fhir:plan ( [
    ( fhir:identifier [
fhir:use [ fhir:v "official" ] ;
fhir:type [
        ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ] ;
fhir:code [ fhir:v "NIIP" ] ;
fhir:display [ fhir:v "National Insurance Payor Identifier (Payor)" ] ;
fhir:userSelected [ fhir:v "true"^^xsd:boolean ]         ] ) ;
fhir:text [ fhir:v "HIOS plan ID" ]       ] ;
fhir:system [ fhir:v "https://www.cms.gov/CCIIO/"^^xsd:anyURI ] ;
fhir:value [ fhir:v "123456789101112" ] ;
fhir:assigner [
fhir:display [ fhir:v "Centers for Medicare and Medicaid Services" ]       ]     ] ) ; #  Information about the cost sharing features of the product 
fhir:type [
      ( fhir:coding [
fhir:system [ fhir:v "http://example.org/planlevel"^^xsd:anyURI ] ;
fhir:code [ fhir:v "bronze" ] ;
fhir:display [ fhir:v "Bronze" ]       ] ) ;
fhir:text [ fhir:v "Bronze" ]     ] ;
    ( fhir:coverageArea [
fhir:reference [ fhir:v "Location/wash-dc-metro" ] ; #  Reference to the product's coverage area, the Washington, DC metro area 
fhir:display [ fhir:v "Washington, DC metro area" ]     ] ) ;
    ( fhir:network [
fhir:reference [ fhir:v "Organization/patriotdental" ] ;
fhir:display [ fhir:v "Patriot Dental Provider Network" ]     ] ) ;
    ( fhir:generalCost [
fhir:type [
        ( fhir:coding [
fhir:system [ fhir:v "http://example.org/cost-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "deductible" ] ;
fhir:display [ fhir:v "Deductible" ]         ] ) ;
fhir:text [ fhir:v "Deductible" ]       ] ; #  Describes the plan's deductible 
fhir:groupSize [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:cost [
fhir:value [ fhir:v "6200"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]       ] ;
fhir:comment [ fhir:v "Includes all prescription and medical costs for in-network providers" ]     ] ) ;
    ( fhir:specificCost [
fhir:category [
        ( fhir:coding [
fhir:system [ fhir:v "http://example.org/cost-category"^^xsd:anyURI ] ;
fhir:code [ fhir:v "medical" ] ;
fhir:display [ fhir:v "Medical" ]         ] )       ] ; #  Describes the costs associated with the medical coverage options 
      ( fhir:benefit [
fhir:type [
          ( fhir:coding [
fhir:system [ fhir:v "http://example.org/benefit-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "001" ] ;
fhir:display [ fhir:v "Primary care visit to treat an injury or illness" ]           ] )         ] ; #  $50 copay for primary care visits with an in-network preferred provider 
        ( fhir:cost [
fhir:type [
            ( fhir:coding [
fhir:system [ fhir:v "http://example.org/cost-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "copay" ] ;
fhir:display [ fhir:v "Copay" ]             ] )           ] ;
fhir:applicability [
            ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/applicability"^^xsd:anyURI ] ;
fhir:code [ fhir:v "in-network" ] ;
fhir:display [ fhir:v "In Network" ]             ] )           ] ;
          ( fhir:qualifiers [
fhir:text [ fhir:v "in-network preferred provider" ]           ] ) ;
fhir:value [
fhir:value [ fhir:v "50"^^xsd:decimal ] ;
fhir:unit [ fhir:v "dollars" ] ;
fhir:system [ fhir:v "urn:iso:std:iso:4217"^^xsd:anyURI ] ;
fhir:code [ fhir:v "USD" ]           ]         ] )       ] )     ] [
fhir:category [
        ( fhir:coding [
fhir:system [ fhir:v "http://example.org/cost-category"^^xsd:anyURI ] ;
fhir:code [ fhir:v "dental" ] ;
fhir:display [ fhir:v "Dental" ]         ] )       ] ; #  describes the costs associated with dental coverage 
      ( fhir:benefit [
fhir:type [
          ( fhir:coding [
fhir:system [ fhir:v "http://example.org/cost-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "052" ] ;
fhir:display [ fhir:v "Basic Dental Care – Adult" ]           ] )         ] ; #  10% coinsurance for routine oral checkup with an in-network dental provider 
        ( fhir:cost [
fhir:type [
            ( fhir:coding [
fhir:system [ fhir:v "http://example.org/costing"^^xsd:anyURI ] ;
fhir:code [ fhir:v "coinsurance" ] ;
fhir:display [ fhir:v "Coinsurance" ]             ] )           ] ;
fhir:applicability [
            ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/applicability"^^xsd:anyURI ] ;
fhir:code [ fhir:v "in-network" ] ;
fhir:display [ fhir:v "In Network" ]             ] )           ] ;
          ( fhir:qualifiers [
fhir:text [ fhir:v "in-network provider" ]           ] ) ;
fhir:value [
fhir:value [ fhir:v "10"^^xsd:decimal ] ;
fhir:unit [ fhir:v "percent" ]           ]         ] )       ] )     ] )
  ] ) . #