Administrative Incubator
0.1.0 - International flag

Administrative Incubator, published by HL7 International / Patient Administration. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/admin-incubator/ and changes regularly. See the Directory of published versions

Resource: Insurance Plan - Detailed Descriptions

Page standards status: Trial-use Maturity Level: 1

Definitions for the InsurancePlan resource

Guidance on how to interpret the contents of this table can be foundhere

0. InsurancePlan
Definition

InsurancePlan describes the costs to the subscriber or beneficiary associated with benefits, as well as additional information about the offering, such as who administers the plan, a coverage area, contact information, etc. The specific benefits covered by the plan are described in the InsuranceProduct referenced in InsurancePlan.product.


A resource that includes narrative, extensions, and contained resources.

ShortPlan detailsA resource with narrative, extensions, and contained resources
Control0..*
Is Modifierfalse
Must Supportfalse
Summaryfalse
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id.trace('id') in %resource.descendants().select(reference | as(uri))) or descendants().where(reference='#' | as(uri)='#').exists()).not()).trace('unmatched', id).empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
2. InsurancePlan.id
Definition

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

ShortLogical id of this artifact
Comments

Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case.

Control0..1
Typeid
Is Modifierfalse
Must Supportfalse
Summarytrue
4. InsurancePlan.meta
Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

ShortMetadata about the resource
Control0..1
TypeMeta
Is Modifierfalse
Must Supportfalse
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
6. InsurancePlan.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

ShortA set of rules under which this content was created
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of its narrative along with other profiles, value sets, etc.

Control0..1
Typeuri
Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supportfalse
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
8. InsurancePlan.language
Definition

The base language in which the resource is written.

ShortLanguage of the resource content
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Control0..1
BindingThe codes SHALL be taken from AllLanguageshttp://hl7.org/fhir/ValueSet/all-languages|6.0.0-ballot3
(required to http://hl7.org/fhir/ValueSet/all-languages|6.0.0-ballot3)

IETF language tag for a human language

Typecode
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supportfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
10. InsurancePlan.text
Definition

A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

ShortText summary of the resource, for human interpretation
Comments

Contained resources do not have a narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

Control0..1
This element is affected by the following invariants: dom-6
TypeNarrative
Is Modifierfalse
Must Supportfalse
Summaryfalse
Alternate Namesnarrative, html, xhtml, display
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
12. InsurancePlan.contained
Definition

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.

ShortContained, inline Resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags in their meta elements, but SHALL NOT have security labels. Contained resources may be a resource type defined in the FHIR specification, or an additional resource.

Control0..*
This element is affected by the following invariants: dom-2, dom-4, dom-3, dom-5
TypeResource
Is Modifierfalse
Must Supportfalse
Summaryfalse
Alternate Namesinline resources, anonymous resources, contained resources
14. InsurancePlan.extension
Definition

May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Must Supportfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
SlicingThis element introduces a set of slices on InsurancePlan.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 16. InsurancePlan.modifierExtension
    Definition

    May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

    ShortExtensions that cannot be ignored
    Comments

    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

    Control0..*
    TypeExtension
    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
    Must Supportfalse
    Summarytrue
    Requirements

    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

    Alternate Namesextensions, user content
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    SlicingThis element introduces a set of slices on InsurancePlan.modifierExtension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 18. InsurancePlan.identifier
      Definition

      Identifiers, such as the plan ID and/or group ID associated with the insurance plan.

      ShortBusiness Identifier for Plan
      Comments

      In some markets, the combination of a plan ID and a group ID are needed to uniquely identify an InsurancePlan. For example, if a single plan (Bronze) is offered to two employer groups (Boilermakers and Aviation), you would represent that using two InsurancePlan resources, as shown below:

      InsurancePlan.identifier  0..*  (Boilermakers)   InsurancePlan/bm
           [0].value = 1234   (bronze plan)
           [0].type = Plan
           [0].system = https://insurance-payer.com/plan-numbers
      
           [1].value = Boilermakers
           [1].type = Group
           [1].system = https:// insurance-payer.com /group-numbers
      
      InsurancePlan.identifier  0..*  (Aviation)   InsurancePlan/av
           [0].value = 1234  (bronze plan)
           [0].type = Plan
           [0].system = https:// insurance-payer.com /plan-numbers
      
           [1].value = Aviation
           [1].type = Group
           [1].system = https:// insurance-payer.com /group-numbers
      
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control0..*
      TypeIdentifier
      Summarytrue
      20. InsurancePlan.type
      Definition

      Type of plan. For example, "Platinum" or "High Deductable".

      ShortClassification of Plan
      Control0..1
      TypeCodeableConcept
      22. InsurancePlan.product
      Definition

      The product that this plan is available under.

      ShortThe product that this plan is available under
      Control0..1
      TypeReference(Insurance Product)
      Summarytrue
      24. InsurancePlan.coverageArea
      Definition

      The geographic region in which a health insurance plan's benefits apply.

      ShortWhere product-plan applies
      Control0..*
      TypeReference(Location)
      Summarytrue
      26. InsurancePlan.network
      Definition

      Reference to the network that providing the type of coverage.

      ShortWhat networks provide coverage
      Comments

      Networks are represented as a hierarchy of organization resources.

      Control0..*
      TypeReference(Organization)
      28. InsurancePlan.generalCost
      Definition

      Overall costs associated with the plan.

      ShortOverall costs
      Control0..*
      TypeBackboneElement
      Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
      30. InsurancePlan.generalCost.id
      Definition

      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

      ShortUnique id for inter-element referencing
      Control0..1
      This element is affected by the following invariants: ele-1
      Typeidstring
      Is Modifierfalse
      XML FormatIn the XML format, this property is represented as an attribute.
      Summaryfalse
      32. InsurancePlan.generalCost.extension
      Definition

      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

      ShortAdditional content defined by implementations
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..*
      TypeExtension
      Is Modifierfalse
      Summaryfalse
      Alternate Namesextensions, user content
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      SlicingThis element introduces a set of slices on InsurancePlan.generalCost.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 34. InsurancePlan.generalCost.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        ShortExtensions that cannot be ignored even if unrecognized
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
        Summarytrue
        Requirements

        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

        Alternate Namesextensions, user content, modifiers
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        36. InsurancePlan.generalCost.type
        Definition

        Type of cost.

        ShortClassification of specific cost
        Control0..1
        TypeCodeableConcept
        38. InsurancePlan.generalCost.groupSize
        Definition

        Number of participants enrolled in the plan.

        ShortNumber of enrollees
        Control0..1
        TypepositiveInt
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        40. InsurancePlan.generalCost.cost
        Definition

        Value of the cost.

        ShortCost value
        Control0..1
        TypeMoney
        42. InsurancePlan.generalCost.comment
        Definition

        Additional information about the general costs associated with this plan.

        ShortAdditional cost information
        Control0..1
        Typestring
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        44. InsurancePlan.specificCost
        Definition

        Costs associated with the coverage provided by the product-plan.

        ShortIndividual cost elements
        Control0..*
        TypeBackboneElement
        Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
        46. InsurancePlan.specificCost.id
        Definition

        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

        ShortUnique id for inter-element referencing
        Control0..1
        This element is affected by the following invariants: ele-1
        Typeidstring
        Is Modifierfalse
        XML FormatIn the XML format, this property is represented as an attribute.
        Summaryfalse
        48. InsurancePlan.specificCost.extension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

        ShortAdditional content defined by implementations
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifierfalse
        Summaryfalse
        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        SlicingThis element introduces a set of slices on InsurancePlan.specificCost.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 50. InsurancePlan.specificCost.modifierExtension
          Definition

          May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

          ShortExtensions that cannot be ignored even if unrecognized
          Comments

          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

          Control0..*
          TypeExtension
          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
          Summarytrue
          Requirements

          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

          Alternate Namesextensions, user content, modifiers
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          52. InsurancePlan.specificCost.category
          Definition

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

          ShortGeneral category of benefit
          Control1..1
          TypeCodeableConcept
          54. InsurancePlan.specificCost.benefit
          Definition

          List of the specific benefits under this category of benefit.

          ShortBenefits list
          Control0..*
          TypeBackboneElement
          Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
          56. InsurancePlan.specificCost.benefit.id
          Definition

          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

          ShortUnique id for inter-element referencing
          Control0..1
          This element is affected by the following invariants: ele-1
          Typeidstring
          Is Modifierfalse
          XML FormatIn the XML format, this property is represented as an attribute.
          Summaryfalse
          58. InsurancePlan.specificCost.benefit.extension
          Definition

          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

          ShortAdditional content defined by implementations
          Comments

          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

          Control0..*
          TypeExtension
          Is Modifierfalse
          Summaryfalse
          Alternate Namesextensions, user content
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          SlicingThis element introduces a set of slices on InsurancePlan.specificCost.benefit.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 60. InsurancePlan.specificCost.benefit.modifierExtension
            Definition

            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

            ShortExtensions that cannot be ignored even if unrecognized
            Comments

            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

            Control0..*
            TypeExtension
            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
            Summarytrue
            Requirements

            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

            Alternate Namesextensions, user content, modifiers
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            62. InsurancePlan.specificCost.benefit.type
            Definition

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

            ShortClassification of benefit provided
            Control1..1
            TypeCodeableConcept
            64. InsurancePlan.specificCost.benefit.cost
            Definition

            List of the costs associated with a specific benefit.

            ShortList of the costs
            Control0..*
            TypeBackboneElement
            Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
            66. InsurancePlan.specificCost.benefit.cost.id
            Definition

            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

            ShortUnique id for inter-element referencing
            Control0..1
            This element is affected by the following invariants: ele-1
            Typeidstring
            Is Modifierfalse
            XML FormatIn the XML format, this property is represented as an attribute.
            Summaryfalse
            68. InsurancePlan.specificCost.benefit.cost.extension
            Definition

            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

            ShortAdditional content defined by implementations
            Comments

            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

            Control0..*
            TypeExtension
            Is Modifierfalse
            Summaryfalse
            Alternate Namesextensions, user content
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            SlicingThis element introduces a set of slices on InsurancePlan.specificCost.benefit.cost.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 70. InsurancePlan.specificCost.benefit.cost.modifierExtension
              Definition

              May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

              ShortExtensions that cannot be ignored even if unrecognized
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control0..*
              TypeExtension
              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
              Summarytrue
              Requirements

              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

              Alternate Namesextensions, user content, modifiers
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              72. InsurancePlan.specificCost.benefit.cost.type
              Definition

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

              ShortClassification of specific cost
              Control1..1
              TypeCodeableConcept
              74. InsurancePlan.specificCost.benefit.cost.applicability
              Definition

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

              Shortin-network | out-of-network | other
              Control0..1
              BindingThe codes SHALL be taken from BenefitCostApplicabilityhttp://hl7.org/fhir/ValueSet/insuranceplan-applicability
              (required to http://hl7.org/fhir/ValueSet/insuranceplan-applicability)

              Whether the cost applies to in-network or out-of-network providers.

              TypeCodeableConcept
              76. InsurancePlan.specificCost.benefit.cost.qualifier
              Definition

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

              ShortAdditional information about the cost
              Control0..*
              TypeCodeableConcept
              78. InsurancePlan.specificCost.benefit.cost.value
              Definition

              The actual cost value. (some of the costs may be represented as percentages rather than currency, e.g. 10% coinsurance).

              ShortThe actual cost value
              Control0..1
              TypeQuantity

              Guidance on how to interpret the contents of this table can be foundhere

              0. InsurancePlan
              Definition

              InsurancePlan describes the costs to the subscriber or beneficiary associated with benefits, as well as additional information about the offering, such as who administers the plan, a coverage area, contact information, etc. The specific benefits covered by the plan are described in the InsuranceProduct referenced in InsurancePlan.product.

              ShortPlan details
              Control0..*
              2. InsurancePlan.identifier
              Definition

              Identifiers, such as the plan ID and/or group ID associated with the insurance plan.

              ShortBusiness Identifier for Plan
              Comments

              In some markets, the combination of a plan ID and a group ID are needed to uniquely identify an InsurancePlan. For example, if a single plan (Bronze) is offered to two employer groups (Boilermakers and Aviation), you would represent that using two InsurancePlan resources, as shown below:

              InsurancePlan.identifier  0..*  (Boilermakers)   InsurancePlan/bm
                   [0].value = 1234   (bronze plan)
                   [0].type = Plan
                   [0].system = https://insurance-payer.com/plan-numbers
              
                   [1].value = Boilermakers
                   [1].type = Group
                   [1].system = https:// insurance-payer.com /group-numbers
              
              InsurancePlan.identifier  0..*  (Aviation)   InsurancePlan/av
                   [0].value = 1234  (bronze plan)
                   [0].type = Plan
                   [0].system = https:// insurance-payer.com /plan-numbers
              
                   [1].value = Aviation
                   [1].type = Group
                   [1].system = https:// insurance-payer.com /group-numbers
              
              NoteThis is a business identifier, not a resource identifier (see discussion)
              Control0..*
              TypeIdentifier
              4. InsurancePlan.type
              Definition

              Type of plan. For example, "Platinum" or "High Deductable".

              ShortClassification of Plan
              Control0..1
              TypeCodeableConcept
              6. InsurancePlan.product
              Definition

              The product that this plan is available under.

              ShortThe product that this plan is available under
              Control0..1
              TypeReference(Insurance Product)
              8. InsurancePlan.coverageArea
              Definition

              The geographic region in which a health insurance plan's benefits apply.

              ShortWhere product-plan applies
              Control0..*
              TypeReference(Location)
              10. InsurancePlan.network
              Definition

              Reference to the network that providing the type of coverage.

              ShortWhat networks provide coverage
              Comments

              Networks are represented as a hierarchy of organization resources.

              Control0..*
              TypeReference(Organization)
              12. InsurancePlan.generalCost
              Definition

              Overall costs associated with the plan.

              ShortOverall costs
              Control0..*
              TypeBackboneElement
              14. InsurancePlan.generalCost.type
              Definition

              Type of cost.

              ShortClassification of specific cost
              Control0..1
              TypeCodeableConcept
              16. InsurancePlan.generalCost.groupSize
              Definition

              Number of participants enrolled in the plan.

              ShortNumber of enrollees
              Control0..1
              TypepositiveInt
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              18. InsurancePlan.generalCost.cost
              Definition

              Value of the cost.

              ShortCost value
              Control0..1
              TypeMoney
              20. InsurancePlan.generalCost.comment
              Definition

              Additional information about the general costs associated with this plan.

              ShortAdditional cost information
              Control0..1
              Typestring
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              22. InsurancePlan.specificCost
              Definition

              Costs associated with the coverage provided by the product-plan.

              ShortIndividual cost elements
              Control0..*
              TypeBackboneElement
              24. InsurancePlan.specificCost.category
              Definition

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

              ShortGeneral category of benefit
              Control1..1
              TypeCodeableConcept
              26. InsurancePlan.specificCost.benefit
              Definition

              List of the specific benefits under this category of benefit.

              ShortBenefits list
              Control0..*
              TypeBackboneElement
              28. InsurancePlan.specificCost.benefit.type
              Definition

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

              ShortClassification of benefit provided
              Control1..1
              TypeCodeableConcept
              30. InsurancePlan.specificCost.benefit.cost
              Definition

              List of the costs associated with a specific benefit.

              ShortList of the costs
              Control0..*
              TypeBackboneElement
              32. InsurancePlan.specificCost.benefit.cost.type
              Definition

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

              ShortClassification of specific cost
              Control1..1
              TypeCodeableConcept
              34. InsurancePlan.specificCost.benefit.cost.applicability
              Definition

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

              Shortin-network | out-of-network | other
              Control0..1
              BindingThe codes SHALL be taken from BenefitCostApplicability
              (required to http://hl7.org/fhir/ValueSet/insuranceplan-applicability)

              Whether the cost applies to in-network or out-of-network providers.

              TypeCodeableConcept
              36. InsurancePlan.specificCost.benefit.cost.qualifier
              Definition

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

              ShortAdditional information about the cost
              Control0..*
              TypeCodeableConcept
              38. InsurancePlan.specificCost.benefit.cost.value
              Definition

              The actual cost value. (some of the costs may be represented as percentages rather than currency, e.g. 10% coinsurance).

              ShortThe actual cost value
              Control0..1
              TypeQuantity

              Guidance on how to interpret the contents of this table can be foundhere

              0. InsurancePlan
              Definition

              InsurancePlan describes the costs to the subscriber or beneficiary associated with benefits, as well as additional information about the offering, such as who administers the plan, a coverage area, contact information, etc. The specific benefits covered by the plan are described in the InsuranceProduct referenced in InsurancePlan.product.

              ShortPlan details
              Control0..*
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
              dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id.trace('id') in %resource.descendants().select(reference | as(uri))) or descendants().where(reference='#' | as(uri)='#').exists()).not()).trace('unmatched', id).empty())
              dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
              dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
              dom-6: A resource should have narrative for robust management (text.`div`.exists())
              2. InsurancePlan.id
              Definition

              The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

              ShortLogical id of this artifact
              Comments

              Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case.

              Control0..1
              Typeid
              Is Modifierfalse
              Must Supportfalse
              Summarytrue
              4. InsurancePlan.meta
              Definition

              The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

              ShortMetadata about the resource
              Control0..1
              TypeMeta
              Is Modifierfalse
              Must Supportfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              6. InsurancePlan.implicitRules
              Definition

              A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

              ShortA set of rules under which this content was created
              Comments

              Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of its narrative along with other profiles, value sets, etc.

              Control0..1
              Typeuri
              Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supportfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              8. InsurancePlan.language
              Definition

              The base language in which the resource is written.

              ShortLanguage of the resource content
              Comments

              Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

              Control0..1
              BindingThe codes SHALL be taken from AllLanguages
              (required to http://hl7.org/fhir/ValueSet/all-languages|6.0.0-ballot3)

              IETF language tag for a human language

              Typecode
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supportfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              10. InsurancePlan.text
              Definition

              A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

              ShortText summary of the resource, for human interpretation
              Comments

              Contained resources do not have a narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

              Control0..1
              This element is affected by the following invariants: dom-6
              TypeNarrative
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Alternate Namesnarrative, html, xhtml, display
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              12. InsurancePlan.contained
              Definition

              These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.

              ShortContained, inline Resources
              Comments

              This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags in their meta elements, but SHALL NOT have security labels. Contained resources may be a resource type defined in the FHIR specification, or an additional resource.

              Control0..*
              This element is affected by the following invariants: dom-2, dom-4, dom-3, dom-5
              TypeResource
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Alternate Namesinline resources, anonymous resources, contained resources
              14. InsurancePlan.extension
              Definition

              May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

              ShortAdditional content defined by implementations
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control0..*
              TypeExtension
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Alternate Namesextensions, user content
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              SlicingThis element introduces a set of slices on InsurancePlan.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 16. InsurancePlan.modifierExtension
                Definition

                May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                ShortExtensions that cannot be ignored
                Comments

                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                Control0..*
                TypeExtension
                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
                Must Supportfalse
                Summarytrue
                Requirements

                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                Alternate Namesextensions, user content
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                SlicingThis element introduces a set of slices on InsurancePlan.modifierExtension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ url
                • 18. InsurancePlan.identifier
                  Definition

                  Identifiers, such as the plan ID and/or group ID associated with the insurance plan.

                  ShortBusiness Identifier for Plan
                  Comments

                  In some markets, the combination of a plan ID and a group ID are needed to uniquely identify an InsurancePlan. For example, if a single plan (Bronze) is offered to two employer groups (Boilermakers and Aviation), you would represent that using two InsurancePlan resources, as shown below:

                  InsurancePlan.identifier  0..*  (Boilermakers)   InsurancePlan/bm
                       [0].value = 1234   (bronze plan)
                       [0].type = Plan
                       [0].system = https://insurance-payer.com/plan-numbers
                  
                       [1].value = Boilermakers
                       [1].type = Group
                       [1].system = https:// insurance-payer.com /group-numbers
                  
                  InsurancePlan.identifier  0..*  (Aviation)   InsurancePlan/av
                       [0].value = 1234  (bronze plan)
                       [0].type = Plan
                       [0].system = https:// insurance-payer.com /plan-numbers
                  
                       [1].value = Aviation
                       [1].type = Group
                       [1].system = https:// insurance-payer.com /group-numbers
                  
                  NoteThis is a business identifier, not a resource identifier (see discussion)
                  Control0..*
                  TypeIdentifier
                  Summarytrue
                  20. InsurancePlan.type
                  Definition

                  Type of plan. For example, "Platinum" or "High Deductable".

                  ShortClassification of Plan
                  Control0..1
                  TypeCodeableConcept
                  22. InsurancePlan.product
                  Definition

                  The product that this plan is available under.

                  ShortThe product that this plan is available under
                  Control0..1
                  TypeReference(Insurance Product)
                  Summarytrue
                  24. InsurancePlan.coverageArea
                  Definition

                  The geographic region in which a health insurance plan's benefits apply.

                  ShortWhere product-plan applies
                  Control0..*
                  TypeReference(Location)
                  Summarytrue
                  26. InsurancePlan.network
                  Definition

                  Reference to the network that providing the type of coverage.

                  ShortWhat networks provide coverage
                  Comments

                  Networks are represented as a hierarchy of organization resources.

                  Control0..*
                  TypeReference(Organization)
                  28. InsurancePlan.generalCost
                  Definition

                  Overall costs associated with the plan.

                  ShortOverall costs
                  Control0..*
                  TypeBackboneElement
                  Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
                  30. InsurancePlan.generalCost.id
                  Definition

                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                  ShortUnique id for inter-element referencing
                  Control0..1
                  This element is affected by the following invariants: ele-1
                  Typeid
                  Is Modifierfalse
                  XML FormatIn the XML format, this property is represented as an attribute.
                  Summaryfalse
                  32. InsurancePlan.generalCost.extension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                  ShortAdditional content defined by implementations
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control0..*
                  TypeExtension
                  Is Modifierfalse
                  Summaryfalse
                  Alternate Namesextensions, user content
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  SlicingThis element introduces a set of slices on InsurancePlan.generalCost.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ url
                  • 34. InsurancePlan.generalCost.modifierExtension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                    ShortExtensions that cannot be ignored even if unrecognized
                    Comments

                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                    Control0..*
                    TypeExtension
                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                    Summarytrue
                    Requirements

                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                    Alternate Namesextensions, user content, modifiers
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    36. InsurancePlan.generalCost.type
                    Definition

                    Type of cost.

                    ShortClassification of specific cost
                    Control0..1
                    TypeCodeableConcept
                    38. InsurancePlan.generalCost.groupSize
                    Definition

                    Number of participants enrolled in the plan.

                    ShortNumber of enrollees
                    Control0..1
                    TypepositiveInt
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    40. InsurancePlan.generalCost.cost
                    Definition

                    Value of the cost.

                    ShortCost value
                    Control0..1
                    TypeMoney
                    42. InsurancePlan.generalCost.comment
                    Definition

                    Additional information about the general costs associated with this plan.

                    ShortAdditional cost information
                    Control0..1
                    Typestring
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    44. InsurancePlan.specificCost
                    Definition

                    Costs associated with the coverage provided by the product-plan.

                    ShortIndividual cost elements
                    Control0..*
                    TypeBackboneElement
                    Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
                    46. InsurancePlan.specificCost.id
                    Definition

                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                    ShortUnique id for inter-element referencing
                    Control0..1
                    This element is affected by the following invariants: ele-1
                    Typeid
                    Is Modifierfalse
                    XML FormatIn the XML format, this property is represented as an attribute.
                    Summaryfalse
                    48. InsurancePlan.specificCost.extension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                    ShortAdditional content defined by implementations
                    Comments

                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                    Control0..*
                    TypeExtension
                    Is Modifierfalse
                    Summaryfalse
                    Alternate Namesextensions, user content
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    SlicingThis element introduces a set of slices on InsurancePlan.specificCost.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • value @ url
                    • 50. InsurancePlan.specificCost.modifierExtension
                      Definition

                      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                      ShortExtensions that cannot be ignored even if unrecognized
                      Comments

                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                      Control0..*
                      TypeExtension
                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                      Summarytrue
                      Requirements

                      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                      Alternate Namesextensions, user content, modifiers
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      52. InsurancePlan.specificCost.category
                      Definition

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

                      ShortGeneral category of benefit
                      Control1..1
                      TypeCodeableConcept
                      54. InsurancePlan.specificCost.benefit
                      Definition

                      List of the specific benefits under this category of benefit.

                      ShortBenefits list
                      Control0..*
                      TypeBackboneElement
                      Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
                      56. InsurancePlan.specificCost.benefit.id
                      Definition

                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                      ShortUnique id for inter-element referencing
                      Control0..1
                      This element is affected by the following invariants: ele-1
                      Typeid
                      Is Modifierfalse
                      XML FormatIn the XML format, this property is represented as an attribute.
                      Summaryfalse
                      58. InsurancePlan.specificCost.benefit.extension
                      Definition

                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                      ShortAdditional content defined by implementations
                      Comments

                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                      Control0..*
                      TypeExtension
                      Is Modifierfalse
                      Summaryfalse
                      Alternate Namesextensions, user content
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      SlicingThis element introduces a set of slices on InsurancePlan.specificCost.benefit.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                      • 60. InsurancePlan.specificCost.benefit.modifierExtension
                        Definition

                        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                        ShortExtensions that cannot be ignored even if unrecognized
                        Comments

                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                        Control0..*
                        TypeExtension
                        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                        Summarytrue
                        Requirements

                        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                        Alternate Namesextensions, user content, modifiers
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        62. InsurancePlan.specificCost.benefit.type
                        Definition

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

                        ShortClassification of benefit provided
                        Control1..1
                        TypeCodeableConcept
                        64. InsurancePlan.specificCost.benefit.cost
                        Definition

                        List of the costs associated with a specific benefit.

                        ShortList of the costs
                        Control0..*
                        TypeBackboneElement
                        Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
                        66. InsurancePlan.specificCost.benefit.cost.id
                        Definition

                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                        ShortUnique id for inter-element referencing
                        Control0..1
                        This element is affected by the following invariants: ele-1
                        Typeid
                        Is Modifierfalse
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Summaryfalse
                        68. InsurancePlan.specificCost.benefit.cost.extension
                        Definition

                        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                        ShortAdditional content defined by implementations
                        Comments

                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                        Control0..*
                        TypeExtension
                        Is Modifierfalse
                        Summaryfalse
                        Alternate Namesextensions, user content
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        SlicingThis element introduces a set of slices on InsurancePlan.specificCost.benefit.cost.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                        • value @ url
                        • 70. InsurancePlan.specificCost.benefit.cost.modifierExtension
                          Definition

                          May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                          ShortExtensions that cannot be ignored even if unrecognized
                          Comments

                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                          Control0..*
                          TypeExtension
                          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                          Summarytrue
                          Requirements

                          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                          Alternate Namesextensions, user content, modifiers
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          72. InsurancePlan.specificCost.benefit.cost.type
                          Definition

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

                          ShortClassification of specific cost
                          Control1..1
                          TypeCodeableConcept
                          74. InsurancePlan.specificCost.benefit.cost.applicability
                          Definition

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

                          Shortin-network | out-of-network | other
                          Control0..1
                          BindingThe codes SHALL be taken from BenefitCostApplicability
                          (required to http://hl7.org/fhir/ValueSet/insuranceplan-applicability)

                          Whether the cost applies to in-network or out-of-network providers.

                          TypeCodeableConcept
                          76. InsurancePlan.specificCost.benefit.cost.qualifier
                          Definition

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

                          ShortAdditional information about the cost
                          Control0..*
                          TypeCodeableConcept
                          78. InsurancePlan.specificCost.benefit.cost.value
                          Definition

                          The actual cost value. (some of the costs may be represented as percentages rather than currency, e.g. 10% coinsurance).

                          ShortThe actual cost value
                          Control0..1
                          TypeQuantity