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 Product - Detailed Descriptions

Page standards status: Trial-use Maturity Level: 1

Definitions for the InsuranceProduct resource

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

0. InsuranceProduct
Definition

A product is a discrete package of health insurance coverage benefits that are offered under a particular network, by an organization (payer) and additional information about the offering, such as who it is owned and administered by, a coverage area, contact information, etc.


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

ShortDetails of a Health Insurance product provided by an organizationA 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())
ipn-1: The organization SHALL at least have a name or an identifier, and possibly more than one ((identifier.count() + name.count()) > 0)
2. InsuranceProduct.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. InsuranceProduct.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. InsuranceProduct.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. InsuranceProduct.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. InsuranceProduct.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. InsuranceProduct.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. InsuranceProduct.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 InsuranceProduct.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 16. InsuranceProduct.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 InsuranceProduct.modifierExtension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 18. InsuranceProduct.identifier
      Definition

      Business identifiers assigned to this health insurance product which remain constant as the resource is updated and propagates from server to server.

      ShortBusiness Identifier for Product
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control0..*
      This element is affected by the following invariants: ipn-1
      TypeIdentifier
      Summarytrue
      20. InsuranceProduct.status
      Definition

      The current state of the health insurance product.

      Shortdraft | active | retired | unknown
      Control0..1
      BindingThe codes SHALL be taken from PublicationStatushttp://hl7.org/fhir/ValueSet/publication-status
      (required to http://hl7.org/fhir/ValueSet/publication-status)

      The lifecycle status of an artifact.

      Typecode
      Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains codes which means that the resource should not be treated as valid
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

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

      Meaning if MissingDefault interpretation is active.
      22. InsuranceProduct.type
      Definition

      The kind of health insurance product.

      ShortKind of product
      Control0..*
      BindingFor example codes, see InsurancePlanTypehttp://hl7.org/fhir/ValueSet/insuranceproduct-type
      (example to http://hl7.org/fhir/ValueSet/insuranceproduct-type)

      Used to categorize the product.

      TypeCodeableConcept
      Summarytrue
      24. InsuranceProduct.name
      Definition

      Official name of the health insurance product as designated by the owner.

      ShortOfficial name
      Comments

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

      Control0..1
      This element is affected by the following invariants: ipn-1
      Typestring
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      26. InsuranceProduct.alias
      Definition

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

      ShortAlternate names
      Comments

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

      Control0..*
      Typestring
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Requirements

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

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

      28. InsuranceProduct.period
      Definition

      The period of time that the health insurance product is available.

      ShortWhen the product is available
      Control0..1
      TypePeriod
      30. InsuranceProduct.ownedBy
      Definition

      The entity that is providing the health insurance product and underwriting the risk. This is typically an insurance carriers, other third-party payers, or health plan sponsors comonly referred to as 'payers'.

      ShortProduct issuer
      Control0..1
      TypeReference(Organization)
      Summarytrue
      Alternate NamesPayer
      32. InsuranceProduct.administeredBy
      Definition

      An organization which administer other services such as underwriting, customer service and/or claims processing on behalf of the health insurance product owner.

      ShortProduct administrator
      Control0..1
      TypeReference(Organization)
      Summarytrue
      34. InsuranceProduct.coverageArea
      Definition

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

      ShortWhere product applies
      Control0..*
      TypeReference(Location)
      Summarytrue
      36. InsuranceProduct.contact
      Definition

      The contact details of communication devices available relevant to the specific Insurance Product. This can include addresses, phone numbers, fax numbers, mobile numbers, email addresses and web sites.

      ShortOfficial contact details relevant to the health insurance product
      Comments

      The address/telecom use code 'home' are not to be used.

      Control0..*
      TypeExtendedContactDetail
      Requirements

      Need to keep track of both simple contact details and also assigned contacts within larger organizations.

      38. InsuranceProduct.endpoint
      Definition

      The technical endpoints providing access to services operated for the health insurance product.

      ShortTechnical endpoint
      Control0..*
      TypeReference(Endpoint)
      Requirements

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

      40. InsuranceProduct.network
      Definition

      Reference to the network included in the health insurance product.

      ShortWhat networks are Included
      Comments

      Networks are represented as a hierarchy of organization resources.

      Control0..*
      TypeReference(Organization)
      42. InsuranceProduct.coverage
      Definition

      Details about the coverage offered by the insurance product.

      ShortCoverage details
      Control0..*
      TypeBackboneElement
      Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
      44. InsuranceProduct.coverage.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
      46. InsuranceProduct.coverage.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 InsuranceProduct.coverage.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 48. InsuranceProduct.coverage.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()))
        50. InsuranceProduct.coverage.type
        Definition

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

        ShortClassification of Coverage
        Control1..1
        TypeCodeableConcept
        52. InsuranceProduct.coverage.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)
        54. InsuranceProduct.coverage.benefit
        Definition

        Specific benefits under this type of coverage.

        ShortList of benefits
        Control1..*
        TypeBackboneElement
        Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
        56. InsuranceProduct.coverage.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. InsuranceProduct.coverage.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 InsuranceProduct.coverage.benefit.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 60. InsuranceProduct.coverage.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. InsuranceProduct.coverage.benefit.type
          Definition

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

          ShortClassification of benefit provided
          Control1..1
          TypeCodeableConcept
          64. InsuranceProduct.coverage.benefit.requirement
          Definition

          The referral requirements to have access/coverage for this benefit.

          ShortReferral requirements
          Control0..1
          Typestring
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          66. InsuranceProduct.coverage.benefit.limit
          Definition

          The specific limits on the benefit.

          ShortLimits on the provided benefits
          Control0..*
          TypeBackboneElement
          Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
          68. InsuranceProduct.coverage.benefit.limit.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
          70. InsuranceProduct.coverage.benefit.limit.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 InsuranceProduct.coverage.benefit.limit.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 72. InsuranceProduct.coverage.benefit.limit.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()))
            74. InsuranceProduct.coverage.benefit.limit.value
            Definition

            The maximum amount of a service item a plan will pay for a covered benefit. For examples. wellness visits, or eyeglasses.

            ShortMaximum value allowed
            Comments

            May also be called “eligible expense,” “payment allowance,” or “negotiated rate.”.

            Control0..1
            TypeQuantity
            76. InsuranceProduct.coverage.benefit.limit.code
            Definition

            The specific limit on the benefit.

            ShortBenefit limit details
            Comments

            Use CodeableConcept.text element if the data is free (uncoded) text.

            Control0..1
            TypeCodeableConcept
            78. InsuranceProduct.related
            Definition

            Another product that is related to this product. Often used to create relationships to parents or families of products.

            ShortAssociated insurance product
            Control0..*
            TypeBackboneElement
            Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
            80. InsuranceProduct.related.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
            82. InsuranceProduct.related.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 InsuranceProduct.related.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 84. InsuranceProduct.related.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()))
              86. InsuranceProduct.related.product
              Definition

              The Related Product reference.

              ShortRelated Product reference
              Control0..1
              TypeReference(Insurance Product)
              88. InsuranceProduct.related.relationship
              Definition

              The relationship of this product to the related product. an example would be 'sub-plan' where this product is a sub-plan of the related.product.

              ShortRelationship of this product to the related product
              Comments

              Use CodeableConcept.text element if the data is free (uncoded) text.

              Control0..1
              TypeCodeableConcept
              90. InsuranceProduct.related.period
              Definition

              Period of time that the product relationship is valid. The start and/or end dates can be empty if this is an open ended relationship.

              ShortPeriod that this Relationship is valid
              Control0..1
              TypePeriod

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

              0. InsuranceProduct
              Definition

              A product is a discrete package of health insurance coverage benefits that are offered under a particular network, by an organization (payer) and additional information about the offering, such as who it is owned and administered by, a coverage area, contact information, etc.

              ShortDetails of a Health Insurance product provided by an organization
              Control0..*
              Invariantsipn-1: The organization SHALL at least have a name or an identifier, and possibly more than one ((identifier.count() + name.count()) > 0)
              2. InsuranceProduct.identifier
              Definition

              Business identifiers assigned to this health insurance product which remain constant as the resource is updated and propagates from server to server.

              ShortBusiness Identifier for Product
              NoteThis is a business identifier, not a resource identifier (see discussion)
              Control0..*
              This element is affected by the following invariants: ipn-1
              TypeIdentifier
              4. InsuranceProduct.status
              Definition

              The current state of the health insurance product.

              Shortdraft | active | retired | unknown
              Control0..1
              BindingThe codes SHALL be taken from PublicationStatus
              (required to http://hl7.org/fhir/ValueSet/publication-status)

              The lifecycle status of an artifact.

              Typecode
              Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains codes which means that the resource should not be treated as valid
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Requirements

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

              Meaning if MissingDefault interpretation is active.
              6. InsuranceProduct.type
              Definition

              The kind of health insurance product.

              ShortKind of product
              Control0..*
              BindingFor example codes, see InsurancePlanType
              (example to http://hl7.org/fhir/ValueSet/insuranceproduct-type)

              Used to categorize the product.

              TypeCodeableConcept
              8. InsuranceProduct.name
              Definition

              Official name of the health insurance product as designated by the owner.

              ShortOfficial name
              Comments

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

              Control0..1
              This element is affected by the following invariants: ipn-1
              Typestring
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              10. InsuranceProduct.alias
              Definition

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

              ShortAlternate names
              Comments

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

              Control0..*
              Typestring
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Requirements

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

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

              12. InsuranceProduct.period
              Definition

              The period of time that the health insurance product is available.

              ShortWhen the product is available
              Control0..1
              TypePeriod
              14. InsuranceProduct.ownedBy
              Definition

              The entity that is providing the health insurance product and underwriting the risk. This is typically an insurance carriers, other third-party payers, or health plan sponsors comonly referred to as 'payers'.

              ShortProduct issuer
              Control0..1
              TypeReference(Organization)
              Alternate NamesPayer
              16. InsuranceProduct.administeredBy
              Definition

              An organization which administer other services such as underwriting, customer service and/or claims processing on behalf of the health insurance product owner.

              ShortProduct administrator
              Control0..1
              TypeReference(Organization)
              18. InsuranceProduct.coverageArea
              Definition

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

              ShortWhere product applies
              Control0..*
              TypeReference(Location)
              20. InsuranceProduct.contact
              Definition

              The contact details of communication devices available relevant to the specific Insurance Product. This can include addresses, phone numbers, fax numbers, mobile numbers, email addresses and web sites.

              ShortOfficial contact details relevant to the health insurance product
              Comments

              The address/telecom use code 'home' are not to be used.

              Control0..*
              TypeExtendedContactDetail
              Requirements

              Need to keep track of both simple contact details and also assigned contacts within larger organizations.

              22. InsuranceProduct.endpoint
              Definition

              The technical endpoints providing access to services operated for the health insurance product.

              ShortTechnical endpoint
              Control0..*
              TypeReference(Endpoint)
              Requirements

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

              24. InsuranceProduct.network
              Definition

              Reference to the network included in the health insurance product.

              ShortWhat networks are Included
              Comments

              Networks are represented as a hierarchy of organization resources.

              Control0..*
              TypeReference(Organization)
              26. InsuranceProduct.coverage
              Definition

              Details about the coverage offered by the insurance product.

              ShortCoverage details
              Control0..*
              TypeBackboneElement
              28. InsuranceProduct.coverage.type
              Definition

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

              ShortClassification of Coverage
              Control1..1
              TypeCodeableConcept
              30. InsuranceProduct.coverage.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)
              32. InsuranceProduct.coverage.benefit
              Definition

              Specific benefits under this type of coverage.

              ShortList of benefits
              Control1..*
              TypeBackboneElement
              34. InsuranceProduct.coverage.benefit.type
              Definition

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

              ShortClassification of benefit provided
              Control1..1
              TypeCodeableConcept
              36. InsuranceProduct.coverage.benefit.requirement
              Definition

              The referral requirements to have access/coverage for this benefit.

              ShortReferral requirements
              Control0..1
              Typestring
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              38. InsuranceProduct.coverage.benefit.limit
              Definition

              The specific limits on the benefit.

              ShortLimits on the provided benefits
              Control0..*
              TypeBackboneElement
              40. InsuranceProduct.coverage.benefit.limit.value
              Definition

              The maximum amount of a service item a plan will pay for a covered benefit. For examples. wellness visits, or eyeglasses.

              ShortMaximum value allowed
              Comments

              May also be called “eligible expense,” “payment allowance,” or “negotiated rate.”.

              Control0..1
              TypeQuantity
              42. InsuranceProduct.coverage.benefit.limit.code
              Definition

              The specific limit on the benefit.

              ShortBenefit limit details
              Comments

              Use CodeableConcept.text element if the data is free (uncoded) text.

              Control0..1
              TypeCodeableConcept
              44. InsuranceProduct.related
              Definition

              Another product that is related to this product. Often used to create relationships to parents or families of products.

              ShortAssociated insurance product
              Control0..*
              TypeBackboneElement
              46. InsuranceProduct.related.product
              Definition

              The Related Product reference.

              ShortRelated Product reference
              Control0..1
              TypeReference(Insurance Product)
              48. InsuranceProduct.related.relationship
              Definition

              The relationship of this product to the related product. an example would be 'sub-plan' where this product is a sub-plan of the related.product.

              ShortRelationship of this product to the related product
              Comments

              Use CodeableConcept.text element if the data is free (uncoded) text.

              Control0..1
              TypeCodeableConcept
              50. InsuranceProduct.related.period
              Definition

              Period of time that the product relationship is valid. The start and/or end dates can be empty if this is an open ended relationship.

              ShortPeriod that this Relationship is valid
              Control0..1
              TypePeriod

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

              0. InsuranceProduct
              Definition

              A product is a discrete package of health insurance coverage benefits that are offered under a particular network, by an organization (payer) and additional information about the offering, such as who it is owned and administered by, a coverage area, contact information, etc.

              ShortDetails of a Health Insurance product provided by an organization
              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())
              ipn-1: The organization SHALL at least have a name or an identifier, and possibly more than one ((identifier.count() + name.count()) > 0)
              2. InsuranceProduct.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. InsuranceProduct.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. InsuranceProduct.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. InsuranceProduct.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. InsuranceProduct.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. InsuranceProduct.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. InsuranceProduct.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 InsuranceProduct.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 16. InsuranceProduct.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 InsuranceProduct.modifierExtension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ url
                • 18. InsuranceProduct.identifier
                  Definition

                  Business identifiers assigned to this health insurance product which remain constant as the resource is updated and propagates from server to server.

                  ShortBusiness Identifier for Product
                  NoteThis is a business identifier, not a resource identifier (see discussion)
                  Control0..*
                  This element is affected by the following invariants: ipn-1
                  TypeIdentifier
                  Summarytrue
                  20. InsuranceProduct.status
                  Definition

                  The current state of the health insurance product.

                  Shortdraft | active | retired | unknown
                  Control0..1
                  BindingThe codes SHALL be taken from PublicationStatus
                  (required to http://hl7.org/fhir/ValueSet/publication-status)

                  The lifecycle status of an artifact.

                  Typecode
                  Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains codes which means that the resource should not be treated as valid
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summarytrue
                  Requirements

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

                  Meaning if MissingDefault interpretation is active.
                  22. InsuranceProduct.type
                  Definition

                  The kind of health insurance product.

                  ShortKind of product
                  Control0..*
                  BindingFor example codes, see InsurancePlanType
                  (example to http://hl7.org/fhir/ValueSet/insuranceproduct-type)

                  Used to categorize the product.

                  TypeCodeableConcept
                  Summarytrue
                  24. InsuranceProduct.name
                  Definition

                  Official name of the health insurance product as designated by the owner.

                  ShortOfficial name
                  Comments

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

                  Control0..1
                  This element is affected by the following invariants: ipn-1
                  Typestring
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summarytrue
                  26. InsuranceProduct.alias
                  Definition

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

                  ShortAlternate names
                  Comments

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

                  Control0..*
                  Typestring
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Requirements

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

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

                  28. InsuranceProduct.period
                  Definition

                  The period of time that the health insurance product is available.

                  ShortWhen the product is available
                  Control0..1
                  TypePeriod
                  30. InsuranceProduct.ownedBy
                  Definition

                  The entity that is providing the health insurance product and underwriting the risk. This is typically an insurance carriers, other third-party payers, or health plan sponsors comonly referred to as 'payers'.

                  ShortProduct issuer
                  Control0..1
                  TypeReference(Organization)
                  Summarytrue
                  Alternate NamesPayer
                  32. InsuranceProduct.administeredBy
                  Definition

                  An organization which administer other services such as underwriting, customer service and/or claims processing on behalf of the health insurance product owner.

                  ShortProduct administrator
                  Control0..1
                  TypeReference(Organization)
                  Summarytrue
                  34. InsuranceProduct.coverageArea
                  Definition

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

                  ShortWhere product applies
                  Control0..*
                  TypeReference(Location)
                  Summarytrue
                  36. InsuranceProduct.contact
                  Definition

                  The contact details of communication devices available relevant to the specific Insurance Product. This can include addresses, phone numbers, fax numbers, mobile numbers, email addresses and web sites.

                  ShortOfficial contact details relevant to the health insurance product
                  Comments

                  The address/telecom use code 'home' are not to be used.

                  Control0..*
                  TypeExtendedContactDetail
                  Requirements

                  Need to keep track of both simple contact details and also assigned contacts within larger organizations.

                  38. InsuranceProduct.endpoint
                  Definition

                  The technical endpoints providing access to services operated for the health insurance product.

                  ShortTechnical endpoint
                  Control0..*
                  TypeReference(Endpoint)
                  Requirements

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

                  40. InsuranceProduct.network
                  Definition

                  Reference to the network included in the health insurance product.

                  ShortWhat networks are Included
                  Comments

                  Networks are represented as a hierarchy of organization resources.

                  Control0..*
                  TypeReference(Organization)
                  42. InsuranceProduct.coverage
                  Definition

                  Details about the coverage offered by the insurance product.

                  ShortCoverage details
                  Control0..*
                  TypeBackboneElement
                  Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
                  44. InsuranceProduct.coverage.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
                  46. InsuranceProduct.coverage.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 InsuranceProduct.coverage.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ url
                  • 48. InsuranceProduct.coverage.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()))
                    50. InsuranceProduct.coverage.type
                    Definition

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

                    ShortClassification of Coverage
                    Control1..1
                    TypeCodeableConcept
                    52. InsuranceProduct.coverage.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)
                    54. InsuranceProduct.coverage.benefit
                    Definition

                    Specific benefits under this type of coverage.

                    ShortList of benefits
                    Control1..*
                    TypeBackboneElement
                    Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
                    56. InsuranceProduct.coverage.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. InsuranceProduct.coverage.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 InsuranceProduct.coverage.benefit.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • value @ url
                    • 60. InsuranceProduct.coverage.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. InsuranceProduct.coverage.benefit.type
                      Definition

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

                      ShortClassification of benefit provided
                      Control1..1
                      TypeCodeableConcept
                      64. InsuranceProduct.coverage.benefit.requirement
                      Definition

                      The referral requirements to have access/coverage for this benefit.

                      ShortReferral requirements
                      Control0..1
                      Typestring
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      66. InsuranceProduct.coverage.benefit.limit
                      Definition

                      The specific limits on the benefit.

                      ShortLimits on the provided benefits
                      Control0..*
                      TypeBackboneElement
                      Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
                      68. InsuranceProduct.coverage.benefit.limit.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
                      70. InsuranceProduct.coverage.benefit.limit.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 InsuranceProduct.coverage.benefit.limit.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                      • 72. InsuranceProduct.coverage.benefit.limit.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()))
                        74. InsuranceProduct.coverage.benefit.limit.value
                        Definition

                        The maximum amount of a service item a plan will pay for a covered benefit. For examples. wellness visits, or eyeglasses.

                        ShortMaximum value allowed
                        Comments

                        May also be called “eligible expense,” “payment allowance,” or “negotiated rate.”.

                        Control0..1
                        TypeQuantity
                        76. InsuranceProduct.coverage.benefit.limit.code
                        Definition

                        The specific limit on the benefit.

                        ShortBenefit limit details
                        Comments

                        Use CodeableConcept.text element if the data is free (uncoded) text.

                        Control0..1
                        TypeCodeableConcept
                        78. InsuranceProduct.related
                        Definition

                        Another product that is related to this product. Often used to create relationships to parents or families of products.

                        ShortAssociated insurance product
                        Control0..*
                        TypeBackboneElement
                        Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
                        80. InsuranceProduct.related.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
                        82. InsuranceProduct.related.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 InsuranceProduct.related.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                        • value @ url
                        • 84. InsuranceProduct.related.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()))
                          86. InsuranceProduct.related.product
                          Definition

                          The Related Product reference.

                          ShortRelated Product reference
                          Control0..1
                          TypeReference(Insurance Product)
                          88. InsuranceProduct.related.relationship
                          Definition

                          The relationship of this product to the related product. an example would be 'sub-plan' where this product is a sub-plan of the related.product.

                          ShortRelationship of this product to the related product
                          Comments

                          Use CodeableConcept.text element if the data is free (uncoded) text.

                          Control0..1
                          TypeCodeableConcept
                          90. InsuranceProduct.related.period
                          Definition

                          Period of time that the product relationship is valid. The start and/or end dates can be empty if this is an open ended relationship.

                          ShortPeriod that this Relationship is valid
                          Control0..1
                          TypePeriod