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
| 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. |
| Short | Details of a Health Insurance product provided by an organizationA resource with narrative, extensions, and contained resources |
| Control | 0..* |
| Is Modifier | false |
| Must Support | false |
| Summary | false |
| Invariants | dom-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. |
| Short | Logical 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. |
| Control | 0..1 |
| Type | id |
| Is Modifier | false |
| Must Support | false |
| Summary | true |
| 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. |
| Short | Metadata about the resource |
| Control | 0..1 |
| Type | Meta |
| Is Modifier | false |
| Must Support | false |
| Summary | true |
| Invariants | ele-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. |
| Short | A 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. |
| Control | 0..1 |
| Type | uri |
| Is Modifier | true 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 Value | This primitive element may be present, or absent, or replaced by an extension |
| Must Support | false |
| Summary | true |
| Invariants | ele-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. |
| Short | Language 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). |
| Control | 0..1 |
| Binding | The 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 |
| Type | code |
| Is Modifier | false |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| Must Support | false |
| Summary | false |
| Invariants | ele-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. |
| Short | Text 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. |
| Control | 0..1 This element is affected by the following invariants: dom-6 |
| Type | Narrative |
| Is Modifier | false |
| Must Support | false |
| Summary | false |
| Alternate Names | narrative, html, xhtml, display |
| Invariants | ele-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. |
| Short | Contained, 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. |
| Control | 0..* This element is affected by the following invariants: dom-2, dom-4, dom-3, dom-5 |
| Type | Resource |
| Is Modifier | false |
| Must Support | false |
| Summary | false |
| Alternate Names | inline 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. |
| Short | Additional 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. |
| Control | 0..* |
| Type | Extension |
| Is Modifier | false |
| Must Support | false |
| Summary | false |
| Alternate Names | extensions, user content |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
| Slicing | This element introduces a set of slices on InsuranceProduct.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 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). |
| Short | Extensions 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. |
| Control | 0..* |
| Type | Extension |
| Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them |
| Must Support | false |
| Summary | true |
| 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 Names | extensions, user content |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
| Slicing | This element introduces a set of slices on InsuranceProduct.modifierExtension. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 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. |
| Short | Business Identifier for Product |
| Note | This is a business identifier, not a resource identifier (see discussion) |
| Control | 0..* This element is affected by the following invariants: ipn-1 |
| Type | Identifier |
| Summary | true |
| 20. InsuranceProduct.status | |
| Definition | The current state of the health insurance product. |
| Short | draft | active | retired | unknown |
| Control | 0..1 |
| Binding | The 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. |
| Type | code |
| Is Modifier | true 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 Value | This primitive element may be present, or absent, or replaced by an extension |
| Summary | true |
| 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 Missing | Default interpretation is active. |
| 22. InsuranceProduct.type | |
| Definition | The kind of health insurance product. |
| Short | Kind of product |
| Control | 0..* |
| Binding | For example codes, see InsurancePlanTypehttp://hl7.org/fhir/ValueSet/insuranceproduct-type (example to http://hl7.org/fhir/ValueSet/insuranceproduct-type)Used to categorize the product. |
| Type | CodeableConcept |
| Summary | true |
| 24. InsuranceProduct.name | |
| Definition | Official name of the health insurance product as designated by the owner. |
| Short | Official 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. |
| Control | 0..1 This element is affected by the following invariants: ipn-1 |
| Type | string |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| Summary | true |
| 26. InsuranceProduct.alias | |
| Definition | A list of alternate names that the product is known as, or was known as in the past. |
| Short | Alternate 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. |
| Control | 0..* |
| Type | string |
| Primitive Value | This 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. |
| Short | When the product is available |
| Control | 0..1 |
| Type | Period |
| 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'. |
| Short | Product issuer |
| Control | 0..1 |
| Type | Reference(Organization) |
| Summary | true |
| Alternate Names | Payer |
| 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. |
| Short | Product administrator |
| Control | 0..1 |
| Type | Reference(Organization) |
| Summary | true |
| 34. InsuranceProduct.coverageArea | |
| Definition | The geographic region in which a health insurance product's benefits apply. |
| Short | Where product applies |
| Control | 0..* |
| Type | Reference(Location) |
| Summary | true |
| 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. |
| Short | Official contact details relevant to the health insurance product |
| Comments | The address/telecom use code 'home' are not to be used. |
| Control | 0..* |
| Type | ExtendedContactDetail |
| 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. |
| Short | Technical endpoint |
| Control | 0..* |
| Type | Reference(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. |
| Short | What networks are Included |
| Comments | Networks are represented as a hierarchy of organization resources. |
| Control | 0..* |
| Type | Reference(Organization) |
| 42. InsuranceProduct.coverage | |
| Definition | Details about the coverage offered by the insurance product. |
| Short | Coverage details |
| Control | 0..* |
| Type | BackboneElement |
| Invariants | ele-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. |
| Short | Unique id for inter-element referencing |
| Control | 0..1 This element is affected by the following invariants: ele-1 |
| Type | idstring |
| Is Modifier | false |
| XML Format | In the XML format, this property is represented as an attribute. |
| Summary | false |
| 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. |
| Short | Additional 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. |
| Control | 0..* |
| Type | Extension |
| Is Modifier | false |
| Summary | false |
| Alternate Names | extensions, user content |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
| Slicing | This element introduces a set of slices on InsuranceProduct.coverage.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 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). |
| Short | Extensions 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. |
| Control | 0..* |
| Type | Extension |
| Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
| Summary | true |
| 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 Names | extensions, user content, modifiers |
| Invariants | ele-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). |
| Short | Classification of Coverage |
| Control | 1..1 |
| Type | CodeableConcept |
| 52. InsuranceProduct.coverage.network | |
| Definition | Reference to the network that providing the type of coverage. |
| Short | What networks provide coverage |
| Comments | Networks are represented as a hierarchy of organization resources. |
| Control | 0..* |
| Type | Reference(Organization) |
| 54. InsuranceProduct.coverage.benefit | |
| Definition | Specific benefits under this type of coverage. |
| Short | List of benefits |
| Control | 1..* |
| Type | BackboneElement |
| Invariants | ele-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. |
| Short | Unique id for inter-element referencing |
| Control | 0..1 This element is affected by the following invariants: ele-1 |
| Type | idstring |
| Is Modifier | false |
| XML Format | In the XML format, this property is represented as an attribute. |
| Summary | false |
| 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. |
| Short | Additional 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. |
| Control | 0..* |
| Type | Extension |
| Is Modifier | false |
| Summary | false |
| Alternate Names | extensions, user content |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
| Slicing | This element introduces a set of slices on InsuranceProduct.coverage.benefit.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 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). |
| Short | Extensions 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. |
| Control | 0..* |
| Type | Extension |
| Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
| Summary | true |
| 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 Names | extensions, user content, modifiers |
| Invariants | ele-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). |
| Short | Classification of benefit provided |
| Control | 1..1 |
| Type | CodeableConcept |
| 64. InsuranceProduct.coverage.benefit.requirement | |
| Definition | The referral requirements to have access/coverage for this benefit. |
| Short | Referral requirements |
| Control | 0..1 |
| Type | string |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| 66. InsuranceProduct.coverage.benefit.limit | |
| Definition | The specific limits on the benefit. |
| Short | Limits on the provided benefits |
| Control | 0..* |
| Type | BackboneElement |
| Invariants | ele-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. |
| Short | Unique id for inter-element referencing |
| Control | 0..1 This element is affected by the following invariants: ele-1 |
| Type | idstring |
| Is Modifier | false |
| XML Format | In the XML format, this property is represented as an attribute. |
| Summary | false |
| 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. |
| Short | Additional 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. |
| Control | 0..* |
| Type | Extension |
| Is Modifier | false |
| Summary | false |
| Alternate Names | extensions, user content |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
| Slicing | This 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: |
| 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). |
| Short | Extensions 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. |
| Control | 0..* |
| Type | Extension |
| Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
| Summary | true |
| 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 Names | extensions, user content, modifiers |
| Invariants | ele-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. |
| Short | Maximum value allowed |
| Comments | May also be called “eligible expense,” “payment allowance,” or “negotiated rate.”. |
| Control | 0..1 |
| Type | Quantity |
| 76. InsuranceProduct.coverage.benefit.limit.code | |
| Definition | The specific limit on the benefit. |
| Short | Benefit limit details |
| Comments | Use |
| Control | 0..1 |
| Type | CodeableConcept |
| 78. InsuranceProduct.related | |
| Definition | Another product that is related to this product. Often used to create relationships to parents or families of products. |
| Short | Associated insurance product |
| Control | 0..* |
| Type | BackboneElement |
| Invariants | ele-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. |
| Short | Unique id for inter-element referencing |
| Control | 0..1 This element is affected by the following invariants: ele-1 |
| Type | idstring |
| Is Modifier | false |
| XML Format | In the XML format, this property is represented as an attribute. |
| Summary | false |
| 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. |
| Short | Additional 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. |
| Control | 0..* |
| Type | Extension |
| Is Modifier | false |
| Summary | false |
| Alternate Names | extensions, user content |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
| Slicing | This element introduces a set of slices on InsuranceProduct.related.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 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). |
| Short | Extensions 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. |
| Control | 0..* |
| Type | Extension |
| Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
| Summary | true |
| 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 Names | extensions, user content, modifiers |
| Invariants | ele-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. |
| Short | Related Product reference |
| Control | 0..1 |
| Type | Reference(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. |
| Short | Relationship of this product to the related product |
| Comments | Use |
| Control | 0..1 |
| Type | CodeableConcept |
| 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. |
| Short | Period that this Relationship is valid |
| Control | 0..1 |
| Type | Period |
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. |
| Short | Details of a Health Insurance product provided by an organization |
| Control | 0..* |
| Invariants | 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.identifier | |
| Definition | Business identifiers assigned to this health insurance product which remain constant as the resource is updated and propagates from server to server. |
| Short | Business Identifier for Product |
| Note | This is a business identifier, not a resource identifier (see discussion) |
| Control | 0..* This element is affected by the following invariants: ipn-1 |
| Type | Identifier |
| 4. InsuranceProduct.status | |
| Definition | The current state of the health insurance product. |
| Short | draft | active | retired | unknown |
| Control | 0..1 |
| Binding | The codes SHALL be taken from PublicationStatus (required to http://hl7.org/fhir/ValueSet/publication-status)The lifecycle status of an artifact. |
| Type | code |
| Is Modifier | true 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 Value | This 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 Missing | Default interpretation is active. |
| 6. InsuranceProduct.type | |
| Definition | The kind of health insurance product. |
| Short | Kind of product |
| Control | 0..* |
| Binding | For example codes, see InsurancePlanType (example to http://hl7.org/fhir/ValueSet/insuranceproduct-type)Used to categorize the product. |
| Type | CodeableConcept |
| 8. InsuranceProduct.name | |
| Definition | Official name of the health insurance product as designated by the owner. |
| Short | Official 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. |
| Control | 0..1 This element is affected by the following invariants: ipn-1 |
| Type | string |
| Primitive Value | This 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. |
| Short | Alternate 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. |
| Control | 0..* |
| Type | string |
| Primitive Value | This 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. |
| Short | When the product is available |
| Control | 0..1 |
| Type | Period |
| 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'. |
| Short | Product issuer |
| Control | 0..1 |
| Type | Reference(Organization) |
| Alternate Names | Payer |
| 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. |
| Short | Product administrator |
| Control | 0..1 |
| Type | Reference(Organization) |
| 18. InsuranceProduct.coverageArea | |
| Definition | The geographic region in which a health insurance product's benefits apply. |
| Short | Where product applies |
| Control | 0..* |
| Type | Reference(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. |
| Short | Official contact details relevant to the health insurance product |
| Comments | The address/telecom use code 'home' are not to be used. |
| Control | 0..* |
| Type | ExtendedContactDetail |
| 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. |
| Short | Technical endpoint |
| Control | 0..* |
| Type | Reference(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. |
| Short | What networks are Included |
| Comments | Networks are represented as a hierarchy of organization resources. |
| Control | 0..* |
| Type | Reference(Organization) |
| 26. InsuranceProduct.coverage | |
| Definition | Details about the coverage offered by the insurance product. |
| Short | Coverage details |
| Control | 0..* |
| Type | BackboneElement |
| 28. InsuranceProduct.coverage.type | |
| Definition | Type of coverage (Medical; Dental; Mental Health; Substance Abuse; Vision; Drug; Short Term; Long Term Care; Hospice; Home Health). |
| Short | Classification of Coverage |
| Control | 1..1 |
| Type | CodeableConcept |
| 30. InsuranceProduct.coverage.network | |
| Definition | Reference to the network that providing the type of coverage. |
| Short | What networks provide coverage |
| Comments | Networks are represented as a hierarchy of organization resources. |
| Control | 0..* |
| Type | Reference(Organization) |
| 32. InsuranceProduct.coverage.benefit | |
| Definition | Specific benefits under this type of coverage. |
| Short | List of benefits |
| Control | 1..* |
| Type | BackboneElement |
| 34. InsuranceProduct.coverage.benefit.type | |
| Definition | Type of benefit (primary care; specialty care; inpatient; outpatient). |
| Short | Classification of benefit provided |
| Control | 1..1 |
| Type | CodeableConcept |
| 36. InsuranceProduct.coverage.benefit.requirement | |
| Definition | The referral requirements to have access/coverage for this benefit. |
| Short | Referral requirements |
| Control | 0..1 |
| Type | string |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| 38. InsuranceProduct.coverage.benefit.limit | |
| Definition | The specific limits on the benefit. |
| Short | Limits on the provided benefits |
| Control | 0..* |
| Type | BackboneElement |
| 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. |
| Short | Maximum value allowed |
| Comments | May also be called “eligible expense,” “payment allowance,” or “negotiated rate.”. |
| Control | 0..1 |
| Type | Quantity |
| 42. InsuranceProduct.coverage.benefit.limit.code | |
| Definition | The specific limit on the benefit. |
| Short | Benefit limit details |
| Comments | Use |
| Control | 0..1 |
| Type | CodeableConcept |
| 44. InsuranceProduct.related | |
| Definition | Another product that is related to this product. Often used to create relationships to parents or families of products. |
| Short | Associated insurance product |
| Control | 0..* |
| Type | BackboneElement |
| 46. InsuranceProduct.related.product | |
| Definition | The Related Product reference. |
| Short | Related Product reference |
| Control | 0..1 |
| Type | Reference(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. |
| Short | Relationship of this product to the related product |
| Comments | Use |
| Control | 0..1 |
| Type | CodeableConcept |
| 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. |
| Short | Period that this Relationship is valid |
| Control | 0..1 |
| Type | Period |
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. |
| Short | Details of a Health Insurance product provided by an organization |
| Control | 0..* |
| Is Modifier | false |
| Must Support | false |
| Summary | false |
| Invariants | dom-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. |
| Short | Logical 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. |
| Control | 0..1 |
| Type | id |
| Is Modifier | false |
| Must Support | false |
| Summary | true |
| 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. |
| Short | Metadata about the resource |
| Control | 0..1 |
| Type | Meta |
| Is Modifier | false |
| Must Support | false |
| Summary | true |
| Invariants | ele-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. |
| Short | A 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. |
| Control | 0..1 |
| Type | uri |
| Is Modifier | true 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 Value | This primitive element may be present, or absent, or replaced by an extension |
| Must Support | false |
| Summary | true |
| Invariants | ele-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. |
| Short | Language 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). |
| Control | 0..1 |
| Binding | The 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 |
| Type | code |
| Is Modifier | false |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| Must Support | false |
| Summary | false |
| Invariants | ele-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. |
| Short | Text 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. |
| Control | 0..1 This element is affected by the following invariants: dom-6 |
| Type | Narrative |
| Is Modifier | false |
| Must Support | false |
| Summary | false |
| Alternate Names | narrative, html, xhtml, display |
| Invariants | ele-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. |
| Short | Contained, 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. |
| Control | 0..* This element is affected by the following invariants: dom-2, dom-4, dom-3, dom-5 |
| Type | Resource |
| Is Modifier | false |
| Must Support | false |
| Summary | false |
| Alternate Names | inline 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. |
| Short | Additional 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. |
| Control | 0..* |
| Type | Extension |
| Is Modifier | false |
| Must Support | false |
| Summary | false |
| Alternate Names | extensions, user content |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
| Slicing | This element introduces a set of slices on InsuranceProduct.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 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). |
| Short | Extensions 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. |
| Control | 0..* |
| Type | Extension |
| Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them |
| Must Support | false |
| Summary | true |
| 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 Names | extensions, user content |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
| Slicing | This element introduces a set of slices on InsuranceProduct.modifierExtension. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 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. |
| Short | Business Identifier for Product |
| Note | This is a business identifier, not a resource identifier (see discussion) |
| Control | 0..* This element is affected by the following invariants: ipn-1 |
| Type | Identifier |
| Summary | true |
| 20. InsuranceProduct.status | |
| Definition | The current state of the health insurance product. |
| Short | draft | active | retired | unknown |
| Control | 0..1 |
| Binding | The codes SHALL be taken from PublicationStatus (required to http://hl7.org/fhir/ValueSet/publication-status)The lifecycle status of an artifact. |
| Type | code |
| Is Modifier | true 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 Value | This primitive element may be present, or absent, or replaced by an extension |
| Summary | true |
| 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 Missing | Default interpretation is active. |
| 22. InsuranceProduct.type | |
| Definition | The kind of health insurance product. |
| Short | Kind of product |
| Control | 0..* |
| Binding | For example codes, see InsurancePlanType (example to http://hl7.org/fhir/ValueSet/insuranceproduct-type)Used to categorize the product. |
| Type | CodeableConcept |
| Summary | true |
| 24. InsuranceProduct.name | |
| Definition | Official name of the health insurance product as designated by the owner. |
| Short | Official 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. |
| Control | 0..1 This element is affected by the following invariants: ipn-1 |
| Type | string |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| Summary | true |
| 26. InsuranceProduct.alias | |
| Definition | A list of alternate names that the product is known as, or was known as in the past. |
| Short | Alternate 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. |
| Control | 0..* |
| Type | string |
| Primitive Value | This 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. |
| Short | When the product is available |
| Control | 0..1 |
| Type | Period |
| 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'. |
| Short | Product issuer |
| Control | 0..1 |
| Type | Reference(Organization) |
| Summary | true |
| Alternate Names | Payer |
| 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. |
| Short | Product administrator |
| Control | 0..1 |
| Type | Reference(Organization) |
| Summary | true |
| 34. InsuranceProduct.coverageArea | |
| Definition | The geographic region in which a health insurance product's benefits apply. |
| Short | Where product applies |
| Control | 0..* |
| Type | Reference(Location) |
| Summary | true |
| 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. |
| Short | Official contact details relevant to the health insurance product |
| Comments | The address/telecom use code 'home' are not to be used. |
| Control | 0..* |
| Type | ExtendedContactDetail |
| 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. |
| Short | Technical endpoint |
| Control | 0..* |
| Type | Reference(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. |
| Short | What networks are Included |
| Comments | Networks are represented as a hierarchy of organization resources. |
| Control | 0..* |
| Type | Reference(Organization) |
| 42. InsuranceProduct.coverage | |
| Definition | Details about the coverage offered by the insurance product. |
| Short | Coverage details |
| Control | 0..* |
| Type | BackboneElement |
| Invariants | ele-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. |
| Short | Unique id for inter-element referencing |
| Control | 0..1 This element is affected by the following invariants: ele-1 |
| Type | id |
| Is Modifier | false |
| XML Format | In the XML format, this property is represented as an attribute. |
| Summary | false |
| 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. |
| Short | Additional 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. |
| Control | 0..* |
| Type | Extension |
| Is Modifier | false |
| Summary | false |
| Alternate Names | extensions, user content |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
| Slicing | This element introduces a set of slices on InsuranceProduct.coverage.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 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). |
| Short | Extensions 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. |
| Control | 0..* |
| Type | Extension |
| Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
| Summary | true |
| 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 Names | extensions, user content, modifiers |
| Invariants | ele-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). |
| Short | Classification of Coverage |
| Control | 1..1 |
| Type | CodeableConcept |
| 52. InsuranceProduct.coverage.network | |
| Definition | Reference to the network that providing the type of coverage. |
| Short | What networks provide coverage |
| Comments | Networks are represented as a hierarchy of organization resources. |
| Control | 0..* |
| Type | Reference(Organization) |
| 54. InsuranceProduct.coverage.benefit | |
| Definition | Specific benefits under this type of coverage. |
| Short | List of benefits |
| Control | 1..* |
| Type | BackboneElement |
| Invariants | ele-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. |
| Short | Unique id for inter-element referencing |
| Control | 0..1 This element is affected by the following invariants: ele-1 |
| Type | id |
| Is Modifier | false |
| XML Format | In the XML format, this property is represented as an attribute. |
| Summary | false |
| 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. |
| Short | Additional 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. |
| Control | 0..* |
| Type | Extension |
| Is Modifier | false |
| Summary | false |
| Alternate Names | extensions, user content |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
| Slicing | This element introduces a set of slices on InsuranceProduct.coverage.benefit.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 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). |
| Short | Extensions 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. |
| Control | 0..* |
| Type | Extension |
| Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
| Summary | true |
| 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 Names | extensions, user content, modifiers |
| Invariants | ele-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). |
| Short | Classification of benefit provided |
| Control | 1..1 |
| Type | CodeableConcept |
| 64. InsuranceProduct.coverage.benefit.requirement | |
| Definition | The referral requirements to have access/coverage for this benefit. |
| Short | Referral requirements |
| Control | 0..1 |
| Type | string |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| 66. InsuranceProduct.coverage.benefit.limit | |
| Definition | The specific limits on the benefit. |
| Short | Limits on the provided benefits |
| Control | 0..* |
| Type | BackboneElement |
| Invariants | ele-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. |
| Short | Unique id for inter-element referencing |
| Control | 0..1 This element is affected by the following invariants: ele-1 |
| Type | id |
| Is Modifier | false |
| XML Format | In the XML format, this property is represented as an attribute. |
| Summary | false |
| 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. |
| Short | Additional 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. |
| Control | 0..* |
| Type | Extension |
| Is Modifier | false |
| Summary | false |
| Alternate Names | extensions, user content |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
| Slicing | This 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: |
| 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). |
| Short | Extensions 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. |
| Control | 0..* |
| Type | Extension |
| Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
| Summary | true |
| 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 Names | extensions, user content, modifiers |
| Invariants | ele-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. |
| Short | Maximum value allowed |
| Comments | May also be called “eligible expense,” “payment allowance,” or “negotiated rate.”. |
| Control | 0..1 |
| Type | Quantity |
| 76. InsuranceProduct.coverage.benefit.limit.code | |
| Definition | The specific limit on the benefit. |
| Short | Benefit limit details |
| Comments | Use |
| Control | 0..1 |
| Type | CodeableConcept |
| 78. InsuranceProduct.related | |
| Definition | Another product that is related to this product. Often used to create relationships to parents or families of products. |
| Short | Associated insurance product |
| Control | 0..* |
| Type | BackboneElement |
| Invariants | ele-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. |
| Short | Unique id for inter-element referencing |
| Control | 0..1 This element is affected by the following invariants: ele-1 |
| Type | id |
| Is Modifier | false |
| XML Format | In the XML format, this property is represented as an attribute. |
| Summary | false |
| 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. |
| Short | Additional 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. |
| Control | 0..* |
| Type | Extension |
| Is Modifier | false |
| Summary | false |
| Alternate Names | extensions, user content |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
| Slicing | This element introduces a set of slices on InsuranceProduct.related.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 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). |
| Short | Extensions 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. |
| Control | 0..* |
| Type | Extension |
| Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
| Summary | true |
| 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 Names | extensions, user content, modifiers |
| Invariants | ele-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. |
| Short | Related Product reference |
| Control | 0..1 |
| Type | Reference(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. |
| Short | Relationship of this product to the related product |
| Comments | Use |
| Control | 0..1 |
| Type | CodeableConcept |
| 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. |
| Short | Period that this Relationship is valid |
| Control | 0..1 |
| Type | Period |