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

Official URL: http://hl7.org/fhir/StructureDefinition/InsuranceProduct Version: 0.1.0
Standards status: Trial-use Draft as of 2021-01-02 Maturity Level: 1 Computable Name: InsuranceProduct
Other Identifiers: OID:2.16.840.1.113883.4.642.5.1354

Details of a Health Insurance product provided by an organization.

Scope and Usage

Insurance offerings will be fully described by the combination of both InsurancePlan (the costs) and InsuranceProduct (the benefits). A given payer’s products typically differ by network type and/or coverage benefits.

​ An InsurancePlan pairs the health insurance coverage benefits under an InsuranceProduct with the particular cost sharing structure offered to a consumer. A given InsuranceProduct may comprise multiple InsurancePlans.

Boundaries and Relationships

Insurance Product describes a list of covered benefits and networks as well as details about who administers the product and applicable coverage areas.

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

​ A Coverage resource establishes the link between an InsurancePlan and a beneficiary and optionally a subscriber.

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Resource Content

Description Differentials, Snapshots, and other representations.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. InsuranceProduct C 0..* DomainResource Details of a Health Insurance product provided by an organization

Elements defined in Ancestors:id, meta, implicitRules, language, text, contained, extension, modifierExtension
Constraints: ipn-1
... identifier ΣC 0..* Identifier Business Identifier for Product
... status ?!Σ 0..1 code draft | active | retired | unknown
Binding: PublicationStatus (required): The lifecycle status of an artifact.
... type Σ 0..* CodeableConcept Kind of product
Binding: InsurancePlanType (example): Used to categorize the product.
... alias 0..* string Alternate names
... period 0..1 Period When the product is available
... ownedBy Σ 0..1 Reference(Organization) Product issuer
... administeredBy Σ 0..1 Reference(Organization) Product administrator
... coverageArea Σ 0..* Reference(Location) Where product applies
... contact 0..* ExtendedContactDetail Official contact details relevant to the health insurance product
... endpoint 0..* Reference(Endpoint) Technical endpoint
... network 0..* Reference(Organization) What networks are Included
... coverage 0..* BackboneElement Coverage details
.... type 1..1 CodeableConcept Classification of Coverage
.... network 0..* Reference(Organization) What networks provide coverage
.... benefit 1..* BackboneElement List of benefits
..... type 1..1 CodeableConcept Classification of benefit provided
..... requirement 0..1 string Referral requirements
..... limit 0..* BackboneElement Limits on the provided benefits
...... value 0..1 Quantity Maximum value allowed
...... code 0..1 CodeableConcept Benefit limit details
... related 0..* BackboneElement Associated insurance product
.... product 0..1 Reference(Insurance Product) Related Product reference
.... relationship 0..1 CodeableConcept Relationship of this product to the related product
.... period 0..1 Period Period that this Relationship is valid

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
InsuranceProduct.status Base required PublicationStatus 📦6.0.0-ballot3 FHIR Std.
InsuranceProduct.type Base example Insurance Plan Type 📦6.0.0-ballot3 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
ipn-1 error InsuranceProduct The organization SHALL at least have a name or an identifier, and possibly more than one (identifier.count() + name.count()) > 0 
<InsuranceProduct xmlns="http://hl7.org/fhir"> ​​doco
 ​<id value="[id]"/><!-- 0..1 ​* ​Logical id of this artifact  -->
 ​<meta><!-- ​I 0..1 ​* ​Metadata about the resource  --></meta>
 ​<implicitRules value="[uri]"/><!-- ​I 0..1 ​* ​A set of rules under which this content was created  -->
 ​<language value="[code]"/><!-- ​I 0..1 ​* Language of the resource content  -->
 ​<text><!-- ​I 0..1 ​* ​Text summary of the resource, for human interpretation  --></text>
 ​<contained><!-- 0..* ​* ​Contained, inline Resources  --></contained>
 ​<extension><!-- See Extensions  ​Additional content defined by implementations  --></extension>
 ​<modifierExtension><!-- ​I 0..* ​* ​Extensions that cannot be ignored  --></modifierExtension>
 <identifier><!-- 0..* ​* ​Business Identifier for Product  --></identifier>
 <status value="[code]"/><!-- 0..1 ​* draft | active | retired | unknown  -->
 <type><!-- 0..* ​* Kind of product  --></type>
 <name value="[string]"/><!-- 0..1 ​* ​Official name  -->
 <alias value="[string]"/><!-- 0..* ​* ​Alternate names  -->
 <period><!-- 0..1 ​* ​When the product is available  --></period>
 <ownedBy><!-- 0..1 ​* ​Product issuer  --></ownedBy>
 <administeredBy><!-- 0..1 ​* ​Product administrator  --></administeredBy>
 <coverageArea><!-- 0..* ​* ​Where product applies  --></coverageArea>
 <contact><!-- 0..* ​* ​Official contact details relevant to the health insurance product  --></contact>
 <endpoint><!-- 0..* ​* ​Technical endpoint  --></endpoint>
 <network><!-- 0..* ​* ​What networks are Included  --></network>
 <coverage> ​I 0..* ​*  <!-- ​I 0..* Coverage details -->
  ​<id value="[id]"/><!-- 0..1 ​* ​Unique id for inter-element referencing   -->
  ​<extension><!-- See Extensions  ​Additional content defined by implementations   --></extension>
  ​<modifierExtension><!-- ​I 0..* ​* ​Extensions that cannot be ignored even if unrecognized   --></modifierExtension>
  <type><!-- 1..1 ​* ​Classification of Coverage   --></type>
  <network><!-- 0..* ​* ​What networks provide coverage   --></network>
  <benefit> ​I 1..* ​*  <!-- ​I 1..* List of benefits -->
   ​<id value="[id]"/><!-- 0..1 ​* ​Unique id for inter-element referencing    -->
   ​<extension><!-- See Extensions  ​Additional content defined by implementations    --></extension>
   ​<modifierExtension><!-- ​I 0..* ​* ​Extensions that cannot be ignored even if unrecognized    --></modifierExtension>
   <type><!-- 1..1 ​* ​Classification of benefit provided    --></type>
   <requirement value="[string]"/><!-- 0..1 ​* ​Referral requirements    -->
   <limit> ​I 0..* ​*  <!-- ​I 0..* Limits on the provided benefits -->
    ​<id value="[id]"/><!-- 0..1 ​* ​Unique id for inter-element referencing     -->
    ​<extension><!-- See Extensions  ​Additional content defined by implementations     --></extension>
    ​<modifierExtension><!-- ​I 0..* ​* ​Extensions that cannot be ignored even if unrecognized     --></modifierExtension>
    <value><!-- 0..1 ​* ​Maximum value allowed     --></value>
    <code><!-- 0..1 ​* ​Benefit limit details     --></code>
   </limit>
  </benefit>
 </coverage>
 <related> ​I 0..* ​*  <!-- ​I 0..* Associated insurance product -->
  ​<id value="[id]"/><!-- 0..1 ​* ​Unique id for inter-element referencing   -->
  ​<extension><!-- See Extensions  ​Additional content defined by implementations   --></extension>
  ​<modifierExtension><!-- ​I 0..* ​* ​Extensions that cannot be ignored even if unrecognized   --></modifierExtension>
  <product><!-- 0..1 ​* ​Related Product reference   --></product>
  <relationship><!-- 0..1 ​* ​Relationship of this product to the related product   --></relationship>
  <period><!-- 0..1 ​* ​Period that this Relationship is valid   --></period>
 </related>
</InsuranceProduct>

​
{​​doco
  "resourceType" : "InsuranceProduct",
  "id" : "<id>", // 0..1 ​Logical id of this artifact
  "meta" : { Meta }, // ​I 0..1 ​Metadata about the resource
  "implicitRules" : "<uri>", // ​I 0..1 ​A set of rules under which this content was created
  "language" : "<code>", // ​I 0..1 Language of the resource content
  "text" : { Narrative }, // ​I 0..1 ​Text summary of the resource, for human interpretation
  "contained" : [{ ​Resource }], // 0..* ​Contained, inline Resources
  (Extensions - see JSON page)
  (Modifier Extensions - see JSON page)
  "identifier" : [{ Identifier }], // 0..* ​Business Identifier for Product
  "status" : "<code>", // 0..1 draft | active | retired | unknown
  "type" : [{ CodeableConcept }], // 0..* Kind of product
  "name" : "<string>", // 0..1 ​Official name
  "alias" : ["<string>"], // 0..* ​Alternate names
  "period" : { Period }, // 0..1 ​When the product is available
  "ownedBy" : { Reference(Organization) }, // 0..1 ​Product issuer
  "administeredBy" : { Reference(Organization) }, // 0..1 ​Product administrator
  "coverageArea" : [{ Reference(Location) }], // 0..* ​Where product applies
  "contact" : [{ ExtendedContactDetail }], // 0..* ​Official contact details relevant to the health insurance product
  "endpoint" : [{ Reference(Endpoint) }], // 0..* ​Technical endpoint
  "network" : [{ Reference(Organization) }], // 0..* ​What networks are Included
  "coverage" : [{ BackboneElement }], // ​I 0..* ​Coverage details
    "id" : "<id>", // 0..1 ​Unique id for inter-element referencing
  (Extensions - see JSON page)
  (Modifier Extensions - see JSON page)
    "type" : { CodeableConcept }, // 1..1 ​Classification of Coverage
    "network" : [{ Reference(Organization) }], // 0..* ​What networks provide coverage
    "benefit" : [{ BackboneElement }] // ​I 1..* ​List of benefits
      "id" : "<id>", // 0..1 ​Unique id for inter-element referencing
  (Extensions - see JSON page)
  (Modifier Extensions - see JSON page)
      "type" : { CodeableConcept }, // 1..1 ​Classification of benefit provided
      "requirement" : "<string>", // 0..1 ​Referral requirements
      "limit" : [{ BackboneElement }] // ​I 0..* ​Limits on the provided benefits
        "id" : "<id>", // 0..1 ​Unique id for inter-element referencing
  (Extensions - see JSON page)
  (Modifier Extensions - see JSON page)
        "value" : { Quantity }, // 0..1 ​Maximum value allowed
        "code" : { CodeableConcept } // 0..1 ​Benefit limit details
      }
    }
  }
  "related" : [{ BackboneElement }] // ​I 0..* ​Associated insurance product
    "id" : "<id>", // 0..1 ​Unique id for inter-element referencing
  (Extensions - see JSON page)
  (Modifier Extensions - see JSON page)
    "product" : { Reference(InsuranceProduct) }, // 0..1 ​Related Product reference
    "relationship" : { CodeableConcept }, // 0..1 ​Relationship of this product to the related product
    "period" : { Period } // 0..1 ​Period that this Relationship is valid
  }
}

​
@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:InsuranceProduct;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  fhir:id [ id ] ; # 0..1 Logical id of this artifact
  fhir:meta [ Meta ] ; # 0..1 ​I Metadata about the resource
  fhir:implicitRules [ uri ] ; # 0..1 ​I A set of rules under which this content was created
  fhir:language [ code ] ; # 0..1 ​I Language of the resource content
  fhir:text [ Narrative ] ; # 0..1 ​I Text summary of the resource, for human interpretation
  fhir:contained  ( [ Resource ] ... ) ; # 0..* Contained, inline Resources
  fhir:extension  ( [ Extension ] ... ) ; # 0..* ​I Additional content defined by implementations
  fhir:modifierExtension  ( [ Extension ] ... ) ; # 0..* ​I Extensions that cannot be ignored
  fhir:identifier  ( [ Identifier ] ... ) ; # 0..* Business Identifier for Product
  fhir:status [ code ] ; # 0..1 draft | active | retired | unknown
  fhir:type  ( [ CodeableConcept ] ... ) ; # 0..* Kind of product
  fhir:name [ string ] ; # 0..1 Official name
  fhir:alias  ( [ string ] ... ) ; # 0..* Alternate names
  fhir:period [ Period ] ; # 0..1 When the product is available
  fhir:ownedBy [ Reference(Organization) ] ; # 0..1 Product issuer
  fhir:administeredBy [ Reference(Organization) ] ; # 0..1 Product administrator
  fhir:coverageArea  ( [ Reference(Location) ] ... ) ; # 0..* Where product applies
  fhir:contact  ( [ ExtendedContactDetail ] ... ) ; # 0..* Official contact details relevant to the health insurance product
  fhir:endpoint  ( [ Reference(Endpoint) ] ... ) ; # 0..* Technical endpoint
  fhir:network  ( [ Reference(Organization) ] ... ) ; # 0..* What networks are Included
  fhir:coverage  ( [ BackboneElement ] ... ) ; # 0..* ​I Coverage details
  fhir:related  ( [ BackboneElement ] ... ) ; # 0..* ​I Associated insurance product
]

Differential View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. InsuranceProduct C 0..* DomainResource Details of a Health Insurance product provided by an organization

Elements defined in Ancestors:id, meta, implicitRules, language, text, contained, extension, modifierExtension
Constraints: ipn-1
... identifier ΣC 0..* Identifier Business Identifier for Product
... status ?!Σ 0..1 code draft | active | retired | unknown
Binding: PublicationStatus (required): The lifecycle status of an artifact.
... type Σ 0..* CodeableConcept Kind of product
Binding: InsurancePlanType (example): Used to categorize the product.
... alias 0..* string Alternate names
... period 0..1 Period When the product is available
... ownedBy Σ 0..1 Reference(Organization) Product issuer
... administeredBy Σ 0..1 Reference(Organization) Product administrator
... coverageArea Σ 0..* Reference(Location) Where product applies
... contact 0..* ExtendedContactDetail Official contact details relevant to the health insurance product
... endpoint 0..* Reference(Endpoint) Technical endpoint
... network 0..* Reference(Organization) What networks are Included
... coverage 0..* BackboneElement Coverage details
.... type 1..1 CodeableConcept Classification of Coverage
.... network 0..* Reference(Organization) What networks provide coverage
.... benefit 1..* BackboneElement List of benefits
..... type 1..1 CodeableConcept Classification of benefit provided
..... requirement 0..1 string Referral requirements
..... limit 0..* BackboneElement Limits on the provided benefits
...... value 0..1 Quantity Maximum value allowed
...... code 0..1 CodeableConcept Benefit limit details
... related 0..* BackboneElement Associated insurance product
.... product 0..1 Reference(Insurance Product) Related Product reference
.... relationship 0..1 CodeableConcept Relationship of this product to the related product
.... period 0..1 Period Period that this Relationship is valid

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
InsuranceProduct.status Base required PublicationStatus 📦6.0.0-ballot3 FHIR Std.
InsuranceProduct.type Base example Insurance Plan Type 📦6.0.0-ballot3 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
ipn-1 error InsuranceProduct The organization SHALL at least have a name or an identifier, and possibly more than one (identifier.count() + name.count()) > 0

 

Other representations of resource: CSV, Excel

Notes:

Notes:

Name Type Description Expression
administered-by reference

Product administrator

 InsuranceProduct.administeredBy
contact-address string

A server defined search that may match any of the string fields in the Address, including line, city, district, state, country, postalCode, and/or text

 InsuranceProduct.contact.address
contact-address-city string

A city specified in an address

 InsuranceProduct.contact.address.city
contact-address-country string

A country specified in an address

 InsuranceProduct.contact.address.country
contact-address-postalcode string

A postal code specified in an address

 InsuranceProduct.contact.address.postalCode
contact-address-state string

A state specified in an address

 InsuranceProduct.contact.address.state
contact-address-use token

A use code specified in an address

 InsuranceProduct.contact.address.use
endpoint reference

Technical endpoint

 InsuranceProduct.endpoint
identifier token

Any identifier for the product (not the accreditation issuer's identifier)

 InsuranceProduct.identifier
name string

A portion of the insurance product's name or alias

 InsuranceProduct.name | InsuranceProduct.alias
owned-by reference

The issuer of the insurance product

 InsuranceProduct.ownedBy
phonetic string

A portion of the product's name using some kind of phonetic matching algorithm

 InsuranceProduct.name
status token

Is the Product record active

 InsuranceProduct.status
type token

A code for the type of insurance product

 InsuranceProduct.type