InsurancePlan
type: StructureDefinition
node role: treeRoot
id:
  v: InsurancePlan
meta:
  last updated:
    v: 2021-01-02T08:58:31.578+11:00
language:
  v: en
text:
  status:
    v: extensions
  div:
    v: Generated Narrative: StructureDefinition InsurancePlan Last updated: 2021-01-02 08:58:31+1100 Name Flags Card. Type Description & Constraints<img src="[binary]" alt="doco" style="background-color: inherit"/> <a href="StructureDefinition-InsurancePlan-definitions.html#InsurancePlan" title="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`.">InsurancePlan 0..* DomainResource Plan details Elements defined in Ancestors:id, meta, implicitRules, language, <a href="http://hl7.org/fhir/R5/domainresource.html" title="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.">text, contained, <a href="http://hl7.org/fhir/R5/domainresource.html" title="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.">extension, <a href="http://hl7.org/fhir/R5/domainresource.html" title="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. Usual…
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-category
    l: structuredefinition-category
  value: String
    v: Financial.General
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status
    l: structuredefinition-standards-status
  value: Code
    v: trial-use
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm
    l: structuredefinition-fmm
  value: Integer
    v: 1
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-security-category
    l: structuredefinition-security-category
  value: Code
    v: business
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-wg
    l: structuredefinition-wg
  value: Code
    v: pa
extension:
  url:
    v: http://hl7.org/fhir/build/StructureDefinition/entered-in-error-status
    l: entered-in-error-status
  value: Code
    v: .status = retired
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/additional-resource
    l: additional-resource
  value: Boolean
    v: true
url:
  v: http://hl7.org/fhir/StructureDefinition/InsurancePlan
  l: InsurancePlan
identifier:
  system:
    v: urn:ietf:rfc:3986
    l: 3986
  value:
    v: urn:oid:2.16.840.1.113883.4.642.5.1354
version:
  v: 0.1.0
name:
  v: InsurancePlan
title:
  v: Insurance Plan
status:
  v: draft
date:
  v: 2021-01-02T08:58:31+11:00
publisher:
  v: HL7 International / Patient Administration
contact:
  name:
    v: HL7 International / Patient Administration
  telecom:
    system:
      v: url
    value:
      v: http://www.hl7.org/Special/committees/pa
contact:
  telecom:
    system:
      v: url
    value:
      v: http://www.hl7.org/Special/committees/pa
description:
  v: Details of a Health Insurance plan provided by an organization under an InsuranceProduct.
jurisdiction:
  coding:
    system:
      v: http://unstats.un.org/unsd/methods/m49/m49.htm
      l: m49.htm
    code:
      v: 001
    display:
      v: World
fhir version:
  v: 6.0.0-ballot3
mapping:
  identity:
    v: w5
  uri:
    v: http://hl7.org/fhir/fivews
    l: fivews
  name:
    v: FiveWs Pattern Mapping
mapping:
  identity:
    v: rim
  uri:
    v: http://hl7.org/v3
    l: v3
  name:
    v: RIM Mapping
kind:
  v: resource
abstract:
  v: false
type:
  v: InsurancePlan
  l: InsurancePlan
base definition:
  v: http://hl7.org/fhir/StructureDefinition/DomainResource
  l: DomainResource
derivation:
  v: specialization
snapshot:
  extension:
    url:
      v: http://hl7.org/fhir/tools/StructureDefinition/snapshot-base-version
      l: snapshot-base-version
    value: String
      v: 6.0.0-ballot3
  element:
    id:
      v: InsurancePlan
    path:
      v: InsurancePlan
    short:
      v: Plan details
    definition:
      v: 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`.
    min:
      v: 0
    max:
      v: *
    base:
      path:
        v: DomainResource
      min:
        v: 0
      max:
        v: *
    constraint:
      key:
        v: dom-2
      severity:
        v: error
      human:
        v: If the resource is contained in another resource, it SHALL NOT contain nested Resources
      expression:
        v: contained.contained.empty()
      source:
        v: http://hl7.org/fhir/StructureDefinition/DomainResource
        l: DomainResource
    constraint:
      key:
        v: dom-3
      severity:
        v: error
      human:
        v: 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
      expression:
        v: contained.where((('#'+id.trace('id') in %resource.descendants().select(reference | as(uri))) or descendants().where(reference='#' | as(uri)='#').exists()).not()).trace('unmatched', id).empty()
      source:
        v: http://hl7.org/fhir/StructureDefinition/DomainResource
        l: DomainResource
    constraint:
      key:
        v: dom-4
      severity:
        v: error
      human:
        v: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
      expression:
        v: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
      source:
        v: http://hl7.org/fhir/StructureDefinition/DomainResource
        l: DomainResource
    constraint:
      key:
        v: dom-5
      severity:
        v: error
      human:
        v: If a resource is contained in another resource, it SHALL NOT have a security label
      expression:
        v: contained.meta.security.empty()

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice
    l: elementdefinition-bestpractice
  value: Boolean
    v: true
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation
    l: elementdefinition-bestpractice-explanation
  value: Markdown
    v: When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.
key:
  v: dom-6
severity:
  v: warning
human:
  v: A resource should have narrative for robust management
expression:
  v: text.`div`.exists()
source:
  v: http://hl7.org/fhir/StructureDefinition/DomainResource
  l: DomainResource

v: false

v: false

v: false

identity:
  v: w5
map:
  v: administrative.entity

identity:
  v: rim
map:
  v: Entity. Role, or Act,Entity, Role, or Act

id:
  v: InsurancePlan.id
path:
  v: InsurancePlan.id
short:
  v: Logical id of this artifact
definition:
  v: The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
comment:
  v: 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.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Resource.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
      l: structuredefinition-fhir-type
    value: Url
      v: id
      l: id
  code:
    v: http://hl7.org/fhirpath/System.String
    l: System.String
must support:
  v: false
is modifier:
  v: false
is summary:
  v: true

id:
  v: InsurancePlan.meta
path:
  v: InsurancePlan.meta
short:
  v: Metadata about the resource
definition:
  v: 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.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Resource.meta
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Meta
    l: Meta
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: true

id:
  v: InsurancePlan.implicitRules
path:
  v: InsurancePlan.implicitRules
short:
  v: A set of rules under which this content was created
definition:
  v: 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.
comment:
  v: 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.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Resource.implicitRules
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: uri
    l: uri
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: false
is modifier:
  v: true
is modifier reason:
  v: This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation
is summary:
  v: true

id:
  v: InsurancePlan.language
path:
  v: InsurancePlan.language
short:
  v: Language of the resource content
definition:
  v: The base language in which the resource is written.
comment:
  v: 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).
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Resource.language
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: code
    l: code
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: Language
  strength:
    v: required
  description:
    v: IETF language tag for a human language
  value set:
    v: http://hl7.org/fhir/ValueSet/all-languages|6.0.0-ballot3
    l: http://hl7.org/fhir/ValueSet/all-languages
  additional:
    purpose:
      v: starter
    value set:
      v: http://hl7.org/fhir/ValueSet/languages|6.0.0-ballot3
      l: http://hl7.org/fhir/ValueSet/languages

id:
  v: InsurancePlan.text
path:
  v: InsurancePlan.text
short:
  v: Text summary of the resource, for human interpretation
definition:
  v: 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.
comment:
  v: 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.
alias:
  v: narrative
alias:
  v: html
alias:
  v: xhtml
alias:
  v: display
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.text
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Narrative
    l: Narrative
condition:
  v: dom-6
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: Act.text?

id:
  v: InsurancePlan.contained
path:
  v: InsurancePlan.contained
short:
  v: Contained, inline Resources
definition:
  v: 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.
comment:
  v: 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](http://build.fhir.org/resource.html#additional).
alias:
  v: inline resources
alias:
  v: anonymous resources
alias:
  v: contained resources
min:
  v: 0
max:
  v: *
base:
  path:
    v: DomainResource.contained
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Resource
    l: Resource
condition:
  v: dom-2
condition:
  v: dom-4
condition:
  v: dom-3
condition:
  v: dom-5
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: InsurancePlan.extension
path:
  v: InsurancePlan.extension
slicing:
  discriminator:
    type:
      v: value
    path:
      v: url
  description:
    v: Extensions are always sliced by (at least) url
  rules:
    v: open
short:
  v: Additional content defined by implementations
definition:
  v: 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.
comment:
  v: 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.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: InsurancePlan.modifierExtension
path:
  v: InsurancePlan.modifierExtension
slicing:
  discriminator:
    type:
      v: value
    path:
      v: url
  description:
    v: Extensions are always sliced by (at least) url
  rules:
    v: open
short:
  v: Extensions that cannot be ignored
definition:
  v: 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).
comment:
  v: 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.
requirements:
  v: 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](http://build.fhir.org/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: DomainResource.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: false
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: InsurancePlan.identifier
path:
  v: InsurancePlan.identifier
short:
  v: Business Identifier for Plan
definition:
  v: Identifiers, such as the plan ID and/or group ID associated with the insurance plan.
comment:
  v: In some markets, the combination of a plan ID and a group ID are needed to uniquely identify an InsurancePlan. For example, if a single plan (Bronze) is offered to two employer groups (Boilermakers and Aviation), you would represent that using two InsurancePlan resources, as shown below: ``` InsurancePlan.identifier 0..* (Boilermakers) InsurancePlan/bm [0].value = 1234 (bronze plan) [0].type = Plan [0].system = https://insurance-payer.com/plan-numbers [1].value = Boilermakers [1].type = Group [1].system = https:// insurance-payer.com /group-numbers ``` ``` InsurancePlan.identifier 0..* (Aviation) InsurancePlan/av [0].value = 1234 (bronze plan) [0].type = Plan [0].system = https:// insurance-payer.com /plan-numbers [1].value = Aviation [1].type = Group [1].system = https:// insurance-payer.com /group-numbers ```
min:
  v: 0
max:
  v: *
base:
  path:
    v: InsurancePlan.identifier
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Identifier
    l: Identifier
is summary:
  v: true
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.identifier
mapping:
  identity:
    v: rim
  map:
    v: .scopes[Role](classCode=IDENT)

id:
  v: InsurancePlan.type
path:
  v: InsurancePlan.type
short:
  v: Classification of Plan
definition:
  v: Type of plan. For example, "Platinum" or "High Deductable".
min:
  v: 0
max:
  v: 1
base:
  path:
    v: InsurancePlan.type
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept

id:
  v: InsurancePlan.product
path:
  v: InsurancePlan.product
short:
  v: The product that this plan is available under
definition:
  v: The product that this plan is available under.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: InsurancePlan.product
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/InsuranceProduct
    l: InsuranceProduct
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: InsurancePlan.coverageArea
path:
  v: InsurancePlan.coverageArea
short:
  v: Where product-plan applies
definition:
  v: The geographic region in which a health insurance plan's benefits apply.
min:
  v: 0
max:
  v: *
base:
  path:
    v: InsurancePlan.coverageArea
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Location
    l: Location
is summary:
  v: true

id:
  v: InsurancePlan.network
path:
  v: InsurancePlan.network
short:
  v: What networks provide coverage
definition:
  v: Reference to the network that providing the type of coverage.
comment:
  v: Networks are represented as a hierarchy of organization resources.
min:
  v: 0
max:
  v: *
base:
  path:
    v: InsurancePlan.network
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Organization
    l: Organization

id:
  v: InsurancePlan.generalCost
path:
  v: InsurancePlan.generalCost
short:
  v: Overall costs
definition:
  v: Overall costs associated with the plan.
min:
  v: 0
max:
  v: *
base:
  path:
    v: InsurancePlan.generalCost
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
    l: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children or both
  expression:
    v: hasValue() or (children().count() > id.count())
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element

id:
  v: InsurancePlan.generalCost.id
path:
  v: InsurancePlan.generalCost.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
      l: structuredefinition-fhir-type
    value: Url
      v: id
      l: id
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    v: http://hl7.org/fhirpath/System.String
    l: System.String
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id:
  v: InsurancePlan.generalCost.extension
path:
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      v: value
    path:
      v: url
  description:
    v: Extensions are always sliced by (at least) url
  rules:
    v: open
short:
  v: Additional content defined by implementations
definition:
  v: 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.
comment:
  v: 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.
alias:
  v: extensions
alias:
  v: user content
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  v: 0
max:
  v: *
base:
  path:
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    v: 0
  max:
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  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
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    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: InsurancePlan.generalCost.modifierExtension
path:
  v: InsurancePlan.generalCost.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: 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).
comment:
  v: 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.
requirements:
  v: 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](http://build.fhir.org/extensibility.html#modifierExtension).
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alias:
  v: user content
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max:
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  max:
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    v: Extension
    l: Extension
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    v: ele-1
  severity:
    v: error
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    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
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    l: Element
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  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
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id:
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path:
  v: InsurancePlan.generalCost.type
short:
  v: Classification of specific cost
definition:
  v: Type of cost.
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id:
  v: InsurancePlan.generalCost.groupSize
path:
  v: InsurancePlan.generalCost.groupSize
short:
  v: Number of enrollees
definition:
  v: Number of participants enrolled in the plan.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: InsurancePlan.generalCost.groupSize
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    v: 0
  max:
    v: 1
type:
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    l: positiveInt

id:
  v: InsurancePlan.generalCost.cost
path:
  v: InsurancePlan.generalCost.cost
short:
  v: Cost value
definition:
  v: Value of the cost.
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  v: 0
max:
  v: 1
base:
  path:
    v: InsurancePlan.generalCost.cost
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    v: 0
  max:
    v: 1
type:
  code:
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    l: Money

id:
  v: InsurancePlan.generalCost.comment
path:
  v: InsurancePlan.generalCost.comment
short:
  v: Additional cost information
definition:
  v: Additional information about the general costs associated with this plan.
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  v: 0
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  v: 1
base:
  path:
    v: InsurancePlan.generalCost.comment
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
    l: string

id:
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  v: InsurancePlan.specificCost
short:
  v: Individual cost elements
definition:
  v: Costs associated with the coverage provided by the product-plan.
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  v: 0
max:
  v: *
base:
  path:
    v: InsurancePlan.specificCost
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    v: 0
  max:
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    v: BackboneElement
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constraint:
  key:
    v: ele-1
  severity:
    v: error
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    v: All FHIR elements must have a @value or children or both
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    v: hasValue() or (children().count() > id.count())
  source:
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id:
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path:
  v: InsurancePlan.specificCost.id
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  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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  v: 0
max:
  v: 1
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      v: id
      l: id
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  v: Additional content defined by implementations
definition:
  v: 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.
comment:
  v: 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.
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    v: Extension
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    v: All FHIR elements must have a @value or children
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id:
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  v: Extensions that cannot be ignored even if unrecognized
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  v: 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).
comment:
  v: 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.
requirements:
  v: 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](http://build.fhir.org/extensibility.html#modifierExtension).
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alias:
  v: user content
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  max:
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    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
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  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: InsurancePlan.specificCost.category
path:
  v: InsurancePlan.specificCost.category
short:
  v: General category of benefit
definition:
  v: General category of benefit (Medical; Dental; Vision; Drug; Mental Health; Substance Abuse; Hospice, Home Health).
min:
  v: 1
max:
  v: 1
base:
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type:
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id:
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extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name
    l: structuredefinition-explicit-type-name
  value: String
    v: PlanBenefit
path:
  v: InsurancePlan.specificCost.benefit
short:
  v: Benefits list
definition:
  v: List of the specific benefits under this category of benefit.
min:
  v: 0
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  v: *
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  path:
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    v: 0
  max:
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    v: All FHIR elements must have a @value or children or both
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    v: hasValue() or (children().count() > id.count())
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    l: Element

id:
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path:
  v: InsurancePlan.specificCost.benefit.id
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  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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  v: 0
max:
  v: 1
base:
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    v: Element.id
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      v: id
      l: id
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    v: http://hl7.org/fhirpath/System.String
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  v: ele-1
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id:
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    v: Extensions are always sliced by (at least) url
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short:
  v: Additional content defined by implementations
definition:
  v: 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.
comment:
  v: 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.
alias:
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alias:
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    v: All FHIR elements must have a @value or children
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id:
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path:
  v: InsurancePlan.specificCost.benefit.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: 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).
comment:
  v: 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.
requirements:
  v: 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](http://build.fhir.org/extensibility.html#modifierExtension).
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    l: Extension
constraint:
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    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  source:
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  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: InsurancePlan.specificCost.benefit.type
path:
  v: InsurancePlan.specificCost.benefit.type
short:
  v: Classification of benefit provided
definition:
  v: Type of specific benefit (preventative; primary care office visit; speciality office visit; hospitalization; emergency room; urgent care).
min:
  v: 1
max:
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base:
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  max:
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type:
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id:
  v: InsurancePlan.specificCost.benefit.cost
path:
  v: InsurancePlan.specificCost.benefit.cost
short:
  v: List of the costs
definition:
  v: List of the costs associated with a specific benefit.
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  v: 0
max:
  v: *
base:
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    v: error
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    v: All FHIR elements must have a @value or children or both
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    v: hasValue() or (children().count() > id.count())
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element

id:
  v: InsurancePlan.specificCost.benefit.cost.id
path:
  v: InsurancePlan.specificCost.benefit.cost.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
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type:
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    value: Url
      v: id
      l: id
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condition:
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  v: false
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  v: false
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id:
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path:
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    v: Extensions are always sliced by (at least) url
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  v: Additional content defined by implementations
definition:
  v: 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.
comment:
  v: 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.
alias:
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alias:
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max:
  v: *
base:
  path:
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  max:
    v: *
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    v: error
  human:
    v: All FHIR elements must have a @value or children
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id:
  v: InsurancePlan.specificCost.benefit.cost.modifierExtension
path:
  v: InsurancePlan.specificCost.benefit.cost.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: 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).
comment:
  v: 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.
requirements:
  v: 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](http://build.fhir.org/extensibility.html#modifierExtension).
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    v: error
  human:
    v: All FHIR elements must have a @value or children
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is summary:
  v: true
mapping:
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    v: N/A

id:
  v: InsurancePlan.specificCost.benefit.cost.type
path:
  v: InsurancePlan.specificCost.benefit.cost.type
short:
  v: Classification of specific cost
definition:
  v: Type of cost (copay; individual cap; family cap; coinsurance; deductible).
min:
  v: 1
max:
  v: 1
base:
  path:
    v: InsurancePlan.specificCost.benefit.cost.type
  min:
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  max:
    v: 1
type:
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    l: CodeableConcept

id:
  v: InsurancePlan.specificCost.benefit.cost.applicability
path:
  v: InsurancePlan.specificCost.benefit.cost.applicability
short:
  v: in-network | out-of-network | other
definition:
  v: Whether the cost applies to in-network or out-of-network providers (in-network; out-of-network; other).
min:
  v: 0
max:
  v: 1
base:
  path:
    v: InsurancePlan.specificCost.benefit.cost.applicability
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    v: 0
  max:
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type:
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    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: BenefitCostApplicability
  strength:
    v: required
  description:
    v: Whether the cost applies to in-network or out-of-network providers.
  value set:
    v: http://hl7.org/fhir/ValueSet/insuranceplan-applicability
    l: insuranceplan-applicability

id:
  v: InsurancePlan.specificCost.benefit.cost.qualifier
path:
  v: InsurancePlan.specificCost.benefit.cost.qualifier
short:
  v: Additional information about the cost
definition:
  v: Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA).
min:
  v: 0
max:
  v: *
base:
  path:
    v: InsurancePlan.specificCost.benefit.cost.qualifier
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: CodeableConcept
    l: CodeableConcept

id:
  v: InsurancePlan.specificCost.benefit.cost.value
path:
  v: InsurancePlan.specificCost.benefit.cost.value
short:
  v: The actual cost value
definition:
  v: The actual cost value. (some of the costs may be represented as percentages rather than currency, e.g. 10% coinsurance).
min:
  v: 0
max:
  v: 1
base:
  path:
    v: InsurancePlan.specificCost.benefit.cost.value
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Quantity
    l: Quantity

element:
  id:
    v: InsurancePlan
  path:
    v: InsurancePlan
  short:
    v: Plan details
  definition:
    v: 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`.
  min:
    v: 0
  max:
    v: *
  mapping:
    identity:
      v: w5
    map:
      v: administrative.entity
element:
  id:
    v: InsurancePlan.identifier
  path:
    v: InsurancePlan.identifier
  short:
    v: Business Identifier for Plan
  definition:
    v: Identifiers, such as the plan ID and/or group ID associated with the insurance plan.
  comment:
    v: In some markets, the combination of a plan ID and a group ID are needed to uniquely identify an InsurancePlan. For example, if a single plan (Bronze) is offered to two employer groups (Boilermakers and Aviation), you would represent that using two InsurancePlan resources, as shown below: ``` InsurancePlan.identifier 0..* (Boilermakers) InsurancePlan/bm [0].value = 1234 (bronze plan) [0].type = Plan [0].system = https://insurance-payer.com/plan-numbers [1].value = Boilermakers [1].type = Group [1].system = https:// insurance-payer.com /group-numbers ``` ``` InsurancePlan.identifier 0..* (Aviation) InsurancePlan/av [0].value = 1234 (bronze plan) [0].type = Plan [0].system = https:// insurance-payer.com /plan-numbers [1].value = Aviation [1].type = Group [1].system = https:// insurance-payer.com /group-numbers ```
  min:
    v: 0
  max:
    v: *
  type:
    code:
      v: Identifier
      l: Identifier
  is summary:
    v: true
  mapping:
    identity:
      v: w5
    map:
      v: FiveWs.identifier
  mapping:
    identity:
      v: rim
    map:
      v: .scopes[Role](classCode=IDENT)
element:
  id:
    v: InsurancePlan.type
  path:
    v: InsurancePlan.type
  short:
    v: Classification of Plan
  definition:
    v: Type of plan. For example, "Platinum" or "High Deductable".
  min:
    v: 0
  max:
    v: 1
  type:
    code:
      v: CodeableConcept
      l: CodeableConcept
element:
  id:
    v: InsurancePlan.product
  path:
    v: InsurancePlan.product
  short:
    v: The product that this plan is available under
  definition:
    v: The product that this plan is available under.
  min:
    v: 0
  max:
    v: 1
  type:
    code:
      v: Reference
      l: Reference
    target profile:
      v: http://hl7.org/fhir/StructureDefinition/InsuranceProduct
      l: InsuranceProduct
  is summary:
    v: true
  mapping:
    identity:
      v: rim
    map:
      v: N/A
element:
  id:
    v: InsurancePlan.coverageArea
  path:
    v: InsurancePlan.coverageArea
  short:
    v: Where product-plan applies
  definition:
    v: The geographic region in which a health insurance plan's benefits apply.
  min:
    v: 0
  max:
    v: *
  type:
    code:
      v: Reference
      l: Reference
    target profile:
      v: http://hl7.org/fhir/StructureDefinition/Location
      l: Location
  is summary:
    v: true
element:
  id:
    v: InsurancePlan.network
  path:
    v: InsurancePlan.network
  short:
    v: What networks provide coverage
  definition:
    v: Reference to the network that providing the type of coverage.
  comment:
    v: Networks are represented as a hierarchy of organization resources.
  min:
    v: 0
  max:
    v: *
  type:
    code:
      v: Reference
      l: Reference
    target profile:
      v: http://hl7.org/fhir/StructureDefinition/Organization
      l: Organization
element:
  id:
    v: InsurancePlan.generalCost
  path:
    v: InsurancePlan.generalCost
  short:
    v: Overall costs
  definition:
    v: Overall costs associated with the plan.
  min:
    v: 0
  max:
    v: *
  type:
    code:
      v: BackboneElement
      l: BackboneElement
element:
  id:
    v: InsurancePlan.generalCost.type
  path:
    v: InsurancePlan.generalCost.type
  short:
    v: Classification of specific cost
  definition:
    v: Type of cost.
  min:
    v: 0
  max:
    v: 1
  type:
    code:
      v: CodeableConcept
      l: CodeableConcept
element:
  id:
    v: InsurancePlan.generalCost.groupSize
  path:
    v: InsurancePlan.generalCost.groupSize
  short:
    v: Number of enrollees
  definition:
    v: Number of participants enrolled in the plan.
  min:
    v: 0
  max:
    v: 1
  type:
    code:
      v: positiveInt
      l: positiveInt
element:
  id:
    v: InsurancePlan.generalCost.cost
  path:
    v: InsurancePlan.generalCost.cost
  short:
    v: Cost value
  definition:
    v: Value of the cost.
  min:
    v: 0
  max:
    v: 1

code:
  v: Money
  l: Money

id:
  v: InsurancePlan.generalCost.comment
path:
  v: InsurancePlan.generalCost.comment
short:
  v: Additional cost information
definition:
  v: Additional information about the general costs associated with this plan.
min:
  v: 0
max:
  v: 1
type:
  code:
    v: string
    l: string

id:
  v: InsurancePlan.specificCost
path:
  v: InsurancePlan.specificCost
short:
  v: Individual cost elements
definition:
  v: Costs associated with the coverage provided by the product-plan.
min:
  v: 0
max:
  v: *
type:
  code:
    v: BackboneElement
    l: BackboneElement

id:
  v: InsurancePlan.specificCost.category
path:
  v: InsurancePlan.specificCost.category
short:
  v: General category of benefit
definition:
  v: General category of benefit (Medical; Dental; Vision; Drug; Mental Health; Substance Abuse; Hospice, Home Health).
min:
  v: 1
max:
  v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept

id:
  v: InsurancePlan.specificCost.benefit
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name
    l: structuredefinition-explicit-type-name
  value: String
    v: PlanBenefit
path:
  v: InsurancePlan.specificCost.benefit
short:
  v: Benefits list
definition:
  v: List of the specific benefits under this category of benefit.
min:
  v: 0
max:
  v: *
type:
  code:
    v: BackboneElement
    l: BackboneElement

id:
  v: InsurancePlan.specificCost.benefit.type
path:
  v: InsurancePlan.specificCost.benefit.type
short:
  v: Classification of benefit provided
definition:
  v: Type of specific benefit (preventative; primary care office visit; speciality office visit; hospitalization; emergency room; urgent care).
min:
  v: 1
max:
  v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept

id:
  v: InsurancePlan.specificCost.benefit.cost
path:
  v: InsurancePlan.specificCost.benefit.cost
short:
  v: List of the costs
definition:
  v: List of the costs associated with a specific benefit.
min:
  v: 0
max:
  v: *
type:
  code:
    v: BackboneElement
    l: BackboneElement

id:
  v: InsurancePlan.specificCost.benefit.cost.type
path:
  v: InsurancePlan.specificCost.benefit.cost.type
short:
  v: Classification of specific cost
definition:
  v: Type of cost (copay; individual cap; family cap; coinsurance; deductible).
min:
  v: 1
max:
  v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept

id:
  v: InsurancePlan.specificCost.benefit.cost.applicability
path:
  v: InsurancePlan.specificCost.benefit.cost.applicability
short:
  v: in-network | out-of-network | other
definition:
  v: Whether the cost applies to in-network or out-of-network providers (in-network; out-of-network; other).
min:
  v: 0
max:
  v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: BenefitCostApplicability
  strength:
    v: required
  description:
    v: Whether the cost applies to in-network or out-of-network providers.
  value set:
    v: http://hl7.org/fhir/ValueSet/insuranceplan-applicability
    l: insuranceplan-applicability

id:
  v: InsurancePlan.specificCost.benefit.cost.qualifier
path:
  v: InsurancePlan.specificCost.benefit.cost.qualifier
short:
  v: Additional information about the cost
definition:
  v: Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA).
min:
  v: 0
max:
  v: *
type:
  code:
    v: CodeableConcept
    l: CodeableConcept

id:
  v: InsurancePlan.specificCost.benefit.cost.value
path:
  v: InsurancePlan.specificCost.benefit.cost.value
short:
  v: The actual cost value
definition:
  v: The actual cost value. (some of the costs may be represented as percentages rather than currency, e.g. 10% coinsurance).
min:
  v: 0
max:
  v: 1
type:
  code:
    v: Quantity
    l: Quantity