DaVinci Payer Data Exchange (PDex) US Drug Formulary
2.0.0 - STU 2 United States of America flag

DaVinci Payer Data Exchange (PDex) US Drug Formulary, published by HL7 Pharmacy Working Group. This is not an authorized publication; it is the continuous build for version 2.0.0). This version is based on the current content of https://github.com/HL7/davinci-pdex-formulary/ and changes regularly. See the Directory of published versions

Resource Profile: Payer Insurance Plan

Official URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PayerInsurancePlan Version: 2.0.0
Active as of 2022-07-26 Computable Name: PayerInsurancePlan

The Payer InsurancePlan that defines the health insurance product, which include coverage benefits that are offered, and additional information about the offering, such as a coverage area, contact information, brochure locations, etc. The health insurance product offers one or more types of coverage, each of which may define a plan of covered benefits with the particular cost sharing structure offered to a consumer. Health insurance plans that include drug coverage reference a formulary that provides details about drugs that are covered under the plan including requirements and limitations of the coverage specific to each drug.

Usage:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from InsurancePlan

Summary

Mandatory: 15 elements (2 nested mandatory elements)
Must-Support: 30 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

  • The element InsurancePlan.coverage is sliced based on the value of pattern:type
  • The element InsurancePlan.coverage.benefit is sliced based on the value of pattern:type
  • The element InsurancePlan.plan is sliced based on the value of pattern:type
  • The element InsurancePlan.plan.specificCost.benefit.cost is sliced based on the value of pattern:type

This structure is derived from InsurancePlan

NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan 0..*InsurancePlanDetails of a Health Insurance product/plan provided by an organization
... meta
.... lastUpdated S1..1instantWhen the resource version last changed
... identifier S1..*IdentifierBusiness Identifier for Product
... status S1..1codedraft | active | retired | unknown
... name S0..1stringOfficial name
... period S0..1PeriodWhen the product is available
... coverageArea S0..*Reference(Insurance Plan Location)Where product applies
... contact 0..*BackboneElementContact information for the Insurance Plan including URLs for brochure and formulary information
.... purpose 0..1CodeableConceptThe type of contact
Binding: Type of plan contact (extensible)
.... name S0..1HumanNameA name associated with the contact
..... text S0..1stringText representation of the full name
.... telecom S0..*ContactPointContact details (telephone, email, etc.) for a contact
..... system S0..1codephone | fax | email | pager | url | sms | other
..... value S0..1stringThe actual contact point details
... Slices for coverage S1..*BackboneElementCoverage details
Slice: Unordered, Open by pattern:type
.... coverage:All Slices Content/Rules for all slices
..... type S1..1CodeableConceptType of coverage
.... coverage:drug-coverage S1..*BackboneElementCoverage details
..... Slices for extension S1..*ExtensionExtension
Slice: Unordered, Open by value:url
..... usdf-FormularyReference-extension S1..*Reference(Formulary)Formulary Reference
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyReference-extension
..... type 1..1CodeableConceptType of coverage
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: DRUGPOL
..... Slices for benefit 1..*BackboneElementList of benefits
Slice: Unordered, Open by pattern:type
...... benefit:All Slices Content/Rules for all slices
....... type 1..1CodeableConceptType of benefit
Binding: Insurance plan type (extensible)
...... benefit:drug-plan S1..*BackboneElementList of benefits
....... type 1..1CodeableConceptType of benefit
Required Pattern: At least the following
........ coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
......... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type
......... code1..1codeSymbol in syntax defined by the system
Fixed Value: Drug
......... display1..1stringRepresentation defined by the system
Fixed Value: Drug
... Slices for plan S1..*BackboneElementPlan details
Slice: Unordered, Open by pattern:type
.... plan:All Slices Content/Rules for all slices
..... type 0..1CodeableConceptType of plan
Binding: Insurance plan type (extensible)
.... plan:drug-plan S1..*BackboneElementDrug plan
..... type 1..1CodeableConceptType of plan
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: Drug
....... display1..1stringRepresentation defined by the system
Fixed Value: Drug
..... network 0..*Reference(Organization)Pharmacy benefit types that are part of the drug plan
..... specificCost S1..*BackboneElementPharmacy benefit type specific cost
...... category S1..1CodeableConceptPharmacy Benefit Type
Binding: Pharmacy benefit types (extensible)
...... benefit S1..*BackboneElementDrug tier benefit
....... type S1..1CodeableConceptType of specific benefit
Binding: Drug tier of medication in health plan (required)
....... Slices for cost S1..*BackboneElementList of the costs
Slice: Unordered, Open by pattern:type
........ cost:All Slices Content/Rules for all slices
......... type 1..1CodeableConceptType of cost
Binding: Benefit type of cost (extensible)
......... qualifiers S1..1CodeableConceptAdditional information about the cost
......... value S0..1QuantityThe actual cost value
........ cost:copay S0..1BackboneElementCopay costs
......... type 1..1CodeableConceptType of cost
Required Pattern: At least the following
.......... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
........... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE
........... code1..1codeSymbol in syntax defined by the system
Fixed Value: copay
......... qualifiers 0..*CodeableConceptAdditional information about the cost
Binding: Qualifier of copay amount (required)
......... value 0..1MoneyQuantityAn amount of money. With regard to precision, see [Decimal Precision](datatypes.html#precision)
.......... value S1..1decimalNumerical value (with implicit precision)
.......... system 0..1uriSystem that defines coded unit form
Required Pattern: urn:iso:std:iso:4217
.......... code 0..1codeCoded form of the unit
Required Pattern: USD
........ cost:coinsurance S0..1BackboneElementCoinsurance costs
......... type 1..1CodeableConceptType of cost
Required Pattern: At least the following
.......... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
........... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE
........... code1..1codeSymbol in syntax defined by the system
Fixed Value: coinsurance
......... qualifiers 0..*CodeableConceptAdditional information about the cost
Binding: Qualifier for coinsurance rate (required)
......... value
.......... system 0..1uriSystem that defines coded unit form
Required Pattern: http://unitsofmeasure.org
.......... code 0..1codeCoded form of the unit
Required Pattern: %

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan I0..*InsurancePlanDetails of a Health Insurance product/plan provided by an organization
... id Σ0..1stringLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... versionId Σ0..1idVersion specific identifier
.... lastUpdated SΣ1..1instantWhen the resource version last changed
.... source Σ0..1uriIdentifies where the resource comes from
.... profile Σ0..*canonical(StructureDefinition)Profiles this resource claims to conform to
.... security Σ0..*CodingSecurity Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.


.... tag Σ0..*CodingTags applied to this resource
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".


... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier SΣI1..*IdentifierBusiness Identifier for Product
... status ?!SΣ1..1codedraft | active | retired | unknown
Binding: PublicationStatus (required): The lifecycle status of an artifact.

... type SΣ1..1CodeableConceptProduct type
Binding: Insurance Product Type (extensible)
... name SΣI0..1stringOfficial name
... alias 0..*stringAlternate names
... period S0..1PeriodWhen the product is available
... ownedBy Σ0..1Reference(Organization)Plan issuer
... administeredBy Σ0..1Reference(Organization)Product administrator
... coverageArea SΣ0..*Reference(Insurance Plan Location)Where product applies
... contact 0..*BackboneElementContact information for the Insurance Plan including URLs for brochure and formulary information
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... purpose 0..1CodeableConceptThe type of contact
Binding: Type of plan contact (extensible)
.... name S0..1HumanNameA name associated with the contact
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ0..1codeusual | official | temp | nickname | anonymous | old | maiden
Binding: NameUse (required): The use of a human name.

..... text SΣ0..1stringText representation of the full name
..... family Σ0..1stringFamily name (often called 'Surname')
..... given Σ0..*stringGiven names (not always 'first'). Includes middle names
This repeating element order: Given Names appear in the correct order for presenting the name
..... prefix Σ0..*stringParts that come before the name
This repeating element order: Prefixes appear in the correct order for presenting the name
..... suffix Σ0..*stringParts that come after the name
This repeating element order: Suffixes appear in the correct order for presenting the name
..... period Σ0..1PeriodTime period when name was/is in use
.... telecom S0..*ContactPointContact details (telephone, email, etc.) for a contact
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... system SΣI0..1codephone | fax | email | pager | url | sms | other
Binding: ContactPointSystem (required): Telecommunications form for contact point.

..... value SΣ0..1stringThe actual contact point details
..... use ?!Σ0..1codehome | work | temp | old | mobile - purpose of this contact point
Binding: ContactPointUse (required): Use of contact point.

..... rank Σ0..1positiveIntSpecify preferred order of use (1 = highest)
..... period Σ0..1PeriodTime period when the contact point was/is in use
.... address 0..1AddressVisiting or postal addresses for the contact
... endpoint 0..*Reference(Endpoint)Technical endpoint
... network 0..*Reference(Organization)What networks are Included
... Slices for coverage S1..*BackboneElementCoverage details
Slice: Unordered, Open by pattern:type
.... coverage:All Slices Content/Rules for all slices
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type S1..1CodeableConceptType of coverage
..... network 0..*Reference(Organization)What networks provide coverage
..... benefit 1..*BackboneElementList of benefits
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... type 1..1CodeableConceptType of benefit
...... requirement 0..1stringReferral requirements
...... limit 0..*BackboneElementBenefit limits
....... id 0..1stringUnique id for inter-element referencing
....... extension 0..*ExtensionAdditional content defined by implementations
....... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
....... value 0..1QuantityMaximum value allowed
....... code 0..1CodeableConceptBenefit limit details
.... coverage:drug-coverage S1..*BackboneElementCoverage details
..... id 0..1stringUnique id for inter-element referencing
..... Slices for extension S1..*ExtensionExtension
Slice: Unordered, Open by value:url
..... usdf-FormularyReference-extension S1..*Reference(Formulary)Formulary Reference
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyReference-extension
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type 1..1CodeableConceptType of coverage
Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: DRUGPOL
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... network 0..*Reference(Organization)What networks provide coverage
..... Slices for benefit 1..*BackboneElementList of benefits
Slice: Unordered, Open by pattern:type
...... benefit:All Slices Content/Rules for all slices
....... id 0..1stringUnique id for inter-element referencing
....... extension 0..*ExtensionAdditional content defined by implementations
....... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
....... type 1..1CodeableConceptType of benefit
Binding: Insurance plan type (extensible)
....... requirement 0..1stringReferral requirements
....... limit 0..*BackboneElementBenefit limits
........ id 0..1stringUnique id for inter-element referencing
........ extension 0..*ExtensionAdditional content defined by implementations
........ modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
........ value 0..1QuantityMaximum value allowed
........ code 0..1CodeableConceptBenefit limit details
...... benefit:drug-plan S1..*BackboneElementList of benefits
....... id 0..1stringUnique id for inter-element referencing
....... extension 0..*ExtensionAdditional content defined by implementations
....... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
....... type 1..1CodeableConceptType of benefit
Required Pattern: At least the following
........ id0..1stringUnique id for inter-element referencing
........ extension0..*ExtensionAdditional content defined by implementations
........ coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
......... id0..1stringUnique id for inter-element referencing
......... extension0..*ExtensionAdditional content defined by implementations
......... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type
......... version0..1stringVersion of the system - if relevant
......... code1..1codeSymbol in syntax defined by the system
Fixed Value: Drug
......... display1..1stringRepresentation defined by the system
Fixed Value: Drug
......... userSelected0..1booleanIf this coding was chosen directly by the user
........ text0..1stringPlain text representation of the concept
....... requirement 0..1stringReferral requirements
....... limit 0..*BackboneElementBenefit limits
........ id 0..1stringUnique id for inter-element referencing
........ extension 0..*ExtensionAdditional content defined by implementations
........ modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
........ value 0..1QuantityMaximum value allowed
........ code 0..1CodeableConceptBenefit limit details
... Slices for plan S1..*BackboneElementPlan details
Slice: Unordered, Open by pattern:type
.... plan:All Slices Content/Rules for all slices
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... identifier Σ0..*IdentifierBusiness Identifier for Product
..... type 0..1CodeableConceptType of plan
Binding: Insurance plan type (extensible)
..... coverageArea Σ0..*Reference(Location)Where product applies
..... network 0..*Reference(Organization)What networks provide coverage
..... generalCost 0..*BackboneElementOverall costs
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... type 0..1CodeableConceptType of cost
...... groupSize 0..1positiveIntNumber of enrollees
...... cost 0..1MoneyCost value
...... comment 0..1stringAdditional cost information
..... specificCost 0..*BackboneElementSpecific costs
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... category 1..1CodeableConceptGeneral category of benefit
...... benefit 0..*BackboneElementBenefits list
....... id 0..1stringUnique id for inter-element referencing
....... extension 0..*ExtensionAdditional content defined by implementations
....... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
....... type 1..1CodeableConceptType of specific benefit
....... cost 0..*BackboneElementList of the costs
........ id 0..1stringUnique id for inter-element referencing
........ extension 0..*ExtensionAdditional content defined by implementations
........ modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
........ type 1..1CodeableConceptType of cost
........ applicability 0..1CodeableConceptin-network | out-of-network | other
Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.

........ qualifiers 0..*CodeableConceptAdditional information about the cost
........ value 0..1QuantityThe actual cost value
.... plan:drug-plan S1..*BackboneElementDrug plan
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... identifier Σ0..*IdentifierBusiness Identifier for Product
..... type 1..1CodeableConceptType of plan
Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: Drug
....... display1..1stringRepresentation defined by the system
Fixed Value: Drug
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... coverageArea Σ0..*Reference(Location)Where product applies
..... network 0..*Reference(Organization)Pharmacy benefit types that are part of the drug plan
..... generalCost 0..*BackboneElementOverall costs
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... type 0..1CodeableConceptType of cost
...... groupSize 0..1positiveIntNumber of enrollees
...... cost 0..1MoneyCost value
...... comment 0..1stringAdditional cost information
..... specificCost S1..*BackboneElementPharmacy benefit type specific cost
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... category S1..1CodeableConceptPharmacy Benefit Type
Binding: Pharmacy benefit types (extensible)
...... benefit S1..*BackboneElementDrug tier benefit
....... id 0..1stringUnique id for inter-element referencing
....... extension 0..*ExtensionAdditional content defined by implementations
....... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
....... type S1..1CodeableConceptType of specific benefit
Binding: Drug tier of medication in health plan (required)
....... Slices for cost S1..*BackboneElementList of the costs
Slice: Unordered, Open by pattern:type
........ cost:All Slices Content/Rules for all slices
......... id 0..1stringUnique id for inter-element referencing
......... extension 0..*ExtensionAdditional content defined by implementations
......... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
......... type 1..1CodeableConceptType of cost
Binding: Benefit type of cost (extensible)
......... applicability 0..1CodeableConceptin-network | out-of-network | other
Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.

......... qualifiers S1..1CodeableConceptAdditional information about the cost
......... value S0..1QuantityThe actual cost value
........ cost:copay S0..1BackboneElementCopay costs
......... id 0..1stringUnique id for inter-element referencing
......... extension 0..*ExtensionAdditional content defined by implementations
......... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
......... type 1..1CodeableConceptType of cost
Required Pattern: At least the following
.......... id0..1stringUnique id for inter-element referencing
.......... extension0..*ExtensionAdditional content defined by implementations
.......... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
........... id0..1stringUnique id for inter-element referencing
........... extension0..*ExtensionAdditional content defined by implementations
........... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE
........... version0..1stringVersion of the system - if relevant
........... code1..1codeSymbol in syntax defined by the system
Fixed Value: copay
........... display0..1stringRepresentation defined by the system
........... userSelected0..1booleanIf this coding was chosen directly by the user
.......... text0..1stringPlain text representation of the concept
......... applicability 0..1CodeableConceptin-network | out-of-network | other
Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.

......... qualifiers 0..*CodeableConceptAdditional information about the cost
Binding: Qualifier of copay amount (required)
......... value I0..1MoneyQuantityAn amount of money. With regard to precision, see [Decimal Precision](datatypes.html#precision)
.......... id 0..1stringUnique id for inter-element referencing
.......... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.......... value SΣ1..1decimalNumerical value (with implicit precision)
.......... comparator ?!Σ0..1code< | <= | >= | > - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.

.......... unit Σ0..1stringUnit representation
.......... system ΣI0..1uriSystem that defines coded unit form
Required Pattern: urn:iso:std:iso:4217
.......... code Σ0..1codeCoded form of the unit
Required Pattern: USD
........ cost:coinsurance S0..1BackboneElementCoinsurance costs
......... id 0..1stringUnique id for inter-element referencing
......... extension 0..*ExtensionAdditional content defined by implementations
......... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
......... type 1..1CodeableConceptType of cost
Required Pattern: At least the following
.......... id0..1stringUnique id for inter-element referencing
.......... extension0..*ExtensionAdditional content defined by implementations
.......... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
........... id0..1stringUnique id for inter-element referencing
........... extension0..*ExtensionAdditional content defined by implementations
........... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE
........... version0..1stringVersion of the system - if relevant
........... code1..1codeSymbol in syntax defined by the system
Fixed Value: coinsurance
........... display0..1stringRepresentation defined by the system
........... userSelected0..1booleanIf this coding was chosen directly by the user
.......... text0..1stringPlain text representation of the concept
......... applicability 0..1CodeableConceptin-network | out-of-network | other
Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.

......... qualifiers 0..*CodeableConceptAdditional information about the cost
Binding: Qualifier for coinsurance rate (required)
......... value 0..1QuantityThe actual cost value
.......... id 0..1stringUnique id for inter-element referencing
.......... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.......... value Σ0..1decimalNumerical value (with implicit precision)
.......... comparator ?!Σ0..1code< | <= | >= | > - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.

.......... unit Σ0..1stringUnit representation
.......... system ΣI0..1uriSystem that defines coded unit form
Required Pattern: http://unitsofmeasure.org
.......... code Σ0..1codeCoded form of the unit
Required Pattern: %

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan I0..*InsurancePlanDetails of a Health Insurance product/plan provided by an organization
... meta Σ0..1MetaMetadata about the resource
.... lastUpdated Σ1..1instantWhen the resource version last changed
... identifier ΣI1..*IdentifierBusiness Identifier for Product
... status ?!Σ1..1codedraft | active | retired | unknown
Binding: PublicationStatus (required): The lifecycle status of an artifact.

... name ΣI0..1stringOfficial name
... period 0..1PeriodWhen the product is available
... coverageArea Σ0..*Reference(Insurance Plan Location)Where product applies
... contact 0..*BackboneElementContact information for the Insurance Plan including URLs for brochure and formulary information
.... name 0..1HumanNameA name associated with the contact
..... text Σ0..1stringText representation of the full name
.... telecom 0..*ContactPointContact details (telephone, email, etc.) for a contact
..... system ΣI0..1codephone | fax | email | pager | url | sms | other
Binding: ContactPointSystem (required): Telecommunications form for contact point.

..... value Σ0..1stringThe actual contact point details
... Slices for coverage 1..*BackboneElementCoverage details
Slice: Unordered, Open by pattern:type
.... coverage:All Slices Content/Rules for all slices
..... type 1..1CodeableConceptType of coverage
.... coverage:drug-coverage 1..*BackboneElementCoverage details
..... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
..... usdf-FormularyReference-extension 1..*Reference(Formulary)Formulary Reference
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyReference-extension
..... benefit:drug-plan 1..*BackboneElementList of benefits
... Slices for plan 1..*BackboneElementPlan details
Slice: Unordered, Open by pattern:type
.... plan:drug-plan 1..*BackboneElementDrug plan
..... specificCost 1..*BackboneElementPharmacy benefit type specific cost
...... category 1..1CodeableConceptPharmacy Benefit Type
Binding: Pharmacy benefit types (extensible)
...... benefit 1..*BackboneElementDrug tier benefit
....... type 1..1CodeableConceptType of specific benefit
Binding: Drug tier of medication in health plan (required)
....... Slices for cost 1..*BackboneElementList of the costs
Slice: Unordered, Open by pattern:type
........ cost:All Slices Content/Rules for all slices
......... qualifiers 1..1CodeableConceptAdditional information about the cost
......... value 0..1QuantityThe actual cost value
........ cost:copay 0..1BackboneElementCopay costs
......... value I0..1MoneyQuantityAn amount of money. With regard to precision, see [Decimal Precision](datatypes.html#precision)
.......... value Σ1..1decimalNumerical value (with implicit precision)
........ cost:coinsurance 0..1BackboneElementCoinsurance costs

doco Documentation for this format

This structure is derived from InsurancePlan

Summary

Mandatory: 15 elements (2 nested mandatory elements)
Must-Support: 30 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

  • The element InsurancePlan.coverage is sliced based on the value of pattern:type
  • The element InsurancePlan.coverage.benefit is sliced based on the value of pattern:type
  • The element InsurancePlan.plan is sliced based on the value of pattern:type
  • The element InsurancePlan.plan.specificCost.benefit.cost is sliced based on the value of pattern:type

Differential View

This structure is derived from InsurancePlan

NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan 0..*InsurancePlanDetails of a Health Insurance product/plan provided by an organization
... meta
.... lastUpdated S1..1instantWhen the resource version last changed
... identifier S1..*IdentifierBusiness Identifier for Product
... status S1..1codedraft | active | retired | unknown
... name S0..1stringOfficial name
... period S0..1PeriodWhen the product is available
... coverageArea S0..*Reference(Insurance Plan Location)Where product applies
... contact 0..*BackboneElementContact information for the Insurance Plan including URLs for brochure and formulary information
.... purpose 0..1CodeableConceptThe type of contact
Binding: Type of plan contact (extensible)
.... name S0..1HumanNameA name associated with the contact
..... text S0..1stringText representation of the full name
.... telecom S0..*ContactPointContact details (telephone, email, etc.) for a contact
..... system S0..1codephone | fax | email | pager | url | sms | other
..... value S0..1stringThe actual contact point details
... Slices for coverage S1..*BackboneElementCoverage details
Slice: Unordered, Open by pattern:type
.... coverage:All Slices Content/Rules for all slices
..... type S1..1CodeableConceptType of coverage
.... coverage:drug-coverage S1..*BackboneElementCoverage details
..... Slices for extension S1..*ExtensionExtension
Slice: Unordered, Open by value:url
..... usdf-FormularyReference-extension S1..*Reference(Formulary)Formulary Reference
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyReference-extension
..... type 1..1CodeableConceptType of coverage
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: DRUGPOL
..... Slices for benefit 1..*BackboneElementList of benefits
Slice: Unordered, Open by pattern:type
...... benefit:All Slices Content/Rules for all slices
....... type 1..1CodeableConceptType of benefit
Binding: Insurance plan type (extensible)
...... benefit:drug-plan S1..*BackboneElementList of benefits
....... type 1..1CodeableConceptType of benefit
Required Pattern: At least the following
........ coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
......... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type
......... code1..1codeSymbol in syntax defined by the system
Fixed Value: Drug
......... display1..1stringRepresentation defined by the system
Fixed Value: Drug
... Slices for plan S1..*BackboneElementPlan details
Slice: Unordered, Open by pattern:type
.... plan:All Slices Content/Rules for all slices
..... type 0..1CodeableConceptType of plan
Binding: Insurance plan type (extensible)
.... plan:drug-plan S1..*BackboneElementDrug plan
..... type 1..1CodeableConceptType of plan
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: Drug
....... display1..1stringRepresentation defined by the system
Fixed Value: Drug
..... network 0..*Reference(Organization)Pharmacy benefit types that are part of the drug plan
..... specificCost S1..*BackboneElementPharmacy benefit type specific cost
...... category S1..1CodeableConceptPharmacy Benefit Type
Binding: Pharmacy benefit types (extensible)
...... benefit S1..*BackboneElementDrug tier benefit
....... type S1..1CodeableConceptType of specific benefit
Binding: Drug tier of medication in health plan (required)
....... Slices for cost S1..*BackboneElementList of the costs
Slice: Unordered, Open by pattern:type
........ cost:All Slices Content/Rules for all slices
......... type 1..1CodeableConceptType of cost
Binding: Benefit type of cost (extensible)
......... qualifiers S1..1CodeableConceptAdditional information about the cost
......... value S0..1QuantityThe actual cost value
........ cost:copay S0..1BackboneElementCopay costs
......... type 1..1CodeableConceptType of cost
Required Pattern: At least the following
.......... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
........... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE
........... code1..1codeSymbol in syntax defined by the system
Fixed Value: copay
......... qualifiers 0..*CodeableConceptAdditional information about the cost
Binding: Qualifier of copay amount (required)
......... value 0..1MoneyQuantityAn amount of money. With regard to precision, see [Decimal Precision](datatypes.html#precision)
.......... value S1..1decimalNumerical value (with implicit precision)
.......... system 0..1uriSystem that defines coded unit form
Required Pattern: urn:iso:std:iso:4217
.......... code 0..1codeCoded form of the unit
Required Pattern: USD
........ cost:coinsurance S0..1BackboneElementCoinsurance costs
......... type 1..1CodeableConceptType of cost
Required Pattern: At least the following
.......... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
........... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE
........... code1..1codeSymbol in syntax defined by the system
Fixed Value: coinsurance
......... qualifiers 0..*CodeableConceptAdditional information about the cost
Binding: Qualifier for coinsurance rate (required)
......... value
.......... system 0..1uriSystem that defines coded unit form
Required Pattern: http://unitsofmeasure.org
.......... code 0..1codeCoded form of the unit
Required Pattern: %

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan I0..*InsurancePlanDetails of a Health Insurance product/plan provided by an organization
... id Σ0..1stringLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... versionId Σ0..1idVersion specific identifier
.... lastUpdated SΣ1..1instantWhen the resource version last changed
.... source Σ0..1uriIdentifies where the resource comes from
.... profile Σ0..*canonical(StructureDefinition)Profiles this resource claims to conform to
.... security Σ0..*CodingSecurity Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.


.... tag Σ0..*CodingTags applied to this resource
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".


... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... text 0..1NarrativeText summary of the resource, for human interpretation