Profile Comparison between http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PayerInsurancePlan vs http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PayerInsurancePlan

Messages

Metadata

Name	Value		Comments
abstract	false
baseDefinition	http://hl7.org/fhir/StructureDefinition/InsurancePlan
copyright
date	2025-02-26T17:11:51+00:00	2026-08-17T18:42:41+00:00	Values Differ
description	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.
experimental
fhirVersion	4.0.1
jurisdiction
jurisdiction[0]	urn:iso:std:iso:3166#US
kind	resource
name	PayerInsurancePlan
publisher	HL7 International / Pharmacy
purpose
status	active
title	Payer Insurance Plan
type	InsurancePlan
url	http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PayerInsurancePlan
version	2.1.0	3.0.0-ballot	Values Differ

Structure

Name	L Flags	L Card.	L Type	L Description & Constraints	R Flags	R Card.	R Type	R Description & Constraints	Comments
InsurancePlan	C	0..*	InsurancePlan	Details of a Health Insurance product/plan provided by an organization	C	0..*	InsurancePlan	Details of a Health Insurance product/plan provided by an organization
id	Σ	0..1	id	Logical id of this artifact	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource	Σ	0..1	Meta	Metadata about the resource
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier	Σ	0..1	id	Version specific identifier
lastUpdated	SΣ	1..1	instant	When the resource version last changed	SΣ	1..1	instant	When the resource version last changed
source	Σ	0..1	uri	Identifies where the resource comes from	Σ	0..1	uri	Identifies where the resource comes from
profile	Σ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to	Σ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: ?? (extensible): Security Labels from the Healthcare Privacy and Security Classification System.	Σ	0..*	Coding	Security Labels applied to this resource Binding: ?? (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags applied to this resource Binding: ?? (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".	Σ	0..*	Coding	Tags applied to this resource Binding: ?? (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: ?? (preferred): A human language. Additional Bindings Purpose ?? Max Binding		0..1	code	Language of the resource content Binding: ?? (preferred): A human language. Additional Bindings Purpose ?? Max Binding	Example/preferred bindings differ at InsurancePlan.language using binding from PayerInsurancePlan
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣC	1..*	Identifier	The business identifier for the plan. The same InsurancePlan may be present in multiple directories and if they have the same identifier they are assumed to be the same plan.	SΣC	1..*	Identifier	The business identifier for the plan. The same InsurancePlan may be present in multiple directories and if they have the same identifier they are assumed to be the same plan.
status	?!SΣ	1..1	code	draft | active | retired | unknown Binding: ?? (required): The lifecycle status of an artifact.	?!SΣ	1..1	code	draft | active | retired | unknown Binding: ?? (required): The lifecycle status of an artifact.
type	SΣ	1..1	CodeableConcept	Product type Binding: ?? (extensible)	SΣ	1..1	CodeableConcept	Product type Binding: ?? (extensible)
name	SΣC	0..1	string	Official name	SΣC	0..1	string	Official name
alias		0..*	string	Alternate names		0..*	string	Alternate names
period	S	0..1	Period	When the product is available	S	0..1	Period	When the product is available
ownedBy	Σ	0..1	Reference(Organization)	Plan issuer	Σ	0..1	Reference(Organization)	Plan issuer
administeredBy	Σ	0..1	Reference(Organization)	Product administrator	Σ	0..1	Reference(Organization)	Product administrator
coverageArea	SΣ	0..*	Reference(Insurance Plan Location)	Where product applies	SΣ	0..*	Reference(Insurance Plan Location)	Where product applies
contact		0..*	BackboneElement	Contact information for the Insurance Plan including URLs for brochure and formulary information		0..*	BackboneElement	Contact information for the Insurance Plan including URLs for brochure and formulary information
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
purpose		0..1	CodeableConcept	The type of contact Binding: ?? (extensible)		0..1	CodeableConcept	The type of contact Binding: ?? (extensible)
name	S	0..1	HumanName	A name associated with the contact	S	0..1	HumanName	A name associated with the contact
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | nickname | anonymous | old | maiden Binding: ?? (required): The use of a human name.	?!Σ	0..1	code	usual | official | temp | nickname | anonymous | old | maiden Binding: ?? (required): The use of a human name.
text	SΣ	0..1	string	Text representation of the full name	SΣ	0..1	string	Text representation of the full name
family	Σ	0..1	string	Family name (often called 'Surname')	Σ	0..1	string	Family name (often called 'Surname')
given	Σ	0..*	string	Given names (not always 'first'). Includes middle names This repeating element order: Given Names appear in the correct order for presenting the name	Σ	0..*	string	Given names (not always 'first'). Includes middle names This repeating element order: Given Names appear in the correct order for presenting the name
prefix	Σ	0..*	string	Parts that come before the name This repeating element order: Prefixes appear in the correct order for presenting the name	Σ	0..*	string	Parts that come before the name This repeating element order: Prefixes appear in the correct order for presenting the name
suffix	Σ	0..*	string	Parts that come after the name This repeating element order: Suffixes appear in the correct order for presenting the name	Σ	0..*	string	Parts that come after the name This repeating element order: Suffixes appear in the correct order for presenting the name
period	Σ	0..1	Period	Time period when name was/is in use	Σ	0..1	Period	Time period when name was/is in use
telecom	S	0..*	ContactPoint	Contact details (telephone, email, etc.) for a contact	S	0..*	ContactPoint	Contact details (telephone, email, etc.) for a contact
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣC	0..1	code	phone | fax | email | pager | url | sms | other Binding: ?? (required): Telecommunications form for contact point.	SΣC	0..1	code	phone | fax | email | pager | url | sms | other Binding: ?? (required): Telecommunications form for contact point.
value	SΣ	0..1	string	The actual contact point details	SΣ	0..1	string	The actual contact point details
use	?!Σ	0..1	code	home | work | temp | old | mobile - purpose of this contact point Binding: ?? (required): Use of contact point.	?!Σ	0..1	code	home | work | temp | old | mobile - purpose of this contact point Binding: ?? (required): Use of contact point.
rank	Σ	0..1	positiveInt	Specify preferred order of use (1 = highest)	Σ	0..1	positiveInt	Specify preferred order of use (1 = highest)
period	Σ	0..1	Period	Time period when the contact point was/is in use	Σ	0..1	Period	Time period when the contact point was/is in use
address		0..1	Address	Visiting or postal addresses for the contact		0..1	Address	Visiting or postal addresses for the contact
endpoint		0..*	Reference(Endpoint)	Technical endpoint		0..*	Reference(Endpoint)	Technical endpoint
network		0..*	Reference(Organization)	What networks are Included		0..*	Reference(Organization)	What networks are Included
Slices for coverage	S	1..*	BackboneElement	Coverage details Slice: Unordered, Open by pattern:type	S	1..*	BackboneElement	Coverage details Slice: Unordered, Open by pattern:type
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	S	1..1	CodeableConcept	Type of coverage	S	1..1	CodeableConcept	Type of coverage
network		0..*	Reference(Organization)	What networks provide coverage		0..*	Reference(Organization)	What networks provide coverage
benefit		1..*	BackboneElement	List of benefits		1..*	BackboneElement	List of benefits
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	CodeableConcept	Type of benefit		1..1	CodeableConcept	Type of benefit
requirement		0..1	string	Referral requirements		0..1	string	Referral requirements
limit		0..*	BackboneElement	Benefit limits		0..*	BackboneElement	Benefit limits
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
value		0..1	Quantity	Maximum value allowed		0..1	Quantity	Maximum value allowed
code		0..1	CodeableConcept	Benefit limit details		0..1	CodeableConcept	Benefit limit details
Slices for plan	S	1..*	BackboneElement	Plan details Slice: Unordered, Open by pattern:type	S	1..*	BackboneElement	Plan details Slice: Unordered, Open by pattern:type
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
identifier	Σ	0..*	Identifier	Business Identifier for Product	Σ	0..*	Identifier	Business Identifier for Product
type		0..1	CodeableConcept	Type of plan Binding: ?? (extensible)		0..1	CodeableConcept	Type of plan Binding: ?? (extensible)
coverageArea	Σ	0..*	Reference(Location)	Where product applies	Σ	0..*	Reference(Location)	Where product applies
network		0..*	Reference(Organization)	What networks provide coverage		0..*	Reference(Organization)	What networks provide coverage
generalCost		0..*	BackboneElement	Overall costs		0..*	BackboneElement	Overall costs
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		0..1	CodeableConcept	Type of cost		0..1	CodeableConcept	Type of cost
groupSize		0..1	positiveInt	Number of enrollees		0..1	positiveInt	Number of enrollees
cost		0..1	Money	Cost value		0..1	Money	Cost value
comment		0..1	string	Additional cost information		0..1	string	Additional cost information
specificCost		0..*	BackboneElement	Specific costs		0..*	BackboneElement	Specific costs
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category		1..1	CodeableConcept	General category of benefit		1..1	CodeableConcept	General category of benefit
benefit		0..*	BackboneElement	Benefits list		0..*	BackboneElement	Benefits list
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	CodeableConcept	Type of specific benefit		1..1	CodeableConcept	Type of specific benefit
cost		0..*	BackboneElement	List of the costs		0..*	BackboneElement	List of the costs
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	CodeableConcept	Type of cost		1..1	CodeableConcept	Type of cost
applicability		0..1	CodeableConcept	in-network | out-of-network | other Binding: ?? (required): Whether the cost applies to in-network or out-of-network providers.		0..1	CodeableConcept	in-network | out-of-network | other Binding: ?? (required): Whether the cost applies to in-network or out-of-network providers.
qualifiers		0..*	CodeableConcept	Additional information about the cost		0..*	CodeableConcept	Additional information about the cost
value		0..1	Quantity	The actual cost value		0..1	Quantity	The actual cost value
Documentation for this format