DaVinci Payer Data Exchange (PDex) US Drug Formulary
2.1.0 - STU2.1 US

DaVinci Payer Data Exchange (PDex) US Drug Formulary, published by HL7 International / Pharmacy. This guide is not an authorized publication; it is the continuous build for version 2.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. 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: 2.1.0
Standards status: Trial-use Computable Name: PayerInsurancePlan
Other Identifiers: OID:2.25.74595174031514506193398850787025340071.42.12

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.

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description Differentials, Snapshots, and other representations.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. InsurancePlan C 0..* InsurancePlan Details of a Health Insurance product/plan provided by an organization
Constraints: ipn-1
... meta Σ 0..1 Meta Metadata about the resource
.... lastUpdated SΣ 1..1 instant When the resource version last changed
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... status ?!SΣ 1..1 code draft | active | retired | unknown
Binding: PublicationStatus (required): The lifecycle status of an artifact.
... type SΣ 1..1 CodeableConcept Product type
Binding: Insurance Product Type VS (extensible)
... name SΣC 0..1 string Official name
... period S 0..1 Period When the product is available
... coverageArea 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
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... purpose 0..1 CodeableConcept The type of contact
Binding: Type of plan contact (extensible)
.... name S 0..1 HumanName A name associated with the contact
..... use ?!Σ 0..1 code usual | official | temp | nickname | anonymous | old | maiden
Binding: NameUse (required): The use of a human name.
..... text SΣ 0..1 string Text representation of the full name
.... telecom S 0..* ContactPoint Contact details (telephone, email, etc.) for a contact
..... system SΣC 0..1 code phone | fax | email | pager | url | sms | other
Binding: ContactPointSystem (required): Telecommunications form for contact point.
..... value 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: ContactPointUse (required): Use of contact point.
... Slices for coverage S 1..* BackboneElement Coverage details
Slice: Unordered, Open by pattern:type
.... coverage:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type S 1..1 CodeableConcept Type of coverage
..... benefit 1..* BackboneElement List of benefits
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... type 1..1 CodeableConcept Type of benefit
.... coverage:drug-coverage S 1..* BackboneElement Coverage details
..... Slices for extension S 1..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:usdf-FormularyReference-extension S 1..* Reference(Formulary) Formulary Reference
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyReference-extension
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type S 1..1 CodeableConcept Type of coverage
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: DRUGPOL
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... Slices for benefit 1..* BackboneElement List of benefits
Slice: Unordered, Open by pattern:type
...... benefit:All Slices Content/Rules for all slices
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
....... type 1..1 CodeableConcept Type of benefit
Binding: Insurance plan type (extensible)
...... benefit:drug-plan S 1..* BackboneElement List of benefits
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
....... type 1..1 CodeableConcept Type of benefit
Binding: Insurance plan type (extensible)
Required Pattern: At least the following
........ id 0..1 string Unique id for inter-element referencing
........ extension 0..* Extension Additional content defined by implementations
........ coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
......... id 0..1 string Unique id for inter-element referencing
......... extension 0..* Extension Additional content defined by implementations
......... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type
......... version 0..1 string Version of the system - if relevant
......... code 1..1 code Symbol in syntax defined by the system
Fixed Value: drug
......... display 1..1 string Representation defined by the system
Fixed Value: Drug
......... userSelected 0..1 boolean If this coding was chosen directly by the user
........ text 0..1 string Plain text representation of the concept
... Slices for plan S 1..* BackboneElement Plan details
Slice: Unordered, Open by pattern:type
.... plan:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type 0..1 CodeableConcept Type of plan
Binding: Insurance plan type (extensible)
.... plan:drug-plan S 1..* BackboneElement Drug plan
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... identifier SΣ 0..* Identifier Business Identifier for Product
..... type 1..1 CodeableConcept Type of plan
Binding: Insurance plan type (extensible)
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: drug
....... display 1..1 string Representation defined by the system
Fixed Value: Drug
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... network 0..* Reference(Organization) Pharmacy benefit types that are part of the drug plan
..... specificCost S 1..* BackboneElement Pharmacy benefit type specific cost
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... category S 1..1 CodeableConcept Pharmacy Benefit Type
Binding: Pharmacy benefit types (extensible)
...... benefit S 1..* BackboneElement Drug tier benefit
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
....... type S 1..1 CodeableConcept Type of specific benefit
Binding: Drug tier of medication in health plan (extensible)
....... Slices for cost S 1..* BackboneElement List of the costs
Slice: Unordered, Open by pattern:type
........ cost:All Slices Content/Rules for all slices
......... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
......... type 1..1 CodeableConcept Type of cost
Binding: Benefit type of cost (extensible)
......... qualifiers S 1..1 CodeableConcept Additional information about the cost
......... value S 0..1 Quantity The actual cost value
........ cost:copay S 0..1 BackboneElement Copay costs
......... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
......... type 1..1 CodeableConcept Type of cost
Binding: Benefit type of cost (extensible)
Required Pattern: At least the following
.......... id 0..1 string Unique id for inter-element referencing
.......... extension 0..* Extension Additional content defined by implementations
.......... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
........... id 0..1 string Unique id for inter-element referencing
........... extension 0..* Extension Additional content defined by implementations
........... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE
........... version 0..1 string Version of the system - if relevant
........... code 1..1 code Symbol in syntax defined by the system
Fixed Value: copay
........... display 0..1 string Representation defined by the system
........... userSelected 0..1 boolean If this coding was chosen directly by the user
.......... text 0..1 string Plain text representation of the concept
......... qualifiers S 1..1 CodeableConcept Additional information about the cost
Binding: Qualifier of copay amount (required)
......... value S 1..1 MoneyQuantity The actual cost value
.......... value SΣ 1..1 decimal Numerical value (with implicit precision)
.......... comparator ?!Σ 0..1 code < | <= | >= | > - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.
.......... system ΣC 0..1 uri System that defines coded unit form
Required Pattern: urn:iso:std:iso:4217
.......... code Σ 0..1 code Coded form of the unit
Required Pattern: USD
........ cost:coinsurance S 0..1 BackboneElement Coinsurance costs
......... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
......... type 1..1 CodeableConcept Type of cost
Binding: Benefit type of cost (extensible)
Required Pattern: At least the following
.......... id 0..1 string Unique id for inter-element referencing
.......... extension 0..* Extension Additional content defined by implementations
.......... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
........... id 0..1 string Unique id for inter-element referencing
........... extension 0..* Extension Additional content defined by implementations
........... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE
........... version 0..1 string Version of the system - if relevant
........... code 1..1 code Symbol in syntax defined by the system
Fixed Value: coinsurance
........... display 0..1 string Representation defined by the system
........... userSelected 0..1 boolean If this coding was chosen directly by the user
.......... text 0..1 string Plain text representation of the concept
......... qualifiers S 1..1 CodeableConcept Additional information about the cost
Binding: Qualifier for coinsurance rate (required)
......... value S 1..1 Quantity The actual cost value
.......... value SΣ 1..1 decimal Numerical value (with implicit precision)
.......... comparator ?!Σ 0..1 code < | <= | >= | > - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.
.......... system ΣC 0..1 uri System that defines coded unit form
Required Pattern: http://unitsofmeasure.org
.......... code Σ 0..1 code Coded form of the unit
Required Pattern: %

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
InsurancePlan.status Base required PublicationStatus 📍4.0.1 FHIR Std.
InsurancePlan.type Base extensible Insurance Product Type VS 📦1.2.0 Da Vinci PDex Plan Net v1.2
InsurancePlan.contact.​purpose Base extensible Type of plan contact 📦2.1.0 This IG
InsurancePlan.contact.​name.use Base required NameUse 📍4.0.1 FHIR Std.
InsurancePlan.contact.​telecom.system Base required ContactPointSystem 📍4.0.1 FHIR Std.
InsurancePlan.contact.​telecom.use Base required ContactPointUse 📍4.0.1 FHIR Std.
InsurancePlan.coverage:drug-coverage.​benefit.type Base extensible Insurance plan type 📦1.0.1 THO v7.1
InsurancePlan.coverage:drug-coverage.​benefit:drug-plan.type Base extensible Insurance plan type 📦1.0.1 THO v7.1
InsurancePlan.plan.type Base extensible Insurance plan type 📦1.0.1 THO v7.1
InsurancePlan.plan:drug-plan.​type Base extensible Insurance plan type 📦1.0.1 THO v7.1
InsurancePlan.plan:drug-plan.​specificCost.category Base extensible Pharmacy benefit types 📦2.1.0 This IG
InsurancePlan.plan:drug-plan.​specificCost.benefit.​type Base extensible Drug tier of medication in health plan 📦2.1.0 This IG
InsurancePlan.plan:drug-plan.​specificCost.benefit.​cost.type Base extensible Benefit type of cost 📦2.1.0 This IG
InsurancePlan.plan:drug-plan.​specificCost.benefit.​cost:copay.type Base extensible Benefit type of cost 📦2.1.0 This IG
InsurancePlan.plan:drug-plan.​specificCost.benefit.​cost:copay.qualifiers Base required Qualifier of copay amount 📦2.1.0 This IG
InsurancePlan.plan:drug-plan.​specificCost.benefit.​cost:copay.value.comparator Base required QuantityComparator 📍4.0.1 FHIR Std.
InsurancePlan.plan:drug-plan.​specificCost.benefit.​cost:coinsurance.type Base extensible Benefit type of cost 📦2.1.0 This IG
InsurancePlan.plan:drug-plan.​specificCost.benefit.​cost:coinsurance.qualifiers Base required Qualifier for coinsurance rate 📦2.1.0 This IG
InsurancePlan.plan:drug-plan.​specificCost.benefit.​cost:coinsurance.value.​comparator Base required QuantityComparator 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error InsurancePlan If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error InsurancePlan If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error InsurancePlan If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error InsurancePlan If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice InsurancePlan A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
ipn-1 error InsurancePlan The organization SHALL at least have a name or an idendtifier, and possibly more than one (identifier.count() + name.count()) > 0

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. InsurancePlan 0..* InsurancePlan Details of a Health Insurance product/plan provided by an organization
... meta
.... lastUpdated S 1..1 instant When the resource version last changed
... identifier S 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 S 1..1 code draft | active | retired | unknown
... name S 0..1 string Official name
... period S 0..1 Period When the product is available
... coverageArea S 0..* Reference(Insurance Plan Location) Where product applies
... contact 0..* BackboneElement Contact information for the Insurance Plan including URLs for brochure and formulary information
.... purpose 0..1 CodeableConcept The type of contact
Binding: Type of plan contact (extensible)
.... name S 0..1 HumanName A name associated with the contact
..... text S 0..1 string Text representation of the full name
.... telecom S 0..* ContactPoint Contact details (telephone, email, etc.) for a contact
..... system S 0..1 code phone | fax | email | pager | url | sms | other
..... value S 0..1 string The actual contact point details
... Slices for coverage S 1..* BackboneElement Coverage details
Slice: Unordered, Open by pattern:type
.... coverage:All Slices Content/Rules for all slices
..... type S 1..1 CodeableConcept Type of coverage
.... coverage:drug-coverage S 1..* BackboneElement Coverage details
..... Slices for extension S 1..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:usdf-FormularyReference-extension S 1..* Reference(Formulary) Formulary Reference
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyReference-extension
..... type 1..1 CodeableConcept Type of coverage
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: DRUGPOL
..... Slices for benefit 1..* BackboneElement List of benefits
Slice: Unordered, Open by pattern:type
...... benefit:All Slices Content/Rules for all slices
....... type 1..1 CodeableConcept Type of benefit
Binding: Insurance plan type (extensible)
...... benefit:drug-plan S 1..* BackboneElement List of benefits
....... type 1..1 CodeableConcept Type of benefit
Required Pattern: At least the following
........ coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
......... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type
......... code 1..1 code Symbol in syntax defined by the system
Fixed Value: drug
......... display 1..1 string Representation defined by the system
Fixed Value: Drug
... Slices for plan S 1..* BackboneElement Plan details
Slice: Unordered, Open by pattern:type
.... plan:All Slices Content/Rules for all slices
..... type 0..1 CodeableConcept Type of plan
Binding: Insurance plan type (extensible)
.... plan:drug-plan S 1..* BackboneElement Drug plan
..... identifier S 0..* Identifier Business Identifier for Product
..... type 1..1 CodeableConcept Type of plan
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: drug
....... display 1..1 string Representation defined by the system
Fixed Value: Drug
..... network 0..* Reference(Organization) Pharmacy benefit types that are part of the drug plan
..... specificCost S 1..* BackboneElement Pharmacy benefit type specific cost
...... category S 1..1 CodeableConcept Pharmacy Benefit Type
Binding: Pharmacy benefit types (extensible)
...... benefit S 1..* BackboneElement Drug tier benefit
....... type S 1..1 CodeableConcept Type of specific benefit
Binding: Drug tier of medication in health plan (extensible)
....... Slices for cost S 1..* BackboneElement List of the costs
Slice: Unordered, Open by pattern:type
........ cost:All Slices Content/Rules for all slices
......... type 1..1 CodeableConcept Type of cost
Binding: Benefit type of cost (extensible)
......... qualifiers S 1..1 CodeableConcept Additional information about the cost
......... value S 0..1 Quantity The actual cost value
........ cost:copay S 0..1 BackboneElement Copay costs
......... type 1..1 CodeableConcept Type of cost
Required Pattern: At least the following
.......... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
........... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE
........... code 1..1 code Symbol in syntax defined by the system
Fixed Value: copay
......... qualifiers 1..1 CodeableConcept Additional information about the cost
Binding: Qualifier of copay amount (required)
......... value 1..1 MoneyQuantity The actual cost value
.......... value S 1..1 decimal Numerical value (with implicit precision)
.......... system 0..1 uri System that defines coded unit form
Required Pattern: urn:iso:std:iso:4217
.......... code 0..1 code Coded form of the unit
Required Pattern: USD
........ cost:coinsurance S 0..1 BackboneElement Coinsurance costs
......... type 1..1 CodeableConcept Type of cost
Required Pattern: At least the following
.......... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
........... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE
........... code 1..1 code Symbol in syntax defined by the system
Fixed Value: coinsurance
......... qualifiers 1..1 CodeableConcept Additional information about the cost
Binding: Qualifier for coinsurance rate (required)
......... value 1..1 Quantity The actual cost value
.......... value S 1..1 decimal Numerical value (with implicit precision)
.......... system 0..1 uri System that defines coded unit form
Required Pattern: http://unitsofmeasure.org
.......... code 0..1 code Coded form of the unit
Required Pattern: %

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
InsurancePlan.type Base extensible Insurance Product Type VS 📦1.2.0 Da Vinci PDex Plan Net v1.2
InsurancePlan.contact.​purpose Base extensible Type of plan contact 📦2.1.0 This IG
InsurancePlan.coverage:drug-coverage.​benefit.type Base extensible Insurance plan type 📦1.0.1 THO v7.1
InsurancePlan.plan.type Base extensible Insurance plan type 📦1.0.1 THO v7.1
InsurancePlan.plan:drug-plan.​specificCost.category Base extensible Pharmacy benefit types 📦2.1.0 This IG
InsurancePlan.plan:drug-plan.​specificCost.benefit.​type Base extensible Drug tier of medication in health plan 📦2.1.0 This IG
InsurancePlan.plan:drug-plan.​specificCost.benefit.​cost.type Base extensible Benefit type of cost 📦2.1.0 This IG
InsurancePlan.plan:drug-plan.​specificCost.benefit.​cost:copay.qualifiers Base required Qualifier of copay amount 📦2.1.0 This IG
InsurancePlan.plan:drug-plan.​specificCost.benefit.​cost:coinsurance.qualifiers Base required Qualifier for coinsurance rate 📦2.1.0 This IG
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. InsurancePlan C 0..* InsurancePlan Details of a Health Insurance product/plan provided by an organization
Constraints: ipn-1
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... versionId Σ 0..1 id Version specific identifier
.... lastUpdated SΣ 1..1 instant When the resource version last changed
.... source Σ 0..1 uri Identifies where the resource comes from
.... profile Σ 0..* canonical(StructureDefinition) Profiles this resource claims to conform to
.... security Σ 0..* Coding Security Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
.... tag Σ 0..* Coding Tags 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 ?!Σ 0..1 uri A set of rules under which this content was created
... 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
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 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.
... status ?!SΣ 1..1 code draft | active | retired | unknown
Binding: PublicationStatus (required): The lifecycle status of an artifact.
... type SΣ 1..1 CodeableConcept Product type
Binding: Insurance Product Type VS (extensible)
... name SΣC 0..1 string Official name
... alias 0..* string Alternate names
... period S 0..1 Period When the product is available
... ownedBy Σ 0..1 Reference(Organization) Plan issuer
... administeredBy Σ 0..1 Reference(Organization) Product administrator
... coverageArea 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
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... purpose 0..1 CodeableConcept The type of contact
Binding: Type of plan contact (extensible)
.... name S 0..1 HumanName A name associated with the contact
..... id 0..1 string Unique id for inter-element referencing
..... extension 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: NameUse (required): The use of a human name.
..... text SΣ 0..1 string Text representation of the full name
..... family 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
..... prefix 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
..... period Σ 0..1 Period Time period when name was/is in use
.... telecom S 0..* ContactPoint Contact details (telephone, email, etc.) for a contact
..... id 0..1 string Unique id for inter-element referencing
..... extension 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: ContactPointSystem (required): Telecommunications form for contact point.
..... value 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: ContactPointUse (required): Use of contact point.
..... rank 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
.... address 0..1 Address Visiting or postal addresses for the contact
... endpoint 0..* Reference(Endpoint) Technical endpoint
... network 0..* Reference(Organization) What networks are Included
... Slices for coverage S 1..* BackboneElement Coverage details
Slice: Unordered, Open by pattern:type
.... coverage:All Slices Content/Rules for all slices
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type S 1..1 CodeableConcept Type of coverage
..... network 0..* Reference(Organization) What networks provide coverage
..... benefit 1..* BackboneElement List of benefits
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... type 1..1 CodeableConcept Type of benefit
...... requirement 0..1 string Referral requirements
...... limit 0..* BackboneElement Benefit limits
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
....... value 0..1 Quantity Maximum value allowed
....... code 0..1 CodeableConcept Benefit limit details
.... coverage:drug-coverage S 1..* BackboneElement Coverage details
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension S 1..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:usdf-FormularyReference-extension S 1..* Reference(Formulary) Formulary Reference
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyReference-extension
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type S 1..1 CodeableConcept Type of coverage
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: DRUGPOL
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... network 0..* Reference(Organization) What networks provide coverage
..... Slices for benefit 1..* BackboneElement List of benefits
Slice: Unordered, Open by pattern:type
...... benefit:All Slices Content/Rules for all slices
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
....... type 1..1 CodeableConcept Type of benefit
Binding: Insurance plan type (extensible)
....... requirement 0..1 string Referral requirements
....... limit 0..* BackboneElement Benefit limits
........ id 0..1 string Unique id for inter-element referencing
........ extension 0..* Extension Additional content defined by implementations
........ modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
........ value 0..1 Quantity Maximum value allowed
........ code 0..1 CodeableConcept Benefit limit details
...... benefit:drug-plan S 1..* BackboneElement List of benefits
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
....... type 1..1 CodeableConcept Type of benefit
Binding: Insurance plan type (extensible)
Required Pattern: At least the following
........ id 0..1 string Unique id for inter-element referencing
........ extension 0..* Extension Additional content defined by implementations
........ coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
......... id 0..1 string Unique id for inter-element referencing
......... extension 0..* Extension Additional content defined by implementations
......... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type
......... version 0..1 string Version of the system - if relevant
......... code 1..1 code Symbol in syntax defined by the system
Fixed Value: drug
......... display 1..1 string Representation defined by the system
Fixed Value: Drug
......... userSelected 0..1 boolean If this coding was chosen directly by the user
........ text 0..1 string Plain text representation of the concept
....... requirement 0..1 string Referral requirements
....... limit 0..* BackboneElement Benefit limits
........ id 0..1 string Unique id for inter-element referencing
........ extension 0..* Extension Additional content defined by implementations
........ modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
........ value 0..1 Quantity Maximum value allowed
........ code 0..1 CodeableConcept Benefit limit details
... Slices for plan S 1..* BackboneElement Plan details
Slice: Unordered, Open by pattern:type
.... plan:All Slices Content/Rules for all slices
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... identifier Σ 0..* Identifier Business Identifier for Product
..... type 0..1 CodeableConcept Type of plan
Binding: Insurance plan type (extensible)
..... coverageArea Σ 0..* Reference(Location) Where product applies
..... network 0..* Reference(Organization) What networks provide coverage
..... generalCost 0..* BackboneElement Overall costs
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... type 0..1 CodeableConcept Type of cost
...... groupSize 0..1 positiveInt Number of enrollees
...... cost 0..1 Money Cost value
...... comment 0..1 string Additional cost information
..... specificCost 0..* BackboneElement Specific costs
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... category 1..1 CodeableConcept General category of benefit
...... benefit 0..* BackboneElement Benefits list
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
....... type 1..1 CodeableConcept Type of specific benefit
....... cost 0..* BackboneElement List of the costs
........ id 0..1 string Unique id for inter-element referencing
........ extension 0..* Extension Additional content defined by implementations
........ modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
........ type 1..1 CodeableConcept Type of cost
........ applicability 0..1 CodeableConcept in-network | out-of-network | other
Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.
........ qualifiers 0..* CodeableConcept Additional information about the cost
........ value 0..1 Quantity The actual cost value
.... plan:drug-plan S 1..* BackboneElement Drug plan
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... identifier SΣ 0..* Identifier Business Identifier for Product
..... type 1..1 CodeableConcept Type of plan
Binding: Insurance plan type (extensible)
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: drug
....... display 1..1 string Representation defined by the system
Fixed Value: Drug
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... coverageArea Σ 0..* Reference(Location) Where product applies
..... network 0..* Reference(Organization) Pharmacy benefit types that are part of the drug plan
..... generalCost 0..* BackboneElement Overall costs
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... type 0..1 CodeableConcept Type of cost
...... groupSize 0..1 positiveInt Number of enrollees
...... cost 0..1 Money Cost value
...... comment 0..1 string Additional cost information
..... specificCost S 1..* BackboneElement Pharmacy benefit type specific cost
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... category S 1..1 CodeableConcept Pharmacy Benefit Type
Binding: Pharmacy benefit types (extensible)
...... benefit S 1..* BackboneElement Drug tier benefit
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
....... type S 1..1 CodeableConcept Type of specific benefit
Binding: Drug tier of medication in health plan (extensible)
....... Slices for cost S 1..* BackboneElement List of the costs
Slice: Unordered, Open by pattern:type
........ cost:All Slices Content/Rules for all slices
......... id 0..1 string Unique id for inter-element referencing
......... extension 0..* Extension Additional content defined by implementations
......... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
......... type 1..1 CodeableConcept Type of cost
Binding: Benefit type of cost (extensible)
......... applicability 0..1 CodeableConcept in-network | out-of-network | other
Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.
......... qualifiers S 1..1 CodeableConcept Additional information about the cost
......... value S 0..1 Quantity The actual cost value
........ cost:copay S 0..1 BackboneElement Copay costs
......... id 0..1 string Unique id for inter-element referencing
......... extension 0..* Extension Additional content defined by implementations
......... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
......... type 1..1 CodeableConcept Type of cost
Binding: Benefit type of cost (extensible)
Required Pattern: At least the following
.......... id 0..1 string Unique id for inter-element referencing
.......... extension 0..* Extension Additional content defined by implementations
.......... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
........... id 0..1 string Unique id for inter-element referencing
........... extension 0..* Extension Additional content defined by implementations
........... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE
........... version 0..1 string Version of the system - if relevant
........... code 1..1 code Symbol in syntax defined by the system
Fixed Value: copay
........... display 0..1 string Representation defined by the system
........... userSelected 0..1 boolean If this coding was chosen directly by the user
.......... text 0..1 string Plain text representation of the concept
......... applicability 0..1 CodeableConcept in-network | out-of-network | other
Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.
......... qualifiers S 1..1 CodeableConcept Additional information about the cost
Binding: Qualifier of copay amount (required)
......... value S 1..1 MoneyQuantity The actual cost value
.......... id 0..1 string Unique id for inter-element referencing
.......... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.......... value SΣ 1..1 decimal Numerical value (with implicit precision)
.......... comparator ?!Σ 0..1 code < | <= | >= | > - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.
.......... unit Σ 0..1 string Unit representation
.......... system ΣC 0..1 uri System that defines coded unit form
Required Pattern: urn:iso:std:iso:4217
.......... code Σ 0..1 code Coded form of the unit
Required Pattern: USD
........ cost:coinsurance S 0..1 BackboneElement Coinsurance costs
......... id 0..1 string Unique id for inter-element referencing
......... extension 0..* Extension Additional content defined by implementations
......... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
......... type 1..1 CodeableConcept Type of cost
Binding: Benefit type of cost (extensible)
Required Pattern: At least the following
.......... id 0..1 string Unique id for inter-element referencing
.......... extension 0..* Extension Additional content defined by implementations
.......... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
........... id 0..1 string Unique id for inter-element referencing
........... extension 0..* Extension Additional content defined by implementations
........... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE
........... version 0..1 string Version of the system - if relevant
........... code 1..1 code Symbol in syntax defined by the system
Fixed Value: coinsurance
........... display 0..1 string Representation defined by the system
........... userSelected 0..1 boolean If this coding was chosen directly by the user
.......... text 0..1 string Plain text representation of the concept
......... applicability 0..1 CodeableConcept in-network | out-of-network | other
Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.
......... qualifiers S 1..1 CodeableConcept Additional information about the cost
Binding: Qualifier for coinsurance rate (required)
......... value S 1..1 Quantity The actual cost value
.......... id 0..1 string Unique id for inter-element referencing
.......... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.......... value SΣ 1..1 decimal Numerical value (with implicit precision)
.......... comparator ?!Σ 0..1 code < | <= | >= | > - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.
.......... unit Σ 0..1 string Unit representation
.......... system ΣC 0..1 uri System that defines coded unit form
Required Pattern: http://unitsofmeasure.org
.......... code Σ 0..1 code Coded form of the unit
Required Pattern: %

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
InsurancePlan.meta.security Base extensible SecurityLabels 📍4.0.1 FHIR Std.
InsurancePlan.meta.tag Base example Common Tags 📍4.0.1 FHIR Std.
InsurancePlan.language Base preferred Common Languages 📍4.0.1 FHIR Std.
InsurancePlan.status Base required PublicationStatus 📍4.0.1 FHIR Std.
InsurancePlan.type Base extensible Insurance Product Type VS 📦1.2.0 Da Vinci PDex Plan Net v1.2
InsurancePlan.contact.​purpose Base extensible Type of plan contact 📦2.1.0 This IG
InsurancePlan.contact.​name.use Base required NameUse 📍4.0.1 FHIR Std.
InsurancePlan.contact.​telecom.system Base required ContactPointSystem 📍4.0.1 FHIR Std.
InsurancePlan.contact.​telecom.use Base required ContactPointUse 📍4.0.1 FHIR Std.
InsurancePlan.coverage:drug-coverage.​benefit.type Base extensible Insurance plan type 📦1.0.1 THO v7.1
InsurancePlan.coverage:drug-coverage.​benefit:drug-plan.type Base extensible Insurance plan type 📦1.0.1 THO v7.1
InsurancePlan.plan.type Base extensible Insurance plan type 📦1.0.1 THO v7.1
InsurancePlan.plan.specificCost.​benefit.cost.applicability Base required Benefit cost applicability 📍4.0.1 FHIR Std.
InsurancePlan.plan:drug-plan.​type Base extensible Insurance plan type 📦1.0.1 THO v7.1
InsurancePlan.plan:drug-plan.​specificCost.category Base extensible Pharmacy benefit types 📦2.1.0 This IG
InsurancePlan.plan:drug-plan.​specificCost.benefit.​type Base extensible Drug tier of medication in health plan 📦2.1.0 This IG
InsurancePlan.plan:drug-plan.​specificCost.benefit.​cost.type Base extensible Benefit type of cost 📦2.1.0 This IG
InsurancePlan.plan:drug-plan.​specificCost.benefit.​cost.applicability Base required Benefit cost applicability 📍4.0.1 FHIR Std.
InsurancePlan.plan:drug-plan.​specificCost.benefit.​cost:copay.type Base extensible Benefit type of cost 📦2.1.0 This IG
InsurancePlan.plan:drug-plan.​specificCost.benefit.​cost:copay.applicability Base required Benefit cost applicability 📍4.0.1 FHIR Std.
InsurancePlan.plan:drug-plan.​specificCost.benefit.​cost:copay.qualifiers Base required Qualifier of copay amount 📦2.1.0 This IG
InsurancePlan.plan:drug-plan.​specificCost.benefit.​cost:copay.value.comparator Base required QuantityComparator 📍4.0.1 FHIR Std.
InsurancePlan.plan:drug-plan.​specificCost.benefit.​cost:coinsurance.type Base extensible Benefit type of cost 📦2.1.0 This IG
InsurancePlan.plan:drug-plan.​specificCost.benefit.​cost:coinsurance.applicability Base required Benefit cost applicability 📍4.0.1 FHIR Std.
InsurancePlan.plan:drug-plan.​specificCost.benefit.​cost:coinsurance.qualifiers Base required Qualifier for coinsurance rate 📦2.1.0 This IG
InsurancePlan.plan:drug-plan.​specificCost.benefit.​cost:coinsurance.value.​comparator Base required QuantityComparator 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error InsurancePlan If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error InsurancePlan If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error InsurancePlan If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error InsurancePlan If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice InsurancePlan A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
ipn-1 error InsurancePlan The organization SHALL at least have a name or an idendtifier, and possibly more than one (identifier.count() + name.count()) > 0

Summary

Mandatory: 15 elements(5 nested mandatory elements)
Must-Support: 32 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 1 is sliced based on the value of InsurancePlan.coverage
  • The element 1 is sliced based on the value of InsurancePlan.coverage.benefit
  • The element 1 is sliced based on the value of InsurancePlan.plan
  • The element 1 is sliced based on the value of InsurancePlan.plan.specificCost.benefit.cost

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. InsurancePlan C 0..* InsurancePlan Details of a Health Insurance product/plan provided by an organization
Constraints: ipn-1
... meta Σ 0..1 Meta Metadata about the resource
.... lastUpdated SΣ 1..1 instant When the resource version last changed
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... status ?!SΣ 1..1 code draft | active | retired | unknown
Binding: PublicationStatus (required): The lifecycle status of an artifact.
... type SΣ 1..1 CodeableConcept Product type
Binding: Insurance Product Type VS (extensible)
... name SΣC 0..1 string Official name
... period S 0..1 Period When the product is available
... coverageArea 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
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... purpose 0..1 CodeableConcept The type of contact
Binding: Type of plan contact (extensible)
.... name S 0..1 HumanName A name associated with the contact
..... use ?!Σ 0..1 code usual | official | temp | nickname | anonymous | old | maiden
Binding: NameUse (required): The use of a human name.
..... text SΣ 0..1 string Text representation of the full name
.... telecom S 0..* ContactPoint Contact details (telephone, email, etc.) for a contact
..... system SΣC 0..1 code phone | fax | email | pager | url | sms | other
Binding: ContactPointSystem (required): Telecommunications form for contact point.
..... value 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: ContactPointUse (required): Use of contact point.
... Slices for coverage S 1..* BackboneElement Coverage details
Slice: Unordered, Open by pattern:type
.... coverage:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type S 1..1 CodeableConcept Type of coverage
..... benefit 1..* BackboneElement List of benefits
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... type 1..1 CodeableConcept Type of benefit
.... coverage:drug-coverage S 1..* BackboneElement Coverage details
..... Slices for extension S 1..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:usdf-FormularyReference-extension S 1..* Reference(Formulary) Formulary Reference
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyReference-extension
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type S 1..1 CodeableConcept Type of coverage
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: DRUGPOL
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... Slices for benefit 1..* BackboneElement List of benefits
Slice: Unordered, Open by pattern:type
...... benefit:All Slices Content/Rules for all slices
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
....... type 1..1 CodeableConcept Type of benefit
Binding: Insurance plan type (extensible)
...... benefit:drug-plan S 1..* BackboneElement List of benefits
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
....... type 1..1 CodeableConcept Type of benefit
Binding: Insurance plan type (extensible)
Required Pattern: At least the following
........ id 0..1 string Unique id for inter-element referencing
........ extension 0..* Extension Additional content defined by implementations
........ coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
......... id 0..1 string Unique id for inter-element referencing
......... extension 0..* Extension Additional content defined by implementations
......... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type
......... version 0..1 string Version of the system - if relevant
......... code 1..1 code Symbol in syntax defined by the system
Fixed Value: drug
......... display 1..1 string Representation defined by the system
Fixed Value: Drug
......... userSelected 0..1 boolean If this coding was chosen directly by the user
........ text 0..1 string Plain text representation of the concept
... Slices for plan S 1..* BackboneElement Plan details
Slice: Unordered, Open by pattern:type
.... plan:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type 0..1 CodeableConcept Type of plan
Binding: Insurance plan type (extensible)
.... plan:drug-plan S 1..* BackboneElement Drug plan
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... identifier SΣ 0..* Identifier Business Identifier for Product
..... type 1..1 CodeableConcept Type of plan
Binding: Insurance plan type (extensible)
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: drug
....... display 1..1 string Representation defined by the system
Fixed Value: Drug
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... network 0..* Reference(Organization) Pharmacy benefit types that are part of the drug plan
..... specificCost S 1..* BackboneElement Pharmacy benefit type specific cost
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... category S 1..1 CodeableConcept Pharmacy Benefit Type
Binding: Pharmacy benefit types (extensible)
...... benefit S 1..* BackboneElement Drug tier benefit
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
....... type S 1..1 CodeableConcept Type of specific benefit
Binding: Drug tier of medication in health plan (extensible)
....... Slices for cost S 1..* BackboneElement List of the costs
Slice: Unordered, Open by pattern:type
........ cost:All Slices Content/Rules for all slices
......... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
......... type 1..1 CodeableConcept Type of cost
Binding: Benefit type of cost (extensible)
......... qualifiers S 1..1 CodeableConcept Additional information about the cost
......... value S 0..1 Quantity The actual cost value
........ cost:copay S 0..1 BackboneElement Copay costs
......... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
......... type 1..1 CodeableConcept Type of cost
Binding: Benefit type of cost (extensible)
Required Pattern: At least the following
.......... id 0..1 string Unique id for inter-element referencing
.......... extension 0..* Extension Additional content defined by implementations
.......... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
........... id 0..1 string Unique id for inter-element referencing
........... extension 0..* Extension Additional content defined by implementations
........... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE
........... version 0..1 string Version of the system - if relevant
........... code 1..1 code Symbol in syntax defined by the system
Fixed Value: copay
........... display 0..1 string Representation defined by the system
........... userSelected 0..1 boolean If this coding was chosen directly by the user
.......... text 0..1 string Plain text representation of the concept
......... qualifiers S 1..1 CodeableConcept Additional information about the cost
Binding: Qualifier of copay amount (required)
......... value S 1..1 MoneyQuantity The actual cost value
.......... value SΣ 1..1 decimal Numerical value (with implicit precision)
.......... comparator ?!Σ 0..1 code < | <= | >= | > - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.
.......... system ΣC 0..1 uri System that defines coded unit form
Required Pattern: urn:iso:std:iso:4217
.......... code Σ 0..1 code Coded form of the unit
Required Pattern: USD
........ cost:coinsurance S 0..1 BackboneElement Coinsurance costs
......... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
......... type 1..1 CodeableConcept Type of cost
Binding: Benefit type of cost (extensible)
Required Pattern: At least the following
.......... id 0..1 string Unique id for inter-element referencing
.......... extension 0..* Extension Additional content defined by implementations
.......... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
........... id 0..1 string Unique id for inter-element referencing
........... extension 0..* Extension Additional content defined by implementations
........... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE
........... version 0..1 string Version of the system - if relevant
........... code 1..1 code Symbol in syntax defined by the system
Fixed Value: coinsurance
........... display 0..1 string Representation defined by the system
........... userSelected 0..1 boolean If this coding was chosen directly by the user
.......... text 0..1 string Plain text representation of the concept
......... qualifiers S 1..1 CodeableConcept Additional information about the cost
Binding: Qualifier for coinsurance rate (required)
......... value S 1..1 Quantity The actual cost value
.......... value SΣ 1..1 decimal Numerical value (with implicit precision)
.......... comparator ?!Σ 0..1 code < | <= | >= | > - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.
.......... system ΣC 0..1 uri System that defines coded unit form
Required Pattern: http://unitsofmeasure.org
.......... code Σ 0..1 code Coded form of the unit
Required Pattern: %

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
InsurancePlan.status Base required PublicationStatus 📍4.0.1 FHIR Std.
InsurancePlan.type Base extensible Insurance Product Type VS 📦1.2.0 Da Vinci PDex Plan Net v1.2
InsurancePlan.contact.​purpose Base extensible Type of plan contact 📦2.1.0 This IG
InsurancePlan.contact.​name.use Base required NameUse 📍4.0.1 FHIR Std.
InsurancePlan.contact.​telecom.system Base required ContactPointSystem 📍4.0.1 FHIR Std.
InsurancePlan.contact.​telecom.use Base required ContactPointUse 📍4.0.1 FHIR Std.
InsurancePlan.coverage:drug-coverage.​benefit.type Base extensible Insurance plan type 📦1.0.1 THO v7.1
InsurancePlan.coverage:drug-coverage.​benefit:drug-plan.type Base extensible Insurance plan type 📦1.0.1 THO v7.1
InsurancePlan.plan.type Base extensible Insurance plan type 📦1.0.1 THO v7.1
InsurancePlan.plan:drug-plan.​type Base extensible Insurance plan type 📦1.0.1 THO v7.1
InsurancePlan.plan:drug-plan.​specificCost.category Base extensible Pharmacy benefit types 📦2.1.0 This IG
InsurancePlan.plan:drug-plan.​specificCost.benefit.​type Base extensible Drug tier of medication in health plan 📦2.1.0 This IG
InsurancePlan.plan:drug-plan.​specificCost.benefit.​cost.type Base extensible Benefit type of cost 📦2.1.0 This IG
InsurancePlan.plan:drug-plan.​specificCost.benefit.​cost:copay.type Base extensible Benefit type of cost 📦2.1.0 This IG
InsurancePlan.plan:drug-plan.​specificCost.benefit.​cost:copay.qualifiers Base required Qualifier of copay amount 📦2.1.0 This IG
InsurancePlan.plan:drug-plan.​specificCost.benefit.​cost:copay.value.comparator Base required QuantityComparator 📍4.0.1 FHIR Std.
InsurancePlan.plan:drug-plan.​specificCost.benefit.​cost:coinsurance.type Base extensible Benefit type of cost 📦2.1.0 This IG
InsurancePlan.plan:drug-plan.​specificCost.benefit.​cost:coinsurance.qualifiers Base required Qualifier for coinsurance rate 📦2.1.0 This IG
InsurancePlan.plan:drug-plan.​specificCost.benefit.​cost:coinsurance.value.​comparator Base required QuantityComparator 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error InsurancePlan If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error InsurancePlan If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error InsurancePlan If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error InsurancePlan If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice InsurancePlan A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
ipn-1 error InsurancePlan The organization SHALL at least have a name or an idendtifier, and possibly more than one (identifier.count() + name.count()) > 0

Differential View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. InsurancePlan 0..* InsurancePlan Details of a Health Insurance product/plan provided by an organization
... meta
.... lastUpdated S 1..1 instant When the resource version last changed
... identifier S 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 S 1..1 code draft | active | retired | unknown
... name S 0..1 string Official name
... period S 0..1 Period When the product is available
... coverageArea S 0..* Reference(Insurance Plan Location) Where product applies
... contact 0..* BackboneElement Contact information for the Insurance Plan including URLs for brochure and formulary information
.... purpose 0..1 CodeableConcept The type of contact
Binding: Type of plan contact (extensible)
.... name S 0..1 HumanName A name associated with the contact
..... text S 0..1 string Text representation of the full name
.... telecom S 0..* ContactPoint Contact details (telephone, email, etc.) for a contact
..... system S 0..1 code phone | fax | email | pager | url | sms | other
..... value S 0..1 string The actual contact point details
... Slices for coverage S 1..* BackboneElement Coverage details
Slice: Unordered, Open by pattern:type
.... coverage:All Slices Content/Rules for all slices
..... type S 1..1 CodeableConcept Type of coverage
.... coverage:drug-coverage S 1..* BackboneElement Coverage details
..... Slices for extension S 1..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:usdf-FormularyReference-extension S 1..* Reference(Formulary) Formulary Reference
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyReference-extension
..... type 1..1 CodeableConcept Type of coverage
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: DRUGPOL
..... Slices for benefit 1..* BackboneElement List of benefits
Slice: Unordered, Open by pattern:type
...... benefit:All Slices Content/Rules for all slices
....... type 1..1 CodeableConcept Type of benefit
Binding: Insurance plan type (extensible)
...... benefit:drug-plan S 1..* BackboneElement List of benefits
....... type 1..1 CodeableConcept Type of benefit
Required Pattern: At least the following
........ coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
......... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type
......... code 1..1 code Symbol in syntax defined by the system
Fixed Value: drug
......... display 1..1 string Representation defined by the system
Fixed Value: Drug
... Slices for plan S 1..* BackboneElement Plan details
Slice: Unordered, Open by pattern:type
.... plan:All Slices Content/Rules for all slices
..... type 0..1 CodeableConcept Type of plan
Binding: Insurance plan type (extensible)
.... plan:drug-plan S 1..* BackboneElement Drug plan
..... identifier S 0..* Identifier Business Identifier for Product
..... type 1..1 CodeableConcept Type of plan
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: drug
....... display 1..1 string Representation defined by the system
Fixed Value: Drug
..... network 0..* Reference(Organization) Pharmacy benefit types that are part of the drug plan
..... specificCost S 1..* BackboneElement Pharmacy benefit type specific cost
...... category S 1..1 CodeableConcept Pharmacy Benefit Type
Binding: Pharmacy benefit types (extensible)
...... benefit S 1..* BackboneElement Drug tier benefit
....... type S 1..1 CodeableConcept Type of specific benefit
Binding: Drug tier of medication in health plan (extensible)
....... Slices for cost S 1..* BackboneElement List of the costs
Slice: Unordered, Open by pattern:type
........ cost:All Slices Content/Rules for all slices
......... type 1..1 CodeableConcept Type of cost
Binding: Benefit type of cost (extensible)
......... qualifiers S 1..1 CodeableConcept Additional information about the cost
......... value S 0..1 Quantity The actual cost value
........ cost:copay S 0..1 BackboneElement Copay costs
......... type 1..1 CodeableConcept Type of cost
Required Pattern: At least the following
.......... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
........... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE
........... code 1..1 code Symbol in syntax defined by the system
Fixed Value: copay
......... qualifiers 1..1 CodeableConcept Additional information about the cost
Binding: Qualifier of copay amount (required)
......... value 1..1 MoneyQuantity The actual cost value
.......... value S 1..1 decimal Numerical value (with implicit precision)
.......... system 0..1 uri System that defines coded unit form
Required Pattern: urn:iso:std:iso:4217
.......... code 0..1 code Coded form of the unit
Required Pattern: USD
........ cost:coinsurance S 0..1 BackboneElement Coinsurance costs
......... type 1..1 CodeableConcept Type of cost
Required Pattern: At least the following
.......... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
........... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE
........... code 1..1 code Symbol in syntax defined by the system
Fixed Value: coinsurance
......... qualifiers 1..1 CodeableConcept Additional information about the cost
Binding: Qualifier for coinsurance rate (required)
......... value 1..1 Quantity The actual cost value
.......... value S 1..1 decimal Numerical value (with implicit precision)
.......... system 0..1 uri System that defines coded unit form
Required Pattern: http://unitsofmeasure.org
.......... code 0..1 code Coded form of the unit
Required Pattern: %

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
InsurancePlan.type Base extensible Insurance Product Type VS 📦1.2.0 Da Vinci PDex Plan Net v1.2
InsurancePlan.contact.​purpose Base extensible Type of plan contact 📦2.1.0 This IG
InsurancePlan.coverage:drug-coverage.​benefit.type Base extensible Insurance plan type 📦1.0.1 THO v7.1
InsurancePlan.plan.type Base extensible Insurance plan type 📦1.0.1 THO v7.1
InsurancePlan.plan:drug-plan.​specificCost.category Base extensible Pharmacy benefit types 📦2.1.0 This IG
InsurancePlan.plan:drug-plan.​specificCost.benefit.​type Base extensible Drug tier of medication in health plan 📦2.1.0 This IG
InsurancePlan.plan:drug-plan.​specificCost.benefit.​cost.type Base extensible Benefit type of cost 📦2.1.0 This IG
InsurancePlan.plan:drug-plan.​specificCost.benefit.​cost:copay.qualifiers Base required Qualifier of copay amount 📦2.1.0 This IG
InsurancePlan.plan:drug-plan.​specificCost.benefit.​cost:coinsurance.qualifiers Base required Qualifier for coinsurance rate 📦2.1.0 This IG

Snapshot ViewView

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. InsurancePlan C 0..* InsurancePlan Details of a Health Insurance product/plan provided by an organization
Constraints: ipn-1
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... versionId Σ 0..1 id Version specific identifier
.... lastUpdated SΣ 1..1 instant When the resource version last changed
.... source Σ 0..1 uri Identifies where the resource comes from
.... profile Σ 0..* canonical(StructureDefinition) Profiles this resource claims to conform to
.... security Σ 0..* Coding Security Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
.... tag Σ 0..* Coding Tags 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 ?!Σ 0..1 uri A set of rules under which this content was created
... 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
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 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.
... status ?!SΣ 1..1 code draft | active | retired | unknown
Binding: PublicationStatus (required): The lifecycle status of an artifact.
... type SΣ 1..1 CodeableConcept Product type
Binding: Insurance Product Type VS (extensible)
... name SΣC 0..1 string Official name
... alias 0..* string Alternate names
... period S 0..1 Period When the product is available
... ownedBy Σ 0..1 Reference(Organization) Plan issuer
... administeredBy Σ 0..1 Reference(Organization) Product administrator
... coverageArea 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
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... purpose 0..1 CodeableConcept The type of contact
Binding: Type of plan contact (extensible)
.... name S 0..1 HumanName A name associated with the contact
..... id 0..1 string Unique id for inter-element referencing
..... extension 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: NameUse (required): The use of a human name.
..... text SΣ 0..1 string Text representation of the full name
..... family 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
..... prefix 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
..... period Σ 0..1 Period Time period when name was/is in use
.... telecom S 0..* ContactPoint Contact details (telephone, email, etc.) for a contact
..... id 0..1 string Unique id for inter-element referencing
..... extension 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: ContactPointSystem (required): Telecommunications form for contact point.
..... value 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: ContactPointUse (required): Use of contact point.
..... rank 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
.... address 0..1 Address Visiting or postal addresses for the contact
... endpoint 0..* Reference(Endpoint) Technical endpoint
... network 0..* Reference(Organization) What networks are Included
... Slices for coverage S 1..* BackboneElement Coverage details
Slice: Unordered, Open by pattern:type
.... coverage:All Slices Content/Rules for all slices
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type S 1..1 CodeableConcept Type of coverage
..... network 0..* Reference(Organization) What networks provide coverage
..... benefit 1..* BackboneElement List of benefits
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... type 1..1 CodeableConcept Type of benefit
...... requirement 0..1 string Referral requirements
...... limit 0..* BackboneElement Benefit limits
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
....... value 0..1 Quantity Maximum value allowed
....... code 0..1 CodeableConcept Benefit limit details
.... coverage:drug-coverage S 1..* BackboneElement Coverage details
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension S 1..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:usdf-FormularyReference-extension S 1..* Reference(Formulary) Formulary Reference
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyReference-extension
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type S 1..1 CodeableConcept Type of coverage
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: DRUGPOL
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... network 0..* Reference(Organization) What networks provide coverage
..... Slices for benefit 1..* BackboneElement List of benefits
Slice: Unordered, Open by pattern:type
...... benefit:All Slices Content/Rules for all slices
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
....... type 1..1 CodeableConcept Type of benefit
Binding: Insurance plan type (extensible)
....... requirement 0..1 string Referral requirements
....... limit 0..* BackboneElement Benefit limits
........ id 0..1 string Unique id for inter-element referencing
........ extension 0..* Extension Additional content defined by implementations
........ modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
........ value 0..1 Quantity Maximum value allowed
........ code 0..1 CodeableConcept Benefit limit details
...... benefit:drug-plan S 1..* BackboneElement List of benefits
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
....... type 1..1 CodeableConcept Type of benefit
Binding: Insurance plan type (extensible)
Required Pattern: At least the following
........ id 0..1 string Unique id for inter-element referencing
........ extension 0..* Extension Additional content defined by implementations
........ coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
......... id 0..1 string Unique id for inter-element referencing
......... extension 0..* Extension Additional content defined by implementations
......... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type
......... version 0..1 string Version of the system - if relevant
......... code 1..1 code Symbol in syntax defined by the system
Fixed Value: drug
......... display 1..1 string Representation defined by the system
Fixed Value: Drug
......... userSelected 0..1 boolean If this coding was chosen directly by the user
........ text 0..1 string Plain text representation of the concept
....... requirement 0..1 string Referral requirements
....... limit 0..* BackboneElement Benefit limits
........ id 0..1 string Unique id for inter-element referencing
........ extension 0..* Extension Additional content defined by implementations
........ modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
........ value 0..1 Quantity Maximum value allowed
........ code 0..1 CodeableConcept Benefit limit details
... Slices for plan S 1..* BackboneElement Plan details
Slice: Unordered, Open by pattern:type
.... plan:All Slices Content/Rules for all slices
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... identifier Σ 0..* Identifier Business Identifier for Product
..... type 0..1 CodeableConcept Type of plan
Binding: Insurance plan type (extensible)
..... coverageArea Σ 0..* Reference(Location) Where product applies
..... network 0..* Reference(Organization) What networks provide coverage
..... generalCost 0..* BackboneElement Overall costs
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... type 0..1 CodeableConcept Type of cost
...... groupSize 0..1 positiveInt Number of enrollees
...... cost 0..1 Money Cost value
...... comment 0..1 string Additional cost information
..... specificCost 0..* BackboneElement Specific costs
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... category 1..1 CodeableConcept General category of benefit
...... benefit 0..* BackboneElement Benefits list
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
....... type 1..1 CodeableConcept Type of specific benefit
....... cost 0..* BackboneElement List of the costs
........ id 0..1 string Unique id for inter-element referencing
........ extension 0..* Extension Additional content defined by implementations
........ modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
........ type 1..1 CodeableConcept Type of cost
........ applicability 0..1 CodeableConcept in-network | out-of-network | other
Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.
........ qualifiers 0..* CodeableConcept Additional information about the cost
........ value 0..1 Quantity The actual cost value
.... plan:drug-plan S 1..* BackboneElement Drug plan
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... identifier SΣ 0..* Identifier Business Identifier for Product
..... type 1..1 CodeableConcept Type of plan
Binding: Insurance plan type (extensible)
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: drug
....... display 1..1 string Representation defined by the system
Fixed Value: Drug
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... coverageArea Σ 0..* Reference(Location) Where product applies
..... network 0..* Reference(Organization) Pharmacy benefit types that are part of the drug plan
..... generalCost 0..* BackboneElement Overall costs
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... type 0..1 CodeableConcept Type of cost
...... groupSize 0..1 positiveInt Number of enrollees
...... cost 0..1 Money Cost value
...... comment 0..1 string Additional cost information
..... specificCost S 1..* BackboneElement Pharmacy benefit type specific cost
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... category S 1..1 CodeableConcept Pharmacy Benefit Type
Binding: Pharmacy benefit types (extensible)
...... benefit S 1..* BackboneElement Drug tier benefit
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
....... type S 1..1 CodeableConcept Type of specific benefit
Binding: Drug tier of medication in health plan (extensible)
....... Slices for cost S 1..* BackboneElement List of the costs
Slice: Unordered, Open by pattern:type
........ cost:All Slices Content/Rules for all slices
......... id 0..1 string Unique id for inter-element referencing
......... extension 0..* Extension Additional content defined by implementations
......... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
......... type 1..1 CodeableConcept Type of cost
Binding: Benefit type of cost (extensible)
......... applicability 0..1 CodeableConcept in-network | out-of-network | other
Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.
......... qualifiers S 1..1 CodeableConcept Additional information about the cost
......... value S 0..1 Quantity The actual cost value
........ cost:copay S 0..1 BackboneElement Copay costs
......... id 0..1 string Unique id for inter-element referencing
......... extension 0..* Extension Additional content defined by implementations
......... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
......... type 1..1 CodeableConcept Type of cost
Binding: Benefit type of cost (extensible)
Required Pattern: At least the following
.......... id 0..1 string Unique id for inter-element referencing
.......... extension 0..* Extension Additional content defined by implementations
.......... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
........... id 0..1 string Unique id for inter-element referencing
........... extension 0..* Extension Additional content defined by implementations
........... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE
........... version 0..1 string Version of the system - if relevant
........... code 1..1 code Symbol in syntax defined by the system
Fixed Value: copay
........... display 0..1 string Representation defined by the system
........... userSelected 0..1 boolean If this coding was chosen directly by the user
.......... text 0..1 string Plain text representation of the concept
......... applicability 0..1 CodeableConcept in-network | out-of-network | other
Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.
......... qualifiers S 1..1 CodeableConcept Additional information about the cost
Binding: Qualifier of copay amount (required)
......... value S 1..1 MoneyQuantity The actual cost value
.......... id 0..1 string Unique id for inter-element referencing
.......... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.......... value SΣ 1..1 decimal Numerical value (with implicit precision)
.......... comparator ?!Σ 0..1 code < | <= | >= | > - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.
.......... unit Σ 0..1 string Unit representation
.......... system ΣC 0..1 uri System that defines coded unit form
Required Pattern: urn:iso:std:iso:4217
.......... code Σ 0..1 code Coded form of the unit
Required Pattern: USD
........ cost:coinsurance S 0..1 BackboneElement Coinsurance costs
......... id 0..1 string Unique id for inter-element referencing
......... extension 0..* Extension Additional content defined by implementations
......... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
......... type 1..1 CodeableConcept Type of cost
Binding: Benefit type of cost (extensible)
Required Pattern: At least the following
.......... id 0..1 string Unique id for inter-element referencing
.......... extension 0..* Extension Additional content defined by implementations
.......... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
........... id 0..1 string Unique id for inter-element referencing
........... extension 0..* Extension Additional content defined by implementations
........... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE
........... version 0..1 string Version of the system - if relevant
........... code 1..1 code Symbol in syntax defined by the system
Fixed Value: coinsurance
........... display 0..1 string Representation defined by the system
........... userSelected 0..1 boolean If this coding was chosen directly by the user
.......... text 0..1 string Plain text representation of the concept
......... applicability 0..1 CodeableConcept in-network | out-of-network | other
Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.
......... qualifiers S 1..1 CodeableConcept Additional information about the cost
Binding: Qualifier for coinsurance rate (required)
......... value S 1..1 Quantity The actual cost value
.......... id 0..1 string Unique id for inter-element referencing
.......... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.......... value SΣ 1..1 decimal Numerical value (with implicit precision)
.......... comparator ?!Σ 0..1 code < | <= | >= | > - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.
.......... unit Σ 0..1 string Unit representation
.......... system ΣC 0..1 uri System that defines coded unit form
Required Pattern: http://unitsofmeasure.org
.......... code Σ 0..1 code Coded form of the unit
Required Pattern: %

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
InsurancePlan.meta.security Base extensible SecurityLabels 📍4.0.1 FHIR Std.
InsurancePlan.meta.tag Base example Common Tags 📍4.0.1 FHIR Std.
InsurancePlan.language Base preferred Common Languages 📍4.0.1 FHIR Std.
InsurancePlan.status Base required PublicationStatus 📍4.0.1 FHIR Std.
InsurancePlan.type Base extensible Insurance Product Type VS 📦1.2.0 Da Vinci PDex Plan Net v1.2
InsurancePlan.contact.​purpose Base extensible Type of plan contact 📦2.1.0 This IG
InsurancePlan.contact.​name.use Base required NameUse 📍4.0.1 FHIR Std.
InsurancePlan.contact.​telecom.system Base required ContactPointSystem 📍4.0.1 FHIR Std.
InsurancePlan.contact.​telecom.use Base required ContactPointUse 📍4.0.1 FHIR Std.
InsurancePlan.coverage:drug-coverage.​benefit.type Base extensible Insurance plan type 📦1.0.1 THO v7.1
InsurancePlan.coverage:drug-coverage.​benefit:drug-plan.type Base extensible Insurance plan type 📦1.0.1 THO v7.1
InsurancePlan.plan.type Base extensible Insurance plan type 📦1.0.1 THO v7.1
InsurancePlan.plan.specificCost.​benefit.cost.applicability Base required Benefit cost applicability 📍4.0.1 FHIR Std.
InsurancePlan.plan:drug-plan.​type Base extensible Insurance plan type 📦1.0.1 THO v7.1
InsurancePlan.plan:drug-plan.​specificCost.category Base extensible Pharmacy benefit types 📦2.1.0 This IG
InsurancePlan.plan:drug-plan.​specificCost.benefit.​type Base extensible Drug tier of medication in health plan 📦2.1.0 This IG
InsurancePlan.plan:drug-plan.​specificCost.benefit.​cost.type Base extensible Benefit type of cost 📦2.1.0 This IG
InsurancePlan.plan:drug-plan.​specificCost.benefit.​cost.applicability Base required Benefit cost applicability 📍4.0.1 FHIR Std.
InsurancePlan.plan:drug-plan.​specificCost.benefit.​cost:copay.type Base extensible Benefit type of cost 📦2.1.0 This IG
InsurancePlan.plan:drug-plan.​specificCost.benefit.​cost:copay.applicability Base required Benefit cost applicability 📍4.0.1 FHIR Std.
InsurancePlan.plan:drug-plan.​specificCost.benefit.​cost:copay.qualifiers Base required Qualifier of copay amount 📦2.1.0 This IG
InsurancePlan.plan:drug-plan.​specificCost.benefit.​cost:copay.value.comparator Base required QuantityComparator 📍4.0.1 FHIR Std.
InsurancePlan.plan:drug-plan.​specificCost.benefit.​cost:coinsurance.type Base extensible Benefit type of cost 📦2.1.0 This IG
InsurancePlan.plan:drug-plan.​specificCost.benefit.​cost:coinsurance.applicability Base required Benefit cost applicability 📍4.0.1 FHIR Std.
InsurancePlan.plan:drug-plan.​specificCost.benefit.​cost:coinsurance.qualifiers Base required Qualifier for coinsurance rate 📦2.1.0 This IG
InsurancePlan.plan:drug-plan.​specificCost.benefit.​cost:coinsurance.value.​comparator Base required QuantityComparator 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error InsurancePlan If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error InsurancePlan If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error InsurancePlan If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error InsurancePlan If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice InsurancePlan A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
ipn-1 error InsurancePlan The organization SHALL at least have a name or an idendtifier, and possibly more than one (identifier.count() + name.count()) > 0

Summary

Mandatory: 15 elements(5 nested mandatory elements)
Must-Support: 32 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 1 is sliced based on the value of InsurancePlan.coverage
  • The element 1 is sliced based on the value of InsurancePlan.coverage.benefit
  • The element 1 is sliced based on the value of InsurancePlan.plan
  • The element 1 is sliced based on the value of InsurancePlan.plan.specificCost.benefit.cost

 

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