DaVinci PDEX Plan Net
1.0.0 - STU1

DaVinci PDEX Plan Net, published by HL7 Financial Management Working Group. This is not an authorized publication; it is the continuous build for version 1.0.0). This version is based on the current content of https://github.com/HL7/davinci-pdex-plan-net/ and changes regularly. See the Directory of published versions

Resource Profile: Plan-Net InsurancePlan

Defining URL:http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/plannet-InsurancePlan
Version:1.0.0
Name:PlannetInsurancePlan
Title:Plan-Net InsurancePlan
Status:Active as of 2020-12-20T02:56:54+00:00
Definition:

An InsurancePlan is a discrete package of health insurance coverage benefits that are offered under a particular network type. A given payer’s products typically differ by network type and/or covered benefits. A plan pairs a product’s covered benefits with the particular cost sharing structure offered to a consumer. A given product may comprise multiple plans (i.e. each plan offers different cost sharing requirements for the same set of covered benefits).

InsurancePlan describes a health insurance offering comprised of a list of covered benefits (i.e. the product), costs associated with those benefits (i.e. the plan), and additional information about the offering, such as who it is owned and administered by, a coverage area, contact information, etc.

Publisher:HL7 Financial Management Working Group
Source Resource:XML / JSON / Turtle

The official URL for this profile is:

http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/plannet-InsurancePlan

Implementation Guidance

  • Note that the relationship between InsurancePlans and Networks is many-to-many. A plan may be associated with multiple networks, and a network may be associated with many plans. In this IG, this is modeled by having InsurancePlans reference networks (directionality of relationship supports this).
  • Networks referenced with InsurancePlan.network apply to all InsurancePlan.plan cost sharing plans. If InsurancePlan.network is not provided, each cost sharing plan must provide at least one network in InsurancePlan.plan.network.
  • To use the coverageArea the preferred form of reference is to create a Location instance with the State or region specified, and possibly provide a GeoJSON.

Formal Views of Profile Content

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

This structure is derived from InsurancePlan

NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan I0..*InsurancePlanDetails of a Health Insurance product/plan provided by an organization
ipn-1: The organization SHALL at least have a name or an idendtifier, and possibly more than one
network-or-plan-Network: If an insuranceplan does not define a network, than each plan must define one
plan-type-is-distinct: Each InsurancePlan.plan should have a distinct plan.type.
... meta
.... lastUpdated 1..1instantWhen the resource version last changed
... identifier
.... type S0..1CodeableConceptDescription of identifier
.... value S0..1stringThe value that is unique
.... assigner S0..1Reference(Organization)Organization that issued id (may be just text)
... status S1..1codedraft | active | retired | unknown
Fixed Value: active
... name S0..1stringOfficial name
... alias S0..*stringAlternate names
... ownedBy S1..1Reference(Plan-Net Organization)Plan issuer
... administeredBy S1..1Reference(Plan-Net Organization)Product administrator
... coverageArea S0..*Reference(Plan-Net Location)Where product applies
... contact S0..*BackboneElementContact for the product
.... name S0..1HumanNameA name associated with the contact
..... text S0..1stringText representation of the full name
.... telecom S0..*ContactPointContact details (telephone, email, etc.) for a contact
..... system S0..1codephone | fax | email | pager | url | sms | other
..... value S0..1stringThe actual contact point details
... endpoint S0..*Reference(Plan-Net Endpoint)Technical endpoint
... network S0..*Reference(Plan-Net Network)What networks are Included
... plan 0..*BackboneElementCost sharing details for the plan
.... type S0..1CodeableConceptCategorization of the cost sharing for the plan
Binding: Insurance Plan Type (extensible)
.... coverageArea S0..*Reference(Plan-Net Location)Where product applies
.... network 0..*Reference(Plan-Net Network)What networks provide coverage

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan I0..*InsurancePlanDetails of a Health Insurance product/plan provided by an organization
network-or-plan-Network: If an insuranceplan does not define a network, than each plan must define one
plan-type-is-distinct: Each InsurancePlan.plan should have a distinct plan.type.
... id Σ0..1stringLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... versionId Σ0..1idVersion specific identifier
.... lastUpdated Σ1..1instantWhen the resource version last changed
.... source Σ0..1uriIdentifies where the resource comes from
.... profile Σ0..*canonical(StructureDefinition)Profiles this resource claims to conform to
.... security Σ0..*CodingSecurity Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.


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


... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier ΣI0..*IdentifierBusiness Identifier for Product
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

.... type SΣ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

.... system Σ0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value SΣ0..1stringThe value that is unique
Example General: 123456
.... period Σ0..1PeriodTime period when id is/was valid for use
.... assigner SΣ0..1Reference(Organization)Organization that issued id (may be just text)
... status ?!SΣ1..1codedraft | active | retired | unknown
Binding: PublicationStatus (required): The lifecycle status of an artifact.


Fixed Value: active
... type SΣ1..1CodeableConceptProduct Type
Binding: Insurance Product Type (extensible)
... name SΣI0..1stringOfficial name
... alias S0..*stringAlternate names
... period 0..1PeriodWhen the product is available
... ownedBy SΣ1..1Reference(Plan-Net Organization)Plan issuer
... administeredBy SΣ1..1Reference(Plan-Net Organization)Product administrator
... coverageArea SΣ0..*Reference(Plan-Net Location)Where product applies
... contact S0..*BackboneElementContact for the product
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... purpose 0..1CodeableConceptThe type of contact
Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party.

.... name S0..1HumanNameA name associated with the contact
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ0..1codeusual | official | temp | nickname | anonymous | old | maiden
Binding: NameUse (required): The use of a human name.

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

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

..... rank Σ0..1positiveIntSpecify preferred order of use (1 = highest)
..... period Σ0..1PeriodTime period when the contact point was/is in use
.... address 0..1AddressVisiting or postal addresses for the contact
... endpoint S0..*Reference(Plan-Net Endpoint)Technical endpoint
... network S0..*Reference(Plan-Net Network)What networks are Included
... coverage 0..*BackboneElementCoverage details
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type 1..1CodeableConceptType of coverage
.... network 0..*Reference(Organization)What networks provide coverage
.... benefit 1..*BackboneElementList of benefits
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type 1..1CodeableConceptType of benefit
..... requirement 0..1stringReferral requirements
..... limit 0..*BackboneElementBenefit limits
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... value 0..1QuantityMaximum value allowed
...... code 0..1CodeableConceptBenefit limit details
... plan 0..*BackboneElementCost sharing details for the plan
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... identifier Σ0..*IdentifierBusiness Identifier for Product
.... type S0..1CodeableConceptCategorization of the cost sharing for the plan
Binding: Insurance Plan Type (extensible)
.... coverageArea SΣ0..*Reference(Plan-Net Location)Where product applies
.... network 0..*Reference(Plan-Net Network)What networks provide coverage
.... generalCost 0..*BackboneElementOverall costs
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type 0..1CodeableConceptType of cost
..... groupSize 0..1positiveIntNumber of enrollees
..... cost 0..1MoneyCost value
..... comment 0..1stringAdditional cost information
.... specificCost 0..*BackboneElementSpecific costs
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... category 1..1CodeableConceptGeneral category of benefit
..... benefit 0..*BackboneElementBenefits list
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... type 1..1CodeableConceptType of specific benefit
...... cost 0..*BackboneElementList of the costs
....... id 0..1stringUnique id for inter-element referencing
....... extension 0..*ExtensionAdditional content defined by implementations
....... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
....... type 1..1CodeableConceptType of cost
....... applicability 0..1CodeableConceptin-network | out-of-network | other
Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.

....... qualifiers 0..*CodeableConceptAdditional information about the cost
....... value 0..1QuantityThe actual cost value

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan I0..*InsurancePlanDetails of a Health Insurance product/plan provided by an organization
network-or-plan-Network: If an insuranceplan does not define a network, than each plan must define one
plan-type-is-distinct: Each InsurancePlan.plan should have a distinct plan.type.
... identifier ΣI0..*IdentifierBusiness Identifier for Product
.... type Σ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

.... value Σ0..1stringThe value that is unique
.... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
... status ?!Σ1..1codedraft | active | retired | unknown
Binding: PublicationStatus (required): The lifecycle status of an artifact.


Fixed Value: active
... type Σ1..1CodeableConceptProduct Type
Binding: Insurance Product Type (extensible)
... alias 0..*stringAlternate names
... ownedBy Σ1..1Reference(Plan-Net Organization)Plan issuer
... administeredBy Σ1..1Reference(Plan-Net Organization)Product administrator
... coverageArea Σ0..*Reference(Plan-Net Location)Where product applies
... contact 0..*BackboneElementContact for the product
.... name 0..1HumanNameA name associated with the contact
..... text Σ0..1stringText representation of the full name
.... telecom 0..*ContactPointContact details (telephone, email, etc.) for a contact
..... system ΣI0..1codephone | fax | email | pager | url | sms | other
Binding: ContactPointSystem (required): Telecommunications form for contact point.

..... value Σ0..1stringThe actual contact point details
... endpoint 0..*Reference(Plan-Net Endpoint)Technical endpoint
... network 0..*Reference(Plan-Net Network)What networks are Included
... plan 0..*BackboneElementCost sharing details for the plan
.... type 0..1CodeableConceptCategorization of the cost sharing for the plan
Binding: Insurance Plan Type (extensible)
.... coverageArea Σ0..*Reference(Plan-Net Location)Where product applies

doco Documentation for this format

Differential View

This structure is derived from InsurancePlan

NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan I0..*InsurancePlanDetails of a Health Insurance product/plan provided by an organization
ipn-1: The organization SHALL at least have a name or an idendtifier, and possibly more than one
network-or-plan-Network: If an insuranceplan does not define a network, than each plan must define one
plan-type-is-distinct: Each InsurancePlan.plan should have a distinct plan.type.
... meta
.... lastUpdated 1..1instantWhen the resource version last changed
... identifier
.... type S0..1CodeableConceptDescription of identifier
.... value S0..1stringThe value that is unique
.... assigner S0..1Reference(Organization)Organization that issued id (may be just text)
... status S1..1codedraft | active | retired | unknown
Fixed Value: active
... name S0..1stringOfficial name
... alias S0..*stringAlternate names
... ownedBy S1..1Reference(Plan-Net Organization)Plan issuer
... administeredBy S1..1Reference(Plan-Net Organization)Product administrator
... coverageArea S0..*Reference(Plan-Net Location)Where product applies
... contact S0..*BackboneElementContact for the product
.... name S0..1HumanNameA name associated with the contact
..... text S0..1stringText representation of the full name
.... telecom S0..*ContactPointContact details (telephone, email, etc.) for a contact
..... system S0..1codephone | fax | email | pager | url | sms | other
..... value S0..1stringThe actual contact point details
... endpoint S0..*Reference(Plan-Net Endpoint)Technical endpoint
... network S0..*Reference(Plan-Net Network)What networks are Included
... plan 0..*BackboneElementCost sharing details for the plan
.... type S0..1CodeableConceptCategorization of the cost sharing for the plan
Binding: Insurance Plan Type (extensible)
.... coverageArea S0..*Reference(Plan-Net Location)Where product applies
.... network 0..*Reference(Plan-Net Network)What networks provide coverage

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan I0..*InsurancePlanDetails of a Health Insurance product/plan provided by an organization
network-or-plan-Network: If an insuranceplan does not define a network, than each plan must define one
plan-type-is-distinct: Each InsurancePlan.plan should have a distinct plan.type.
... id Σ0..1stringLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... versionId Σ0..1idVersion specific identifier
.... lastUpdated Σ1..1instantWhen the resource version last changed
.... source Σ0..1uriIdentifies where the resource comes from
.... profile Σ0..*canonical(StructureDefinition)Profiles this resource claims to conform to
.... security Σ0..*CodingSecurity Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.


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


... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier ΣI0..*IdentifierBusiness Identifier for Product
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

.... type SΣ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

.... system Σ0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value SΣ0..1stringThe value that is unique
Example General: 123456
.... period Σ0..1PeriodTime period when id is/was valid for use
.... assigner SΣ0..1Reference(Organization)Organization that issued id (may be just text)
... status ?!SΣ1..1codedraft | active | retired | unknown
Binding: PublicationStatus (required): The lifecycle status of an artifact.


Fixed Value: active
... type SΣ1..1CodeableConceptProduct Type
Binding: Insurance Product Type (extensible)
... name SΣI0..1stringOfficial name
... alias S0..*stringAlternate names
... period 0..1PeriodWhen the product is available
... ownedBy SΣ1..1Reference(Plan-Net Organization)Plan issuer
... administeredBy SΣ1..1Reference(Plan-Net Organization)Product administrator
... coverageArea SΣ0..*Reference(Plan-Net Location)Where product applies
... contact S0..*BackboneElementContact for the product
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... purpose 0..1CodeableConceptThe type of contact
Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party.

.... name S0..1HumanNameA name associated with the contact
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ0..1codeusual | official | temp | nickname | anonymous | old | maiden
Binding: NameUse (required): The use of a human name.

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

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

..... rank Σ0..1positiveIntSpecify preferred order of use (1 = highest)
..... period Σ0..1PeriodTime period when the contact point was/is in use
.... address 0..1AddressVisiting or postal addresses for the contact
... endpoint S0..*Reference(Plan-Net Endpoint)Technical endpoint
... network S0..*Reference(Plan-Net Network)What networks are Included
... coverage 0..*BackboneElementCoverage details
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type 1..1CodeableConceptType of coverage
.... network 0..*Reference(Organization)What networks provide coverage
.... benefit 1..*BackboneElementList of benefits
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type 1..1CodeableConceptType of benefit
..... requirement 0..1stringReferral requirements
..... limit 0..*BackboneElementBenefit limits
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... value 0..1QuantityMaximum value allowed
...... code 0..1CodeableConceptBenefit limit details
... plan 0..*BackboneElementCost sharing details for the plan
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... identifier Σ0..*IdentifierBusiness Identifier for Product
.... type S0..1CodeableConceptCategorization of the cost sharing for the plan
Binding: Insurance Plan Type (extensible)
.... coverageArea SΣ0..*Reference(Plan-Net Location)Where product applies
.... network 0..*Reference(Plan-Net Network)What networks provide coverage
.... generalCost 0..*BackboneElementOverall costs
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type 0..1CodeableConceptType of cost
..... groupSize 0..1positiveIntNumber of enrollees
..... cost 0..1MoneyCost value
..... comment 0..1stringAdditional cost information
.... specificCost 0..*BackboneElementSpecific costs
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... category 1..1CodeableConceptGeneral category of benefit
..... benefit 0..*BackboneElementBenefits list
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... type 1..1CodeableConceptType of specific benefit
...... cost 0..*BackboneElementList of the costs
....... id 0..1stringUnique id for inter-element referencing
....... extension 0..*ExtensionAdditional content defined by implementations
....... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
....... type 1..1CodeableConceptType of cost
....... applicability 0..1CodeableConceptin-network | out-of-network | other
Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.

....... qualifiers 0..*CodeableConceptAdditional information about the cost
....... value 0..1QuantityThe actual cost value

doco Documentation for this format

 

Other representations of profile: Schematron

Terminology Bindings

PathConformanceValueSet / Code
InsurancePlan.meta.securityextensibleAll Security Labels
InsurancePlan.meta.tagexampleCommonTags
InsurancePlan.languagepreferredCommonLanguages
Max Binding: AllLanguages
InsurancePlan.identifier.userequiredIdentifierUse
InsurancePlan.identifier.typeextensibleIdentifier Type Codes
InsurancePlan.statusrequiredFixed Value: active
InsurancePlan.typeextensibleInsuranceProductTypeVS
InsurancePlan.contact.purposeextensibleContactEntityType
InsurancePlan.contact.name.userequiredNameUse
InsurancePlan.contact.telecom.systemrequiredContactPointSystem
InsurancePlan.contact.telecom.userequiredContactPointUse
InsurancePlan.plan.typeextensibleInsurancePlanTypeVS
InsurancePlan.plan.specificCost.benefit.cost.applicabilityrequiredBenefitCostApplicability

Constraints

IdPathDetailsRequirements
network-or-plan-NetworkInsurancePlanIf an insuranceplan does not define a network, than each plan must define one
: network.exists() or plan.network.exists.allTrue()
plan-type-is-distinctInsurancePlanEach InsurancePlan.plan should have a distinct plan.type.
: plan.type.coding.code.isDistinct()