abstractbaseDefinitioncopyrightdate- Values Differ
descriptionexperimentalfhirVersionjurisdiction
jurisdiction[0]kindnamepublisher- Values Differ
purposestatustitletypeurlversion- Values Differ
| Left: | Plan-Net InsurancePlan (http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/plannet-InsurancePlan) |
| Right: | Plan-Net InsurancePlan (http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/plannet-InsurancePlan) |
| Error | StructureDefinition.version | Values for version differ: '1.1.0' vs '1.2.0' |
| Information | StructureDefinition.date | Values for date differ: '2022-04-04T14:02:01+00:00' vs '2024-12-17T17:18:47+00:00' |
| Information | StructureDefinition.publisher | Values for publisher differ: 'HL7 Financial Management Working Group' vs 'HL7 International / Financial Management' |
| Name | Value | Comments | |
|---|---|---|---|
| abstract | false | ||
| baseDefinition | http://hl7.org/fhir/StructureDefinition/InsurancePlan | ||
| copyright | |||
| date | 2022-04-04T14:02:01+00:00 | 2024-12-17T17:18:47+00:00 |
|
| description | 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. | ||
| experimental | |||
| fhirVersion | 4.0.1 | ||
| jurisdiction | |||
| jurisdiction[0] | urn:iso:std:iso:3166#US | ||
| kind | resource | ||
| name | PlannetInsurancePlan | ||
| publisher | HL7 Financial Management Working Group | HL7 International / Financial Management |
|
| purpose | |||
| status | active | ||
| title | Plan-Net InsurancePlan | ||
| type | InsurancePlan | ||
| url | http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/plannet-InsurancePlan | ||
| version | 1.1.0 | 1.2.0 |
|
| Name | L Flags | L Card. | L Type | L Description & Constraints | R Flags | R Card. | R Type | R Description & Constraints | Comments | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
 InsurancePlan | C | 0..* | InsurancePlan | Details of a Health Insurance product/plan provided by an organization 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, then each plan must define one plan-type-is-distinct: Each InsurancePlan.plan should have a distinct plan.type. | C | 0..* | InsurancePlan | Details 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, then each plan must define one plan-type-is-distinct: Each InsurancePlan.plan should have a distinct plan.type. | |||||||||
 id | Σ | 0..1 | string | Logical id of this artifact | Σ | 0..1 | id | Logical id of this artifact | |||||||||
 meta | Σ | 0..1 | Meta | Metadata about the resource | Σ | 0..1 | Meta | Metadata about the resource | |||||||||
 id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
 Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||||||
| versionId | Σ | 0..1 | id | Version specific identifier | Σ | 0..1 | id | Version specific identifier | |||||||||
| lastUpdated | Σ | 1..1 | instant | When the resource version last changed | Σ | 1..1 | instant | When the resource version last changed | |||||||||
| source | Σ | 0..1 | uri | Identifies where the resource comes from | Σ | 0..1 | uri | Identifies where the resource comes from | |||||||||
| profile | Σ | 0..* | canonical(StructureDefinition) | Profiles this resource claims to conform to | Σ | 0..* | canonical(StructureDefinition) | Profiles this resource claims to conform to | |||||||||
| security | Σ | 0..* | Coding | Security Labels applied to this resource Binding: ?? (extensible): Security Labels from the Healthcare Privacy and Security Classification System. | Σ | 0..* | Coding | Security Labels applied to this resource Binding: ?? (extensible): Security Labels from the Healthcare Privacy and Security Classification System. | |||||||||
| tag | Σ | 0..* | Coding | Tags applied to this resource Binding: ?? (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". | Σ | 0..* | Coding | Tags applied to this resource Binding: ?? (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". | |||||||||
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ?!Σ | 0..1 | uri | A set of rules under which this content was created | |||||||||
| language | 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language.
| 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language.
| |||||||||||
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||||||||
| contained | 0..* | Resource | Contained, inline Resources | 0..* | Resource | Contained, inline Resources | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
 modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ?! | 0..* | Extension | Extensions that cannot be ignored | |||||||||
| identifier | ΣC | 0..* | Identifier | Business Identifier for Product | ΣC | 0..* | Identifier | Business Identifier for Product | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||||||
| use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: ?? (required): Identifies the purpose for this identifier, if known . | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: ?? (required): Identifies the purpose for this identifier, if known . | |||||||||
| type | SΣ | 0..1 | CodeableConcept | Description of identifier Binding: ?? (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. | SΣ | 0..1 | CodeableConcept | Description of identifier Binding: ?? (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. | |||||||||
| system | Σ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | Σ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | |||||||||
| value | SΣ | 0..1 | string | The value that is unique Example General: 123456 | SΣ | 0..1 | string | The value that is unique Example General: 123456 | |||||||||
| period | Σ | 0..1 | Period | Time period when id is/was valid for use | Σ | 0..1 | Period | Time period when id is/was valid for use | |||||||||
| assigner | SΣ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | SΣ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | |||||||||
| status | ?!SΣ | 1..1 | code | draft | active | retired | unknown Binding: ?? (required): The lifecycle status of an artifact. Fixed Value: active | ?!SΣ | 1..1 | code | draft | active | retired | unknown Binding: ?? (required): The lifecycle status of an artifact. Fixed Value: active | |||||||||
| type | SΣ | 1..1 | CodeableConcept | Product Type Binding: ?? (extensible) | SΣ | 1..1 | CodeableConcept | Product Type Binding: ?? (extensible) | |||||||||
| name | SΣC | 0..1 | string | Official name | SΣC | 0..1 | string | Official name | |||||||||
| alias | S | 0..* | string | Alternate names | S | 0..* | string | Alternate names | |||||||||
| period | S | 0..1 | Period | When the product is available | S | 0..1 | Period | When the product is available | |||||||||
| ownedBy | SΣ | 1..1 | Reference(Plan-Net Organization) | Plan issuer | SΣ | 1..1 | Reference(Plan-Net Organization) | Plan issuer | |||||||||
| administeredBy | SΣ | 1..1 | Reference(Plan-Net Organization) | Product administrator | SΣ | 1..1 | Reference(Plan-Net Organization) | Product administrator | |||||||||
| coverageArea | SΣ | 0..* | Reference(Plan-Net Location) | Where product applies | SΣ | 0..* | Reference(Plan-Net Location) | Where product applies | |||||||||
| contact | S | 0..* | BackboneElement | Contact for the product | S | 0..* | BackboneElement | Contact for the product | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| purpose | 0..1 | CodeableConcept | The type of contact Binding: ?? (extensible): The purpose for which you would contact a contact party. | 0..1 | CodeableConcept | The type of contact Binding: ?? (extensible): The purpose for which you would contact a contact party. | |||||||||||
| name | S | 0..1 | HumanName | A name associated with the contact | S | 0..1 | HumanName | A name associated with the contact | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||||||
| use | ?!Σ | 0..1 | code | usual | official | temp | nickname | anonymous | old | maiden Binding: ?? (required): The use of a human name. | ?!Σ | 0..1 | code | usual | official | temp | nickname | anonymous | old | maiden Binding: ?? (required): The use of a human name. | |||||||||
| text | SΣ | 0..1 | string | Text representation of the full name | SΣ | 0..1 | string | Text representation of the full name | |||||||||
| family | Σ | 0..1 | string | Family name (often called 'Surname') | Σ | 0..1 | string | Family name (often called 'Surname') | |||||||||
| given | Σ | 0..* | string | Given names (not always 'first'). Includes middle names This repeating element order: Given Names appear in the correct order for presenting the name | Σ | 0..* | string | Given names (not always 'first'). Includes middle names This repeating element order: Given Names appear in the correct order for presenting the name | |||||||||
| prefix | Σ | 0..* | string | Parts that come before the name This repeating element order: Prefixes appear in the correct order for presenting the name | Σ | 0..* | string | Parts that come before the name This repeating element order: Prefixes appear in the correct order for presenting the name | |||||||||
| suffix | Σ | 0..* | string | Parts that come after the name This repeating element order: Suffixes appear in the correct order for presenting the name | Σ | 0..* | string | Parts that come after the name This repeating element order: Suffixes appear in the correct order for presenting the name | |||||||||
| period | Σ | 0..1 | Period | Time period when name was/is in use | Σ | 0..1 | Period | Time period when name was/is in use | |||||||||
| telecom | S | 0..* | ContactPoint | Contact details (telephone, email, etc.) for a contact | S | 0..* | ContactPoint | Contact details (telephone, email, etc.) for a contact | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||||||
| system | SΣC | 0..1 | code | phone | fax | email | pager | url | sms | other Binding: ?? (required): Telecommunications form for contact point. | SΣC | 0..1 | code | phone | fax | email | pager | url | sms | other Binding: ?? (required): Telecommunications form for contact point. | |||||||||
| value | SΣ | 0..1 | string | The actual contact point details | SΣ | 0..1 | string | The actual contact point details | |||||||||
| use | ?!Σ | 0..1 | code | home | work | temp | old | mobile - purpose of this contact point Binding: ?? (required): Use of contact point. | ?!Σ | 0..1 | code | home | work | temp | old | mobile - purpose of this contact point Binding: ?? (required): Use of contact point. | |||||||||
| rank | Σ | 0..1 | positiveInt | Specify preferred order of use (1 = highest) | Σ | 0..1 | positiveInt | Specify preferred order of use (1 = highest) | |||||||||
| period | Σ | 0..1 | Period | Time period when the contact point was/is in use | Σ | 0..1 | Period | Time period when the contact point was/is in use | |||||||||
| address | 0..1 | Address | Visiting or postal addresses for the contact | 0..1 | Address | Visiting or postal addresses for the contact | |||||||||||
| endpoint | S | 0..* | Reference(Plan-Net Endpoint) | Technical endpoint | S | 0..* | Reference(Plan-Net Endpoint) | Technical endpoint | |||||||||
| network | S | 0..* | Reference(Plan-Net Network) | What networks are Included | S | 0..* | Reference(Plan-Net Network) | What networks are Included | |||||||||
| coverage | 0..* | BackboneElement | Coverage details | 0..* | BackboneElement | Coverage details | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| type | 1..1 | CodeableConcept | Type of coverage | 1..1 | CodeableConcept | Type of coverage | |||||||||||
| network | 0..* | Reference(Organization) | What networks provide coverage | 0..* | Reference(Organization) | What networks provide coverage | |||||||||||
 benefit | 1..* | BackboneElement | List of benefits | 1..* | BackboneElement | List of benefits | |||||||||||
 id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| type | 1..1 | CodeableConcept | Type of benefit | 1..1 | CodeableConcept | Type of benefit | |||||||||||
| requirement | 0..1 | string | Referral requirements | 0..1 | string | Referral requirements | |||||||||||
| limit | 0..* | BackboneElement | Benefit limits | 0..* | BackboneElement | Benefit limits | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| value | 0..1 | Quantity | Maximum value allowed | 0..1 | Quantity | Maximum value allowed | |||||||||||
| code | 0..1 | CodeableConcept | Benefit limit details | 0..1 | CodeableConcept | Benefit limit details | |||||||||||
| plan | 0..* | BackboneElement | Cost sharing details for the plan | 0..* | BackboneElement | Cost sharing details for the plan | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| identifier | Σ | 0..* | Identifier | Business Identifier for Product | Σ | 0..* | Identifier | Business Identifier for Product | |||||||||
| type | S | 0..1 | CodeableConcept | Categorization of the cost sharing for the plan Binding: ?? (extensible) | S | 0..1 | CodeableConcept | Categorization of the cost sharing for the plan Binding: ?? (extensible) | |||||||||
| coverageArea | SΣ | 0..* | Reference(Plan-Net Location) | Where product applies | SΣ | 0..* | Reference(Plan-Net Location) | Where product applies | |||||||||
| network | 0..* | Reference(Plan-Net Network) | What networks provide coverage | 0..* | Reference(Plan-Net Network) | What networks provide coverage | |||||||||||
| generalCost | 0..* | BackboneElement | Overall costs | 0..* | BackboneElement | Overall costs | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| type | 0..1 | CodeableConcept | Type of cost | 0..1 | CodeableConcept | Type of cost | |||||||||||
| groupSize | 0..1 | positiveInt | Number of enrollees | 0..1 | positiveInt | Number of enrollees | |||||||||||
| cost | 0..1 | Money | Cost value | 0..1 | Money | Cost value | |||||||||||
| comment | 0..1 | string | Additional cost information | 0..1 | string | Additional cost information | |||||||||||
| specificCost | 0..* | BackboneElement | Specific costs | 0..* | BackboneElement | Specific costs | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| category | 1..1 | CodeableConcept | General category of benefit | 1..1 | CodeableConcept | General category of benefit | |||||||||||
| benefit | 0..* | BackboneElement | Benefits list | 0..* | BackboneElement | Benefits list | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| type | 1..1 | CodeableConcept | Type of specific benefit | 1..1 | CodeableConcept | Type of specific benefit | |||||||||||
| cost | 0..* | BackboneElement | List of the costs | 0..* | BackboneElement | List of the costs | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| type | 1..1 | CodeableConcept | Type of cost | 1..1 | CodeableConcept | Type of cost | |||||||||||
| applicability | 0..1 | CodeableConcept | in-network | out-of-network | other Binding: ?? (required): Whether the cost applies to in-network or out-of-network providers. | 0..1 | CodeableConcept | in-network | out-of-network | other Binding: ?? (required): Whether the cost applies to in-network or out-of-network providers. | |||||||||||
| qualifiers | 0..* | CodeableConcept | Additional information about the cost | 0..* | CodeableConcept | Additional information about the cost | |||||||||||
| value | 0..1 | Quantity | The actual cost value | 0..1 | Quantity | The actual cost value | |||||||||||
| Documentation for this format | |||||||||||||||||