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.

• Key Elements Table
• Differential Table
• Snapshot Table
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Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
InsurancePlan	C	0..*	InsurancePlan	Details of a Health Insurance product/plan provided by an organization Constraints: ipn-1, network-or-plan-Network, plan-type-is-distinct
InsurancePlan.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
InsurancePlan.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
InsurancePlan.Slices for identifier	Σ This element is included in summaries. C	0..*	Identifier	Business Identifier for Product Slice: Unordered, Open by value:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
InsurancePlan.Slices for identifier.identifier:All Slices				Content/Rules for all slices
InsurancePlan.Slices for identifier.identifier:All Slices.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
InsurancePlan.Slices for identifier.identifier:All Slices.type	S This element must be supported. Σ This element is included in summaries.	0..1	CodeableConcept	Description 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.
InsurancePlan.Slices for identifier.identifier:All Slices.value	S This element must be supported. Σ This element is included in summaries.	0..1	string	The value that is unique Example General: 123456
InsurancePlan.Slices for identifier.identifier:All Slices.assigner	S This element must be supported. Σ This element is included in summaries.	0..1	Reference(Organization)	Organization that issued id (may be just text)
InsurancePlan.Slices for identifier.identifier:MA-PLAN-ID	S This element must be supported. Σ This element is included in summaries. C	0..1	Identifier	Business Identifier for Product
InsurancePlan.Slices for identifier.identifier:MA-PLAN-ID.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
InsurancePlan.Slices for identifier.identifier:MA-PLAN-ID.type	Σ This element is included in summaries.	0..1	CodeableConcept	Description 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.
InsurancePlan.Slices for identifier.identifier:MA-PLAN-ID.system	S This element must be supported. Σ This element is included in summaries.	1..1	uri	The namespace for the identifier value Required Pattern: http://cms.gov/medicare/ma-plan-id (extensions allowed)
InsurancePlan.Slices for identifier.identifier:MA-PLAN-ID.value	Σ This element is included in summaries.	1..1	string	The value that is unique Example General: 123456
InsurancePlan.Slices for identifier.identifier:MA-PLAN-ID.assigner	Σ This element is included in summaries.	0..1	Reference(Organization)	Organization that issued id (may be just text)
InsurancePlan.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact. Fixed Value: active (no extensions allowed)
InsurancePlan.type	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	Product Type Binding: Insurance Product Type VS (extensible)
InsurancePlan.name	S This element must be supported. Σ This element is included in summaries. C	0..1	string	Official name
InsurancePlan.alias	S This element must be supported.	0..*	string	Alternate names
InsurancePlan.period	S This element must be supported.	0..1	Period	When the product is available
InsurancePlan.ownedBy	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(Plan-Net Organization)	Plan issuer
InsurancePlan.administeredBy	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(Plan-Net Organization)	Product administrator
InsurancePlan.coverageArea	S This element must be supported. Σ This element is included in summaries.	0..*	Reference(Plan-Net Location)	Where product applies
InsurancePlan.contact	S This element must be supported.	0..*	BackboneElement	Contact for the product
InsurancePlan.contact.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
InsurancePlan.contact.name	S This element must be supported.	0..1	HumanName	A name associated with the contact
InsurancePlan.contact.name.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | nickname | anonymous | old | maiden Binding: NameUse (required): The use of a human name.
InsurancePlan.contact.name.text	S This element must be supported. Σ This element is included in summaries.	0..1	string	Text representation of the full name
InsurancePlan.contact.telecom	S This element must be supported.	0..*	ContactPoint	Contact details (telephone, email, etc.) for a contact
InsurancePlan.contact.telecom.system	S This element must be supported. Σ This element is included in summaries. C	0..1	code	phone | fax | email | pager | url | sms | other Binding: ContactPointSystem (required): Telecommunications form for contact point.
InsurancePlan.contact.telecom.value	S This element must be supported. Σ This element is included in summaries.	0..1	string	The actual contact point details
InsurancePlan.contact.telecom.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	home | work | temp | old | mobile - purpose of this contact point Binding: ContactPointUse (required): Use of contact point.
InsurancePlan.endpoint	S This element must be supported.	0..*	Reference(Plan-Net Endpoint)	Technical endpoint
InsurancePlan.network	S This element must be supported.	0..*	Reference(Plan-Net Network)	What networks are Included
InsurancePlan.plan		0..*	BackboneElement	Cost sharing details for the plan
InsurancePlan.plan.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
InsurancePlan.plan.type	S This element must be supported.	0..1	CodeableConcept	Categorization of the cost sharing for the plan Binding: Insurance Plan TypeVS (extensible)
InsurancePlan.plan.coverageArea	S This element must be supported. Σ This element is included in summaries.	0..*	Reference(Plan-Net Location)	Where product applies
InsurancePlan.plan.network		0..*	Reference(Plan-Net Network)	What networks provide coverage
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
InsurancePlan.identifier.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
InsurancePlan.identifier.​type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
InsurancePlan.identifier:MA-PLAN-ID.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
InsurancePlan.identifier:MA-PLAN-ID.​type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
InsurancePlan.status	Base	required	PublicationStatus	📍4.0.1	FHIR Std.
InsurancePlan.type	Base	extensible	Insurance Product Type VS	📦2.0.0-ballot	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.plan.type	Base	extensible	Insurance Plan TypeVS	📦2.0.0-ballot	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
network-or-plan-Network	error	InsurancePlan	If an insuranceplan does not define a network, then each plan must define one	network.exists() or plan.network.exists()
plan-type-is-distinct	error	InsurancePlan	Each InsurancePlan.plan should have a distinct plan.type.	plan.type.coding.code.isDistinct()

This structure is derived from InsurancePlan

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
InsurancePlan	C	0..*	InsurancePlan	Details of a Health Insurance product/plan provided by an organization Constraints: network-or-plan-Network, plan-type-is-distinct
InsurancePlan.Slices for identifier		0..*	Identifier	Business Identifier for Product Slice: Unordered, Open by value:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
InsurancePlan.Slices for identifier.identifier:All Slices				Content/Rules for all slices
InsurancePlan.Slices for identifier.identifier:All Slices.type	S This element must be supported.	0..1	CodeableConcept	Description of identifier
InsurancePlan.Slices for identifier.identifier:All Slices.value	S This element must be supported.	0..1	string	The value that is unique
InsurancePlan.Slices for identifier.identifier:All Slices.assigner	S This element must be supported.	0..1	Reference(Organization)	Organization that issued id (may be just text)
InsurancePlan.Slices for identifier.identifier:MA-PLAN-ID	S This element must be supported.	0..1	Identifier	Business Identifier for Product
InsurancePlan.Slices for identifier.identifier:MA-PLAN-ID.system	S This element must be supported.	1..1	uri	The namespace for the identifier value Required Pattern: http://cms.gov/medicare/ma-plan-id (extensions allowed)
InsurancePlan.Slices for identifier.identifier:MA-PLAN-ID.value		1..1	string	The value that is unique
InsurancePlan.status	S This element must be supported.	1..1	code	draft | active | retired | unknown Fixed Value: active (no extensions allowed)
InsurancePlan.type	S This element must be supported.	1..1	CodeableConcept	Product Type Binding: Insurance Product Type VS (extensible)
InsurancePlan.name	S This element must be supported.	0..1	string	Official name
InsurancePlan.alias	S This element must be supported.	0..*	string	Alternate names
InsurancePlan.period	S This element must be supported.	0..1	Period	When the product is available
InsurancePlan.ownedBy	S This element must be supported.	1..1	Reference(Plan-Net Organization)	Plan issuer
InsurancePlan.administeredBy	S This element must be supported.	1..1	Reference(Plan-Net Organization)	Product administrator
InsurancePlan.coverageArea	S This element must be supported.	0..*	Reference(Plan-Net Location)	Where product applies
InsurancePlan.contact	S This element must be supported.	0..*	BackboneElement	Contact for the product
InsurancePlan.contact.name	S This element must be supported.	0..1	HumanName	A name associated with the contact
InsurancePlan.contact.name.text	S This element must be supported.	0..1	string	Text representation of the full name
InsurancePlan.contact.telecom	S This element must be supported.	0..*	ContactPoint	Contact details (telephone, email, etc.) for a contact
InsurancePlan.contact.telecom.system	S This element must be supported.	0..1	code	phone | fax | email | pager | url | sms | other
InsurancePlan.contact.telecom.value	S This element must be supported.	0..1	string	The actual contact point details
InsurancePlan.endpoint	S This element must be supported.	0..*	Reference(Plan-Net Endpoint)	Technical endpoint
InsurancePlan.network	S This element must be supported.	0..*	Reference(Plan-Net Network)	What networks are Included
InsurancePlan.plan		0..*	BackboneElement	Cost sharing details for the plan
InsurancePlan.plan.type	S This element must be supported.	0..1	CodeableConcept	Categorization of the cost sharing for the plan Binding: Insurance Plan TypeVS (extensible)
InsurancePlan.plan.coverageArea	S This element must be supported.	0..*	Reference(Plan-Net Location)	Where product applies
InsurancePlan.plan.network		0..*	Reference(Plan-Net Network)	What networks provide coverage
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
InsurancePlan.type	Base	extensible	Insurance Product Type VS	📦2.0.0-ballot	This IG
InsurancePlan.plan.type	Base	extensible	Insurance Plan TypeVS	📦2.0.0-ballot	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
network-or-plan-Network	error	InsurancePlan	If an insuranceplan does not define a network, then each plan must define one	network.exists() or plan.network.exists()
plan-type-is-distinct	error	InsurancePlan	Each InsurancePlan.plan should have a distinct plan.type.	plan.type.coding.code.isDistinct()

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
InsurancePlan	C	0..*	InsurancePlan	Details of a Health Insurance product/plan provided by an organization Constraints: ipn-1, network-or-plan-Network, plan-type-is-distinct
InsurancePlan.id	Σ This element is included in summaries.	0..1	id	Logical id of this artifact
InsurancePlan.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
InsurancePlan.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
InsurancePlan.language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
InsurancePlan.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
InsurancePlan.contained		0..*	Resource	Contained, inline Resources
InsurancePlan.extension		0..*	Extension	Additional content defined by implementations
InsurancePlan.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
InsurancePlan.Slices for identifier	Σ This element is included in summaries. C	0..*	Identifier	Business Identifier for Product Slice: Unordered, Open by value:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
InsurancePlan.Slices for identifier.identifier:All Slices				Content/Rules for all slices
InsurancePlan.Slices for identifier.identifier:All Slices.id		0..1	string	Unique id for inter-element referencing
InsurancePlan.Slices for identifier.identifier:All Slices.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
InsurancePlan.Slices for identifier.identifier:All Slices.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
InsurancePlan.Slices for identifier.identifier:All Slices.type	S This element must be supported. Σ This element is included in summaries.	0..1	CodeableConcept	Description 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.
InsurancePlan.Slices for identifier.identifier:All Slices.system	Σ This element is included in summaries.	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
InsurancePlan.Slices for identifier.identifier:All Slices.value	S This element must be supported. Σ This element is included in summaries.	0..1	string	The value that is unique Example General: 123456
InsurancePlan.Slices for identifier.identifier:All Slices.period	Σ This element is included in summaries.	0..1	Period	Time period when id is/was valid for use
InsurancePlan.Slices for identifier.identifier:All Slices.assigner	S This element must be supported. Σ This element is included in summaries.	0..1	Reference(Organization)	Organization that issued id (may be just text)
InsurancePlan.Slices for identifier.identifier:MA-PLAN-ID	S This element must be supported. Σ This element is included in summaries. C	0..1	Identifier	Business Identifier for Product
InsurancePlan.Slices for identifier.identifier:MA-PLAN-ID.id		0..1	string	Unique id for inter-element referencing
InsurancePlan.Slices for identifier.identifier:MA-PLAN-ID.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
InsurancePlan.Slices for identifier.identifier:MA-PLAN-ID.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
InsurancePlan.Slices for identifier.identifier:MA-PLAN-ID.type	Σ This element is included in summaries.	0..1	CodeableConcept	Description 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.
InsurancePlan.Slices for identifier.identifier:MA-PLAN-ID.system	S This element must be supported. Σ This element is included in summaries.	1..1	uri	The namespace for the identifier value Required Pattern: http://cms.gov/medicare/ma-plan-id (extensions allowed)
InsurancePlan.Slices for identifier.identifier:MA-PLAN-ID.value	Σ This element is included in summaries.	1..1	string	The value that is unique Example General: 123456
InsurancePlan.Slices for identifier.identifier:MA-PLAN-ID.period	Σ This element is included in summaries.	0..1	Period	Time period when id is/was valid for use
InsurancePlan.Slices for identifier.identifier:MA-PLAN-ID.assigner	Σ This element is included in summaries.	0..1	Reference(Organization)	Organization that issued id (may be just text)
InsurancePlan.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact. Fixed Value: active (no extensions allowed)
InsurancePlan.type	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	Product Type Binding: Insurance Product Type VS (extensible)
InsurancePlan.name	S This element must be supported. Σ This element is included in summaries. C	0..1	string	Official name
InsurancePlan.alias	S This element must be supported.	0..*	string	Alternate names
InsurancePlan.period	S This element must be supported.	0..1	Period	When the product is available
InsurancePlan.ownedBy	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(Plan-Net Organization)	Plan issuer
InsurancePlan.administeredBy	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(Plan-Net Organization)	Product administrator
InsurancePlan.coverageArea	S This element must be supported. Σ This element is included in summaries.	0..*	Reference(Plan-Net Location)	Where product applies
InsurancePlan.contact	S This element must be supported.	0..*	BackboneElement	Contact for the product
InsurancePlan.contact.id		0..1	string	Unique id for inter-element referencing
InsurancePlan.contact.extension		0..*	Extension	Additional content defined by implementations
InsurancePlan.contact.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
InsurancePlan.contact.purpose		0..1	CodeableConcept	The type of contact Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party.
InsurancePlan.contact.name	S This element must be supported.	0..1	HumanName	A name associated with the contact
InsurancePlan.contact.name.id		0..1	string	Unique id for inter-element referencing
InsurancePlan.contact.name.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
InsurancePlan.contact.name.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | nickname | anonymous | old | maiden Binding: NameUse (required): The use of a human name.
InsurancePlan.contact.name.text	S This element must be supported. Σ This element is included in summaries.	0..1	string	Text representation of the full name
InsurancePlan.contact.name.family	Σ This element is included in summaries.	0..1	string	Family name (often called 'Surname')
InsurancePlan.contact.name.given	Σ This element is included in summaries.	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
InsurancePlan.contact.name.prefix	Σ This element is included in summaries.	0..*	string	Parts that come before the name This repeating element order: Prefixes appear in the correct order for presenting the name
InsurancePlan.contact.name.suffix	Σ This element is included in summaries.	0..*	string	Parts that come after the name This repeating element order: Suffixes appear in the correct order for presenting the name
InsurancePlan.contact.name.period	Σ This element is included in summaries.	0..1	Period	Time period when name was/is in use
InsurancePlan.contact.telecom	S This element must be supported.	0..*	ContactPoint	Contact details (telephone, email, etc.) for a contact
InsurancePlan.contact.telecom.id		0..1	string	Unique id for inter-element referencing
InsurancePlan.contact.telecom.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
InsurancePlan.contact.telecom.system	S This element must be supported. Σ This element is included in summaries. C	0..1	code	phone | fax | email | pager | url | sms | other Binding: ContactPointSystem (required): Telecommunications form for contact point.
InsurancePlan.contact.telecom.value	S This element must be supported. Σ This element is included in summaries.	0..1	string	The actual contact point details
InsurancePlan.contact.telecom.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	home | work | temp | old | mobile - purpose of this contact point Binding: ContactPointUse (required): Use of contact point.
InsurancePlan.contact.telecom.rank	Σ This element is included in summaries.	0..1	positiveInt	Specify preferred order of use (1 = highest)
InsurancePlan.contact.telecom.period	Σ This element is included in summaries.	0..1	Period	Time period when the contact point was/is in use
InsurancePlan.contact.address		0..1	Address	Visiting or postal addresses for the contact
InsurancePlan.endpoint	S This element must be supported.	0..*	Reference(Plan-Net Endpoint)	Technical endpoint
InsurancePlan.network	S This element must be supported.	0..*	Reference(Plan-Net Network)	What networks are Included
InsurancePlan.coverage		0..*	BackboneElement	Coverage details
InsurancePlan.coverage.id		0..1	string	Unique id for inter-element referencing
InsurancePlan.coverage.extension		0..*	Extension	Additional content defined by implementations
InsurancePlan.coverage.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
InsurancePlan.coverage.type		1..1	CodeableConcept	Type of coverage
InsurancePlan.coverage.network		0..*	Reference(Organization)	What networks provide coverage
InsurancePlan.coverage.benefit		1..*	BackboneElement	List of benefits
InsurancePlan.coverage.benefit.id		0..1	string	Unique id for inter-element referencing
InsurancePlan.coverage.benefit.extension		0..*	Extension	Additional content defined by implementations
InsurancePlan.coverage.benefit.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
InsurancePlan.coverage.benefit.type		1..1	CodeableConcept	Type of benefit
InsurancePlan.coverage.benefit.requirement		0..1	string	Referral requirements
InsurancePlan.coverage.benefit.limit		0..*	BackboneElement	Benefit limits
InsurancePlan.coverage.benefit.limit.id		0..1	string	Unique id for inter-element referencing
InsurancePlan.coverage.benefit.limit.extension		0..*	Extension	Additional content defined by implementations
InsurancePlan.coverage.benefit.limit.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
InsurancePlan.coverage.benefit.limit.value		0..1	Quantity	Maximum value allowed
InsurancePlan.coverage.benefit.limit.code		0..1	CodeableConcept	Benefit limit details
InsurancePlan.plan		0..*	BackboneElement	Cost sharing details for the plan
InsurancePlan.plan.id		0..1	string	Unique id for inter-element referencing
InsurancePlan.plan.extension		0..*	Extension	Additional content defined by implementations
InsurancePlan.plan.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
InsurancePlan.plan.identifier	Σ This element is included in summaries.	0..*	Identifier	Business Identifier for Product
InsurancePlan.plan.type	S This element must be supported.	0..1	CodeableConcept	Categorization of the cost sharing for the plan Binding: Insurance Plan TypeVS (extensible)
InsurancePlan.plan.coverageArea	S This element must be supported. Σ This element is included in summaries.	0..*	Reference(Plan-Net Location)	Where product applies
InsurancePlan.plan.network		0..*	Reference(Plan-Net Network)	What networks provide coverage
InsurancePlan.plan.generalCost		0..*	BackboneElement	Overall costs
InsurancePlan.plan.generalCost.id		0..1	string	Unique id for inter-element referencing
InsurancePlan.plan.generalCost.extension		0..*	Extension	Additional content defined by implementations
InsurancePlan.plan.generalCost.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
InsurancePlan.plan.generalCost.type		0..1	CodeableConcept	Type of cost
InsurancePlan.plan.generalCost.groupSize		0..1	positiveInt	Number of enrollees
InsurancePlan.plan.generalCost.cost		0..1	Money	Cost value
InsurancePlan.plan.generalCost.comment		0..1	string	Additional cost information
InsurancePlan.plan.specificCost		0..*	BackboneElement	Specific costs
InsurancePlan.plan.specificCost.id		0..1	string	Unique id for inter-element referencing
InsurancePlan.plan.specificCost.extension		0..*	Extension	Additional content defined by implementations
InsurancePlan.plan.specificCost.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
InsurancePlan.plan.specificCost.category		1..1	CodeableConcept	General category of benefit
InsurancePlan.plan.specificCost.benefit		0..*	BackboneElement	Benefits list
InsurancePlan.plan.specificCost.benefit.id		0..1	string	Unique id for inter-element referencing
InsurancePlan.plan.specificCost.benefit.extension		0..*	Extension	Additional content defined by implementations
InsurancePlan.plan.specificCost.benefit.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
InsurancePlan.plan.specificCost.benefit.type		1..1	CodeableConcept	Type of specific benefit
InsurancePlan.plan.specificCost.benefit.cost		0..*	BackboneElement	List of the costs
InsurancePlan.plan.specificCost.benefit.cost.id		0..1	string	Unique id for inter-element referencing
InsurancePlan.plan.specificCost.benefit.cost.extension		0..*	Extension	Additional content defined by implementations
InsurancePlan.plan.specificCost.benefit.cost.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
InsurancePlan.plan.specificCost.benefit.cost.type		1..1	CodeableConcept	Type of cost
InsurancePlan.plan.specificCost.benefit.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.
InsurancePlan.plan.specificCost.benefit.cost.qualifiers		0..*	CodeableConcept	Additional information about the cost
InsurancePlan.plan.specificCost.benefit.cost.value		0..1	Quantity	The actual cost value
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
InsurancePlan.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
InsurancePlan.identifier.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
InsurancePlan.identifier.​type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
InsurancePlan.identifier:MA-PLAN-ID.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
InsurancePlan.identifier:MA-PLAN-ID.​type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
InsurancePlan.status	Base	required	PublicationStatus	📍4.0.1	FHIR Std.
InsurancePlan.type	Base	extensible	Insurance Product Type VS	📦2.0.0-ballot	This IG
InsurancePlan.contact.​purpose	Base	extensible	Contact entity type	📍4.0.1	FHIR Std.
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.plan.type	Base	extensible	Insurance Plan TypeVS	📦2.0.0-ballot	This IG
InsurancePlan.plan.specificCost.​benefit.cost.applicability	Base	required	Benefit cost applicability	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
network-or-plan-Network	error	InsurancePlan	If an insuranceplan does not define a network, then each plan must define one	network.exists() or plan.network.exists()
plan-type-is-distinct	error	InsurancePlan	Each InsurancePlan.plan should have a distinct plan.type.	plan.type.coding.code.isDistinct()

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
InsurancePlan	C	0..*	InsurancePlan	Details of a Health Insurance product/plan provided by an organization Constraints: ipn-1, network-or-plan-Network, plan-type-is-distinct
InsurancePlan.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
InsurancePlan.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
InsurancePlan.Slices for identifier	Σ This element is included in summaries. C	0..*	Identifier	Business Identifier for Product Slice: Unordered, Open by value:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
InsurancePlan.Slices for identifier.identifier:All Slices				Content/Rules for all slices
InsurancePlan.Slices for identifier.identifier:All Slices.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
InsurancePlan.Slices for identifier.identifier:All Slices.type	S This element must be supported. Σ This element is included in summaries.	0..1	CodeableConcept	Description 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.
InsurancePlan.Slices for identifier.identifier:All Slices.value	S This element must be supported. Σ This element is included in summaries.	0..1	string	The value that is unique Example General: 123456
InsurancePlan.Slices for identifier.identifier:All Slices.assigner	S This element must be supported. Σ This element is included in summaries.	0..1	Reference(Organization)	Organization that issued id (may be just text)
InsurancePlan.Slices for identifier.identifier:MA-PLAN-ID	S This element must be supported. Σ This element is included in summaries. C	0..1	Identifier	Business Identifier for Product
InsurancePlan.Slices for identifier.identifier:MA-PLAN-ID.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
InsurancePlan.Slices for identifier.identifier:MA-PLAN-ID.type	Σ This element is included in summaries.	0..1	CodeableConcept	Description 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.
InsurancePlan.Slices for identifier.identifier:MA-PLAN-ID.system	S This element must be supported. Σ This element is included in summaries.	1..1	uri	The namespace for the identifier value Required Pattern: http://cms.gov/medicare/ma-plan-id (extensions allowed)
InsurancePlan.Slices for identifier.identifier:MA-PLAN-ID.value	Σ This element is included in summaries.	1..1	string	The value that is unique Example General: 123456
InsurancePlan.Slices for identifier.identifier:MA-PLAN-ID.assigner	Σ This element is included in summaries.	0..1	Reference(Organization)	Organization that issued id (may be just text)
InsurancePlan.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact. Fixed Value: active (no extensions allowed)
InsurancePlan.type	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	Product Type Binding: Insurance Product Type VS (extensible)
InsurancePlan.name	S This element must be supported. Σ This element is included in summaries. C	0..1	string	Official name
InsurancePlan.alias	S This element must be supported.	0..*	string	Alternate names
InsurancePlan.period	S This element must be supported.	0..1	Period	When the product is available
InsurancePlan.ownedBy	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(Plan-Net Organization)	Plan issuer
InsurancePlan.administeredBy	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(Plan-Net Organization)	Product administrator
InsurancePlan.coverageArea	S This element must be supported. Σ This element is included in summaries.	0..*	Reference(Plan-Net Location)	Where product applies
InsurancePlan.contact	S This element must be supported.	0..*	BackboneElement	Contact for the product
InsurancePlan.contact.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
InsurancePlan.contact.name	S This element must be supported.	0..1	HumanName	A name associated with the contact
InsurancePlan.contact.name.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | nickname | anonymous | old | maiden Binding: NameUse (required): The use of a human name.
InsurancePlan.contact.name.text	S This element must be supported. Σ This element is included in summaries.	0..1	string	Text representation of the full name
InsurancePlan.contact.telecom	S This element must be supported.	0..*	ContactPoint	Contact details (telephone, email, etc.) for a contact
InsurancePlan.contact.telecom.system	S This element must be supported. Σ This element is included in summaries. C	0..1	code	phone | fax | email | pager | url | sms | other Binding: ContactPointSystem (required): Telecommunications form for contact point.
InsurancePlan.contact.telecom.value	S This element must be supported. Σ This element is included in summaries.	0..1	string	The actual contact point details
InsurancePlan.contact.telecom.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	home | work | temp | old | mobile - purpose of this contact point Binding: ContactPointUse (required): Use of contact point.
InsurancePlan.endpoint	S This element must be supported.	0..*	Reference(Plan-Net Endpoint)	Technical endpoint
InsurancePlan.network	S This element must be supported.	0..*	Reference(Plan-Net Network)	What networks are Included
InsurancePlan.plan		0..*	BackboneElement	Cost sharing details for the plan
InsurancePlan.plan.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
InsurancePlan.plan.type	S This element must be supported.	0..1	CodeableConcept	Categorization of the cost sharing for the plan Binding: Insurance Plan TypeVS (extensible)
InsurancePlan.plan.coverageArea	S This element must be supported. Σ This element is included in summaries.	0..*	Reference(Plan-Net Location)	Where product applies
InsurancePlan.plan.network		0..*	Reference(Plan-Net Network)	What networks provide coverage
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
InsurancePlan.identifier.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
InsurancePlan.identifier.​type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
InsurancePlan.identifier:MA-PLAN-ID.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
InsurancePlan.identifier:MA-PLAN-ID.​type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
InsurancePlan.status	Base	required	PublicationStatus	📍4.0.1	FHIR Std.
InsurancePlan.type	Base	extensible	Insurance Product Type VS	📦2.0.0-ballot	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.plan.type	Base	extensible	Insurance Plan TypeVS	📦2.0.0-ballot	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
network-or-plan-Network	error	InsurancePlan	If an insuranceplan does not define a network, then each plan must define one	network.exists() or plan.network.exists()
plan-type-is-distinct	error	InsurancePlan	Each InsurancePlan.plan should have a distinct plan.type.	plan.type.coding.code.isDistinct()

Differential View

This structure is derived from InsurancePlan

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
InsurancePlan	C	0..*	InsurancePlan	Details of a Health Insurance product/plan provided by an organization Constraints: network-or-plan-Network, plan-type-is-distinct
InsurancePlan.Slices for identifier		0..*	Identifier	Business Identifier for Product Slice: Unordered, Open by value:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
InsurancePlan.Slices for identifier.identifier:All Slices				Content/Rules for all slices
InsurancePlan.Slices for identifier.identifier:All Slices.type	S This element must be supported.	0..1	CodeableConcept	Description of identifier
InsurancePlan.Slices for identifier.identifier:All Slices.value	S This element must be supported.	0..1	string	The value that is unique
InsurancePlan.Slices for identifier.identifier:All Slices.assigner	S This element must be supported.	0..1	Reference(Organization)	Organization that issued id (may be just text)
InsurancePlan.Slices for identifier.identifier:MA-PLAN-ID	S This element must be supported.	0..1	Identifier	Business Identifier for Product
InsurancePlan.Slices for identifier.identifier:MA-PLAN-ID.system	S This element must be supported.	1..1	uri	The namespace for the identifier value Required Pattern: http://cms.gov/medicare/ma-plan-id (extensions allowed)
InsurancePlan.Slices for identifier.identifier:MA-PLAN-ID.value		1..1	string	The value that is unique
InsurancePlan.status	S This element must be supported.	1..1	code	draft | active | retired | unknown Fixed Value: active (no extensions allowed)
InsurancePlan.type	S This element must be supported.	1..1	CodeableConcept	Product Type Binding: Insurance Product Type VS (extensible)
InsurancePlan.name	S This element must be supported.	0..1	string	Official name
InsurancePlan.alias	S This element must be supported.	0..*	string	Alternate names
InsurancePlan.period	S This element must be supported.	0..1	Period	When the product is available
InsurancePlan.ownedBy	S This element must be supported.	1..1	Reference(Plan-Net Organization)	Plan issuer
InsurancePlan.administeredBy	S This element must be supported.	1..1	Reference(Plan-Net Organization)	Product administrator
InsurancePlan.coverageArea	S This element must be supported.	0..*	Reference(Plan-Net Location)	Where product applies
InsurancePlan.contact	S This element must be supported.	0..*	BackboneElement	Contact for the product
InsurancePlan.contact.name	S This element must be supported.	0..1	HumanName	A name associated with the contact
InsurancePlan.contact.name.text	S This element must be supported.	0..1	string	Text representation of the full name
InsurancePlan.contact.telecom	S This element must be supported.	0..*	ContactPoint	Contact details (telephone, email, etc.) for a contact
InsurancePlan.contact.telecom.system	S This element must be supported.	0..1	code	phone | fax | email | pager | url | sms | other
InsurancePlan.contact.telecom.value	S This element must be supported.	0..1	string	The actual contact point details
InsurancePlan.endpoint	S This element must be supported.	0..*	Reference(Plan-Net Endpoint)	Technical endpoint
InsurancePlan.network	S This element must be supported.	0..*	Reference(Plan-Net Network)	What networks are Included
InsurancePlan.plan		0..*	BackboneElement	Cost sharing details for the plan
InsurancePlan.plan.type	S This element must be supported.	0..1	CodeableConcept	Categorization of the cost sharing for the plan Binding: Insurance Plan TypeVS (extensible)
InsurancePlan.plan.coverageArea	S This element must be supported.	0..*	Reference(Plan-Net Location)	Where product applies
InsurancePlan.plan.network		0..*	Reference(Plan-Net Network)	What networks provide coverage
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
InsurancePlan.type	Base	extensible	Insurance Product Type VS	📦2.0.0-ballot	This IG
InsurancePlan.plan.type	Base	extensible	Insurance Plan TypeVS	📦2.0.0-ballot	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
network-or-plan-Network	error	InsurancePlan	If an insuranceplan does not define a network, then each plan must define one	network.exists() or plan.network.exists()
plan-type-is-distinct	error	InsurancePlan	Each InsurancePlan.plan should have a distinct plan.type.	plan.type.coding.code.isDistinct()

Snapshot ViewView

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
InsurancePlan	C	0..*	InsurancePlan	Details of a Health Insurance product/plan provided by an organization Constraints: ipn-1, network-or-plan-Network, plan-type-is-distinct
InsurancePlan.id	Σ This element is included in summaries.	0..1	id	Logical id of this artifact
InsurancePlan.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
InsurancePlan.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
InsurancePlan.language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
InsurancePlan.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
InsurancePlan.contained		0..*	Resource	Contained, inline Resources
InsurancePlan.extension		0..*	Extension	Additional content defined by implementations
InsurancePlan.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
InsurancePlan.Slices for identifier	Σ This element is included in summaries. C	0..*	Identifier	Business Identifier for Product Slice: Unordered, Open by value:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
InsurancePlan.Slices for identifier.identifier:All Slices				Content/Rules for all slices
InsurancePlan.Slices for identifier.identifier:All Slices.id		0..1	string	Unique id for inter-element referencing
InsurancePlan.Slices for identifier.identifier:All Slices.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
InsurancePlan.Slices for identifier.identifier:All Slices.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
InsurancePlan.Slices for identifier.identifier:All Slices.type	S This element must be supported. Σ This element is included in summaries.	0..1	CodeableConcept	Description 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.
InsurancePlan.Slices for identifier.identifier:All Slices.system	Σ This element is included in summaries.	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
InsurancePlan.Slices for identifier.identifier:All Slices.value	S This element must be supported. Σ This element is included in summaries.	0..1	string	The value that is unique Example General: 123456
InsurancePlan.Slices for identifier.identifier:All Slices.period	Σ This element is included in summaries.	0..1	Period	Time period when id is/was valid for use
InsurancePlan.Slices for identifier.identifier:All Slices.assigner	S This element must be supported. Σ This element is included in summaries.	0..1	Reference(Organization)	Organization that issued id (may be just text)
InsurancePlan.Slices for identifier.identifier:MA-PLAN-ID	S This element must be supported. Σ This element is included in summaries. C	0..1	Identifier	Business Identifier for Product
InsurancePlan.Slices for identifier.identifier:MA-PLAN-ID.id		0..1	string	Unique id for inter-element referencing
InsurancePlan.Slices for identifier.identifier:MA-PLAN-ID.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
InsurancePlan.Slices for identifier.identifier:MA-PLAN-ID.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
InsurancePlan.Slices for identifier.identifier:MA-PLAN-ID.type	Σ This element is included in summaries.	0..1	CodeableConcept	Description 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.
InsurancePlan.Slices for identifier.identifier:MA-PLAN-ID.system	S This element must be supported. Σ This element is included in summaries.	1..1	uri	The namespace for the identifier value Required Pattern: http://cms.gov/medicare/ma-plan-id (extensions allowed)
InsurancePlan.Slices for identifier.identifier:MA-PLAN-ID.value	Σ This element is included in summaries.	1..1	string	The value that is unique Example General: 123456
InsurancePlan.Slices for identifier.identifier:MA-PLAN-ID.period	Σ This element is included in summaries.	0..1	Period	Time period when id is/was valid for use
InsurancePlan.Slices for identifier.identifier:MA-PLAN-ID.assigner	Σ This element is included in summaries.	0..1	Reference(Organization)	Organization that issued id (may be just text)
InsurancePlan.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact. Fixed Value: active (no extensions allowed)
InsurancePlan.type	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	Product Type Binding: Insurance Product Type VS (extensible)
InsurancePlan.name	S This element must be supported. Σ This element is included in summaries. C	0..1	string	Official name
InsurancePlan.alias	S This element must be supported.	0..*	string	Alternate names
InsurancePlan.period	S This element must be supported.	0..1	Period	When the product is available
InsurancePlan.ownedBy	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(Plan-Net Organization)	Plan issuer
InsurancePlan.administeredBy	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(Plan-Net Organization)	Product administrator
InsurancePlan.coverageArea	S This element must be supported. Σ This element is included in summaries.	0..*	Reference(Plan-Net Location)	Where product applies
InsurancePlan.contact	S This element must be supported.	0..*	BackboneElement	Contact for the product
InsurancePlan.contact.id		0..1	string	Unique id for inter-element referencing
InsurancePlan.contact.extension		0..*	Extension	Additional content defined by implementations
InsurancePlan.contact.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
InsurancePlan.contact.purpose		0..1	CodeableConcept	The type of contact Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party.
InsurancePlan.contact.name	S This element must be supported.	0..1	HumanName	A name associated with the contact
InsurancePlan.contact.name.id		0..1	string	Unique id for inter-element referencing
InsurancePlan.contact.name.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
InsurancePlan.contact.name.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | nickname | anonymous | old | maiden Binding: NameUse (required): The use of a human name.
InsurancePlan.contact.name.text	S This element must be supported. Σ This element is included in summaries.	0..1	string	Text representation of the full name
InsurancePlan.contact.name.family	Σ This element is included in summaries.	0..1	string	Family name (often called 'Surname')
InsurancePlan.contact.name.given	Σ This element is included in summaries.	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
InsurancePlan.contact.name.prefix	Σ This element is included in summaries.	0..*	string	Parts that come before the name This repeating element order: Prefixes appear in the correct order for presenting the name
InsurancePlan.contact.name.suffix	Σ This element is included in summaries.	0..*	string	Parts that come after the name This repeating element order: Suffixes appear in the correct order for presenting the name
InsurancePlan.contact.name.period	Σ This element is included in summaries.	0..1	Period	Time period when name was/is in use
InsurancePlan.contact.telecom	S This element must be supported.	0..*	ContactPoint	Contact details (telephone, email, etc.) for a contact
InsurancePlan.contact.telecom.id		0..1	string	Unique id for inter-element referencing
InsurancePlan.contact.telecom.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
InsurancePlan.contact.telecom.system	S This element must be supported. Σ This element is included in summaries. C	0..1	code	phone | fax | email | pager | url | sms | other Binding: ContactPointSystem (required): Telecommunications form for contact point.
InsurancePlan.contact.telecom.value	S This element must be supported. Σ This element is included in summaries.	0..1	string	The actual contact point details
InsurancePlan.contact.telecom.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	home | work | temp | old | mobile - purpose of this contact point Binding: ContactPointUse (required): Use of contact point.
InsurancePlan.contact.telecom.rank	Σ This element is included in summaries.	0..1	positiveInt	Specify preferred order of use (1 = highest)
InsurancePlan.contact.telecom.period	Σ This element is included in summaries.	0..1	Period	Time period when the contact point was/is in use
InsurancePlan.contact.address		0..1	Address	Visiting or postal addresses for the contact
InsurancePlan.endpoint	S This element must be supported.	0..*	Reference(Plan-Net Endpoint)	Technical endpoint
InsurancePlan.network	S This element must be supported.	0..*	Reference(Plan-Net Network)	What networks are Included
InsurancePlan.coverage		0..*	BackboneElement	Coverage details
InsurancePlan.coverage.id		0..1	string	Unique id for inter-element referencing
InsurancePlan.coverage.extension		0..*	Extension	Additional content defined by implementations
InsurancePlan.coverage.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
InsurancePlan.coverage.type		1..1	CodeableConcept	Type of coverage
InsurancePlan.coverage.network		0..*	Reference(Organization)	What networks provide coverage
InsurancePlan.coverage.benefit		1..*	BackboneElement	List of benefits
InsurancePlan.coverage.benefit.id		0..1	string	Unique id for inter-element referencing
InsurancePlan.coverage.benefit.extension		0..*	Extension	Additional content defined by implementations
InsurancePlan.coverage.benefit.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
InsurancePlan.coverage.benefit.type		1..1	CodeableConcept	Type of benefit
InsurancePlan.coverage.benefit.requirement		0..1	string	Referral requirements
InsurancePlan.coverage.benefit.limit		0..*	BackboneElement	Benefit limits
InsurancePlan.coverage.benefit.limit.id		0..1	string	Unique id for inter-element referencing
InsurancePlan.coverage.benefit.limit.extension		0..*	Extension	Additional content defined by implementations
InsurancePlan.coverage.benefit.limit.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
InsurancePlan.coverage.benefit.limit.value		0..1	Quantity	Maximum value allowed
InsurancePlan.coverage.benefit.limit.code		0..1	CodeableConcept	Benefit limit details
InsurancePlan.plan		0..*	BackboneElement	Cost sharing details for the plan
InsurancePlan.plan.id		0..1	string	Unique id for inter-element referencing
InsurancePlan.plan.extension		0..*	Extension	Additional content defined by implementations
InsurancePlan.plan.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
InsurancePlan.plan.identifier	Σ This element is included in summaries.	0..*	Identifier	Business Identifier for Product
InsurancePlan.plan.type	S This element must be supported.	0..1	CodeableConcept	Categorization of the cost sharing for the plan Binding: Insurance Plan TypeVS (extensible)
InsurancePlan.plan.coverageArea	S This element must be supported. Σ This element is included in summaries.	0..*	Reference(Plan-Net Location)	Where product applies
InsurancePlan.plan.network		0..*	Reference(Plan-Net Network)	What networks provide coverage
InsurancePlan.plan.generalCost		0..*	BackboneElement	Overall costs
InsurancePlan.plan.generalCost.id		0..1	string	Unique id for inter-element referencing
InsurancePlan.plan.generalCost.extension		0..*	Extension	Additional content defined by implementations
InsurancePlan.plan.generalCost.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
InsurancePlan.plan.generalCost.type		0..1	CodeableConcept	Type of cost
InsurancePlan.plan.generalCost.groupSize		0..1	positiveInt	Number of enrollees
InsurancePlan.plan.generalCost.cost		0..1	Money	Cost value
InsurancePlan.plan.generalCost.comment		0..1	string	Additional cost information
InsurancePlan.plan.specificCost		0..*	BackboneElement	Specific costs
InsurancePlan.plan.specificCost.id		0..1	string	Unique id for inter-element referencing
InsurancePlan.plan.specificCost.extension		0..*	Extension	Additional content defined by implementations
InsurancePlan.plan.specificCost.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
InsurancePlan.plan.specificCost.category		1..1	CodeableConcept	General category of benefit
InsurancePlan.plan.specificCost.benefit		0..*	BackboneElement	Benefits list
InsurancePlan.plan.specificCost.benefit.id		0..1	string	Unique id for inter-element referencing
InsurancePlan.plan.specificCost.benefit.extension		0..*	Extension	Additional content defined by implementations
InsurancePlan.plan.specificCost.benefit.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
InsurancePlan.plan.specificCost.benefit.type		1..1	CodeableConcept	Type of specific benefit
InsurancePlan.plan.specificCost.benefit.cost		0..*	BackboneElement	List of the costs
InsurancePlan.plan.specificCost.benefit.cost.id		0..1	string	Unique id for inter-element referencing
InsurancePlan.plan.specificCost.benefit.cost.extension		0..*	Extension	Additional content defined by implementations
InsurancePlan.plan.specificCost.benefit.cost.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
InsurancePlan.plan.specificCost.benefit.cost.type		1..1	CodeableConcept	Type of cost
InsurancePlan.plan.specificCost.benefit.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.
InsurancePlan.plan.specificCost.benefit.cost.qualifiers		0..*	CodeableConcept	Additional information about the cost
InsurancePlan.plan.specificCost.benefit.cost.value		0..1	Quantity	The actual cost value
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
InsurancePlan.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
InsurancePlan.identifier.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
InsurancePlan.identifier.​type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
InsurancePlan.identifier:MA-PLAN-ID.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
InsurancePlan.identifier:MA-PLAN-ID.​type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
InsurancePlan.status	Base	required	PublicationStatus	📍4.0.1	FHIR Std.
InsurancePlan.type	Base	extensible	Insurance Product Type VS	📦2.0.0-ballot	This IG
InsurancePlan.contact.​purpose	Base	extensible	Contact entity type	📍4.0.1	FHIR Std.
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.plan.type	Base	extensible	Insurance Plan TypeVS	📦2.0.0-ballot	This IG
InsurancePlan.plan.specificCost.​benefit.cost.applicability	Base	required	Benefit cost applicability	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
network-or-plan-Network	error	InsurancePlan	If an insuranceplan does not define a network, then each plan must define one	network.exists() or plan.network.exists()
plan-type-is-distinct	error	InsurancePlan	Each InsurancePlan.plan should have a distinct plan.type.	plan.type.coding.code.isDistinct()

This structure is derived from InsurancePlan

Summary

Mandatory: 4 elements(2 nested mandatory elements)
Must-Support: 23 elements
Fixed: 1 element

Structures

This structure refers to these other structures:

• Plan-Net Organization (http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/plannet-Organization)
• Plan-Net Location (http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/plannet-Location)
• Plan-Net Endpoint (http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/plannet-Endpoint)
• Plan-Net Network (http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/plannet-Network)

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of InsurancePlan.identifier