PayerPlanPeriod
type: StructureDefinition
node role: treeRoot
id:
  v: PayerPlanPeriod
language:
  v: en
text:
  status:
    v: extensions
  div:
    v: Generated Narrative: StructureDefinition PayerPlanPeriod Language: en Name Flags Card. Type Description & Constraints<img src="[binary]" alt="doco" style="background-color: inherit"/> <a href="StructureDefinition-PayerPlanPeriod-definitions.html#PayerPlanPeriod" title="The PAYER_PLAN_PERIOD table captures details of the period of time that a Person is continuously enrolled under a specific health Plan benefit structure from a given Payer. Each Person receiving healthcare is typically covered by a health benefit plan, which pays for (fully or partially), or directly provides, the care. These benefit plans are provided by payers, such as health insurances or state or government agencies. In each plan the details of the health benefits are defined for the Person or her family, and the health benefit Plan might change over time typically with increasing utilization (reaching certain cost thresholds such as deductibles), plan availability and purchasing choices of the Person. The unique combinations of Payer organizations, health benefit Plans and time periods in which they are valid for a Person are recorded in this table.">PayerPlanPeriod 0..* Base Payer Plan Period OMOP Table Instances of this logical model can be the target of a Reference #xD; payer_plan_period_id 1..1 code Payer Plan Period Identifier #xD; person_id 1..1 integer Person #xD; payer_plan_period_start_date 1..1 date Payer Plan Period Start Date #xD; payer_plan_period_end_date 1..1 date Payer Plan Period End Date #xD; payer_concept_id 0..1 code Payer #xD; payer_source_value 0..1 string Payer Source Value #xD; payer_source_concept_id 0..1 code Payer Source #xD; plan_concept_id 0..1 code Plan #xD; plan_source_value 0..1 string Plan Source Value #xD; plan_source_concept_id 0..1 code Plan Source #xD; sponsor_concept_id 0..1 code Sponsor #xD; sponsor_source_value 0..1 string Sponsor Source Value #xD; sponsor_source_concept_id 0..1 code Sponsor Source #xD; family_source_value 0..1 string Family Source Value #x…
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-type-characteristics
    l: structuredefinition-type-characteristics
  value: Code
    v: can-be-target
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-wg
    l: structuredefinition-wg
  value: Code
    v: brr
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm
    l: structuredefinition-fmm
  value: Integer
    v: 1
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom
        l: structuredefinition-conformance-derivedFrom
      value: Canonical
        v: http://hl7.org/fhir/uv/omop/ImplementationGuide/hl7.fhir.uv.omop
        l: hl7.fhir.uv.omop
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status
    l: structuredefinition-standards-status
  value: Code
    v: informative
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom
        l: structuredefinition-conformance-derivedFrom
      value: Canonical
        v: http://hl7.org/fhir/uv/omop/ImplementationGuide/hl7.fhir.uv.omop
        l: hl7.fhir.uv.omop
url:
  v: http://hl7.org/fhir/uv/omop/StructureDefinition/PayerPlanPeriod
  l: PayerPlanPeriod
version:
  v: 1.0.0
name:
  v: PayerPlanPeriod
title:
  v: Payer Plan Period OMOP Table
status:
  v: active
date:
  v: 2026-04-02T22:51:15+00:00
publisher:
  v: HL7 International / Biomedical Research and Regulation
contact:
  name:
    v: HL7 International / Biomedical Research and Regulation
  telecom:
    system:
      v: url
    value:
      v: http://www.hl7.org/Special/committees/rcrim
description:
  v: The PAYER_PLAN_PERIOD table captures details of the period of time that a Person is continuously enrolled under a specific health Plan benefit structure from a given Payer. Each Person receiving healthcare is typically covered by a health benefit plan, which pays for (fully or partially), or directly provides, the care. These benefit plans are provided by payers, such as health insurances or state or government agencies. In each plan the details of the health benefits are defined for the Person or her family, and the health benefit Plan might change over time typically with increasing utilization (reaching certain cost thresholds such as deductibles), plan availability and purchasing choices of the Person. The unique combinations of Payer organizations, health benefit Plans and time periods in which they are valid for a Person are recorded in this table.
jurisdiction:
  coding:
    system:
      v: http://unstats.un.org/unsd/methods/m49/m49.htm
      l: m49.htm
    code:
      v: 001
    display:
      v: World
fhir version:
  v: 5.0.0
mapping:
  identity:
    v: rim
  uri:
    v: http://hl7.org/v3
    l: v3
  name:
    v: RIM Mapping
kind:
  v: logical
abstract:
  v: false
type:
  v: http://hl7.org/fhir/uv/omop/StructureDefinition/PayerPlanPeriod
  l: PayerPlanPeriod
base definition:
  v: http://hl7.org/fhir/StructureDefinition/Base
  l: Base
derivation:
  v: specialization
snapshot:
  extension:
    url:
      v: http://hl7.org/fhir/tools/StructureDefinition/snapshot-base-version
      l: snapshot-base-version
    value: String
      v: 5.0.0
  element:
    id:
      v: PayerPlanPeriod
    path:
      v: PayerPlanPeriod
    short:
      v: Payer Plan Period OMOP Table
    definition:
      v: The PAYER_PLAN_PERIOD table captures details of the period of time that a Person is continuously enrolled under a specific health Plan benefit structure from a given Payer. Each Person receiving healthcare is typically covered by a health benefit plan, which pays for (fully or partially), or directly provides, the care. These benefit plans are provided by payers, such as health insurances or state or government agencies. In each plan the details of the health benefits are defined for the Person or her family, and the health benefit Plan might change over time typically with increasing utilization (reaching certain cost thresholds such as deductibles), plan availability and purchasing choices of the Person. The unique combinations of Payer organizations, health benefit Plans and time periods in which they are valid for a Person are recorded in this table.
    min:
      v: 0
    max:
      v: *
    base:
      path:
        v: Base
      min:
        v: 0
      max:
        v: *
    is modifier:
      v: false
    mapping:
      identity:
        v: rim
      map:
        v: n/a
  element:
    id:
      v: PayerPlanPeriod.payer-plan-period-id
    path:
      v: PayerPlanPeriod.payer_plan_period_id
    short:
      v: Payer Plan Period Identifier
    definition:
      v: Payer Plan Period Identifier
    min:
      v: 1
    max:
      v: 1
    base:
      path:
        v: PayerPlanPeriod.payer_plan_period_id
      min:
        v: 1
      max:
        v: 1
    type:
      code:
        v: code
        l: code
  element:
    id:
      v: PayerPlanPeriod.person-id
    path:
      v: PayerPlanPeriod.person_id
    short:
      v: Person
    definition:
      v: The Person covered by the Plan.
    min:
      v: 1
    max:
      v: 1
    base:
      path:
        v: PayerPlanPeriod.person_id
      min:
        v: 1
      max:
        v: 1
    type:
      code:
        v: integer
        l: integer
  element:
    id:
      v: PayerPlanPeriod.payer-plan-period-start-date
    path:
      v: PayerPlanPeriod.payer_plan_period_start_date
    short:
      v: Payer Plan Period Start Date
    definition:
      v: Start date of Plan coverage.
    min:
      v: 1
    max:
      v: 1
    base:
      path:
        v: PayerPlanPeriod.payer_plan_period_start_date

v: 1

v: 1

code:
  v: date
  l: date

id:
  v: PayerPlanPeriod.payer-plan-period-end-date
path:
  v: PayerPlanPeriod.payer_plan_period_end_date
short:
  v: Payer Plan Period End Date
definition:
  v: End date of Plan coverage.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: PayerPlanPeriod.payer_plan_period_end_date
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: date
    l: date

id:
  v: PayerPlanPeriod.payer-concept-id
path:
  v: PayerPlanPeriod.payer_concept_id
short:
  v: Payer
definition:
  v: This field represents the organization who reimburses the provider which administers care to the Person.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: PayerPlanPeriod.payer_concept_id
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: code
    l: code

id:
  v: PayerPlanPeriod.payer-source-value
path:
  v: PayerPlanPeriod.payer_source_value
short:
  v: Payer Source Value
definition:
  v: This is the Payer as it appears in the source data.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: PayerPlanPeriod.payer_source_value
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
    l: string

id:
  v: PayerPlanPeriod.payer-source-concept-id
path:
  v: PayerPlanPeriod.payer_source_concept_id
short:
  v: Payer Source
definition:
  v: Payer Source
min:
  v: 0
max:
  v: 1
base:
  path:
    v: PayerPlanPeriod.payer_source_concept_id
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: code
    l: code

id:
  v: PayerPlanPeriod.plan-concept-id
path:
  v: PayerPlanPeriod.plan_concept_id
short:
  v: Plan
definition:
  v: This field represents the specific health benefit Plan the Person is enrolled in.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: PayerPlanPeriod.plan_concept_id
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: code
    l: code

id:
  v: PayerPlanPeriod.plan-source-value
path:
  v: PayerPlanPeriod.plan_source_value
short:
  v: Plan Source Value
definition:
  v: This is the health benefit Plan of the Person as it appears in the source data.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: PayerPlanPeriod.plan_source_value
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
    l: string

id:
  v: PayerPlanPeriod.plan-source-concept-id
path:
  v: PayerPlanPeriod.plan_source_concept_id
short:
  v: Plan Source
definition:
  v: Plan Source
min:
  v: 0
max:
  v: 1
base:
  path:
    v: PayerPlanPeriod.plan_source_concept_id
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: code
    l: code

id:
  v: PayerPlanPeriod.sponsor-concept-id
path:
  v: PayerPlanPeriod.sponsor_concept_id
short:
  v: Sponsor
definition:
  v: This field represents the sponsor of the Plan who finances the Plan. This includes self-insured, small group health plan and large group health plan.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: PayerPlanPeriod.sponsor_concept_id
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: code
    l: code

id:
  v: PayerPlanPeriod.sponsor-source-value
path:
  v: PayerPlanPeriod.sponsor_source_value
short:
  v: Sponsor Source Value
definition:
  v: The Plan sponsor as it appears in the source data.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: PayerPlanPeriod.sponsor_source_value
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
    l: string

id:
  v: PayerPlanPeriod.sponsor-source-concept-id
path:
  v: PayerPlanPeriod.sponsor_source_concept_id
short:
  v: Sponsor Source
definition:
  v: Sponsor Source
min:
  v: 0
max:
  v: 1
base:
  path:
    v: PayerPlanPeriod.sponsor_source_concept_id
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: code
    l: code

id:
  v: PayerPlanPeriod.family-source-value
path:
  v: PayerPlanPeriod.family_source_value
short:
  v: Family Source Value
definition:
  v: The common identifier for all people (often a family) that covered by the same policy.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: PayerPlanPeriod.family_source_value
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
    l: string

id:
  v: PayerPlanPeriod.stop-reason-concept-id
path:
  v: PayerPlanPeriod.stop_reason_concept_id
short:
  v: Stop Reason
definition:
  v: This field represents the reason the Person left the Plan, if known.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: PayerPlanPeriod.stop_reason_concept_id
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: code
    l: code

id:
  v: PayerPlanPeriod.stop-reason-source-value
path:
  v: PayerPlanPeriod.stop_reason_source_value
short:
  v: Stop Reason Source Value
definition:
  v: The Plan stop reason as it appears in the source data.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: PayerPlanPeriod.stop_reason_source_value
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
    l: string

id:
  v: PayerPlanPeriod.stop-reason-source-concept-id
path:
  v: PayerPlanPeriod.stop_reason_source_concept_id
short:
  v: Stop Reason Source
definition:
  v: Stop Reason Source
min:
  v: 0
max:
  v: 1
base:
  path:
    v: PayerPlanPeriod.stop_reason_source_concept_id
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: code
    l: code

element:
  id:
    v: PayerPlanPeriod
  path:
    v: PayerPlanPeriod
  short:
    v: Payer Plan Period OMOP Table
  definition:
    v: The PAYER_PLAN_PERIOD table captures details of the period of time that a Person is continuously enrolled under a specific health Plan benefit structure from a given Payer. Each Person receiving healthcare is typically covered by a health benefit plan, which pays for (fully or partially), or directly provides, the care. These benefit plans are provided by payers, such as health insurances or state or government agencies. In each plan the details of the health benefits are defined for the Person or her family, and the health benefit Plan might change over time typically with increasing utilization (reaching certain cost thresholds such as deductibles), plan availability and purchasing choices of the Person. The unique combinations of Payer organizations, health benefit Plans and time periods in which they are valid for a Person are recorded in this table.
element:
  id:
    v: PayerPlanPeriod.payer-plan-period-id
  path:
    v: PayerPlanPeriod.payer_plan_period_id
  short:
    v: Payer Plan Period Identifier
  definition:
    v: Payer Plan Period Identifier
  min:
    v: 1
  max:
    v: 1
  type:
    code:
      v: code
      l: code
element:
  id:
    v: PayerPlanPeriod.person-id
  path:
    v: PayerPlanPeriod.person_id
  short:
    v: Person
  definition:
    v: The Person covered by the Plan.
  min:
    v: 1
  max:
    v: 1
  type:
    code:
      v: integer
      l: integer
element:
  id:
    v: PayerPlanPeriod.payer-plan-period-start-date
  path:
    v: PayerPlanPeriod.payer_plan_period_start_date
  short:
    v: Payer Plan Period Start Date
  definition:
    v: Start date of Plan coverage.
  min:
    v: 1
  max:
    v: 1
  type:
    code:
      v: date
      l: date
element:
  id:
    v: PayerPlanPeriod.payer-plan-period-end-date
  path:
    v: PayerPlanPeriod.payer_plan_period_end_date
  short:
    v: Payer Plan Period End Date
  definition:
    v: End date of Plan coverage.
  min:
    v: 1
  max:
    v: 1
  type:
    code:
      v: date
      l: date
element:
  id:
    v: PayerPlanPeriod.payer-concept-id
  path:
    v: PayerPlanPeriod.payer_concept_id
  short:
    v: Payer
  definition:
    v: This field represents the organization who reimburses the provider which administers care to the Person.
  min:
    v: 0
  max:
    v: 1
  type:
    code:
      v: code
      l: code
element:
  id:
    v: PayerPlanPeriod.payer-source-value
  path:
    v: PayerPlanPeriod.payer_source_value
  short:
    v: Payer Source Value
  definition:
    v: This is the Payer as it appears in the source data.
  min:
    v: 0
  max:
    v: 1
  type:
    code:
      v: string
      l: string
element:
  id:
    v: PayerPlanPeriod.payer-source-concept-id
  path:
    v: PayerPlanPeriod.payer_source_concept_id
  short:
    v: Payer Source
  definition:
    v: Payer Source
  min:
    v: 0
  max:
    v: 1
  type:
    code:
      v: code
      l: code
element:
  id:
    v: PayerPlanPeriod.plan-concept-id
  path:
    v: PayerPlanPeriod.plan_concept_id
  short:
    v: Plan
  definition:
    v: This field represents the specific health benefit Plan the Person is enrolled in.
  min:
    v: 0
  max:
    v: 1
  type:
    code:
      v: code
      l: code
element:
  id:
    v: PayerPlanPeriod.plan-source-value
  path:
    v: PayerPlanPeriod.plan_source_value
  short:
    v: Plan Source Value
  definition:
    v: This is the health benefit Plan of the Person as it appears in the source data.
  min:
    v: 0
  max:
    v: 1
  type:
    code:
      v: string
      l: string
element:
  id:
    v: PayerPlanPeriod.plan-source-concept-id
  path:
    v: PayerPlanPeriod.plan_source_concept_id
  short:
    v: Plan Source
  definition:
    v: Plan Source
  min:
    v: 0
  max:
    v: 1
  type:
    code:
      v: code
      l: code
element:
  id:
    v: PayerPlanPeriod.sponsor-concept-id
  path:
    v: PayerPlanPeriod.sponsor_concept_id
  short:
    v: Sponsor
  definition:
    v: This field represents the sponsor of the Plan who finances the Plan. This includes self-insured, small group health plan and large group health plan.
  min:
    v: 0
  max:
    v: 1
  type:
    code:
      v: code
      l: code
element:
  id:
    v: PayerPlanPeriod.sponsor-source-value
  path:
    v: PayerPlanPeriod.sponsor_source_value

v: Sponsor Source Value

v: The Plan sponsor as it appears in the source data.

v: 0

v: 1

code:
  v: string
  l: string

id:
  v: PayerPlanPeriod.sponsor-source-concept-id
path:
  v: PayerPlanPeriod.sponsor_source_concept_id
short:
  v: Sponsor Source
definition:
  v: Sponsor Source
min:
  v: 0
max:
  v: 1
type:
  code:
    v: code
    l: code

id:
  v: PayerPlanPeriod.family-source-value
path:
  v: PayerPlanPeriod.family_source_value
short:
  v: Family Source Value
definition:
  v: The common identifier for all people (often a family) that covered by the same policy.
min:
  v: 0
max:
  v: 1
type:
  code:
    v: string
    l: string

id:
  v: PayerPlanPeriod.stop-reason-concept-id
path:
  v: PayerPlanPeriod.stop_reason_concept_id
short:
  v: Stop Reason
definition:
  v: This field represents the reason the Person left the Plan, if known.
min:
  v: 0
max:
  v: 1
type:
  code:
    v: code
    l: code

id:
  v: PayerPlanPeriod.stop-reason-source-value
path:
  v: PayerPlanPeriod.stop_reason_source_value
short:
  v: Stop Reason Source Value
definition:
  v: The Plan stop reason as it appears in the source data.
min:
  v: 0
max:
  v: 1
type:
  code:
    v: string
    l: string

id:
  v: PayerPlanPeriod.stop-reason-source-concept-id
path:
  v: PayerPlanPeriod.stop_reason_source_concept_id
short:
  v: Stop Reason Source
definition:
  v: Stop Reason Source
min:
  v: 0
max:
  v: 1
type:
  code:
    v: code
    l: code