National Directory of Healthcare Providers & Services (NDH) Implementation Guide, published by HL7 International / Patient Administration. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-us-ndh/ and changes regularly. See the Directory of published versions

• Content
• Detailed Descriptions
• Mappings
• Examples
• XML
• JSON
• TTL

Resource Profile: National Directory API InsurancePlan Profile

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.

Usage:

• Refer to this Resource Profile: National Directory API Organization Profile
• Examples for this Resource Profile: Medicare Advantage Plan and Medicare Advantage Plan
• CapabilityStatements using this Resource Profile: National Directory API Base Expanded Server Capability Statement, National Directory API Base Server Capability Statement, National Directory API Capability Statement and NDH Attestation Server Capability Statement

Formal Views of Profile Content

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

• Key Elements Table
• Differential Table
• Snapshot Table
• Statistics/References
• All

Name	Flags	Card.	Type	Description & Constraints
InsurancePlan	C	0..*	NdhInsurancePlan	Details of a Health Insurance product/plan provided by an organization dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management ipn-1: The organization SHALL at least have a name or an idendtifier, and possibly more than one network-or-NatlDirwork: 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.
meta	SΣ	0..1	Meta	Metadata about the resource ele-1: All FHIR elements must have a @value or children
lastUpdated	Σ	1..1	instant	When the resource version last changed ele-1: All FHIR elements must have a @value or children
profile	Σ	1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to ele-1: All FHIR elements must have a @value or children
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:usage-restriction		0..*	Reference(NDH Base Restriction) {c}	Usage Restriction URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-usage-restriction ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:verification-status	S	1..1	CodeableConcept	NDH Verification Status URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-verification-status Binding: NDH Verification Status Value Set (extensible) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
identifier	SΣC	0..*	Identifier	Business Identifier for Product ele-1: All FHIR elements must have a @value or children
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:identifier-status	S	1..1	code	NDH Identifier Status URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-identifier-status Binding: Identifier Status Value Set (required) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
use	?!SΣ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
type	SΣ	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. ele-1: All FHIR elements must have a @value or children
system	SΣ	0..1	uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/identifiers/patient
value	SΣ	0..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456
assigner	SΣ	0..1	Reference(National Directory API Organization Profile)	Organization that issued id (may be just text) ele-1: All FHIR elements must have a @value or children
status	?!SΣ	1..1	code	draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact. ele-1: All FHIR elements must have a @value or children Fixed Value: active
type	SΣ	1..1	CodeableConcept	Product Type Binding: Insurance Product Type (extensible) ele-1: All FHIR elements must have a @value or children
name	SΣC	0..1	string	Official name ele-1: All FHIR elements must have a @value or children
alias	S	0..*	string	Alternate names ele-1: All FHIR elements must have a @value or children
period	S	0..1	Period	When the product is available ele-1: All FHIR elements must have a @value or children
ownedBy	SΣ	1..1	Reference(National Directory API Organization Profile)	Plan issuer ele-1: All FHIR elements must have a @value or children
administeredBy	SΣ	1..1	Reference(National Directory API Organization Profile)	Product administrator ele-1: All FHIR elements must have a @value or children
coverageArea	SΣ	0..*	Reference(National Directory API Location Profile)	Where product applies ele-1: All FHIR elements must have a @value or children
contact	S	0..*	BackboneElement	Contact for the product ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
purpose	S	0..1	CodeableConcept	The type of contact Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party. ele-1: All FHIR elements must have a @value or children
name	S	0..1	HumanName	A name associated with the contact ele-1: All FHIR elements must have a @value or children
use	?!SΣ	0..1	code	usual | official | temp | nickname | anonymous | old | maiden Binding: NameUse (required): The use of a human name. ele-1: All FHIR elements must have a @value or children
text	SΣ	0..1	string	Text representation of the full name ele-1: All FHIR elements must have a @value or children
family	SΣ	0..1	string	Family name (often called 'Surname') ele-1: All FHIR elements must have a @value or children
given	SΣ	0..*	string	Given names (not always 'first'). Includes middle names ele-1: All FHIR elements must have a @value or children This repeating element order: Given Names appear in the correct order for presenting the name
prefix	SΣ	0..*	string	Parts that come before the name ele-1: All FHIR elements must have a @value or children This repeating element order: Prefixes appear in the correct order for presenting the name
suffix	SΣ	0..*	string	Parts that come after the name ele-1: All FHIR elements must have a @value or children This repeating element order: Suffixes appear in the correct order for presenting the name
period	SΣ	0..1	Period	Time period when name was/is in use ele-1: All FHIR elements must have a @value or children
telecom	S	0..*	ContactPoint	Contact details (telephone, email, etc.) for a contact ele-1: All FHIR elements must have a @value or children
Slices for extension				Content/Rules for all slices
extension:contactpoint-availabletime	S	0..*	(Complex)	NDH Contactpoint Availabletime URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-contactpoint-availabletime ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:via-intermediary	S	0..1	Reference(NDH Base PractitionerRole | NDH Base OrganizationAffiliation Profile | NDH Base Location Profile | NDH Base Organization Profile)	NDH Via Intermediary URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-via-intermediary ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
system	SΣC	0..1	code	phone | fax | email | pager | url | sms | other Binding: ContactPointSystem (required): Telecommunications form for contact point. ele-1: All FHIR elements must have a @value or children
value	SΣ	0..1	string	The actual contact point details ele-1: All FHIR elements must have a @value or children
use	?!SΣ	0..1	code	home | work | temp | old | mobile - purpose of this contact point Binding: ContactPointUse (required): Use of contact point. ele-1: All FHIR elements must have a @value or children
rank	SΣ	0..1	positiveInt	Specify preferred order of use (1 = highest) ele-1: All FHIR elements must have a @value or children
endpoint	S	0..*	Reference(National Directory API Endpoint Profile)	Technical endpoint ele-1: All FHIR elements must have a @value or children
network	S	0..*	Reference(National Directory API Network Profile)	What networks are Included ele-1: All FHIR elements must have a @value or children
coverage	S	0..*	BackboneElement	Coverage details ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
type	S	1..1	CodeableConcept	Type of coverage Binding: Insurance Coverage Type (extensible) ele-1: All FHIR elements must have a @value or children
network	S	0..*	Reference(National Directory API Network Profile)	What networks provide coverage ele-1: All FHIR elements must have a @value or children
benefit	S	1..*	BackboneElement	List of benefits ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
type	S	1..1	CodeableConcept	Type of benefit Binding: Benefit Type Value Set (extensible) ele-1: All FHIR elements must have a @value or children
requirement	S	0..1	string	Referral requirements ele-1: All FHIR elements must have a @value or children
limit	S	0..*	BackboneElement	Benefit limits ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
value	S	0..1	Quantity	Maximum value allowed ele-1: All FHIR elements must have a @value or children
code	S	0..1	CodeableConcept	Benefit limit details ele-1: All FHIR elements must have a @value or children
plan	S	0..*	BackboneElement	Cost sharing details for the plan ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
identifier	SΣ	0..*	Identifier	Business Identifier for Product ele-1: All FHIR elements must have a @value or children
Slices for extension				Content/Rules for all slices
extension:identifier-status	S	0..1	code	NDH Identifier Status URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-identifier-status Binding: Identifier Status Value Set (required) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
use	?!SΣ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
type	SΣ	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. ele-1: All FHIR elements must have a @value or children
system	SΣ	0..1	uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/identifiers/patient
value	SΣ	0..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456
period	SΣ	0..1	Period	Time period when id is/was valid for use ele-1: All FHIR elements must have a @value or children
assigner	SΣ	0..1	Reference(National Directory API Organization Profile)	Organization that issued id (may be just text) ele-1: All FHIR elements must have a @value or children
type	S	0..1	CodeableConcept	Categorization of the cost sharing for the plan Binding: Insuranceplan Plan Type (extensible) ele-1: All FHIR elements must have a @value or children
coverageArea	SΣ	0..*	Reference(National Directory API Location Profile)	Where product applies ele-1: All FHIR elements must have a @value or children
network	S	0..*	Reference(National Directory API Network Profile)	What networks provide coverage ele-1: All FHIR elements must have a @value or children
generalCost	S	0..*	BackboneElement	Overall costs ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
type	S	0..1	CodeableConcept	Type of cost ele-1: All FHIR elements must have a @value or children
groupSize	S	0..1	positiveInt	Number of enrollees ele-1: All FHIR elements must have a @value or children
cost	S	0..1	Money	Cost value ele-1: All FHIR elements must have a @value or children
comment	S	0..1	string	Additional cost information ele-1: All FHIR elements must have a @value or children
specificCost	S	0..*	BackboneElement	Specific costs ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
category	S	1..1	CodeableConcept	General category of benefit ele-1: All FHIR elements must have a @value or children
benefit	S	0..*	BackboneElement	Benefits list ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
type	S	1..1	CodeableConcept	Type of specific benefit ele-1: All FHIR elements must have a @value or children
cost	S	0..*	BackboneElement	List of the costs ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
type	S	1..1	CodeableConcept	Type of cost ele-1: All FHIR elements must have a @value or children
applicability	S	0..1	CodeableConcept	in-network | out-of-network | other Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers. ele-1: All FHIR elements must have a @value or children
qualifiers	S	0..*	CodeableConcept	Additional information about the cost ele-1: All FHIR elements must have a @value or children
value	S	0..1	Quantity	The actual cost value ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
InsurancePlan.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
InsurancePlan.identifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
InsurancePlan.status	required	Fixed Value: active http://hl7.org/fhir/ValueSet/publication-status|4.0.1 from the FHIR Standard
InsurancePlan.type	extensible	InsuranceProductType http://terminology.hl7.org/ValueSet/insurance-product-type
InsurancePlan.contact.purpose	extensible	ContactEntityType http://hl7.org/fhir/ValueSet/contactentity-type from the FHIR Standard
InsurancePlan.contact.name.use	required	NameUse http://hl7.org/fhir/ValueSet/name-use|4.0.1 from the FHIR Standard
InsurancePlan.contact.telecom.system	required	ContactPointSystem http://hl7.org/fhir/ValueSet/contact-point-system|4.0.1 from the FHIR Standard
InsurancePlan.contact.telecom.use	required	ContactPointUse http://hl7.org/fhir/ValueSet/contact-point-use|4.0.1 from the FHIR Standard
InsurancePlan.coverage.type	extensible	InsuranceCoverageType http://terminology.hl7.org/ValueSet/insurance-coverage-type
InsurancePlan.coverage.benefit.type	extensible	BenefitTypeVS http://hl7.org/fhir/us/ndh/ValueSet/BenefitTypeVS from this IG
InsurancePlan.plan.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
InsurancePlan.plan.identifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
InsurancePlan.plan.type	extensible	InsuranceplanPlanType http://terminology.hl7.org/ValueSet/insuranceplan-plan-type
InsurancePlan.plan.specificCost.benefit.cost.applicability	required	BenefitCostApplicability http://hl7.org/fhir/ValueSet/insuranceplan-applicability|4.0.1 from the FHIR Standard

This structure is derived from NdhInsurancePlan

Name	Flags	Card.	Type	Description & Constraints
InsurancePlan			NdhInsurancePlan
meta	S	0..1	Meta	Metadata about the resource
profile		1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to
extension		1..*	Extension	Extension
Slices for extension				Content/Rules for all slices
extension:verification-status	S	1..1	VerificationStatus	NDH Verification Status
identifier
extension		1..*	Extension	Extension
Slices for extension				Content/Rules for all slices
extension:identifier-status	S	1..1	IdentifierStatus	NDH Identifier Status
use	S	0..1	code	usual | official | temp | secondary | old (If known)
type	S	0..1	CodeableConcept	Description of identifier
system	S	0..1	uri	The namespace for the identifier value
value	S	0..1	string	The value that is unique
assigner	S	0..1	Reference(National Directory API Organization Profile)	Organization that issued id (may be just text)
alias	S	0..*	string	Alternate names
period	S	0..1	Period	When the product is available
ownedBy	S	1..1	Reference(National Directory API Organization Profile)	Plan issuer
administeredBy	S	1..1	Reference(National Directory API Organization Profile)	Product administrator
coverageArea		0..*	Reference(National Directory API Location Profile)	Where product applies
contact	S	0..*	BackboneElement	Contact for the product
purpose	S	0..1	CodeableConcept	The type of contact
name	S	0..1	HumanName	A name associated with the contact
use	S	0..1	code	usual | official | temp | nickname | anonymous | old | maiden
text	S	0..1	string	Text representation of the full name
family	S	0..1	string	Family name (often called 'Surname')
given	S	0..*	string	Given names (not always 'first'). Includes middle names
prefix	S	0..*	string	Parts that come before the name
suffix	S	0..*	string	Parts that come after the name
period	S	0..1	Period	Time period when name was/is in use
telecom	S	0..*	ContactPoint	Contact details (telephone, email, etc.) for a contact
Slices for extension				Content/Rules for all slices
extension:contactpoint-availabletime	S	0..*	ContactPointAvailableTime	NDH Contactpoint Availabletime
extension:via-intermediary	S	0..1	ViaIntermediary	NDH Via Intermediary
system	S	0..1	code	phone | fax | email | pager | url | sms | other
value	S	0..1	string	The actual contact point details
use	S	0..1	code	home | work | temp | old | mobile - purpose of this contact point
rank	S	0..1	positiveInt	Specify preferred order of use (1 = highest)
endpoint	S	0..*	Reference(National Directory API Endpoint Profile)	Technical endpoint
network		0..*	Reference(National Directory API Network Profile)	What networks are Included
coverage	S	0..*	BackboneElement	Coverage details
type	S	1..1	CodeableConcept	Type of coverage
network		0..*	Reference(National Directory API Network Profile)	What networks provide coverage
benefit	S	1..*	BackboneElement	List of benefits
type	S	1..1	CodeableConcept	Type of benefit
requirement	S	0..1	string	Referral requirements
limit	S	0..*	BackboneElement	Benefit limits
value	S	0..1	Quantity	Maximum value allowed
code	S	0..1	CodeableConcept	Benefit limit details
plan	S	0..*	BackboneElement	Cost sharing details for the plan
identifier	S	0..*	Identifier	Business Identifier for Product
Slices for extension				Content/Rules for all slices
extension:identifier-status	S	0..1	IdentifierStatus	NDH Identifier Status
use	S	0..1	code	usual | official | temp | secondary | old (If known)
type	S	0..1	CodeableConcept	Description of identifier
system	S	0..1	uri	The namespace for the identifier value
value	S	0..1	string	The value that is unique
period	S	0..1	Period	Time period when id is/was valid for use
assigner	S	0..1	Reference(National Directory API Organization Profile)	Organization that issued id (may be just text)
type	S	0..1	CodeableConcept	Categorization of the cost sharing for the plan
coverageArea	S	0..*	Reference(National Directory API Location Profile)	Where product applies
network	S	0..*	Reference(National Directory API Network Profile)	What networks provide coverage
generalCost	S	0..*	BackboneElement	Overall costs
type	S	0..1	CodeableConcept	Type of cost
groupSize	S	0..1	positiveInt	Number of enrollees
cost	S	0..1	Money	Cost value
comment	S	0..1	string	Additional cost information
specificCost	S	0..*	BackboneElement	Specific costs
category	S	1..1	CodeableConcept	General category of benefit
benefit	S	0..*	BackboneElement	Benefits list
type	S	1..1	CodeableConcept	Type of specific benefit
cost	S	0..*	BackboneElement	List of the costs
type	S	1..1	CodeableConcept	Type of cost
applicability	S	0..1	CodeableConcept	in-network | out-of-network | other
qualifiers	S	0..*	CodeableConcept	Additional information about the cost
value	S	0..1	Quantity	The actual cost value
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
InsurancePlan	C	0..*	NdhInsurancePlan	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-NatlDirwork: 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	id	Logical id of this artifact
meta	SΣ	0..1	Meta	Metadata about the resource
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	Σ	1..1	instant	When the resource version last changed
source	Σ	0..1	uri	Identifies where the resource comes from
profile	Σ	1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:usage-restriction		0..*	Reference(NDH Base Restriction) {c}	Usage Restriction URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-usage-restriction
extension:verification-status	S	1..1	CodeableConcept	NDH Verification Status URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-verification-status Binding: NDH Verification Status Value Set (extensible)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣC	0..*	Identifier	Business Identifier for Product
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:identifier-status	S	1..1	code	NDH Identifier Status URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-identifier-status Binding: Identifier Status Value Set (required)
use	?!SΣ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	SΣ	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.
system	SΣ	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
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	SΣ	0..1	Reference(National Directory API Organization Profile)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact. Fixed Value: active
type	SΣ	1..1	CodeableConcept	Product Type Binding: Insurance Product Type (extensible)
name	SΣC	0..1	string	Official name
alias	S	0..*	string	Alternate names
period	S	0..1	Period	When the product is available
ownedBy	SΣ	1..1	Reference(National Directory API Organization Profile)	Plan issuer
administeredBy	SΣ	1..1	Reference(National Directory API Organization Profile)	Product administrator
coverageArea	SΣ	0..*	Reference(National Directory API Location Profile)	Where product applies
contact	S	0..*	BackboneElement	Contact for the product
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
purpose	S	0..1	CodeableConcept	The type of contact Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party.
name	S	0..1	HumanName	A name associated with the contact
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!SΣ	0..1	code	usual | official | temp | nickname | anonymous | old | maiden Binding: NameUse (required): The use of a human name.
text	SΣ	0..1	string	Text representation of the full name
family	SΣ	0..1	string	Family name (often called 'Surname')
given	SΣ	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	SΣ	0..*	string	Parts that come before the name This repeating element order: Prefixes appear in the correct order for presenting the name
suffix	SΣ	0..*	string	Parts that come after the name This repeating element order: Suffixes appear in the correct order for presenting the name
period	SΣ	0..1	Period	Time period when name was/is in use
telecom	S	0..*	ContactPoint	Contact details (telephone, email, etc.) for a contact
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
extension:contactpoint-availabletime	S	0..*	(Complex)	NDH Contactpoint Availabletime URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-contactpoint-availabletime
extension:via-intermediary	S	0..1	Reference(NDH Base PractitionerRole | NDH Base OrganizationAffiliation Profile | NDH Base Location Profile | NDH Base Organization Profile)	NDH Via Intermediary URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-via-intermediary
system	SΣC	0..1	code	phone | fax | email | pager | url | sms | other Binding: ContactPointSystem (required): Telecommunications form for contact point.
value	SΣ	0..1	string	The actual contact point details
use	?!SΣ	0..1	code	home | work | temp | old | mobile - purpose of this contact point Binding: ContactPointUse (required): Use of contact point.
rank	SΣ	0..1	positiveInt	Specify preferred order of use (1 = highest)
period	Σ	0..1	Period	Time period when the contact point was/is in use
address		0..1	Address	Visiting or postal addresses for the contact
endpoint	S	0..*	Reference(National Directory API Endpoint Profile)	Technical endpoint
network	S	0..*	Reference(National Directory API Network Profile)	What networks are Included
coverage	S	0..*	BackboneElement	Coverage details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	S	1..1	CodeableConcept	Type of coverage Binding: Insurance Coverage Type (extensible)
network	S	0..*	Reference(National Directory API Network Profile)	What networks provide coverage
benefit	S	1..*	BackboneElement	List of benefits
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	S	1..1	CodeableConcept	Type of benefit Binding: Benefit Type Value Set (extensible)
requirement	S	0..1	string	Referral requirements
limit	S	0..*	BackboneElement	Benefit limits
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
value	S	0..1	Quantity	Maximum value allowed
code	S	0..1	CodeableConcept	Benefit limit details
plan	S	0..*	BackboneElement	Cost sharing details for the plan
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
identifier	SΣ	0..*	Identifier	Business Identifier for Product
id		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
extension:identifier-status	S	0..1	code	NDH Identifier Status URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-identifier-status Binding: Identifier Status Value Set (required)
use	?!SΣ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	SΣ	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.
system	SΣ	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
period	SΣ	0..1	Period	Time period when id is/was valid for use
assigner	SΣ	0..1	Reference(National Directory API Organization Profile)	Organization that issued id (may be just text)
type	S	0..1	CodeableConcept	Categorization of the cost sharing for the plan Binding: Insuranceplan Plan Type (extensible)
coverageArea	SΣ	0..*	Reference(National Directory API Location Profile)	Where product applies
network	S	0..*	Reference(National Directory API Network Profile)	What networks provide coverage
generalCost	S	0..*	BackboneElement	Overall costs
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	S	0..1	CodeableConcept	Type of cost
groupSize	S	0..1	positiveInt	Number of enrollees
cost	S	0..1	Money	Cost value
comment	S	0..1	string	Additional cost information
specificCost	S	0..*	BackboneElement	Specific costs
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category	S	1..1	CodeableConcept	General category of benefit
benefit	S	0..*	BackboneElement	Benefits list
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	S	1..1	CodeableConcept	Type of specific benefit
cost	S	0..*	BackboneElement	List of the costs
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	S	1..1	CodeableConcept	Type of cost
applicability	S	0..1	CodeableConcept	in-network | out-of-network | other Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.
qualifiers	S	0..*	CodeableConcept	Additional information about the cost
value	S	0..1	Quantity	The actual cost value
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
InsurancePlan.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
InsurancePlan.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
InsurancePlan.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
InsurancePlan.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
InsurancePlan.identifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
InsurancePlan.status	required	Fixed Value: active http://hl7.org/fhir/ValueSet/publication-status|4.0.1 from the FHIR Standard
InsurancePlan.type	extensible	InsuranceProductType http://terminology.hl7.org/ValueSet/insurance-product-type
InsurancePlan.contact.purpose	extensible	ContactEntityType http://hl7.org/fhir/ValueSet/contactentity-type from the FHIR Standard
InsurancePlan.contact.name.use	required	NameUse http://hl7.org/fhir/ValueSet/name-use|4.0.1 from the FHIR Standard
InsurancePlan.contact.telecom.system	required	ContactPointSystem http://hl7.org/fhir/ValueSet/contact-point-system|4.0.1 from the FHIR Standard
InsurancePlan.contact.telecom.use	required	ContactPointUse http://hl7.org/fhir/ValueSet/contact-point-use|4.0.1 from the FHIR Standard
InsurancePlan.coverage.type	extensible	InsuranceCoverageType http://terminology.hl7.org/ValueSet/insurance-coverage-type
InsurancePlan.coverage.benefit.type	extensible	BenefitTypeVS http://hl7.org/fhir/us/ndh/ValueSet/BenefitTypeVS from this IG
InsurancePlan.plan.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
InsurancePlan.plan.identifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
InsurancePlan.plan.type	extensible	InsuranceplanPlanType http://terminology.hl7.org/ValueSet/insuranceplan-plan-type
InsurancePlan.plan.specificCost.benefit.cost.applicability	required	BenefitCostApplicability http://hl7.org/fhir/ValueSet/insuranceplan-applicability|4.0.1 from the FHIR Standard

This structure is derived from NdhInsurancePlan

Summary

Mandatory: 4 elements(3 nested mandatory elements)
Must-Support: 64 elements

Structures

This structure refers to these other structures:

• National Directory API Organization Profile (http://hl7.org/fhir/us/ndh/StructureDefinition/ndh-ndapi-Organization)
• National Directory API Location Profile (http://hl7.org/fhir/us/ndh/StructureDefinition/ndh-ndapi-Location)
• National Directory API Endpoint Profile (http://hl7.org/fhir/us/ndh/StructureDefinition/ndh-ndapi-Endpoint)
• National Directory API Network Profile (http://hl7.org/fhir/us/ndh/StructureDefinition/ndh-ndapi-Network)

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
InsurancePlan	C	0..*	NdhInsurancePlan	Details of a Health Insurance product/plan provided by an organization dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management ipn-1: The organization SHALL at least have a name or an idendtifier, and possibly more than one network-or-NatlDirwork: 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.
meta	SΣ	0..1	Meta	Metadata about the resource ele-1: All FHIR elements must have a @value or children
lastUpdated	Σ	1..1	instant	When the resource version last changed ele-1: All FHIR elements must have a @value or children
profile	Σ	1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to ele-1: All FHIR elements must have a @value or children
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:usage-restriction		0..*	Reference(NDH Base Restriction) {c}	Usage Restriction URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-usage-restriction ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:verification-status	S	1..1	CodeableConcept	NDH Verification Status URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-verification-status Binding: NDH Verification Status Value Set (extensible) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
identifier	SΣC	0..*	Identifier	Business Identifier for Product ele-1: All FHIR elements must have a @value or children
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:identifier-status	S	1..1	code	NDH Identifier Status URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-identifier-status Binding: Identifier Status Value Set (required) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
use	?!SΣ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
type	SΣ	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. ele-1: All FHIR elements must have a @value or children
system	SΣ	0..1	uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/identifiers/patient
value	SΣ	0..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456
assigner	SΣ	0..1	Reference(National Directory API Organization Profile)	Organization that issued id (may be just text) ele-1: All FHIR elements must have a @value or children
status	?!SΣ	1..1	code	draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact. ele-1: All FHIR elements must have a @value or children Fixed Value: active
type	SΣ	1..1	CodeableConcept	Product Type Binding: Insurance Product Type (extensible) ele-1: All FHIR elements must have a @value or children
name	SΣC	0..1	string	Official name ele-1: All FHIR elements must have a @value or children
alias	S	0..*	string	Alternate names ele-1: All FHIR elements must have a @value or children
period	S	0..1	Period	When the product is available ele-1: All FHIR elements must have a @value or children
ownedBy	SΣ	1..1	Reference(National Directory API Organization Profile)	Plan issuer ele-1: All FHIR elements must have a @value or children
administeredBy	SΣ	1..1	Reference(National Directory API Organization Profile)	Product administrator ele-1: All FHIR elements must have a @value or children
coverageArea	SΣ	0..*	Reference(National Directory API Location Profile)	Where product applies ele-1: All FHIR elements must have a @value or children
contact	S	0..*	BackboneElement	Contact for the product ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
purpose	S	0..1	CodeableConcept	The type of contact Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party. ele-1: All FHIR elements must have a @value or children
name	S	0..1	HumanName	A name associated with the contact ele-1: All FHIR elements must have a @value or children
use	?!SΣ	0..1	code	usual | official | temp | nickname | anonymous | old | maiden Binding: NameUse (required): The use of a human name. ele-1: All FHIR elements must have a @value or children
text	SΣ	0..1	string	Text representation of the full name ele-1: All FHIR elements must have a @value or children
family	SΣ	0..1	string	Family name (often called 'Surname') ele-1: All FHIR elements must have a @value or children
given	SΣ	0..*	string	Given names (not always 'first'). Includes middle names ele-1: All FHIR elements must have a @value or children This repeating element order: Given Names appear in the correct order for presenting the name
prefix	SΣ	0..*	string	Parts that come before the name ele-1: All FHIR elements must have a @value or children This repeating element order: Prefixes appear in the correct order for presenting the name
suffix	SΣ	0..*	string	Parts that come after the name ele-1: All FHIR elements must have a @value or children This repeating element order: Suffixes appear in the correct order for presenting the name
period	SΣ	0..1	Period	Time period when name was/is in use ele-1: All FHIR elements must have a @value or children
telecom	S	0..*	ContactPoint	Contact details (telephone, email, etc.) for a contact ele-1: All FHIR elements must have a @value or children
Slices for extension				Content/Rules for all slices
extension:contactpoint-availabletime	S	0..*	(Complex)	NDH Contactpoint Availabletime URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-contactpoint-availabletime ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:via-intermediary	S	0..1	Reference(NDH Base PractitionerRole | NDH Base OrganizationAffiliation Profile | NDH Base Location Profile | NDH Base Organization Profile)	NDH Via Intermediary URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-via-intermediary ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
system	SΣC	0..1	code	phone | fax | email | pager | url | sms | other Binding: ContactPointSystem (required): Telecommunications form for contact point. ele-1: All FHIR elements must have a @value or children
value	SΣ	0..1	string	The actual contact point details ele-1: All FHIR elements must have a @value or children
use	?!SΣ	0..1	code	home | work | temp | old | mobile - purpose of this contact point Binding: ContactPointUse (required): Use of contact point. ele-1: All FHIR elements must have a @value or children
rank	SΣ	0..1	positiveInt	Specify preferred order of use (1 = highest) ele-1: All FHIR elements must have a @value or children
endpoint	S	0..*	Reference(National Directory API Endpoint Profile)	Technical endpoint ele-1: All FHIR elements must have a @value or children
network	S	0..*	Reference(National Directory API Network Profile)	What networks are Included ele-1: All FHIR elements must have a @value or children
coverage	S	0..*	BackboneElement	Coverage details ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
type	S	1..1	CodeableConcept	Type of coverage Binding: Insurance Coverage Type (extensible) ele-1: All FHIR elements must have a @value or children
network	S	0..*	Reference(National Directory API Network Profile)	What networks provide coverage ele-1: All FHIR elements must have a @value or children
benefit	S	1..*	BackboneElement	List of benefits ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
type	S	1..1	CodeableConcept	Type of benefit Binding: Benefit Type Value Set (extensible) ele-1: All FHIR elements must have a @value or children
requirement	S	0..1	string	Referral requirements ele-1: All FHIR elements must have a @value or children
limit	S	0..*	BackboneElement	Benefit limits ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
value	S	0..1	Quantity	Maximum value allowed ele-1: All FHIR elements must have a @value or children
code	S	0..1	CodeableConcept	Benefit limit details ele-1: All FHIR elements must have a @value or children
plan	S	0..*	BackboneElement	Cost sharing details for the plan ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
identifier	SΣ	0..*	Identifier	Business Identifier for Product ele-1: All FHIR elements must have a @value or children
Slices for extension				Content/Rules for all slices
extension:identifier-status	S	0..1	code	NDH Identifier Status URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-identifier-status Binding: Identifier Status Value Set (required) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
use	?!SΣ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
type	SΣ	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. ele-1: All FHIR elements must have a @value or children
system	SΣ	0..1	uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/identifiers/patient
value	SΣ	0..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456
period	SΣ	0..1	Period	Time period when id is/was valid for use ele-1: All FHIR elements must have a @value or children
assigner	SΣ	0..1	Reference(National Directory API Organization Profile)	Organization that issued id (may be just text) ele-1: All FHIR elements must have a @value or children
type	S	0..1	CodeableConcept	Categorization of the cost sharing for the plan Binding: Insuranceplan Plan Type (extensible) ele-1: All FHIR elements must have a @value or children
coverageArea	SΣ	0..*	Reference(National Directory API Location Profile)	Where product applies ele-1: All FHIR elements must have a @value or children
network	S	0..*	Reference(National Directory API Network Profile)	What networks provide coverage ele-1: All FHIR elements must have a @value or children
generalCost	S	0..*	BackboneElement	Overall costs ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
type	S	0..1	CodeableConcept	Type of cost ele-1: All FHIR elements must have a @value or children
groupSize	S	0..1	positiveInt	Number of enrollees ele-1: All FHIR elements must have a @value or children
cost	S	0..1	Money	Cost value ele-1: All FHIR elements must have a @value or children
comment	S	0..1	string	Additional cost information ele-1: All FHIR elements must have a @value or children
specificCost	S	0..*	BackboneElement	Specific costs ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
category	S	1..1	CodeableConcept	General category of benefit ele-1: All FHIR elements must have a @value or children
benefit	S	0..*	BackboneElement	Benefits list ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
type	S	1..1	CodeableConcept	Type of specific benefit ele-1: All FHIR elements must have a @value or children
cost	S	0..*	BackboneElement	List of the costs ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
type	S	1..1	CodeableConcept	Type of cost ele-1: All FHIR elements must have a @value or children
applicability	S	0..1	CodeableConcept	in-network | out-of-network | other Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers. ele-1: All FHIR elements must have a @value or children
qualifiers	S	0..*	CodeableConcept	Additional information about the cost ele-1: All FHIR elements must have a @value or children
value	S	0..1	Quantity	The actual cost value ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
InsurancePlan.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
InsurancePlan.identifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
InsurancePlan.status	required	Fixed Value: active http://hl7.org/fhir/ValueSet/publication-status|4.0.1 from the FHIR Standard
InsurancePlan.type	extensible	InsuranceProductType http://terminology.hl7.org/ValueSet/insurance-product-type
InsurancePlan.contact.purpose	extensible	ContactEntityType http://hl7.org/fhir/ValueSet/contactentity-type from the FHIR Standard
InsurancePlan.contact.name.use	required	NameUse http://hl7.org/fhir/ValueSet/name-use|4.0.1 from the FHIR Standard
InsurancePlan.contact.telecom.system	required	ContactPointSystem http://hl7.org/fhir/ValueSet/contact-point-system|4.0.1 from the FHIR Standard
InsurancePlan.contact.telecom.use	required	ContactPointUse http://hl7.org/fhir/ValueSet/contact-point-use|4.0.1 from the FHIR Standard
InsurancePlan.coverage.type	extensible	InsuranceCoverageType http://terminology.hl7.org/ValueSet/insurance-coverage-type
InsurancePlan.coverage.benefit.type	extensible	BenefitTypeVS http://hl7.org/fhir/us/ndh/ValueSet/BenefitTypeVS from this IG
InsurancePlan.plan.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
InsurancePlan.plan.identifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
InsurancePlan.plan.type	extensible	InsuranceplanPlanType http://terminology.hl7.org/ValueSet/insuranceplan-plan-type
InsurancePlan.plan.specificCost.benefit.cost.applicability	required	BenefitCostApplicability http://hl7.org/fhir/ValueSet/insuranceplan-applicability|4.0.1 from the FHIR Standard

Differential View

This structure is derived from NdhInsurancePlan

Name	Flags	Card.	Type	Description & Constraints
InsurancePlan			NdhInsurancePlan
meta	S	0..1	Meta	Metadata about the resource
profile		1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to
extension		1..*	Extension	Extension
Slices for extension				Content/Rules for all slices
extension:verification-status	S	1..1	VerificationStatus	NDH Verification Status
identifier
extension		1..*	Extension	Extension
Slices for extension				Content/Rules for all slices
extension:identifier-status	S	1..1	IdentifierStatus	NDH Identifier Status
use	S	0..1	code	usual | official | temp | secondary | old (If known)
type	S	0..1	CodeableConcept	Description of identifier
system	S	0..1	uri	The namespace for the identifier value
value	S	0..1	string	The value that is unique
assigner	S	0..1	Reference(National Directory API Organization Profile)	Organization that issued id (may be just text)
alias	S	0..*	string	Alternate names
period	S	0..1	Period	When the product is available
ownedBy	S	1..1	Reference(National Directory API Organization Profile)	Plan issuer
administeredBy	S	1..1	Reference(National Directory API Organization Profile)	Product administrator
coverageArea		0..*	Reference(National Directory API Location Profile)	Where product applies
contact	S	0..*	BackboneElement	Contact for the product
purpose	S	0..1	CodeableConcept	The type of contact
name	S	0..1	HumanName	A name associated with the contact
use	S	0..1	code	usual | official | temp | nickname | anonymous | old | maiden
text	S	0..1	string	Text representation of the full name
family	S	0..1	string	Family name (often called 'Surname')
given	S	0..*	string	Given names (not always 'first'). Includes middle names
prefix	S	0..*	string	Parts that come before the name
suffix	S	0..*	string	Parts that come after the name
period	S	0..1	Period	Time period when name was/is in use
telecom	S	0..*	ContactPoint	Contact details (telephone, email, etc.) for a contact
Slices for extension				Content/Rules for all slices
extension:contactpoint-availabletime	S	0..*	ContactPointAvailableTime	NDH Contactpoint Availabletime
extension:via-intermediary	S	0..1	ViaIntermediary	NDH Via Intermediary
system	S	0..1	code	phone | fax | email | pager | url | sms | other
value	S	0..1	string	The actual contact point details
use	S	0..1	code	home | work | temp | old | mobile - purpose of this contact point
rank	S	0..1	positiveInt	Specify preferred order of use (1 = highest)
endpoint	S	0..*	Reference(National Directory API Endpoint Profile)	Technical endpoint
network		0..*	Reference(National Directory API Network Profile)	What networks are Included
coverage	S	0..*	BackboneElement	Coverage details
type	S	1..1	CodeableConcept	Type of coverage
network		0..*	Reference(National Directory API Network Profile)	What networks provide coverage
benefit	S	1..*	BackboneElement	List of benefits
type	S	1..1	CodeableConcept	Type of benefit
requirement	S	0..1	string	Referral requirements
limit	S	0..*	BackboneElement	Benefit limits
value	S	0..1	Quantity	Maximum value allowed
code	S	0..1	CodeableConcept	Benefit limit details
plan	S	0..*	BackboneElement	Cost sharing details for the plan
identifier	S	0..*	Identifier	Business Identifier for Product
Slices for extension				Content/Rules for all slices
extension:identifier-status	S	0..1	IdentifierStatus	NDH Identifier Status
use	S	0..1	code	usual | official | temp | secondary | old (If known)
type	S	0..1	CodeableConcept	Description of identifier
system	S	0..1	uri	The namespace for the identifier value
value	S	0..1	string	The value that is unique
period	S	0..1	Period	Time period when id is/was valid for use
assigner	S	0..1	Reference(National Directory API Organization Profile)	Organization that issued id (may be just text)
type	S	0..1	CodeableConcept	Categorization of the cost sharing for the plan
coverageArea	S	0..*	Reference(National Directory API Location Profile)	Where product applies
network	S	0..*	Reference(National Directory API Network Profile)	What networks provide coverage
generalCost	S	0..*	BackboneElement	Overall costs
type	S	0..1	CodeableConcept	Type of cost
groupSize	S	0..1	positiveInt	Number of enrollees
cost	S	0..1	Money	Cost value
comment	S	0..1	string	Additional cost information
specificCost	S	0..*	BackboneElement	Specific costs
category	S	1..1	CodeableConcept	General category of benefit
benefit	S	0..*	BackboneElement	Benefits list
type	S	1..1	CodeableConcept	Type of specific benefit
cost	S	0..*	BackboneElement	List of the costs
type	S	1..1	CodeableConcept	Type of cost
applicability	S	0..1	CodeableConcept	in-network | out-of-network | other
qualifiers	S	0..*	CodeableConcept	Additional information about the cost
value	S	0..1	Quantity	The actual cost value
Documentation for this format

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
InsurancePlan	C	0..*	NdhInsurancePlan	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-NatlDirwork: 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	id	Logical id of this artifact
meta	SΣ	0..1	Meta	Metadata about the resource
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	Σ	1..1	instant	When the resource version last changed
source	Σ	0..1	uri	Identifies where the resource comes from
profile	Σ	1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:usage-restriction		0..*	Reference(NDH Base Restriction) {c}	Usage Restriction URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-usage-restriction
extension:verification-status	S	1..1	CodeableConcept	NDH Verification Status URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-verification-status Binding: NDH Verification Status Value Set (extensible)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣC	0..*	Identifier	Business Identifier for Product
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:identifier-status	S	1..1	code	NDH Identifier Status URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-identifier-status Binding: Identifier Status Value Set (required)
use	?!SΣ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	SΣ	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.
system	SΣ	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
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	SΣ	0..1	Reference(National Directory API Organization Profile)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact. Fixed Value: active
type	SΣ	1..1	CodeableConcept	Product Type Binding: Insurance Product Type (extensible)
name	SΣC	0..1	string	Official name
alias	S	0..*	string	Alternate names
period	S	0..1	Period	When the product is available
ownedBy	SΣ	1..1	Reference(National Directory API Organization Profile)	Plan issuer
administeredBy	SΣ	1..1	Reference(National Directory API Organization Profile)	Product administrator
coverageArea	SΣ	0..*	Reference(National Directory API Location Profile)	Where product applies
contact	S	0..*	BackboneElement	Contact for the product
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
purpose	S	0..1	CodeableConcept	The type of contact Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party.
name	S	0..1	HumanName	A name associated with the contact
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!SΣ	0..1	code	usual | official | temp | nickname | anonymous | old | maiden Binding: NameUse (required): The use of a human name.
text	SΣ	0..1	string	Text representation of the full name
family	SΣ	0..1	string	Family name (often called 'Surname')
given	SΣ	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	SΣ	0..*	string	Parts that come before the name This repeating element order: Prefixes appear in the correct order for presenting the name
suffix	SΣ	0..*	string	Parts that come after the name This repeating element order: Suffixes appear in the correct order for presenting the name
period	SΣ	0..1	Period	Time period when name was/is in use
telecom	S	0..*	ContactPoint	Contact details (telephone, email, etc.) for a contact
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
extension:contactpoint-availabletime	S	0..*	(Complex)	NDH Contactpoint Availabletime URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-contactpoint-availabletime
extension:via-intermediary	S	0..1	Reference(NDH Base PractitionerRole | NDH Base OrganizationAffiliation Profile | NDH Base Location Profile | NDH Base Organization Profile)	NDH Via Intermediary URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-via-intermediary
system	SΣC	0..1	code	phone | fax | email | pager | url | sms | other Binding: ContactPointSystem (required): Telecommunications form for contact point.
value	SΣ	0..1	string	The actual contact point details
use	?!SΣ	0..1	code	home | work | temp | old | mobile - purpose of this contact point Binding: ContactPointUse (required): Use of contact point.
rank	SΣ	0..1	positiveInt	Specify preferred order of use (1 = highest)
period	Σ	0..1	Period	Time period when the contact point was/is in use
address		0..1	Address	Visiting or postal addresses for the contact
endpoint	S	0..*	Reference(National Directory API Endpoint Profile)	Technical endpoint
network	S	0..*	Reference(National Directory API Network Profile)	What networks are Included
coverage	S	0..*	BackboneElement	Coverage details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	S	1..1	CodeableConcept	Type of coverage Binding: Insurance Coverage Type (extensible)
network	S	0..*	Reference(National Directory API Network Profile)	What networks provide coverage
benefit	S	1..*	BackboneElement	List of benefits
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	S	1..1	CodeableConcept	Type of benefit Binding: Benefit Type Value Set (extensible)
requirement	S	0..1	string	Referral requirements
limit	S	0..*	BackboneElement	Benefit limits
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
value	S	0..1	Quantity	Maximum value allowed
code	S	0..1	CodeableConcept	Benefit limit details
plan	S	0..*	BackboneElement	Cost sharing details for the plan
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
identifier	SΣ	0..*	Identifier	Business Identifier for Product
id		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
extension:identifier-status	S	0..1	code	NDH Identifier Status URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-identifier-status Binding: Identifier Status Value Set (required)
use	?!SΣ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	SΣ	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.
system	SΣ	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
period	SΣ	0..1	Period	Time period when id is/was valid for use
assigner	SΣ	0..1	Reference(National Directory API Organization Profile)	Organization that issued id (may be just text)
type	S	0..1	CodeableConcept	Categorization of the cost sharing for the plan Binding: Insuranceplan Plan Type (extensible)
coverageArea	SΣ	0..*	Reference(National Directory API Location Profile)	Where product applies
network	S	0..*	Reference(National Directory API Network Profile)	What networks provide coverage
generalCost	S	0..*	BackboneElement	Overall costs
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	S	0..1	CodeableConcept	Type of cost
groupSize	S	0..1	positiveInt	Number of enrollees
cost	S	0..1	Money	Cost value
comment	S	0..1	string	Additional cost information
specificCost	S	0..*	BackboneElement	Specific costs
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category	S	1..1	CodeableConcept	General category of benefit
benefit	S	0..*	BackboneElement	Benefits list
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	S	1..1	CodeableConcept	Type of specific benefit
cost	S	0..*	BackboneElement	List of the costs
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	S	1..1	CodeableConcept	Type of cost
applicability	S	0..1	CodeableConcept	in-network | out-of-network | other Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.
qualifiers	S	0..*	CodeableConcept	Additional information about the cost
value	S	0..1	Quantity	The actual cost value
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
InsurancePlan.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
InsurancePlan.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
InsurancePlan.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
InsurancePlan.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
InsurancePlan.identifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
InsurancePlan.status	required	Fixed Value: active http://hl7.org/fhir/ValueSet/publication-status|4.0.1 from the FHIR Standard
InsurancePlan.type	extensible	InsuranceProductType http://terminology.hl7.org/ValueSet/insurance-product-type
InsurancePlan.contact.purpose	extensible	ContactEntityType http://hl7.org/fhir/ValueSet/contactentity-type from the FHIR Standard
InsurancePlan.contact.name.use	required	NameUse http://hl7.org/fhir/ValueSet/name-use|4.0.1 from the FHIR Standard
InsurancePlan.contact.telecom.system	required	ContactPointSystem http://hl7.org/fhir/ValueSet/contact-point-system|4.0.1 from the FHIR Standard
InsurancePlan.contact.telecom.use	required	ContactPointUse http://hl7.org/fhir/ValueSet/contact-point-use|4.0.1 from the FHIR Standard
InsurancePlan.coverage.type	extensible	InsuranceCoverageType http://terminology.hl7.org/ValueSet/insurance-coverage-type
InsurancePlan.coverage.benefit.type	extensible	BenefitTypeVS http://hl7.org/fhir/us/ndh/ValueSet/BenefitTypeVS from this IG
InsurancePlan.plan.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
InsurancePlan.plan.identifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
InsurancePlan.plan.type	extensible	InsuranceplanPlanType http://terminology.hl7.org/ValueSet/insuranceplan-plan-type
InsurancePlan.plan.specificCost.benefit.cost.applicability	required	BenefitCostApplicability http://hl7.org/fhir/ValueSet/insuranceplan-applicability|4.0.1 from the FHIR Standard

This structure is derived from NdhInsurancePlan

Summary

Mandatory: 4 elements(3 nested mandatory elements)
Must-Support: 64 elements

Structures

This structure refers to these other structures:

• National Directory API Organization Profile (http://hl7.org/fhir/us/ndh/StructureDefinition/ndh-ndapi-Organization)
• National Directory API Location Profile (http://hl7.org/fhir/us/ndh/StructureDefinition/ndh-ndapi-Location)
• National Directory API Endpoint Profile (http://hl7.org/fhir/us/ndh/StructureDefinition/ndh-ndapi-Endpoint)
• National Directory API Network Profile (http://hl7.org/fhir/us/ndh/StructureDefinition/ndh-ndapi-Network)