This is the Continuous Integration Build of FHIR (will be incorrect/inconsistent at times).
See the Directory of published versions
Patient Administration Work Group | Maturity Level: 1 | Trial Use | Security Category: Business | Compartments: No defined compartments |
InsurancePlan describes the costs to the subscriber or beneficiary associated with benefits, as well as additional information about the offering, such as who administers the plan, a coverage area, contact information, etc. The specific benefits covered by the plan are described in the InsuranceProduct
referenced in InsurancePlan.product
.
Insurance offerings will be fully described by the combination of both InsurancePlan (the costs) and InsuranceProduct (the benefits). However, some systems may only need to represent the InsurancePlan, so that Coverage resources can describe which plan is associated with a given beneficiary. In that case, there will be some other system that is responsible for tracking the benefits associated with the plan.
An InsurancePlan pairs the health insurance coverage benefits under an InsuranceProduct with the particular cost sharing structure offered to a consumer. A given InsuranceProduct may comprise multiple InsurancePlans.
InsuranceProduct describes a list of covered benefits and networks as well as details about who administers the product and applicable coverage areas.
InsurancePlan describes the costs to the subscriber or beneficiary associated with benefits, as well as additional information about the offering, such as who administers the plan, a coverage area, contact information, etc. The specific benefits covered by the plan are described in the InsuranceProduct referenced in InsurancePlan.product.
A Coverage resource establishes the link between an InsurancePlan and a beneficiary and optionally a subscriber.
Additional definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions, the spreadsheet version & the dependency analysis
Path | ValueSet | Type | Documentation |
---|---|---|---|
InsurancePlan.specificCost.benefit.cost.applicability | BenefitCostApplicability | Required | Whether the cost applies to in-network or out-of-network providers. |
Search parameters for this resource. See also the full list of search parameters for this resource, and check the Extensions registry for search parameters on extensions related to this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.
Name | Type | Description | Expression | In Common |
coverage-area | reference | Location(s) insurance product is intended for/available to | InsurancePlan.coverageArea (Location) |
|
identifier | token | External identifiers for this item | InsurancePlan.identifier | |
network | reference | The product this plan is available to | InsurancePlan.network (Organization) |
|
product | reference | The product this plan is available to | InsurancePlan.product (InsuranceProduct) |
|
type | token | A code for the type of insurance plan | InsurancePlan.type |