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Patient Administration icon Work GroupMaturity Level: 1 Trial UseSecurity Category: Business Compartments: No defined compartments

Detailed Descriptions for the elements in the InsuranceProduct resource.

InsuranceProduct
Definition

Details of a Health Insurance product provided by an organization.

Short DisplayDetails of a Health Insurance product provided by an organization
Cardinality0..*
TypeDomainResource
Summaryfalse
Invariants
Defined on this element
ipn-1Rule The organization SHALL at least have a name or an identifier, and possibly more than one(identifier.count() + name.count()) > 0
InsuranceProduct.identifier
Definition

Business identifiers assigned to this health insurance product which remain constant as the resource is updated and propagates from server to server.

Short DisplayBusiness Identifier for Product
NoteThis is a business identifier, not a resource identifier (see discussion)
Cardinality0..*
TypeIdentifier
Summarytrue
Invariants
Affect this element
ipn-1Rule The organization SHALL at least have a name or an identifier, and possibly more than one(identifier.count() + name.count()) > 0
InsuranceProduct.status
Definition

The current state of the health insurance product.

Short Displaydraft | active | retired | unknown
Cardinality0..1
Terminology BindingPublicationStatus (Required)
Typecode
Is Modifiertrue (Reason: This element is labeled as a modifier because it is a status element that contains codes which means that the resource should not be treated as valid)
Meaning if MissingDefault interpretation is active.
Requirements

Need a flag to indicate a record is no longer to be used and should generally be hidden for the user in the UI.

Summarytrue
InsuranceProduct.type
Definition

The kind of health insurance product.

Short DisplayKind of product
Cardinality0..*
Terminology BindingInsurance Plan Type (Example)
TypeCodeableConcept
Summarytrue
InsuranceProduct.name
Definition

Official name of the health insurance product as designated by the owner.

Short DisplayOfficial name
Cardinality0..1
Typestring
Summarytrue
Comments

If the name of the product changes, consider putting the old name in the alias column so that it can still be located through searches.

Invariants
Affect this element
ipn-1Rule The organization SHALL at least have a name or an identifier, and possibly more than one(identifier.count() + name.count()) > 0
InsuranceProduct.alias
Definition

A list of alternate names that the product is known as, or was known as in the past.

Short DisplayAlternate names
Cardinality0..*
Typestring
Requirements

Over time products go through many changes and can be known by different names.

For searching knowing previous names that the product was known by can be very useful.

Summaryfalse
Comments

There are no dates associated with the alias/historic names, as this is not intended to track when names were used, but to assist in searching so that older names can still result in identifying the product.

InsuranceProduct.period
Definition

The period of time that the health insurance product is available.

Short DisplayWhen the product is available
Cardinality0..1
TypePeriod
Summaryfalse
InsuranceProduct.ownedBy
Definition

The entity that is providing the health insurance product and underwriting the risk. This is typically an insurance carriers, other third-party payers, or health plan sponsors comonly referred to as 'payers'.

Short DisplayProduct issuer
Cardinality0..1
TypeReference(Organization)
Alternate NamesPayer
Summarytrue
InsuranceProduct.administeredBy
Definition

An organization which administer other services such as underwriting, customer service and/or claims processing on behalf of the health insurance product owner.

Short DisplayProduct administrator
Cardinality0..1
TypeReference(Organization)
Summarytrue
InsuranceProduct.coverageArea
Definition

The geographic region in which a health insurance product's benefits apply.

Short DisplayWhere product applies
Cardinality0..*
TypeReference(Location)
Summarytrue
InsuranceProduct.contact
Definition

The contact details of communication devices available relevant to the specific Insurance Product. This can include addresses, phone numbers, fax numbers, mobile numbers, email addresses and web sites.

Short DisplayOfficial contact details relevant to the health insurance product
Cardinality0..*
TypeExtendedContactDetail
Requirements

Need to keep track of both simple contact details and also assigned contacts within larger organizations.

Summaryfalse
Comments

The address/telecom use code 'home' are not to be used.

InsuranceProduct.endpoint
Definition

The technical endpoints providing access to services operated for the health insurance product.

Short DisplayTechnical endpoint
Cardinality0..*
TypeReference(Endpoint)
Requirements

Organizations have multiple systems that provide various services and need to be able to define the technical connection details for how to connect to them, and for what purpose.

Summaryfalse
InsuranceProduct.network
Definition

Reference to the network included in the health insurance product.

Short DisplayWhat networks are Included
Cardinality0..*
TypeReference(Organization)
Summaryfalse
Comments

Networks are represented as a hierarchy of organization resources.

InsuranceProduct.coverage
Definition

Details about the coverage offered by the insurance product.

Short DisplayCoverage details
Cardinality0..*
Summaryfalse
InsuranceProduct.coverage.type
Definition

Type of coverage (Medical; Dental; Mental Health; Substance Abuse; Vision; Drug; Short Term; Long Term Care; Hospice; Home Health).

Short DisplayClassification of Coverage
Cardinality1..1
TypeCodeableConcept
Summaryfalse
InsuranceProduct.coverage.network
Definition

Reference to the network that providing the type of coverage.

Short DisplayWhat networks provide coverage
Cardinality0..*
TypeReference(Organization)
Summaryfalse
Comments

Networks are represented as a hierarchy of organization resources.

InsuranceProduct.coverage.benefit
Definition

Specific benefits under this type of coverage.

Short DisplayList of benefits
Cardinality1..*
Summaryfalse
InsuranceProduct.coverage.benefit.type
Definition

Type of benefit (primary care; specialty care; inpatient; outpatient).

Short DisplayClassification of benefit provided
Cardinality1..1
TypeCodeableConcept
Summaryfalse
InsuranceProduct.coverage.benefit.requirement
Definition

The referral requirements to have access/coverage for this benefit.

Short DisplayReferral requirements
Cardinality0..1
Typestring
Summaryfalse
InsuranceProduct.coverage.benefit.limit
Definition

The specific limits on the benefit.

Short DisplayLimits on the provided benefits
Cardinality0..*
Summaryfalse
InsuranceProduct.coverage.benefit.limit.value
Definition

The maximum amount of a service item a plan will pay for a covered benefit. For examples. wellness visits, or eyeglasses.

Short DisplayMaximum value allowed
Cardinality0..1
TypeQuantity
Summaryfalse
Comments

May also be called “eligible expense,” “payment allowance,” or “negotiated rate.”.

InsuranceProduct.coverage.benefit.limit.code
Definition

The specific limit on the benefit.

Short DisplayBenefit limit details
Cardinality0..1
TypeCodeableConcept
Summaryfalse
Comments

Use CodeableConcept.text element if the data is free (uncoded) text.

InsuranceProduct.related
Definition

Another product that is related to this product. Often used to create relationships to parents or families of products.

Short DisplayAssociated insurance product
Cardinality0..*
Summaryfalse
InsuranceProduct.related.product
Definition

The Related Product reference.

Short DisplayRelated Product reference
Cardinality0..1
TypeReference(InsuranceProduct)
Summaryfalse
InsuranceProduct.related.relationship
Definition

The relationship of this product to the related product. an example would be 'sub-plan' where this product is a sub-plan of the related.product.

Short DisplayRelationship of this product to the related product
Cardinality0..1
TypeCodeableConcept
Summaryfalse
Comments

Use CodeableConcept.text element if the data is free (uncoded) text.

InsuranceProduct.related.period
Definition

Period of time that the product relationship is valid. The start and/or end dates can be empty if this is an open ended relationship.

Short DisplayPeriod that this Relationship is valid
Cardinality0..1
TypePeriod
Summaryfalse