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8.36 Ресурс InsurancePlan - Назначение

Patient Administration Work GroupMaturity Level: 0 Trial UseSecurity Category: Business Compartments: Not linked to any defined compartments

Details of a Health Insurance product/plan provided by an organization.

A product 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 coverage benefits. A plan pairs the health insurance coverage benefits under a product with the particular cost sharing structure offered to a consumer. A given product may comprise multiple plans.

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.

TBD.

На этот ресурс ссылается UsageContext

Структура

ИмяФлагиКард.ТипОписание и ограниченияdoco
.. InsurancePlan ITUDomainResourceDetails of a Health Insurance product/plan provided by an organization
+ Rule: The organization SHALL at least have a name or an idendtifier, and possibly more than one
Элементы, определённые в прародителе: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier ΣI0..*IdentifierBusiness Identifier for Product
... status ?!Σ0..1codedraft | active | retired | unknown
PublicationStatus (Required)
... type Σ0..*CodeableConceptKind of product
Insurance plan type (Example)
... name ΣI0..1stringOfficial name
... alias 0..*stringAlternate names
... period 0..1PeriodWhen the product is available
... ownedBy Σ0..1Reference(Organization)Plan issuer
... administeredBy Σ0..1Reference(Organization)Product administrator
... coverageArea Σ0..*Reference(Location)Where product applies
... contact 0..*BackboneElementContact for the product
.... purpose 0..1CodeableConceptThe type of contact
Contact entity type (Extensible)
.... name 0..1HumanNameA name associated with the contact
.... telecom 0..*ContactPointContact details (telephone, email, etc.) for a contact
.... address 0..1AddressVisiting or postal addresses for the contact
... endpoint 0..*Reference(Endpoint)Technical endpoint
... network 0..*Reference(Organization)What networks are Included
... coverage 0..*BackboneElementCoverage details
.... type 1..1CodeableConceptType of coverage
.... network 0..*Reference(Organization)What networks provide coverage
.... benefit 1..*BackboneElementList of benefits
..... type 1..1CodeableConceptType of benefit
..... requirement 0..1stringReferral requirements
..... limit 0..*BackboneElementBenefit limits
...... value 0..1QuantityMaximum value allowed
...... code 0..1CodeableConceptBenefit limit details
... plan 0..*BackboneElementPlan details
.... identifier Σ0..*IdentifierBusiness Identifier for Product
.... type 0..1CodeableConceptType of plan
.... coverageArea Σ0..*Reference(Location)Where product applies
.... network 0..*Reference(Organization)What networks provide coverage
.... generalCost 0..*BackboneElementOverall costs
..... type 0..1CodeableConceptType of cost
..... groupSize 0..1positiveIntNumber of enrollees
..... cost 0..1MoneyCost value
..... comment 0..1stringAdditional cost information
.... specificCost 0..*BackboneElementSpecific costs
..... category 1..1CodeableConceptGeneral category of benefit
..... benefit 0..*BackboneElementBenefits list
...... type 1..1CodeableConceptType of specific benefit
...... cost 0..*BackboneElementList of the costs
....... type 1..1CodeableConceptType of cost
....... applicability 0..1CodeableConceptin-network | out-of-network | other
Benefit cost applicability (Required)
....... qualifiers 0..*CodeableConceptAdditional information about the cost
....... value 0..1QuantityThe actual cost value

doco Документация по этому формату

UML-диаграмма (Legend)

InsurancePlan (DomainResource)Business identifiers assigned to this health insurance product which remain constant as the resource is updated and propagates from server to serveridentifier : Identifier [0..*]The current state of the health insurance product (this element modifies the meaning of other elements)status : code [0..1] « The lifecycle status of an artifact. (Strength=Required)PublicationStatus! »The kind of health insurance producttype : CodeableConcept [0..*] « Used to categorize the product/plan. (Strength=Example)InsurancePlanType?? »Official name of the health insurance product as designated by the ownername : string [0..1]A list of alternate names that the product is known as, or was known as in the pastalias : string [0..*]The period of time that the health insurance product is availableperiod : Period [0..1]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'ownedBy : Reference [0..1] « Organization »An organization which administer other services such as underwriting, customer service and/or claims processing on behalf of the health insurance product owneradministeredBy : Reference [0..1] « Organization »The geographic region in which a health insurance product's benefits applycoverageArea : Reference [0..*] « Location »The technical endpoints providing access to services operated for the health insurance productendpoint : Reference [0..*] « Endpoint »Reference to the network included in the health insurance productnetwork : Reference [0..*] « Organization »ContactIndicates a purpose for which the contact can be reachedpurpose : CodeableConcept [0..1] « The purpose for which you would contact a contact party. (Strength=Extensible)ContactEntityType+ »A name associated with the contactname : HumanName [0..1]A contact detail (e.g. a telephone number or an email address) by which the party may be contactedtelecom : ContactPoint [0..*]Visiting or postal addresses for the contactaddress : Address [0..1]CoverageType of coverage (Medical; Dental; Mental Health; Substance Abuse; Vision; Drug; Short Term; Long Term Care; Hospice; Home Health)type : CodeableConcept [1..1]Reference to the network that providing the type of coveragenetwork : Reference [0..*] « Organization »CoverageBenefitType of benefit (primary care; speciality care; inpatient; outpatient)type : CodeableConcept [1..1]The referral requirements to have access/coverage for this benefitrequirement : string [0..1]LimitThe maximum amount of a service item a plan will pay for a covered benefit. For examples. wellness visits, or eyeglassesvalue : Quantity [0..1]The specific limit on the benefitcode : CodeableConcept [0..1]PlanBusiness identifiers assigned to this health insurance plan which remain constant as the resource is updated and propagates from server to serveridentifier : Identifier [0..*]Type of plan. For example, "Platinum" or "High Deductable"type : CodeableConcept [0..1]The geographic region in which a health insurance plan's benefits applycoverageArea : Reference [0..*] « Location »Reference to the network that providing the type of coveragenetwork : Reference [0..*] « Organization »GeneralCostType of costtype : CodeableConcept [0..1]Number of participants enrolled in the plangroupSize : positiveInt [0..1]Value of the costcost : Money [0..1]Additional information about the general costs associated with this plancomment : string [0..1]SpecificCostGeneral category of benefit (Medical; Dental; Vision; Drug; Mental Health; Substance Abuse; Hospice, Home Health)category : CodeableConcept [1..1]PlanBenefitType of specific benefit (preventative; primary care office visit; speciality office visit; hospitalization; emergency room; urgent care)type : CodeableConcept [1..1]CostType of cost (copay; individual cap; family cap; coinsurance; deductible)type : CodeableConcept [1..1]Whether the cost applies to in-network or out-of-network providers (in-network; out-of-network; other)applicability : CodeableConcept [0..1] « Whether the cost applies to in-network or out-of-network providers. (Strength=Required)BenefitCostApplicability! »Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA)qualifiers : CodeableConcept [0..*]The actual cost value. (some of the costs may be represented as percentages rather than currency, e.g. 10% coinsurance)value : Quantity [0..1]The contact for the health insurance product for a certain purposecontact[0..*]The specific limits on the benefitlimit[0..*]Specific benefits under this type of coveragebenefit[1..*]Details about the coverage offered by the insurance productcoverage[0..*]Overall costs associated with the plangeneralCost[0..*]List of the costs associated with a specific benefitcost[0..*]List of the specific benefits under this category of benefitbenefit[0..*]Costs associated with the coverage provided by the productspecificCost[0..*]Details about an insurance planplan[0..*]

XML-шаблон

<InsurancePlan xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- ?? 0..* Identifier Business Identifier for Product --></identifier>
 <status value="[code]"/><!-- 0..1 draft | active | retired | unknown -->
 <type><!-- 0..* CodeableConcept Kind of product --></type>
 <name value="[string]"/><!-- ?? 0..1 Official name -->
 <alias value="[string]"/><!-- 0..* Alternate names -->
 <period><!-- 0..1 Period When the product is available --></period>
 <ownedBy><!-- 0..1 Reference(Organization) Plan issuer --></ownedBy>
 <administeredBy><!-- 0..1 Reference(Organization) Product administrator --></administeredBy>
 <coverageArea><!-- 0..* Reference(Location) Where product applies --></coverageArea>
 <contact>  <!-- 0..* Contact for the product -->
  <purpose><!-- 0..1 CodeableConcept The type of contact --></purpose>
  <name><!-- 0..1 HumanName A name associated with the contact --></name>
  <telecom><!-- 0..* ContactPoint Contact details (telephone, email, etc.)  for a contact --></telecom>
  <address><!-- 0..1 Address Visiting or postal addresses for the contact --></address>
 </contact>
 <endpoint><!-- 0..* Reference(Endpoint) Technical endpoint --></endpoint>
 <network><!-- 0..* Reference(Organization) What networks are Included --></network>
 <coverage>  <!-- 0..* Coverage details -->
  <type><!-- 1..1 CodeableConcept Type of coverage --></type>
  <network><!-- 0..* Reference(Organization) What networks provide coverage --></network>
  <benefit>  <!-- 1..* List of benefits -->
   <type><!-- 1..1 CodeableConcept Type of benefit --></type>
   <requirement value="[string]"/><!-- 0..1 Referral requirements -->
   <limit>  <!-- 0..* Benefit limits -->
    <value><!-- 0..1 Quantity Maximum value allowed --></value>
    <code><!-- 0..1 CodeableConcept Benefit limit details --></code>
   </limit>
  </benefit>
 </coverage>
 <plan>  <!-- 0..* Plan details -->
  <identifier><!-- 0..* Identifier Business Identifier for Product --></identifier>
  <type><!-- 0..1 CodeableConcept Type of plan --></type>
  <coverageArea><!-- 0..* Reference(Location) Where product applies --></coverageArea>
  <network><!-- 0..* Reference(Organization) What networks provide coverage --></network>
  <generalCost>  <!-- 0..* Overall costs -->
   <type><!-- 0..1 CodeableConcept Type of cost --></type>
   <groupSize value="[positiveInt]"/><!-- 0..1 Number of enrollees -->
   <cost><!-- 0..1 Money Cost value --></cost>
   <comment value="[string]"/><!-- 0..1 Additional cost information -->
  </generalCost>
  <specificCost>  <!-- 0..* Specific costs -->
   <category><!-- 1..1 CodeableConcept General category of benefit --></category>
   <benefit>  <!-- 0..* Benefits list -->
    <type><!-- 1..1 CodeableConcept Type of specific benefit --></type>
    <cost>  <!-- 0..* List of the costs -->
     <type><!-- 1..1 CodeableConcept Type of cost --></type>
     <applicability><!-- 0..1 CodeableConcept in-network | out-of-network | other --></applicability>
     <qualifiers><!-- 0..* CodeableConcept Additional information about the cost --></qualifiers>
     <value><!-- 0..1 Quantity The actual cost value --></value>
    </cost>
   </benefit>
  </specificCost>
 </plan>
</InsurancePlan>

JSON-шаблон

{doco
  "resourceType" : "InsurancePlan",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // C? Business Identifier for Product
  "status" : "<code>", // draft | active | retired | unknown
  "type" : [{ CodeableConcept }], // Kind of product
  "name" : "<string>", // C? Official name
  "alias" : ["<string>"], // Alternate names
  "period" : { Period }, // When the product is available
  "ownedBy" : { Reference(Organization) }, // Plan issuer
  "administeredBy" : { Reference(Organization) }, // Product administrator
  "coverageArea" : [{ Reference(Location) }], // Where product applies
  "contact" : [{ // Contact for the product
    "purpose" : { CodeableConcept }, // The type of contact
    "name" : { HumanName }, // A name associated with the contact
    "telecom" : [{ ContactPoint }], // Contact details (telephone, email, etc.)  for a contact
    "address" : { Address } // Visiting or postal addresses for the contact
  }],
  "endpoint" : [{ Reference(Endpoint) }], // Technical endpoint
  "network" : [{ Reference(Organization) }], // What networks are Included
  "coverage" : [{ // Coverage details
    "type" : { CodeableConcept }, // R!  Type of coverage
    "network" : [{ Reference(Organization) }], // What networks provide coverage
    "benefit" : [{ // R!  List of benefits
      "type" : { CodeableConcept }, // R!  Type of benefit
      "requirement" : "<string>", // Referral requirements
      "limit" : [{ // Benefit limits
        "value" : { Quantity }, // Maximum value allowed
        "code" : { CodeableConcept } // Benefit limit details
      }]
    }]
  }],
  "plan" : [{ // Plan details
    "identifier" : [{ Identifier }], // Business Identifier for Product
    "type" : { CodeableConcept }, // Type of plan
    "coverageArea" : [{ Reference(Location) }], // Where product applies
    "network" : [{ Reference(Organization) }], // What networks provide coverage
    "generalCost" : [{ // Overall costs
      "type" : { CodeableConcept }, // Type of cost
      "groupSize" : "<positiveInt>", // Number of enrollees
      "cost" : { Money }, // Cost value
      "comment" : "<string>" // Additional cost information
    }],
    "specificCost" : [{ // Specific costs
      "category" : { CodeableConcept }, // R!  General category of benefit
      "benefit" : [{ // Benefits list
        "type" : { CodeableConcept }, // R!  Type of specific benefit
        "cost" : [{ // List of the costs
          "type" : { CodeableConcept }, // R!  Type of cost
          "applicability" : { CodeableConcept }, // in-network | out-of-network | other
          "qualifiers" : [{ CodeableConcept }], // Additional information about the cost
          "value" : { Quantity } // The actual cost value
        }]
      }]
    }]
  }]
}

Turtle-шаблон

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:InsurancePlan;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:InsurancePlan.identifier [ Identifier ], ... ; # 0..* Business Identifier for Product
  fhir:InsurancePlan.status [ code ]; # 0..1 draft | active | retired | unknown
  fhir:InsurancePlan.type [ CodeableConcept ], ... ; # 0..* Kind of product
  fhir:InsurancePlan.name [ string ]; # 0..1 Official name
  fhir:InsurancePlan.alias [ string ], ... ; # 0..* Alternate names
  fhir:InsurancePlan.period [ Period ]; # 0..1 When the product is available
  fhir:InsurancePlan.ownedBy [ Reference(Organization) ]; # 0..1 Plan issuer
  fhir:InsurancePlan.administeredBy [ Reference(Organization) ]; # 0..1 Product administrator
  fhir:InsurancePlan.coverageArea [ Reference(Location) ], ... ; # 0..* Where product applies
  fhir:InsurancePlan.contact [ # 0..* Contact for the product
    fhir:InsurancePlan.contact.purpose [ CodeableConcept ]; # 0..1 The type of contact
    fhir:InsurancePlan.contact.name [ HumanName ]; # 0..1 A name associated with the contact
    fhir:InsurancePlan.contact.telecom [ ContactPoint ], ... ; # 0..* Contact details (telephone, email, etc.)  for a contact
    fhir:InsurancePlan.contact.address [ Address ]; # 0..1 Visiting or postal addresses for the contact
  ], ...;
  fhir:InsurancePlan.endpoint [ Reference(Endpoint) ], ... ; # 0..* Technical endpoint
  fhir:InsurancePlan.network [ Reference(Organization) ], ... ; # 0..* What networks are Included
  fhir:InsurancePlan.coverage [ # 0..* Coverage details
    fhir:InsurancePlan.coverage.type [ CodeableConcept ]; # 1..1 Type of coverage
    fhir:InsurancePlan.coverage.network [ Reference(Organization) ], ... ; # 0..* What networks provide coverage
    fhir:InsurancePlan.coverage.benefit [ # 1..* List of benefits
      fhir:InsurancePlan.coverage.benefit.type [ CodeableConcept ]; # 1..1 Type of benefit
      fhir:InsurancePlan.coverage.benefit.requirement [ string ]; # 0..1 Referral requirements
      fhir:InsurancePlan.coverage.benefit.limit [ # 0..* Benefit limits
        fhir:InsurancePlan.coverage.benefit.limit.value [ Quantity ]; # 0..1 Maximum value allowed
        fhir:InsurancePlan.coverage.benefit.limit.code [ CodeableConcept ]; # 0..1 Benefit limit details
      ], ...;
    ], ...;
  ], ...;
  fhir:InsurancePlan.plan [ # 0..* Plan details
    fhir:InsurancePlan.plan.identifier [ Identifier ], ... ; # 0..* Business Identifier for Product
    fhir:InsurancePlan.plan.type [ CodeableConcept ]; # 0..1 Type of plan
    fhir:InsurancePlan.plan.coverageArea [ Reference(Location) ], ... ; # 0..* Where product applies
    fhir:InsurancePlan.plan.network [ Reference(Organization) ], ... ; # 0..* What networks provide coverage
    fhir:InsurancePlan.plan.generalCost [ # 0..* Overall costs
      fhir:InsurancePlan.plan.generalCost.type [ CodeableConcept ]; # 0..1 Type of cost
      fhir:InsurancePlan.plan.generalCost.groupSize [ positiveInt ]; # 0..1 Number of enrollees
      fhir:InsurancePlan.plan.generalCost.cost [ Money ]; # 0..1 Cost value
      fhir:InsurancePlan.plan.generalCost.comment [ string ]; # 0..1 Additional cost information
    ], ...;
    fhir:InsurancePlan.plan.specificCost [ # 0..* Specific costs
      fhir:InsurancePlan.plan.specificCost.category [ CodeableConcept ]; # 1..1 General category of benefit
      fhir:InsurancePlan.plan.specificCost.benefit [ # 0..* Benefits list
        fhir:InsurancePlan.plan.specificCost.benefit.type [ CodeableConcept ]; # 1..1 Type of specific benefit
        fhir:InsurancePlan.plan.specificCost.benefit.cost [ # 0..* List of the costs
          fhir:InsurancePlan.plan.specificCost.benefit.cost.type [ CodeableConcept ]; # 1..1 Type of cost
          fhir:InsurancePlan.plan.specificCost.benefit.cost.applicability [ CodeableConcept ]; # 0..1 in-network | out-of-network | other
          fhir:InsurancePlan.plan.specificCost.benefit.cost.qualifiers [ CodeableConcept ], ... ; # 0..* Additional information about the cost
          fhir:InsurancePlan.plan.specificCost.benefit.cost.value [ Quantity ]; # 0..1 The actual cost value
        ], ...;
      ], ...;
    ], ...;
  ], ...;
]

Changes since R3

This resource did not exist in Release 2

This analysis is available as XML or JSON.

Структура

ИмяФлагиКард.ТипОписание и ограниченияdoco
.. InsurancePlan ITUDomainResourceDetails of a Health Insurance product/plan provided by an organization
+ Rule: The organization SHALL at least have a name or an idendtifier, and possibly more than one
Элементы, определённые в прародителе: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier ΣI0..*IdentifierBusiness Identifier for Product
... status ?!Σ0..1codedraft | active | retired | unknown
PublicationStatus (Required)
... type Σ0..*CodeableConceptKind of product
Insurance plan type (Example)
... name ΣI0..1stringOfficial name
... alias 0..*stringAlternate names
... period 0..1PeriodWhen the product is available
... ownedBy Σ0..1Reference(Organization)Plan issuer
... administeredBy Σ0..1Reference(Organization)Product administrator
... coverageArea Σ0..*Reference(Location)Where product applies
... contact 0..*BackboneElementContact for the product
.... purpose 0..1CodeableConceptThe type of contact
Contact entity type (Extensible)
.... name 0..1HumanNameA name associated with the contact
.... telecom 0..*ContactPointContact details (telephone, email, etc.) for a contact
.... address 0..1AddressVisiting or postal addresses for the contact
... endpoint 0..*Reference(Endpoint)Technical endpoint
... network 0..*Reference(Organization)What networks are Included
... coverage 0..*BackboneElementCoverage details
.... type 1..1CodeableConceptType of coverage
.... network 0..*Reference(Organization)What networks provide coverage
.... benefit 1..*BackboneElementList of benefits
..... type 1..1CodeableConceptType of benefit
..... requirement 0..1stringReferral requirements
..... limit 0..*BackboneElementBenefit limits
...... value 0..1QuantityMaximum value allowed
...... code 0..1CodeableConceptBenefit limit details
... plan 0..*BackboneElementPlan details
.... identifier Σ0..*IdentifierBusiness Identifier for Product
.... type 0..1CodeableConceptType of plan
.... coverageArea Σ0..*Reference(Location)Where product applies
.... network 0..*Reference(Organization)What networks provide coverage
.... generalCost 0..*BackboneElementOverall costs
..... type 0..1CodeableConceptType of cost
..... groupSize 0..1positiveIntNumber of enrollees
..... cost 0..1MoneyCost value
..... comment 0..1stringAdditional cost information
.... specificCost 0..*BackboneElementSpecific costs
..... category 1..1CodeableConceptGeneral category of benefit
..... benefit 0..*BackboneElementBenefits list
...... type 1..1CodeableConceptType of specific benefit
...... cost 0..*BackboneElementList of the costs
....... type 1..1CodeableConceptType of cost
....... applicability 0..1CodeableConceptin-network | out-of-network | other
Benefit cost applicability (Required)
....... qualifiers 0..*CodeableConceptAdditional information about the cost
....... value 0..1QuantityThe actual cost value

doco Документация по этому формату

UML-диаграмма (Legend)

InsurancePlan (DomainResource)Business identifiers assigned to this health insurance product which remain constant as the resource is updated and propagates from server to serveridentifier : Identifier [0..*]The current state of the health insurance product (this element modifies the meaning of other elements)status : code [0..1] « The lifecycle status of an artifact. (Strength=Required)PublicationStatus! »The kind of health insurance producttype : CodeableConcept [0..*] « Used to categorize the product/plan. (Strength=Example)InsurancePlanType?? »Official name of the health insurance product as designated by the ownername : string [0..1]A list of alternate names that the product is known as, or was known as in the pastalias : string [0..*]The period of time that the health insurance product is availableperiod : Period [0..1]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'ownedBy : Reference [0..1] « Organization »An organization which administer other services such as underwriting, customer service and/or claims processing on behalf of the health insurance product owneradministeredBy : Reference [0..1] « Organization »The geographic region in which a health insurance product's benefits applycoverageArea : Reference [0..*] « Location »The technical endpoints providing access to services operated for the health insurance productendpoint : Reference [0..*] « Endpoint »Reference to the network included in the health insurance productnetwork : Reference [0..*] « Organization »ContactIndicates a purpose for which the contact can be reachedpurpose : CodeableConcept [0..1] « The purpose for which you would contact a contact party. (Strength=Extensible)ContactEntityType+ »A name associated with the contactname : HumanName [0..1]A contact detail (e.g. a telephone number or an email address) by which the party may be contactedtelecom : ContactPoint [0..*]Visiting or postal addresses for the contactaddress : Address [0..1]CoverageType of coverage (Medical; Dental; Mental Health; Substance Abuse; Vision; Drug; Short Term; Long Term Care; Hospice; Home Health)type : CodeableConcept [1..1]Reference to the network that providing the type of coveragenetwork : Reference [0..*] « Organization »CoverageBenefitType of benefit (primary care; speciality care; inpatient; outpatient)type : CodeableConcept [1..1]The referral requirements to have access/coverage for this benefitrequirement : string [0..1]LimitThe maximum amount of a service item a plan will pay for a covered benefit. For examples. wellness visits, or eyeglassesvalue : Quantity [0..1]The specific limit on the benefitcode : CodeableConcept [0..1]PlanBusiness identifiers assigned to this health insurance plan which remain constant as the resource is updated and propagates from server to serveridentifier : Identifier [0..*]Type of plan. For example, "Platinum" or "High Deductable"type : CodeableConcept [0..1]The geographic region in which a health insurance plan's benefits applycoverageArea : Reference [0..*] « Location »Reference to the network that providing the type of coveragenetwork : Reference [0..*] « Organization »GeneralCostType of costtype : CodeableConcept [0..1]Number of participants enrolled in the plangroupSize : positiveInt [0..1]Value of the costcost : Money [0..1]Additional information about the general costs associated with this plancomment : string [0..1]SpecificCostGeneral category of benefit (Medical; Dental; Vision; Drug; Mental Health; Substance Abuse; Hospice, Home Health)category : CodeableConcept [1..1]PlanBenefitType of specific benefit (preventative; primary care office visit; speciality office visit; hospitalization; emergency room; urgent care)type : CodeableConcept [1..1]CostType of cost (copay; individual cap; family cap; coinsurance; deductible)type : CodeableConcept [1..1]Whether the cost applies to in-network or out-of-network providers (in-network; out-of-network; other)applicability : CodeableConcept [0..1] « Whether the cost applies to in-network or out-of-network providers. (Strength=Required)BenefitCostApplicability! »Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA)qualifiers : CodeableConcept [0..*]The actual cost value. (some of the costs may be represented as percentages rather than currency, e.g. 10% coinsurance)value : Quantity [0..1]The contact for the health insurance product for a certain purposecontact[0..*]The specific limits on the benefitlimit[0..*]Specific benefits under this type of coveragebenefit[1..*]Details about the coverage offered by the insurance productcoverage[0..*]Overall costs associated with the plangeneralCost[0..*]List of the costs associated with a specific benefitcost[0..*]List of the specific benefits under this category of benefitbenefit[0..*]Costs associated with the coverage provided by the productspecificCost[0..*]Details about an insurance planplan[0..*]

XML-шаблон

<InsurancePlan xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- ?? 0..* Identifier Business Identifier for Product --></identifier>
 <status value="[code]"/><!-- 0..1 draft | active | retired | unknown -->
 <type><!-- 0..* CodeableConcept Kind of product --></type>
 <name value="[string]"/><!-- ?? 0..1 Official name -->
 <alias value="[string]"/><!-- 0..* Alternate names -->
 <period><!-- 0..1 Period When the product is available --></period>
 <ownedBy><!-- 0..1 Reference(Organization) Plan issuer --></ownedBy>
 <administeredBy><!-- 0..1 Reference(Organization) Product administrator --></administeredBy>
 <coverageArea><!-- 0..* Reference(Location) Where product applies --></coverageArea>
 <contact>  <!-- 0..* Contact for the product -->
  <purpose><!-- 0..1 CodeableConcept The type of contact --></purpose>
  <name><!-- 0..1 HumanName A name associated with the contact --></name>
  <telecom><!-- 0..* ContactPoint Contact details (telephone, email, etc.)  for a contact --></telecom>
  <address><!-- 0..1 Address Visiting or postal addresses for the contact --></address>
 </contact>
 <endpoint><!-- 0..* Reference(Endpoint) Technical endpoint --></endpoint>
 <network><!-- 0..* Reference(Organization) What networks are Included --></network>
 <coverage>  <!-- 0..* Coverage details -->
  <type><!-- 1..1 CodeableConcept Type of coverage --></type>
  <network><!-- 0..* Reference(Organization) What networks provide coverage --></network>
  <benefit>  <!-- 1..* List of benefits -->
   <type><!-- 1..1 CodeableConcept Type of benefit --></type>
   <requirement value="[string]"/><!-- 0..1 Referral requirements -->
   <limit>  <!-- 0..* Benefit limits -->
    <value><!-- 0..1 Quantity Maximum value allowed --></value>
    <code><!-- 0..1 CodeableConcept Benefit limit details --></code>
   </limit>
  </benefit>
 </coverage>
 <plan>  <!-- 0..* Plan details -->
  <identifier><!-- 0..* Identifier Business Identifier for Product --></identifier>
  <type><!-- 0..1 CodeableConcept Type of plan --></type>
  <coverageArea><!-- 0..* Reference(Location) Where product applies --></coverageArea>
  <network><!-- 0..* Reference(Organization) What networks provide coverage --></network>
  <generalCost>  <!-- 0..* Overall costs -->
   <type><!-- 0..1 CodeableConcept Type of cost --></type>
   <groupSize value="[positiveInt]"/><!-- 0..1 Number of enrollees -->
   <cost><!-- 0..1 Money Cost value --></cost>
   <comment value="[string]"/><!-- 0..1 Additional cost information -->
  </generalCost>
  <specificCost>  <!-- 0..* Specific costs -->
   <category><!-- 1..1 CodeableConcept General category of benefit --></category>
   <benefit>  <!-- 0..* Benefits list -->
    <type><!-- 1..1 CodeableConcept Type of specific benefit --></type>
    <cost>  <!-- 0..* List of the costs -->
     <type><!-- 1..1 CodeableConcept Type of cost --></type>
     <applicability><!-- 0..1 CodeableConcept in-network | out-of-network | other --></applicability>
     <qualifiers><!-- 0..* CodeableConcept Additional information about the cost --></qualifiers>
     <value><!-- 0..1 Quantity The actual cost value --></value>
    </cost>
   </benefit>
  </specificCost>
 </plan>
</InsurancePlan>

JSON-шаблон

{doco
  "resourceType" : "InsurancePlan",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // C? Business Identifier for Product
  "status" : "<code>", // draft | active | retired | unknown
  "type" : [{ CodeableConcept }], // Kind of product
  "name" : "<string>", // C? Official name
  "alias" : ["<string>"], // Alternate names
  "period" : { Period }, // When the product is available
  "ownedBy" : { Reference(Organization) }, // Plan issuer
  "administeredBy" : { Reference(Organization) }, // Product administrator
  "coverageArea" : [{ Reference(Location) }], // Where product applies
  "contact" : [{ // Contact for the product
    "purpose" : { CodeableConcept }, // The type of contact
    "name" : { HumanName }, // A name associated with the contact
    "telecom" : [{ ContactPoint }], // Contact details (telephone, email, etc.)  for a contact
    "address" : { Address } // Visiting or postal addresses for the contact
  }],
  "endpoint" : [{ Reference(Endpoint) }], // Technical endpoint
  "network" : [{ Reference(Organization) }], // What networks are Included
  "coverage" : [{ // Coverage details
    "type" : { CodeableConcept }, // R!  Type of coverage
    "network" : [{ Reference(Organization) }], // What networks provide coverage
    "benefit" : [{ // R!  List of benefits
      "type" : { CodeableConcept }, // R!  Type of benefit
      "requirement" : "<string>", // Referral requirements
      "limit" : [{ // Benefit limits
        "value" : { Quantity }, // Maximum value allowed
        "code" : { CodeableConcept } // Benefit limit details
      }]
    }]
  }],
  "plan" : [{ // Plan details
    "identifier" : [{ Identifier }], // Business Identifier for Product
    "type" : { CodeableConcept }, // Type of plan
    "coverageArea" : [{ Reference(Location) }], // Where product applies
    "network" : [{ Reference(Organization) }], // What networks provide coverage
    "generalCost" : [{ // Overall costs
      "type" : { CodeableConcept }, // Type of cost
      "groupSize" : "<positiveInt>", // Number of enrollees
      "cost" : { Money }, // Cost value
      "comment" : "<string>" // Additional cost information
    }],
    "specificCost" : [{ // Specific costs
      "category" : { CodeableConcept }, // R!  General category of benefit
      "benefit" : [{ // Benefits list
        "type" : { CodeableConcept }, // R!  Type of specific benefit
        "cost" : [{ // List of the costs
          "type" : { CodeableConcept }, // R!  Type of cost
          "applicability" : { CodeableConcept }, // in-network | out-of-network | other
          "qualifiers" : [{ CodeableConcept }], // Additional information about the cost
          "value" : { Quantity } // The actual cost value
        }]
      }]
    }]
  }]
}

Turtle-шаблон

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:InsurancePlan;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:InsurancePlan.identifier [ Identifier ], ... ; # 0..* Business Identifier for Product
  fhir:InsurancePlan.status [ code ]; # 0..1 draft | active | retired | unknown
  fhir:InsurancePlan.type [ CodeableConcept ], ... ; # 0..* Kind of product
  fhir:InsurancePlan.name [ string ]; # 0..1 Official name
  fhir:InsurancePlan.alias [ string ], ... ; # 0..* Alternate names
  fhir:InsurancePlan.period [ Period ]; # 0..1 When the product is available
  fhir:InsurancePlan.ownedBy [ Reference(Organization) ]; # 0..1 Plan issuer
  fhir:InsurancePlan.administeredBy [ Reference(Organization) ]; # 0..1 Product administrator
  fhir:InsurancePlan.coverageArea [ Reference(Location) ], ... ; # 0..* Where product applies
  fhir:InsurancePlan.contact [ # 0..* Contact for the product
    fhir:InsurancePlan.contact.purpose [ CodeableConcept ]; # 0..1 The type of contact
    fhir:InsurancePlan.contact.name [ HumanName ]; # 0..1 A name associated with the contact
    fhir:InsurancePlan.contact.telecom [ ContactPoint ], ... ; # 0..* Contact details (telephone, email, etc.)  for a contact
    fhir:InsurancePlan.contact.address [ Address ]; # 0..1 Visiting or postal addresses for the contact
  ], ...;
  fhir:InsurancePlan.endpoint [ Reference(Endpoint) ], ... ; # 0..* Technical endpoint
  fhir:InsurancePlan.network [ Reference(Organization) ], ... ; # 0..* What networks are Included
  fhir:InsurancePlan.coverage [ # 0..* Coverage details
    fhir:InsurancePlan.coverage.type [ CodeableConcept ]; # 1..1 Type of coverage
    fhir:InsurancePlan.coverage.network [ Reference(Organization) ], ... ; # 0..* What networks provide coverage
    fhir:InsurancePlan.coverage.benefit [ # 1..* List of benefits
      fhir:InsurancePlan.coverage.benefit.type [ CodeableConcept ]; # 1..1 Type of benefit
      fhir:InsurancePlan.coverage.benefit.requirement [ string ]; # 0..1 Referral requirements
      fhir:InsurancePlan.coverage.benefit.limit [ # 0..* Benefit limits
        fhir:InsurancePlan.coverage.benefit.limit.value [ Quantity ]; # 0..1 Maximum value allowed
        fhir:InsurancePlan.coverage.benefit.limit.code [ CodeableConcept ]; # 0..1 Benefit limit details
      ], ...;
    ], ...;
  ], ...;
  fhir:InsurancePlan.plan [ # 0..* Plan details
    fhir:InsurancePlan.plan.identifier [ Identifier ], ... ; # 0..* Business Identifier for Product
    fhir:InsurancePlan.plan.type [ CodeableConcept ]; # 0..1 Type of plan
    fhir:InsurancePlan.plan.coverageArea [ Reference(Location) ], ... ; # 0..* Where product applies
    fhir:InsurancePlan.plan.network [ Reference(Organization) ], ... ; # 0..* What networks provide coverage
    fhir:InsurancePlan.plan.generalCost [ # 0..* Overall costs
      fhir:InsurancePlan.plan.generalCost.type [ CodeableConcept ]; # 0..1 Type of cost
      fhir:InsurancePlan.plan.generalCost.groupSize [ positiveInt ]; # 0..1 Number of enrollees
      fhir:InsurancePlan.plan.generalCost.cost [ Money ]; # 0..1 Cost value
      fhir:InsurancePlan.plan.generalCost.comment [ string ]; # 0..1 Additional cost information
    ], ...;
    fhir:InsurancePlan.plan.specificCost [ # 0..* Specific costs
      fhir:InsurancePlan.plan.specificCost.category [ CodeableConcept ]; # 1..1 General category of benefit
      fhir:InsurancePlan.plan.specificCost.benefit [ # 0..* Benefits list
        fhir:InsurancePlan.plan.specificCost.benefit.type [ CodeableConcept ]; # 1..1 Type of specific benefit
        fhir:InsurancePlan.plan.specificCost.benefit.cost [ # 0..* List of the costs
          fhir:InsurancePlan.plan.specificCost.benefit.cost.type [ CodeableConcept ]; # 1..1 Type of cost
          fhir:InsurancePlan.plan.specificCost.benefit.cost.applicability [ CodeableConcept ]; # 0..1 in-network | out-of-network | other
          fhir:InsurancePlan.plan.specificCost.benefit.cost.qualifiers [ CodeableConcept ], ... ; # 0..* Additional information about the cost
          fhir:InsurancePlan.plan.specificCost.benefit.cost.value [ Quantity ]; # 0..1 The actual cost value
        ], ...;
      ], ...;
    ], ...;
  ], ...;
]

Changes since Release 3

This resource did not exist in Release 2

This analysis is available as XML or JSON.

 

See the Profiles & Extensions and the Альтернативные определения: Основное определение XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions & the Анализ зависимостей

PathОписаниеТипСсылка
InsurancePlan.status The lifecycle status of an artifact.RequiredPublicationStatus
InsurancePlan.type Used to categorize the product/plan.ExampleInsurancePlanType
InsurancePlan.contact.purpose The purpose for which you would contact a contact party.ExtensibleContactEntityType
InsurancePlan.plan.specificCost.benefit.cost.applicability Whether the cost applies to in-network or out-of-network providers.RequiredBenefitCostApplicability

idLevelLocationОпределениеExpression
ipn-1Rule (base)The organization SHALL at least have a name or an idendtifier, and possibly more than one(identifier.count() + name.count()) > 0

Параметры поиска для этого ресурса. Также к нему применяются общие параметры. Более подробную информацию о поиске в REST, обмене сообщениями и сервисах см. в разделе Поиск.

ИмяТипОпределениеВыражениеIn Common
addressstringA server defined search that may match any of the string fields in the Address, including line, city, district, state, country, postalCode, and/or textInsurancePlan.contact.address
address-citystringA city specified in an addressInsurancePlan.contact.address.city
address-countrystringA country specified in an addressInsurancePlan.contact.address.country
address-postalcodestringA postal code specified in an addressInsurancePlan.contact.address.postalCode
address-statestringA state specified in an addressInsurancePlan.contact.address.state
address-usetokenA use code specified in an addressInsurancePlan.contact.address.use
administered-byreferenceProduct administratorInsurancePlan.administeredBy
(Organization)
endpointreferenceTechnical endpointInsurancePlan.endpoint
(Endpoint)
identifiertokenAny identifier for the organization (not the accreditation issuer's identifier)InsurancePlan.identifier
namestringA portion of the organization's name or aliasname | alias
owned-byreferenceAn organization of which this organization forms a partInsurancePlan.ownedBy
(Organization)
phoneticstringA portion of the organization's name using some kind of phonetic matching algorithmInsurancePlan.name
statustokenIs the Organization record activeInsurancePlan.status
typetokenA code for the type of organizationInsurancePlan.type