StructureDefinition-usdf-PayerInsurancePlan

Sourcehl7.fhir.us.Davinci-drug-formulary#2.0.0:DaVinci Payer Data Exchange (PDex) US Drug Formulary (v4.0.1)
resourceTypeStructureDefinition
idusdf-PayerInsurancePlan
canonicalhttp://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PayerInsurancePlan
version2.0.0
statusactive
publisherHL7 Pharmacy Working Group
namePayerInsurancePlan
titlePayer Insurance Plan
date2022-08-25T13:09:53+00:00
descriptionThe Payer InsurancePlan that defines the health insurance product, which include coverage benefits that are offered, and additional information about the offering, such as a coverage area, contact information, brochure locations, etc. The health insurance product offers one or more types of coverage, each of which may define a plan of covered benefits with the particular cost sharing structure offered to a consumer. Health insurance plans that include drug coverage reference a formulary that provides details about drugs that are covered under the plan including requirements and limitations of the coverage specific to each drug.
jurisdictionsus
fhirVersion4.0.1
kindresource
abstractfalse
sdTtypeInsurancePlan
derivationconstraint
basehttp://hl7.org/fhir/StructureDefinition/InsurancePlan
Usages
Name Flags Card. Type Description & Constraints doco
. . InsurancePlan InsurancePlan
. . . meta
. . . . lastUpdated S 1..
. . . identifier S 1..
. . . status S 1..
. . . type S 1..1 Product type
Binding: Insurance Product Type VS ( extensible )
. . . name S
. . . period S
. . . coverageArea S Reference (Insurance Plan Location)
. . . contact Contact information for the Insurance Plan including URLs for brochure and formulary information
. . . . purpose Binding: Type of plan contact ( extensible )
. . . . name S
. . . . . text S
. . . . telecom S
. . . . . system S
. . . . . value S
. . . Slices for coverage S 1 .. Slice: Unordered, Open by pattern:type
. . . . coverage:All Slices Content/Rules for all slices
. . . . . type S
. . . . coverage:drug-coverage S 1..*
. . . . . Slices for extension S 1.. Slice: Unordered, Open by value:url
. . . . . usdf-FormularyReference-extension S 1..* Reference (Formulary) Formulary Reference
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyReference-extension
. . . . . type Required Pattern: At least the following
. . . . . . coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
. . . . . . . system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
. . . . . . . code 1..1 code Symbol in syntax defined by the system
Fixed Value: DRUGPOL
. . . . . Slices for benefit Slice: Unordered, Open by pattern:type
. . . . . . benefit:All Slices Content/Rules for all slices
. . . . . . . type Binding: todo ( extensible )
. . . . . . benefit:drug-plan S 1..*
. . . . . . . type Required Pattern: At least the following
. . . . . . . . coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
. . . . . . . . . system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type
. . . . . . . . . code 1..1 code Symbol in syntax defined by the system
Fixed Value: Drug
. . . . . . . . . display 1..1 string Representation defined by the system
Fixed Value: Drug
. . . Slices for plan S 1 .. Slice: Unordered, Open by pattern:type
. . . . plan:All Slices Content/Rules for all slices
. . . . . type Binding: todo ( extensible )
. . . . plan:drug-plan S 1..* Drug plan
. . . . . type 1.. Required Pattern: At least the following
. . . . . . coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
. . . . . . . system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type
. . . . . . . code 1..1 code Symbol in syntax defined by the system
Fixed Value: Drug
. . . . . . . display 1..1 string Representation defined by the system
Fixed Value: Drug
. . . . . network Pharmacy benefit types that are part of the drug plan
. . . . . specificCost S 1.. Pharmacy benefit type specific cost
. . . . . . category S Pharmacy Benefit Type
Binding: Pharmacy benefit types ( extensible )
. . . . . . benefit S 1.. Drug tier benefit
. . . . . . . type S Binding: Drug tier of medication in health plan ( required )
. . . . . . . Slices for cost S 1 .. Slice: Unordered, Open by pattern:type
. . . . . . . . cost:All Slices Content/Rules for all slices
. . . . . . . . . type Binding: Benefit type of cost ( extensible )
. . . . . . . . . qualifiers S 1..1
. . . . . . . . . value S
. . . . . . . . cost:copay S 0..1 Copay costs
. . . . . . . . . type Required Pattern: At least the following
. . . . . . . . . . coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
. . . . . . . . . . . system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE
. . . . . . . . . . . code 1..1 code Symbol in syntax defined by the system
Fixed Value: copay
. . . . . . . . . qualifiers Binding: Qualifier of copay amount ( required )
. . . . . . . . . value Quantity
. . . . . . . . . . value S 1..
. . . . . . . . . . system Required Pattern: urn:iso:std:iso:4217
. . . . . . . . . . code Required Pattern: USD
. . . . . . . . cost:coinsurance S 0..1 Coinsurance costs
. . . . . . . . . type Required Pattern: At least the following
. . . . . . . . . . coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
. . . . . . . . . . . system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE
. . . . . . . . . . . code 1..1 code Symbol in syntax defined by the system
Fixed Value: coinsurance
. . . . . . . . . qualifiers Binding: Qualifier for coinsurance rate ( required )
. . . . . . . . . value
. . . . . . . . . . system Required Pattern: http://unitsofmeasure.org
. . . . . . . . . . code Required Pattern: %

doco Documentation for this format

Produced 06 Apr 2023