StructureDefinition-NatlDirEndpointQry-InsurancePlan

Sourcehl7.fhir.us.directory-query#current:National Healthcare Directory Query (v4.0.1)
resourceTypeStructureDefinition
idNatlDirEndpointQry-InsurancePlan
canonicalhttp://hl7.org/fhir/us/directory-query/StructureDefinition/NatlDirEndpointQry-InsurancePlan
version1.0.0-ballot
statusactive
publisherHL7 International - Patient Administration Work Group
nameNatlDirEndpointQryInsurancePlan
titleNational Directory Endpoint Qry Exchange InsurancePlan
date2022-12-08T23:00:33+00:00
descriptionAn 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.
jurisdictionsus
fhirVersion4.0.1
kindresource
abstractfalse
sdTtypeInsurancePlan
derivationconstraint
basehttp://hl7.org/fhir/StructureDefinition/InsurancePlan
Usages
Name Flags Card. Type Description & Constraints doco
. . InsurancePlan C InsurancePlan 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
. . . . lastUpdated 1..
. . . identifier S
. . . status 1.. Fixed Value: active
. . . type S 1..1 Product Type
Binding: Insurance Product Type Value Set ( extensible )
. . . name S
. . . ownedBy S 1.. Reference (National Directory Endpoint Qry Exchange Organization)
. . . administeredBy S 1.. Reference (National Directory Endpoint Qry Exchange Organization)
. . . coverageArea S Reference (National Directory Endpoint Qry Exchange Location)
. . . endpoint Reference (National Directory Endpoint Qry Exchange Endpoint)
. . . network S Reference (National Directory Endpoint Qry Exchange Network)
. . . coverage
. . . . network S
. . . . benefit
. . . . . type S
. . . plan Cost sharing details for the plan
. . . . type Categorization of the cost sharing for the plan
Binding: Insurance Plan Type Value Set ( extensible )
. . . . coverageArea Reference (National Directory Endpoint Qry Exchange Location)
. . . . network Reference (National Directory Endpoint Qry Exchange Network)

doco Documentation for this format

Produced 06 Apr 2023