StructureDefinition-ndh-InsurancePlan

Sourcehl7.fhir.us.ndh#current:National Directory of Healthcare Providers & Services (NDH) Implementation Guide (v4.0.1)
resourceTypeStructureDefinition
idndh-InsurancePlan
canonicalhttp://hl7.org/fhir/us/ndh/StructureDefinition/ndh-InsurancePlan
version1.0.0-ballot
statusactive
publisherHL7 International - Patient Administration Work Group
nameNdhInsurancePlan
titleNDH Base InsurancePlan Profile
date2023-07-29T19:27:44+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.
copyrightHL7 International
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..
. . . Slices for extension Slice: Unordered, Open by value:url
. . . usage-restriction 0..* Reference (NDH Base Restriction) { c } Usage Restriction
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-usage-restriction
. . . verification-status 0..1 CodeableConcept NDH Verification Status
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-verification-status
Binding: NDH Verification Status Value Set ( extensible )
. . . identifier S
. . . . identifier-status 0..1 code NDH Identifier Status
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-identifier-status
Binding: Identifier Status Value Set ( required )
. . . . assigner Reference (NDH Base Organization Profile)
. . . status S 1.. Fixed Value: active
. . . type S 1..1 Product Type
Binding: Insurance Product Type Value Set ( extensible )
. . . name S
. . . ownedBy S 1.. Reference (NDH Base Organization Profile)
. . . administeredBy S 1.. Reference (NDH Base Organization Profile)
. . . coverageArea S Reference (NDH Base Location Profile)
. . . contact
. . . . telecom
. . . . . contactpoint-availabletime 0..* (Complex) NDH Contactpoint Availabletime
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-contactpoint-availabletime
. . . . . via-intermediary 0..1 Reference (NDH Base PractitionerRole | NDH Base OrganizationAffiliation Profile | NDH Base Location Profile | NDH Base Organization Profile) Via Intermediary
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-via-intermediary
. . . endpoint Reference (NDH Base Endpoint Profile)
. . . network S Reference (NDH Base Network Profile)
. . . coverage
. . . . type Binding: NDH Insurance Coverage Type Value Set ( extensible )
. . . . network S Reference (NDH Base Network Profile)
. . . . benefit
. . . . . type Binding: NDH Benefit Type Value Set ( extensible )
. . . plan Cost sharing details for the plan
. . . . identifier
. . . . . identifier-status 0..1 code NDH Identifier Status
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-identifier-status
Binding: Identifier Status Value Set ( required )
. . . . . assigner Reference (NDH Base Organization Profile)
. . . . type Categorization of the cost sharing for the plan
Binding: Insurance Plan Type Value Set ( extensible )
. . . . coverageArea Reference (NDH Base Location Profile)
. . . . network Reference (NDH Base Network Profile)

doco Documentation for this format

Produced 08 Sep 2023