Source | hl7.fhir.us.ndh#current:National Directory of Healthcare Providers & Services (NDH) Implementation Guide (v4.0.1) |
resourceType | StructureDefinition |
id | ndh-InsurancePlan |
canonical | http://hl7.org/fhir/us/ndh/StructureDefinition/ndh-InsurancePlan |
version | 1.0.0-ballot |
status | active |
publisher | HL7 International - Patient Administration Work Group |
name | NdhInsurancePlan |
title | NDH Base InsurancePlan Profile |
date | 2023-07-29T19:27:44+00:00 |
description | An 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. |
copyright | HL7 International |
jurisdictions | us |
fhirVersion | 4.0.1 |
kind | resource |
abstract | false |
sdTtype | InsurancePlan |
derivation | constraint |
base | http://hl7.org/fhir/StructureDefinition/InsurancePlan |
Usages |
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Name | Flags | Card. | Type |
Description & Constraints
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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. |
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1.. | |||
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Slice: Unordered, Open by value:url | |||
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0..* | Reference (NDH Base Restriction) { c } |
Usage Restriction URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-usage-restriction |
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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 ) |
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S | |||
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0..1 | code |
NDH Identifier Status
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-identifier-status Binding: Identifier Status Value Set ( required ) |
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Reference (NDH Base Organization Profile) | |||
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S | 1.. | Fixed Value: active | |
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S | 1..1 |
Product Type Binding: Insurance Product Type Value Set ( extensible ) |
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S | |||
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S | 1.. | Reference (NDH Base Organization Profile) | |
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S | 1.. | Reference (NDH Base Organization Profile) | |
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S | Reference (NDH Base Location Profile) | ||
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0..* | (Complex) |
NDH Contactpoint Availabletime
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-contactpoint-availabletime |
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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 |
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Reference (NDH Base Endpoint Profile) | |||
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S | Reference (NDH Base Network Profile) | ||
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Binding: NDH Insurance Coverage Type Value Set ( extensible ) | |||
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S | Reference (NDH Base Network Profile) | ||
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Binding: NDH Benefit Type Value Set ( extensible ) | |||
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Cost sharing details for the plan | |||
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0..1 | code |
NDH Identifier Status
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-identifier-status Binding: Identifier Status Value Set ( required ) |
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Reference (NDH Base Organization Profile) | |||
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Categorization of the cost sharing for the plan Binding: Insurance Plan Type Value Set ( extensible ) |
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Reference (NDH Base Location Profile) | |||
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Reference (NDH Base Network Profile) | |||
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Produced 08 Sep 2023