description: InsurancePlan represents the product that can be offered to the customer. It 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. It provides the details of a contractual arrangement between an individual or entity (the policyholder) and an insurance provider.\r\nA plan describes the Health coverage issued to you directly (individual plan) or through an employer, union, or other group sponsor (employer group plan) that provides coverage for certain health care costs. It pairs the health insurance coverage benefits under a product with the particular cost sharing structure offered to a consumer.
package_name: ndhm.in
derivation: constraint
name: InsurancePlan
type: InsurancePlan
elements:
  coverageArea: {mustSupport: true, index: 15}
  name: {short: Official name of the product, mustSupport: true, index: 10}
  coverage:
    short: Coverage details for e.g. In-Patient Hospitalization, Day Care etc.
    mustSupport: true
    index: 18
    extensions:
      claim-condition: {url: 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition', type: Extension, isModifier: false, index: 19}
      claim-supportingInfoRequirement: {url: 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement', type: Extension, short: 'Essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address', isModifier: false, index: 20}
    elements:
      extension:
        type: Extension
        isModifier: false
        url: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition
        index: 19
        slicing:
          slices:
            claim-condition:
              match: {}
              schema: {type: Extension, isModifier: false, url: 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition', index: 19}
            claim-supportingInfoRequirement:
              match: {}
              schema: {type: Extension, short: 'Essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address', isModifier: false, url: 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement', index: 20}
      type:
        binding: {strength: example, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-coverage-type'}
        index: 21
        elements:
          coding:
            index: 22
            elements:
              system: {index: 23}
              code: {index: 24}
              display: {index: 25}
            required: [display, system, code]
          text: {mustSupport: true, index: 26}
      benefit:
        short: List of benefits e.g. consultation, oxygen, robotic surgery etc.
        mustSupport: true
        index: 27
        extensions:
          claim-condition: {url: 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition', type: Extension, isModifier: false, index: 28}
        elements:
          extension:
            type: Extension
            isModifier: false
            url: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition
            index: 28
            slicing:
              slices:
                claim-condition:
                  match: {}
                  schema: {type: Extension, isModifier: false, url: 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition', index: 28}
          type:
            binding: {strength: example, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-benefit-type'}
            index: 29
            elements:
              coding:
                index: 30
                elements:
                  system: {index: 31}
                  code: {index: 32}
                  display: {index: 33}
                required: [display, system, code]
              text: {mustSupport: true, index: 34}
  type:
    short: Type of product that indicates the predominant type.
    binding: {strength: example, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-insuranceplan-type'}
    mustSupport: true
    index: 4
    elements:
      coding:
        index: 5
        elements:
          system: {index: 6}
          code: {index: 7}
          display: {index: 8}
        required: [display, system, code]
      text: {mustSupport: true, index: 9}
  extension:
    type: Extension
    short: Excluded coverage details within a health insurance product. It outlines services, treatments or conditions not covered. e.g. pre-existing disease, specific disease/procedure wating period etc.
    isModifier: false
    url: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion
    index: 0
    slicing:
      slices:
        claim-exclusion:
          match: {}
          schema: {type: Extension, short: 'Excluded coverage details within a health insurance product. It outlines services, treatments or conditions not covered. e.g. pre-existing disease, specific disease/procedure wating period etc.', isModifier: false, url: 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion', index: 0}
        claim-supportingInfoRequirement:
          match: {}
          schema: {type: Extension, short: 'Essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address', isModifier: false, url: 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement', index: 1}
  alias: {mustSupport: true, index: 11}
  status: {mustSupport: true, index: 3}
  identifier: {short: Identifier provided by payer to uniquely identify the product covering a list of combinations offered to consumers under this particular insurance plan., mustSupport: true, index: 2}
  administeredBy:
    type: Reference
    mustSupport: true
    refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization']
    index: 14
  ownedBy:
    type: Reference
    mustSupport: true
    refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization']
    index: 13
  network:
    type: Reference
    short: Network included in the health insurance product.
    mustSupport: true
    refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization']
    index: 17
  period: {mustSupport: true, index: 12}
  plan:
    short: Cost sharing details for the plan offered to a consumer.
    mustSupport: true
    index: 35
    extensions:
      claim-exclusion: {url: 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion', type: Extension, short: 'Excluded coverage details within a plan. It outlines services, treatments or conditions not covered. e.g. pre-existing disease, specific disease/procedure waiting period etc.', isModifier: false, index: 36}
    elements:
      extension:
        type: Extension
        short: Excluded coverage details within a plan. It outlines services, treatments or conditions not covered. e.g. pre-existing disease, specific disease/procedure waiting period etc.
        isModifier: false
        url: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion
        index: 36
        slicing:
          slices:
            claim-exclusion:
              match: {}
              schema: {type: Extension, short: 'Excluded coverage details within a plan. It outlines services, treatments or conditions not covered. e.g. pre-existing disease, specific disease/procedure waiting period etc.', isModifier: false, url: 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion', index: 36}
      type:
        binding: {strength: example, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-plan-type'}
        mustSupport: true
        index: 37
        elements:
          coding:
            index: 38
            elements:
              system: {index: 39}
              code: {index: 40}
              display: {index: 41}
            required: [display, system, code]
          text: {mustSupport: true, index: 42}
      coverageArea: {mustSupport: true, index: 43}
      network:
        type: Reference
        refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization']
        index: 44
      generalCost: {short: Sum insured amount associated with the plan., mustSupport: true, index: 45}
      specificCost:
        mustSupport: true
        index: 46
        elements:
          category:
            binding: {strength: example, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-benefitcategory'}
            mustSupport: true
            index: 47
            elements:
              coding:
                index: 48
                elements:
                  system: {index: 49}
                  code: {index: 50}
                  display: {index: 51}
                required: [display, system, code]
              text: {mustSupport: true, index: 52}
          benefit:
            elements:
              type:
                binding: {strength: example, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-productorservice'}
                index: 53
                elements:
                  coding:
                    index: 54
                    elements:
                      system: {index: 55}
                      code: {index: 56}
                      display: {index: 57}
                    required: [display, system, code]
                  text: {mustSupport: true, index: 58}
    required: [type]
  contact: {mustSupport: true, index: 16}
package_version: 5.0.0
extensions:
  claim-exclusion: {url: 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion', type: Extension, short: 'Excluded coverage details within a health insurance product. It outlines services, treatments or conditions not covered. e.g. pre-existing disease, specific disease/procedure wating period etc.', isModifier: false, index: 0}
  claim-supportingInfoRequirement: {url: 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement', type: Extension, short: 'Essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address', isModifier: false, index: 1}
class: profile
kind: resource
url: https://nrces.in/ndhm/fhir/r4/StructureDefinition/InsurancePlan
base: http://hl7.org/fhir/StructureDefinition/InsurancePlan
version: 5.0.0
required: [coverage, ownedBy, name, status, identifier, type, period]