description: Details of a Health Insurance product/plan provided by an organization.
package_name: hl7.fhir.r5.core
derivation: specialization
name: InsurancePlan
type: InsurancePlan
elements:
  coverageArea:
    isModifier: false
    short: Where product applies
    refers: ['http://hl7.org/fhir/StructureDefinition/Location']
    type: Reference
    mustSupport: false
    array: true
    isSummary: true
    index: 8
  name: {isModifier: false, short: Official name, type: string, mustSupport: false, isSummary: true, index: 3}
  coverage:
    isModifier: false
    short: Coverage details
    index: 12
    type: BackboneElement
    mustSupport: false
    array: true
    elements:
      type: {isModifier: false, short: Type of coverage, type: CodeableConcept, mustSupport: false, isSummary: false, index: 13}
      network:
        isModifier: false
        short: What networks provide coverage
        refers: ['http://hl7.org/fhir/StructureDefinition/Organization']
        type: Reference
        mustSupport: false
        array: true
        isSummary: false
        index: 14
      benefit:
        min: 1
        isModifier: false
        short: List of benefits
        index: 15
        type: BackboneElement
        mustSupport: false
        array: true
        elements:
          type: {isModifier: false, short: Type of benefit, type: CodeableConcept, mustSupport: false, isSummary: false, index: 16}
          requirement: {isModifier: false, short: Referral requirements, type: string, mustSupport: false, isSummary: false, index: 17}
          limit:
            isModifier: false
            short: Benefit limits
            type: BackboneElement
            mustSupport: false
            array: true
            isSummary: false
            index: 18
            elements:
              value: {isModifier: false, short: Maximum value allowed, type: Quantity, mustSupport: false, isSummary: false, index: 19}
              code: {isModifier: false, short: Benefit limit details, type: CodeableConcept, mustSupport: false, isSummary: false, index: 20}
        required: [type]
        isSummary: false
    required: [type, benefit]
    isSummary: false
  type:
    isModifier: false
    short: Kind of product
    type: CodeableConcept
    mustSupport: false
    array: true
    binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/insuranceplan-type'}
    isSummary: true
    index: 2
  alias: {isModifier: false, short: Alternate names, type: string, mustSupport: false, array: true, isSummary: false, index: 4}
  status:
    isModifier: true
    short: draft | active | retired | unknown
    index: 1
    type: code
    mustSupport: false
    meaningWhenMissing: Default interpretation is active.
    binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/publication-status|5.0.0-snapshot3'}
    isModifierReason: This element is labeled as a modifier because it is a status element that contains codes which means that the resource should not be treated as valid
    isSummary: true
  identifier: {isModifier: false, short: Business Identifier for Product, type: Identifier, mustSupport: false, array: true, isSummary: true, index: 0}
  administeredBy:
    isModifier: false
    short: Product administrator
    refers: ['http://hl7.org/fhir/StructureDefinition/Organization']
    type: Reference
    mustSupport: false
    isSummary: true
    index: 7
  ownedBy:
    isModifier: false
    short: Product issuer
    refers: ['http://hl7.org/fhir/StructureDefinition/Organization']
    type: Reference
    mustSupport: false
    isSummary: true
    index: 6
  network:
    isModifier: false
    short: What networks are Included
    refers: ['http://hl7.org/fhir/StructureDefinition/Organization']
    type: Reference
    mustSupport: false
    array: true
    isSummary: false
    index: 11
  period: {isModifier: false, short: When the product is available, type: Period, mustSupport: false, isSummary: false, index: 5}
  plan:
    isModifier: false
    short: Plan details
    type: BackboneElement
    mustSupport: false
    array: true
    isSummary: false
    index: 21
    elements:
      identifier: {isModifier: false, short: Business Identifier for Product, type: Identifier, mustSupport: false, array: true, isSummary: true, index: 22}
      type: {isModifier: false, short: Type of plan, type: CodeableConcept, mustSupport: false, isSummary: false, index: 23}
      coverageArea:
        isModifier: false
        short: Where product applies
        refers: ['http://hl7.org/fhir/StructureDefinition/Location']
        type: Reference
        mustSupport: false
        array: true
        isSummary: true
        index: 24
      network:
        isModifier: false
        short: What networks provide coverage
        refers: ['http://hl7.org/fhir/StructureDefinition/Organization']
        type: Reference
        mustSupport: false
        array: true
        isSummary: false
        index: 25
      generalCost:
        isModifier: false
        short: Overall costs
        type: BackboneElement
        mustSupport: false
        array: true
        isSummary: false
        index: 26
        elements:
          type: {isModifier: false, short: Type of cost, type: CodeableConcept, mustSupport: false, isSummary: false, index: 27}
          groupSize: {isModifier: false, short: Number of enrollees, type: positiveInt, mustSupport: false, isSummary: false, index: 28}
          cost: {isModifier: false, short: Cost value, type: Money, mustSupport: false, isSummary: false, index: 29}
          comment: {isModifier: false, short: Additional cost information, type: string, mustSupport: false, isSummary: false, index: 30}
      specificCost:
        isModifier: false
        short: Specific costs
        index: 31
        type: BackboneElement
        mustSupport: false
        array: true
        elements:
          category: {isModifier: false, short: General category of benefit, type: CodeableConcept, mustSupport: false, isSummary: false, index: 32}
          benefit:
            isModifier: false
            short: Benefits list
            index: 33
            type: BackboneElement
            mustSupport: false
            array: true
            elements:
              type: {isModifier: false, short: Type of specific benefit, type: CodeableConcept, mustSupport: false, isSummary: false, index: 34}
              cost:
                isModifier: false
                short: List of the costs
                index: 35
                type: BackboneElement
                mustSupport: false
                array: true
                elements:
                  type: {isModifier: false, short: Type of cost, type: CodeableConcept, mustSupport: false, isSummary: false, index: 36}
                  applicability:
                    isModifier: false
                    short: in-network | out-of-network | other
                    type: CodeableConcept
                    mustSupport: false
                    binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/insuranceplan-applicability|5.0.0-snapshot3'}
                    isSummary: false
                    index: 37
                  qualifiers: {isModifier: false, short: Additional information about the cost, type: CodeableConcept, mustSupport: false, array: true, isSummary: false, index: 38}
                  value: {isModifier: false, short: The actual cost value, type: Quantity, mustSupport: false, isSummary: false, index: 39}
                required: [type]
                isSummary: false
            required: [type]
            isSummary: false
        required: [category]
        isSummary: false
  endpoint:
    isModifier: false
    short: Technical endpoint
    refers: ['http://hl7.org/fhir/StructureDefinition/Endpoint']
    type: Reference
    mustSupport: false
    array: true
    isSummary: false
    index: 10
  contact: {isModifier: false, short: Official contact details relevant to the health insurance plan/product, type: ExtendedContactDetail, mustSupport: false, array: true, isSummary: false, index: 9}
package_version: 5.0.0-snapshot3
class: resource
kind: resource
url: http://hl7.org/fhir/StructureDefinition/InsurancePlan
base: http://hl7.org/fhir/StructureDefinition/DomainResource
version: 5.0.0-snapshot3