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).\n\nInsurancePlan 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.
package_name: hl7.fhir.us.davinci-pdex-plan-net
derivation: constraint
name: PlannetInsurancePlan
type: InsurancePlan
elements:
  coverageArea:
    type: Reference
    mustSupport: true
    refers: ['http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/plannet-Location']
    index: 10
  meta:
    elements:
      lastUpdated: {index: 0}
    required: [lastUpdated]
  name: {mustSupport: true, index: 6}
  type:
    short: Product Type
    binding: {strength: extensible, valueSet: 'http://hl7.org/fhir/us/davinci-pdex-plan-net/ValueSet/InsuranceProductTypeVS'}
    mustSupport: true
    index: 5
  alias: {mustSupport: true, index: 7}
  status:
    pattern: {type: Code, value: active}
    mustSupport: true
    index: 4
  identifier:
    elements:
      type: {mustSupport: true, index: 1}
      value: {mustSupport: true, index: 2}
      assigner: {mustSupport: true, index: 3}
  administeredBy:
    type: Reference
    mustSupport: true
    refers: ['http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/plannet-Organization']
    index: 9
  ownedBy:
    type: Reference
    mustSupport: true
    refers: ['http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/plannet-Organization']
    index: 8
  network:
    type: Reference
    mustSupport: true
    refers: ['http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/plannet-Network']
    index: 18
  plan:
    short: Cost sharing details for the plan
    index: 19
    elements:
      type:
        short: Categorization of the cost sharing for the plan
        binding: {strength: extensible, valueSet: 'http://hl7.org/fhir/us/davinci-pdex-plan-net/ValueSet/InsurancePlanTypeVS'}
        mustSupport: true
        index: 20
      coverageArea:
        type: Reference
        mustSupport: true
        refers: ['http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/plannet-Location']
        index: 21
      network:
        type: Reference
        refers: ['http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/plannet-Network']
        index: 22
  endpoint:
    type: Reference
    mustSupport: true
    refers: ['http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/plannet-Endpoint']
    index: 17
  contact:
    mustSupport: true
    index: 11
    elements:
      name:
        mustSupport: true
        index: 12
        elements:
          text: {mustSupport: true, index: 13}
      telecom:
        mustSupport: true
        index: 14
        elements:
          system: {mustSupport: true, index: 15}
          value: {mustSupport: true, index: 16}
package_version: 1.0.0
class: profile
kind: resource
url: http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/plannet-InsurancePlan
base: http://hl7.org/fhir/StructureDefinition/InsurancePlan
version: 1.0.0
required: [ownedBy, status, administeredBy, type]