description: Details of a Health Insurance product/plan provided by an organization.
package_name: hl7.fhir.r4.core
derivation: specialization
name: InsurancePlan
type: InsurancePlan
elements:
  coverageArea:
    short: Where product applies
    refers: ['http://hl7.org/fhir/StructureDefinition/Location']
    type: Reference
    array: true
    isSummary: true
    index: 8
  name: {short: Official name, type: string, isSummary: true, index: 3}
  coverage:
    type: BackboneElement
    short: Coverage details
    array: true
    index: 16
    elements:
      type: {type: CodeableConcept, short: Type of coverage, index: 17}
      network:
        short: What networks provide coverage
        refers: ['http://hl7.org/fhir/StructureDefinition/Organization']
        type: Reference
        array: true
        index: 18
      benefit:
        type: BackboneElement
        short: List of benefits
        array: true
        min: 1
        index: 19
        elements:
          type: {type: CodeableConcept, short: Type of benefit, index: 20}
          requirement: {type: string, short: Referral requirements, index: 21}
          limit:
            type: BackboneElement
            short: Benefit limits
            array: true
            index: 22
            elements:
              value: {type: Quantity, short: Maximum value allowed, index: 23}
              code: {type: CodeableConcept, short: Benefit limit details, index: 24}
        required: [type]
    required: [type, benefit]
  type:
    short: Kind of product
    type: CodeableConcept
    array: true
    binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/insuranceplan-type'}
    isSummary: true
    index: 2
  alias: {short: Alternate names, type: string, array: true, index: 4}
  status:
    isModifier: true
    short: draft | active | retired | unknown
    type: code
    meaningWhenMissing: Default interpretation is active.
    binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/publication-status|4.0.1'}
    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
    index: 1
  identifier: {short: Business Identifier for Product, type: Identifier, array: true, isSummary: true, index: 0}
  administeredBy:
    short: Product administrator
    refers: ['http://hl7.org/fhir/StructureDefinition/Organization']
    type: Reference
    isSummary: true
    index: 7
  ownedBy:
    short: Plan issuer
    refers: ['http://hl7.org/fhir/StructureDefinition/Organization']
    type: Reference
    isSummary: true
    index: 6
  network:
    short: What networks are Included
    refers: ['http://hl7.org/fhir/StructureDefinition/Organization']
    type: Reference
    array: true
    index: 15
  period: {type: Period, short: When the product is available, index: 5}
  plan:
    type: BackboneElement
    short: Plan details
    array: true
    index: 25
    elements:
      identifier: {short: Business Identifier for Product, type: Identifier, array: true, isSummary: true, index: 26}
      type: {type: CodeableConcept, short: Type of plan, index: 27}
      coverageArea:
        short: Where product applies
        refers: ['http://hl7.org/fhir/StructureDefinition/Location']
        type: Reference
        array: true
        isSummary: true
        index: 28
      network:
        short: What networks provide coverage
        refers: ['http://hl7.org/fhir/StructureDefinition/Organization']
        type: Reference
        array: true
        index: 29
      generalCost:
        type: BackboneElement
        short: Overall costs
        array: true
        index: 30
        elements:
          type: {type: CodeableConcept, short: Type of cost, index: 31}
          groupSize: {type: positiveInt, short: Number of enrollees, index: 32}
          cost: {type: Money, short: Cost value, index: 33}
          comment: {type: string, short: Additional cost information, index: 34}
      specificCost:
        type: BackboneElement
        short: Specific costs
        array: true
        index: 35
        elements:
          category: {type: CodeableConcept, short: General category of benefit, index: 36}
          benefit:
            type: BackboneElement
            short: Benefits list
            array: true
            index: 37
            elements:
              type: {type: CodeableConcept, short: Type of specific benefit, index: 38}
              cost:
                type: BackboneElement
                short: List of the costs
                array: true
                index: 39
                elements:
                  type: {type: CodeableConcept, short: Type of cost, index: 40}
                  applicability:
                    type: CodeableConcept
                    short: in-network | out-of-network | other
                    binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/insuranceplan-applicability|4.0.1'}
                    index: 41
                  qualifiers: {type: CodeableConcept, short: Additional information about the cost, array: true, index: 42}
                  value: {type: Quantity, short: The actual cost value, index: 43}
                required: [type]
            required: [type]
        required: [category]
  endpoint:
    short: Technical endpoint
    refers: ['http://hl7.org/fhir/StructureDefinition/Endpoint']
    type: Reference
    array: true
    index: 14
  contact:
    short: Contact for the product
    type: BackboneElement
    array: true
    index: 9
    elements:
      purpose:
        short: The type of contact
        type: CodeableConcept
        binding: {strength: extensible, valueSet: 'http://hl7.org/fhir/ValueSet/contactentity-type'}
        index: 10
      name: {short: A name associated with the contact, type: HumanName, index: 11}
      telecom: {short: 'Contact details (telephone, email, etc.)  for a contact', type: ContactPoint, array: true, index: 12}
      address: {short: Visiting or postal addresses for the contact, type: Address, index: 13}
package_version: 4.0.1
class: resource
kind: resource
url: http://hl7.org/fhir/StructureDefinition/InsurancePlan
base: http://hl7.org/fhir/StructureDefinition/DomainResource
version: 4.0.1