FHIR Implementation Guide for HCX
0.8.0 - CI Build

FHIR Implementation Guide for HCX - Local Development build (v0.8.0). See the Directory of published versions

Resource Profile: HCX InsurancePlan

Defining URL:https://ig.hcxprotocol.io/v0.8/StructureDefinition-HCXInsurancePlan.html
Version:0.8.0
Name:HCXInsurancePlan
Status:Draft as of 2021-12-28 (Standards Status: Trial Use)
Definition:

Details of a Health Insurance product/plan provided by an organization.

Publisher:HCX Open Community
Maturity:0
Source Resource:XML / JSON / Turtle

The official URL for this profile is: 

https://ig.hcxprotocol.io/v0.8/StructureDefinition-HCXInsurancePlan.html

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan C0..*InsurancePlanDetails of a Health Insurance product/plan provided by an organization
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier ΣC0..*IdentifierBusiness Identifier for Product
... status ?!Σ0..1codedraft | active | retired | unknown
Binding: PublicationStatus (required): The lifecycle status of an artifact.

... type Σ0..*CodeableConceptKind of product
Binding: InsurancePlanType (example): Used to categorize the product/plan.


... name ΣC0..1stringOfficial name
... alias 0..*stringAlternate names
... period 0..1PeriodWhen the product is available
... ownedBy Σ0..1Reference(Organization)Plan issuer
... administeredBy Σ0..1Reference(Organization)Product administrator
... coverageArea Σ0..*Reference(Location)Where product applies
... contact 0..*BackboneElementContact for the product
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... purpose 0..1CodeableConceptThe type of contact
Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party.

.... name 0..1HumanNameA name associated with the contact
.... telecom 0..*ContactPointContact details (telephone, email, etc.) for a contact
.... address 0..1AddressVisiting or postal addresses for the contact
... endpoint 0..*Reference(Endpoint)Technical endpoint
... network 0..*Reference(Organization)What networks are Included
... coverage 0..*BackboneElementCoverage details
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type 1..1CodeableConceptType of coverage
.... network 0..*Reference(Organization)What networks provide coverage
.... benefit 1..*BackboneElementList of benefits
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type 1..1CodeableConceptType of benefit
..... requirement 0..1stringReferral requirements
..... limit 0..*BackboneElementBenefit limits
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... value 0..1QuantityMaximum value allowed
...... code 0..1CodeableConceptBenefit limit details
... plan 0..*BackboneElementPlan details
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... proofOfIdDocuments 0..*(Complex)List of documents for Proof of Identification.
URL: https://ig.hcxprotocol.io/v0.8/StructureDefinition-HCXProofOfIdentificationExtension.html
.... proofOfPresenceDocuments 0..*(Complex)List of documents for Proof of Presence.
URL: https://ig.hcxprotocol.io/v0.8/StructureDefinition-HCXProofOfPresenceExtension.html
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... identifier Σ0..*IdentifierBusiness Identifier for Product
.... type 0..1CodeableConceptType of plan
.... coverageArea Σ0..*Reference(Location)Where product applies
.... network 0..*Reference(Organization)What networks provide coverage
.... generalCost 0..*BackboneElementOverall costs
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type 0..1CodeableConceptType of cost
..... groupSize 0..1positiveIntNumber of enrollees
..... cost 0..1MoneyCost value
..... comment 0..1stringAdditional cost information
.... specificCost 0..*BackboneElementSpecific costs
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... category 1..1CodeableConceptGeneral category of benefit
..... benefit 0..*BackboneElementBenefits list
...... id 0..1stringUnique id for inter-element referencing
...... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
...... clinicalDiagnosticDocuments 0..*(Complex)List of documents to be submitted to claim the benefit.
URL: https://ig.hcxprotocol.io/v0.8/StructureDefinition-HCXDiagnosticDocumentsExtension.html
...... informationalMessages 0..*(Complex)Messages related to the benefit.
URL: https://ig.hcxprotocol.io/v0.8/StructureDefinition-HCXInformationalMessagesExtension.html
...... questionnnaires 0..*(Complex)Questionnaires to be answered to claim the benefit.
URL: https://ig.hcxprotocol.io/v0.8/StructureDefinition-HCXQuestionnairesExtension.html
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... type 1..1CodeableConceptType of specific benefit
...... cost 0..*BackboneElementList of the costs
....... id 0..1stringUnique id for inter-element referencing
....... extension 0..*ExtensionAdditional content defined by implementations
....... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
....... type 1..1CodeableConceptType of cost
....... applicability 0..1CodeableConceptin-network | out-of-network | other
Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.

....... qualifiers 0..*CodeableConceptAdditional information about the cost
....... value 0..1QuantityThe actual cost value

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
​.. InsurancePlan C0..*InsurancePlanDetails of a Health Insurance product/plan provided by an organization

doco Documentation for this format

Differential View

This structure is derived from InsurancePlan

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan C0..*InsurancePlanDetails of a Health Insurance product/plan provided by an organization
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier ΣC0..*IdentifierBusiness Identifier for Product
... status ?!Σ0..1codedraft | active | retired | unknown
Binding: PublicationStatus (required): The lifecycle status of an artifact.

... type Σ0..*CodeableConceptKind of product
Binding: InsurancePlanType (example): Used to categorize the product/plan.


... name ΣC0..1stringOfficial name
... alias 0..*stringAlternate names
... period 0..1PeriodWhen the product is available
... ownedBy Σ0..1Reference(Organization)Plan issuer
... administeredBy Σ0..1Reference(Organization)Product administrator
... coverageArea Σ0..*Reference(Location)Where product applies
... contact 0..*BackboneElementContact for the product
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... purpose 0..1CodeableConceptThe type of contact
Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party.

.... name 0..1HumanNameA name associated with the contact
.... telecom 0..*ContactPointContact details (telephone, email, etc.) for a contact
.... address 0..1AddressVisiting or postal addresses for the contact
... endpoint 0..*Reference(Endpoint)Technical endpoint
... network 0..*Reference(Organization)What networks are Included
... coverage 0..*BackboneElementCoverage details
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type 1..1CodeableConceptType of coverage
.... network 0..*Reference(Organization)What networks provide coverage
.... benefit 1..*BackboneElementList of benefits
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type 1..1CodeableConceptType of benefit
..... requirement 0..1stringReferral requirements
..... limit 0..*BackboneElementBenefit limits
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... value 0..1QuantityMaximum value allowed
...... code 0..1CodeableConceptBenefit limit details
... plan 0..*BackboneElementPlan details
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... proofOfIdDocuments 0..*(Complex)List of documents for Proof of Identification.
URL: https://ig.hcxprotocol.io/v0.8/StructureDefinition-HCXProofOfIdentificationExtension.html
.... proofOfPresenceDocuments 0..*(Complex)List of documents for Proof of Presence.
URL: https://ig.hcxprotocol.io/v0.8/StructureDefinition-HCXProofOfPresenceExtension.html
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... identifier Σ0..*IdentifierBusiness Identifier for Product
.... type 0..1CodeableConceptType of plan
.... coverageArea Σ0..*Reference(Location)Where product applies
.... network 0..*Reference(Organization)What networks provide coverage
.... generalCost 0..*BackboneElementOverall costs
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type 0..1CodeableConceptType of cost
..... groupSize 0..1positiveIntNumber of enrollees
..... cost 0..1MoneyCost value
..... comment 0..1stringAdditional cost information
.... specificCost 0..*BackboneElementSpecific costs
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... category 1..1CodeableConceptGeneral category of benefit
..... benefit 0..*BackboneElementBenefits list
...... id 0..1stringUnique id for inter-element referencing
...... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
...... clinicalDiagnosticDocuments 0..*(Complex)List of documents to be submitted to claim the benefit.
URL: https://ig.hcxprotocol.io/v0.8/StructureDefinition-HCXDiagnosticDocumentsExtension.html
...... informationalMessages 0..*(Complex)Messages related to the benefit.
URL: https://ig.hcxprotocol.io/v0.8/StructureDefinition-HCXInformationalMessagesExtension.html
...... questionnnaires 0..*(Complex)Questionnaires to be answered to claim the benefit.
URL: https://ig.hcxprotocol.io/v0.8/StructureDefinition-HCXQuestionnairesExtension.html
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... type 1..1CodeableConceptType of specific benefit
...... cost 0..*BackboneElementList of the costs
....... id 0..1stringUnique id for inter-element referencing
....... extension 0..*ExtensionAdditional content defined by implementations
....... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
....... type 1..1CodeableConceptType of cost
....... applicability 0..1CodeableConceptin-network | out-of-network | other
Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.

....... qualifiers 0..*CodeableConceptAdditional information about the cost
....... value 0..1QuantityThe actual cost value

doco Documentation for this format

 

Other representations of profile: CSV, Excel, Schematron

Terminology Bindings

PathConformanceValueSet
InsurancePlan.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
InsurancePlan.statusrequiredPublicationStatus
InsurancePlan.typeexampleInsurancePlanType
InsurancePlan.contact.purposeextensibleContactEntityType
InsurancePlan.plan.specificCost.benefit.cost.applicabilityrequiredBenefitCostApplicability

Constraints

IdGradePath(s)DetailsRequirements
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()