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

Business identifiers assigned to this health insurance product which remain constant Identifiers, such as the resource is updated and propagates from server to server. plan ID and/or group ID associated with the insurance plan.

The current state of In some markets, the health insurance product. Short Display draft | active | retired | unknown Cardinality 0..1 Terminology Binding PublicationStatus ( Required ) Type code Is Modifier true (Reason: This element is labeled as a modifier because it is combination of a status element that contains codes which means that the resource should not be treated as valid) Meaning if Missing Default interpretation is active. Requirements Need plan ID and a flag group ID are needed to indicate uniquely identify an InsurancePlan. For example, if a record single plan (Bronze) is no longer offered to be used two employer groups (Boilermakers and should generally be hidden for the user in the UI. Aviation), you would represent that using two InsurancePlan resources, as shown below:

InsurancePlan.identifier  0..*  (Boilermakers)   InsurancePlan/bm
     [0].value = 1234   (bronze plan)
     [0].type = Plan
     [0].system = https://insurance-payer.com/plan-numbers

     [1].value = Boilermakers
     [1].type = Group
     [1].system = https:// insurance-payer.com /group-numbers

Summary

InsurancePlan.identifier  0..*  (Aviation)   InsurancePlan/av
     [0].value = 1234  (bronze plan)
     [0].type = Plan
     [0].system = https:// insurance-payer.com /plan-numbers

     [1].value = Aviation
     [1].type = Group
     [1].system = https:// insurance-payer.com /group-numbers

true

The kind Type of health insurance product. plan. For example, "Platinum" or "High Deductable".

Official name of the health insurance product as designated by the owner. Short Display Official name Cardinality 0..1 Type string Summary true Comments If the name of the product/plan changes, consider putting the old name in the alias column so that it can still be located through searches. Invariants Affect this element ipn-1 Rule The organization SHALL at least have a name or an identifier, and possibly more than one (identifier.count() + name.count()) > 0 InsurancePlan.alias Element Id InsurancePlan.alias Definition A list of alternate names that the product is known as, or was known as in the past. Short Display Alternate names Cardinality 0..* Type string Requirements Over time products/plans go through many changes and can be known by different names. For searching knowing previous names that the product/plan was known by can be very useful. Summary false Comments There are no dates associated with the alias/historic names, as this plan is not intended to track when names were used, but to assist in searching so that older names can still result in identifying the product/plan. InsurancePlan.period Element Id InsurancePlan.period Definition The period of time that the health insurance product is available. available under.

The geographic region in which a health insurance product's plan's benefits apply.

Reference to the network that providing the type of coverage.

Networks are represented as a hierarchy of organization resources.

Overall costs associated with the plan.

Type of cost.

Number of participants enrolled in the plan.

Value of the cost.

Additional information about the general costs associated with this plan.

Costs associated with the coverage provided by the product. product-plan.

General category of benefit (Medical; Dental; Vision; Drug; Mental Health; Substance Abuse; Hospice, Home Health).

List of the specific benefits under this category of benefit.

Type of specific benefit (preventative; primary care office visit; speciality office visit; hospitalization; emergency room; urgent care).

List of the costs associated with a specific benefit.

Type of cost (copay; individual cap; family cap; coinsurance; deductible).

Whether the cost applies to in-network or out-of-network providers (in-network; out-of-network; other).

Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA).

The actual cost value. (some of the costs may be represented as percentages rather than currency, e.g. 10% coinsurance).