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

Business identifiers assigned to this health insurance product which remain constant as the resource is updated and propagates from server to server.

The current state of the health insurance product.

Need a flag to indicate a record is no longer to be used and should generally be hidden for the user in the UI.

The kind of health insurance product.

Official name of the health insurance product as designated by the owner.

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.

A list of alternate names that the product is known as, or was known as in the past.

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.

There are no dates associated with the alias/historic names, as this 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.

The period of time that the health insurance product is available.

The entity that is providing the health insurance product and underwriting the risk. This is typically an insurance carriers, other third-party payers, or health plan sponsors comonly referred to as 'payers'.

An organization which administer other services such as underwriting, customer service and/or claims processing on behalf of the health insurance product owner.

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

The contact for the health insurance product for a certain purpose. Cardinality 0..* Requirements Need to keep track details of assigned contact points within bigger organization. Comments Where multiple contacts for the same purpose are provided there is a standard extension that can be used communication devices available relevant to determine which one is the preferred contact to use. InsurancePlan.contact.purpose Element Id InsurancePlan.contact.purpose Definition Indicates a purpose for which the contact specific Insurance Plan/Product. This can be reached. include addresses, phone numbers, fax numbers, mobile numbers, email addresses and web sites.

People have (primary) ways Need to keep track of both simple contact them in some way such as phone, email. InsurancePlan.contact.address Element Id InsurancePlan.contact.address Definition Visiting or postal addresses for the contact. details and also assigned contacts within larger organizations.

May need The address/telecom use code 'home' are not to keep track of a contact party's address for contacting, billing or reporting requirements. be used.

The technical endpoints providing access to services operated for the health insurance product.

Organizations have multiple systems that provide various services and need to be able to define the technical connection details for how to connect to them, and for what purpose.

Reference to the network included in the health insurance product.

Networks are represented as a hierarchy of organization resources.

Details about the coverage offered by the insurance product.

Type of coverage (Medical; Dental; Mental Health; Substance Abuse; Vision; Drug; Short Term; Long Term Care; Hospice; Home Health).

Reference to the network that providing the type of coverage.

Networks are represented as a hierarchy of organization resources.

Specific benefits under this type of coverage.

Type of benefit (primary care; speciality care; inpatient; outpatient).

The referral requirements to have access/coverage for this benefit.

The specific limits on the benefit.

The maximum amount of a service item a plan will pay for a covered benefit. For examples. wellness visits, or eyeglasses.

May also be called “eligible expense,” “payment allowance,” or “negotiated rate.”.

The specific limit on the benefit.

Use CodeableConcept.text element if the data is free (uncoded) text.

Details about an insurance plan.

Business identifiers assigned to this health insurance plan which remain constant as the resource is updated and propagates from server to server.

Type of plan. For example, "Platinum" or "High Deductable".

The geographic region in which a health insurance 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.

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).