Finance and Insurance Service (FAIS)
1.0.0 - trial-use International flag

This page is part of the IHE ITI Finance and Insurance Services (v1.0.0: Publication) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Resource Profile: FAIS InsurancePlan Profile

Official URL: https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.InsurancePlan Version: 1.0.0
Active as of 2024-11-13 Computable Name: FAISInsurancePlan

The FAIS Insurance Plan profile for creating Coverage resources to enroll beneficiaries.

Usage:

Formal Views of Profile Content

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

This structure is derived from InsurancePlan

NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan 0..* InsurancePlan Details of a Health Insurance product/plan provided by an organization
... implicitRules 0..0
... modifierExtension 0..0
... status 1..1 code draft | active | retired | unknown
... type 1..1 CodeableConcept Kind of product
... name 1..1 string Official name
... ownedBy 1..1 Reference(Organization) Plan issuer
... administeredBy 1..1 Reference(Organization) Product administrator
... coverage 1..* BackboneElement Coverage details
... plan 1..* BackboneElement Plan details

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan C 0..* InsurancePlan Details of a Health Insurance product/plan provided by an organization
ipn-1: The organization SHALL at least have a name or an idendtifier, and possibly more than one
... status ?!Σ 1..1 code draft | active | retired | unknown
Binding: PublicationStatus (required): The lifecycle status of an artifact.

... type Σ 1..1 CodeableConcept Kind of product
Binding: InsurancePlanType (example): Used to categorize the product/plan.


... name ΣC 1..1 string Official name
... ownedBy Σ 1..1 Reference(Organization) Plan issuer
... administeredBy Σ 1..1 Reference(Organization) Product administrator
... coverage 1..* BackboneElement Coverage details
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 CodeableConcept Type of coverage
.... benefit 1..* BackboneElement List of benefits
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type 1..1 CodeableConcept Type of benefit
... plan 1..* BackboneElement Plan details
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
InsurancePlan.statusrequiredPublicationStatus
http://hl7.org/fhir/ValueSet/publication-status|4.0.1
from the FHIR Standard
InsurancePlan.typeexampleInsurancePlanType
http://hl7.org/fhir/ValueSet/insuranceplan-type
from the FHIR Standard
NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan C 0..* InsurancePlan Details of a Health Insurance product/plan provided by an organization
ipn-1: The organization SHALL at least have a name or an idendtifier, and possibly more than one
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... identifier ΣC 0..* Identifier Business Identifier for Product
... status ?!Σ 1..1 code draft | active | retired | unknown
Binding: PublicationStatus (required): The lifecycle status of an artifact.

... type Σ 1..1 CodeableConcept Kind of product
Binding: InsurancePlanType (example): Used to categorize the product/plan.


... name ΣC 1..1 string Official name
... alias 0..* string Alternate names
... period 0..1 Period When the product is available
... ownedBy Σ 1..1 Reference(Organization) Plan issuer
... administeredBy Σ 1..1 Reference(Organization) Product administrator
... coverageArea Σ 0..* Reference(Location) Where product applies
... contact 0..* BackboneElement Contact for the product
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... purpose 0..1 CodeableConcept The type of contact
Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party.

.... name 0..1 HumanName A name associated with the contact
.... telecom 0..* ContactPoint Contact details (telephone, email, etc.) for a contact
.... address 0..1 Address Visiting or postal addresses for the contact
... endpoint 0..* Reference(Endpoint) Technical endpoint
... network 0..* Reference(Organization) What networks are Included
... coverage 1..* BackboneElement Coverage details
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 CodeableConcept Type of coverage
.... network 0..* Reference(Organization) What networks provide coverage
.... benefit 1..* BackboneElement List of benefits
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type 1..1 CodeableConcept Type of benefit
..... requirement 0..1 string Referral requirements
..... limit 0..* BackboneElement Benefit limits
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... value 0..1 Quantity Maximum value allowed
...... code 0..1 CodeableConcept Benefit limit details
... plan 1..* BackboneElement Plan details
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... identifier Σ 0..* Identifier Business Identifier for Product
.... type 0..1 CodeableConcept Type of plan
.... coverageArea Σ 0..* Reference(Location) Where product applies
.... network 0..* Reference(Organization) What networks provide coverage
.... generalCost 0..* BackboneElement Overall costs
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type 0..1 CodeableConcept Type of cost
..... groupSize 0..1 positiveInt Number of enrollees
..... cost 0..1 Money Cost value
..... comment 0..1 string Additional cost information
.... specificCost 0..* BackboneElement Specific costs
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category 1..1 CodeableConcept General category of benefit
..... benefit 0..* BackboneElement Benefits list
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... type 1..1 CodeableConcept Type of specific benefit
...... cost 0..* BackboneElement List of the costs
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
....... type 1..1 CodeableConcept Type of cost
....... applicability 0..1 CodeableConcept in-network | out-of-network | other
Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.

....... qualifiers 0..* CodeableConcept Additional information about the cost
....... value 0..1 Quantity The actual cost value

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
InsurancePlan.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
InsurancePlan.statusrequiredPublicationStatus
http://hl7.org/fhir/ValueSet/publication-status|4.0.1
from the FHIR Standard
InsurancePlan.typeexampleInsurancePlanType
http://hl7.org/fhir/ValueSet/insuranceplan-type
from the FHIR Standard
InsurancePlan.contact.purposeextensibleContactEntityType
http://hl7.org/fhir/ValueSet/contactentity-type
from the FHIR Standard
InsurancePlan.plan.specificCost.benefit.cost.applicabilityrequiredBenefitCostApplicability
http://hl7.org/fhir/ValueSet/insuranceplan-applicability|4.0.1
from the FHIR Standard

This structure is derived from InsurancePlan

Summary

Mandatory: 7 elements
Prohibited: 2 elements

Differential View

This structure is derived from InsurancePlan

NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan 0..* InsurancePlan Details of a Health Insurance product/plan provided by an organization
... implicitRules 0..0
... modifierExtension 0..0
... status 1..1 code draft | active | retired | unknown
... type 1..1 CodeableConcept Kind of product
... name 1..1 string Official name
... ownedBy 1..1 Reference(Organization) Plan issuer
... administeredBy 1..1 Reference(Organization) Product administrator
... coverage 1..* BackboneElement Coverage details
... plan 1..* BackboneElement Plan details

doco Documentation for this format

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan C 0..* InsurancePlan Details of a Health Insurance product/plan provided by an organization
ipn-1: The organization SHALL at least have a name or an idendtifier, and possibly more than one
... status ?!Σ 1..1 code draft | active | retired | unknown
Binding: PublicationStatus (required): The lifecycle status of an artifact.

... type Σ 1..1 CodeableConcept Kind of product
Binding: InsurancePlanType (example): Used to categorize the product/plan.


... name ΣC 1..1 string Official name
... ownedBy Σ 1..1 Reference(Organization) Plan issuer
... administeredBy Σ 1..1 Reference(Organization) Product administrator
... coverage 1..* BackboneElement Coverage details
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 CodeableConcept Type of coverage
.... benefit 1..* BackboneElement List of benefits
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type 1..1 CodeableConcept Type of benefit
... plan 1..* BackboneElement Plan details
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
InsurancePlan.statusrequiredPublicationStatus
http://hl7.org/fhir/ValueSet/publication-status|4.0.1
from the FHIR Standard
InsurancePlan.typeexampleInsurancePlanType
http://hl7.org/fhir/ValueSet/insuranceplan-type
from the FHIR Standard

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan C 0..* InsurancePlan Details of a Health Insurance product/plan provided by an organization
ipn-1: The organization SHALL at least have a name or an idendtifier, and possibly more than one
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... identifier ΣC 0..* Identifier Business Identifier for Product
... status ?!Σ 1..1 code draft | active | retired | unknown
Binding: PublicationStatus (required): The lifecycle status of an artifact.

... type Σ 1..1 CodeableConcept Kind of product
Binding: InsurancePlanType (example): Used to categorize the product/plan.


... name ΣC 1..1 string Official name
... alias 0..* string Alternate names
... period 0..1 Period When the product is available
... ownedBy Σ 1..1 Reference(Organization) Plan issuer
... administeredBy Σ 1..1 Reference(Organization) Product administrator
... coverageArea Σ 0..* Reference(Location) Where product applies
... contact 0..* BackboneElement Contact for the product
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... purpose 0..1 CodeableConcept The type of contact
Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party.

.... name 0..1 HumanName A name associated with the contact
.... telecom 0..* ContactPoint Contact details (telephone, email, etc.) for a contact
.... address 0..1 Address Visiting or postal addresses for the contact
... endpoint 0..* Reference(Endpoint) Technical endpoint
... network 0..* Reference(Organization) What networks are Included
... coverage 1..* BackboneElement Coverage details
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 CodeableConcept Type of coverage
.... network 0..* Reference(Organization) What networks provide coverage
.... benefit 1..* BackboneElement List of benefits
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type 1..1 CodeableConcept Type of benefit
..... requirement 0..1 string Referral requirements
..... limit 0..* BackboneElement Benefit limits
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... value 0..1 Quantity Maximum value allowed
...... code 0..1 CodeableConcept Benefit limit details
... plan 1..* BackboneElement Plan details
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... identifier Σ 0..* Identifier Business Identifier for Product
.... type 0..1 CodeableConcept Type of plan
.... coverageArea Σ 0..* Reference(Location) Where product applies
.... network 0..* Reference(Organization) What networks provide coverage
.... generalCost 0..* BackboneElement Overall costs
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type 0..1 CodeableConcept Type of cost
..... groupSize 0..1 positiveInt Number of enrollees
..... cost 0..1 Money Cost value
..... comment 0..1 string Additional cost information
.... specificCost 0..* BackboneElement Specific costs
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category 1..1 CodeableConcept General category of benefit
..... benefit 0..* BackboneElement Benefits list
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... type 1..1 CodeableConcept Type of specific benefit
...... cost 0..* BackboneElement List of the costs
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
....... type 1..1 CodeableConcept Type of cost
....... applicability 0..1 CodeableConcept in-network | out-of-network | other
Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.

....... qualifiers 0..* CodeableConcept Additional information about the cost
....... value 0..1 Quantity The actual cost value

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
InsurancePlan.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
InsurancePlan.statusrequiredPublicationStatus
http://hl7.org/fhir/ValueSet/publication-status|4.0.1
from the FHIR Standard
InsurancePlan.typeexampleInsurancePlanType
http://hl7.org/fhir/ValueSet/insuranceplan-type
from the FHIR Standard
InsurancePlan.contact.purposeextensibleContactEntityType
http://hl7.org/fhir/ValueSet/contactentity-type
from the FHIR Standard
InsurancePlan.plan.specificCost.benefit.cost.applicabilityrequiredBenefitCostApplicability
http://hl7.org/fhir/ValueSet/insuranceplan-applicability|4.0.1
from the FHIR Standard

This structure is derived from InsurancePlan

Summary

Mandatory: 7 elements
Prohibited: 2 elements

 

Other representations of profile: CSV, Excel, Schematron