FHIR Implementation Guide for ABDM
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FHIR Implementation Guide for ABDM - Local Development build (v7.0.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: InsurancePlan

Official URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/InsurancePlan Version: 7.0.0
Draft as of 2025-03-18 Computable Name: InsurancePlan

InsurancePlan represents the product that can be offered to the customer. It describes a health insurance offering comprised of a list of covered benefits (i.e. the product), costs associated with those benefits (i.e. the plan), and additional information about the offering. It provides the details of a contractual arrangement between an individual or entity (the policyholder) and an insurance provider. A plan describes the Health coverage issued to you directly (individual plan) or through an employer, union, or other group sponsor (employer group plan) that provides coverage for certain health care costs. It pairs the health insurance coverage benefits under a product with the particular cost sharing structure offered to a consumer.

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

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

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. InsurancePlan C 0..* InsurancePlan Details of a Health Insurance product/plan provided by an organization
Constraints: ipn-1
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:claim-exclusion 0..* (Complex) Excluded coverage details within a health insurance product. It outlines services, treatments or conditions not covered. e.g. pre-existing disease, specific disease/procedure waiting period etc.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion
.... extension:claim-supportingInfoRequirement 0..* (Complex) Essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... status ?!SΣ 1..1 code draft | active | retired | unknown
Binding: PublicationStatus (required): The lifecycle status of an artifact.
... type SΣ 1..1 CodeableConcept Type of product that indicates the predominant type.
Binding: InsurancePlan Type (example): The valueset is created by referring the Health Insurance Data Reporting Manual provided by the Insurance Information Bureau of India (IIB). For more information, visit IIB's official website: https://iib.gov.in or access the manual directly at: https://healthapp.iib.gov.in/IIB/datamanuals/hidmanual08.pdf.
.... coding Σ 0..1 Coding Code defined by a terminology system
..... system Σ 1..1 uri Identity of the terminology system
..... code Σ 1..1 code Symbol in syntax defined by the system
..... display Σ 1..1 string Representation defined by the system
.... text SΣ 0..1 string Plain text representation of the concept
... name SΣC 1..1 string Official name of the product
... alias S 0..* string Alternate names
... period S 1..1 Period When the product is available
... ownedBy SΣ 1..1 Reference(Organization) Plan issuer
... administeredBy SΣ 0..1 Reference(Organization) Product administrator
... coverageArea SΣ 0..* Reference(Location) Where product applies
... contact S 0..* BackboneElement Contact for the product
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
... network S 0..* Reference(Organization) Network included in the health insurance product.
... coverage S 1..* BackboneElement Coverage details for e.g. In-Patient Hospitalization, Day Care etc.
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:claim-condition 0..* (Complex) Outlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance product.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition
..... extension:claim-supportingInfoRequirement 0..* (Complex) Essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 CodeableConcept Type of coverage
Binding: Coverage Type (example)
..... coding Σ 0..1 Coding Code defined by a terminology system
...... system Σ 1..1 uri Identity of the terminology system
...... code Σ 1..1 code Symbol in syntax defined by the system
...... display Σ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
.... network 0..* Reference(Organization) What networks provide coverage
.... benefit S 1..* BackboneElement List of benefits e.g. consultation, oxygen, robotic surgery etc.
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:claim-condition 0..* (Complex) Outlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance product.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition
...... extension:claimSupportingInfoRequirement 0..* (Complex) Enumerates essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type 1..1 CodeableConcept Type of benefit
Binding: Benefit Type (example)
...... coding Σ 0..1 Coding Code defined by a terminology system
....... system Σ 1..1 uri Identity of the terminology system
....... code Σ 1..1 code Symbol in syntax defined by the system
....... display Σ 1..1 string Representation defined by the system
...... text SΣ 0..1 string Plain text representation of the concept
... plan S 0..* BackboneElement Cost sharing details for the plan offered to a consumer.
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:claim-exclusion 0..* (Complex) Excluded coverage details within a plan. It outlines services, treatments or conditions not covered. e.g. pre-existing disease, specific disease/procedure waiting period etc.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion
..... extension:claimCondition 0..* (Complex) Outlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance product.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition
..... extension:claimSupportingInfoRequirement 0..* (Complex) Enumerates essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type S 1..1 CodeableConcept Type of plan
Binding: Plan Type (example)
..... coding Σ 0..1 Coding Code defined by a terminology system
...... system Σ 1..1 uri Identity of the terminology system
...... code Σ 1..1 code Symbol in syntax defined by the system
...... display Σ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
.... coverageArea SΣ 0..* Reference(Location) Where product applies
.... network 0..* Reference(Organization) What networks provide coverage
.... generalCost S 0..* BackboneElement Sum insured amount associated with the plan.
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... specificCost S 0..* BackboneElement Specific costs
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category S 1..1 CodeableConcept General category of benefit
Binding: Benefit Category (example)
...... coding Σ 0..1 Coding Code defined by a terminology system
....... system Σ 1..1 uri Identity of the terminology system
....... code Σ 1..1 code Symbol in syntax defined by the system
....... display Σ 1..1 string Representation defined by the system
...... text SΣ 0..1 string Plain text representation of the concept
..... benefit 0..* BackboneElement Benefits list
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... type 1..1 CodeableConcept Type of specific benefit
Binding: ProductorService (example)
....... coding Σ 0..1 Coding Code defined by a terminology system
........ system Σ 1..1 uri Identity of the terminology system
........ code Σ 1..1 code Symbol in syntax defined by the system
........ display Σ 1..1 string Representation defined by the system
....... text SΣ 0..1 string Plain text representation of the concept

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
InsurancePlan.status Base required PublicationStatus 📍4.0.1 FHIR Std.
InsurancePlan.type Base example InsurancePlan Type 📦7.0.0 This IG
InsurancePlan.coverage.​type Base example Coverage Type 📦7.0.0 This IG
InsurancePlan.coverage.​benefit.type Base example Benefit Type 📦7.0.0 This IG
InsurancePlan.plan.type Base example Plan Type 📦7.0.0 This IG
InsurancePlan.plan.specificCost.​category Base example Benefit Category 📦7.0.0 This IG
InsurancePlan.plan.specificCost.​benefit.type Base example ProductorService 📦7.0.0 This IG

Constraints

Id Grade Path(s) Description Expression
dom-2 error InsurancePlan If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error InsurancePlan If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error InsurancePlan If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error InsurancePlan If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice InsurancePlan A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
ipn-1 error InsurancePlan The organization SHALL at least have a name or an idendtifier, and possibly more than one (identifier.count() + name.count()) > 0

This structure is derived from InsurancePlan

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. InsurancePlan 0..* InsurancePlan Details of a Health Insurance product/plan provided by an organization
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:claim-exclusion 0..* (Complex) Excluded coverage details within a health insurance product. It outlines services, treatments or conditions not covered. e.g. pre-existing disease, specific disease/procedure waiting period etc.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion
.... extension:claim-supportingInfoRequirement 0..* (Complex) Essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
... identifier S 1..1 Identifier Identifier provided by payer to uniquely identify the product covering a list of combinations offered to consumers under this particular insurance plan.
... status S 1..1 code draft | active | retired | unknown
.... coding 0..1 Coding Code defined by a terminology system
..... system 1..1 uri Identity of the terminology system
..... code 1..1 code Symbol in syntax defined by the system
..... display 1..1 string Representation defined by the system
.... text S 0..1 string Plain text representation of the concept
... name S 1..1 string Official name of the product
... alias S 0..* string Alternate names
... period S 1..1 Period When the product is available
... ownedBy S 1..1 Reference(Organization) Plan issuer
... administeredBy S 0..1 Reference(Organization) Product administrator
... coverageArea S 0..* Reference(Location) Where product applies
... contact S 0..* BackboneElement Contact for the product
... network S 0..* Reference(Organization) Network included in the health insurance product.
... coverage S 1..* BackboneElement Coverage details for e.g. In-Patient Hospitalization, Day Care etc.
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:claim-condition 0..* (Complex) Outlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance product.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition
..... extension:claim-supportingInfoRequirement 0..* (Complex) Essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
.... type 1..1 CodeableConcept Type of coverage
Binding: Coverage Type (example)
..... coding 0..1 Coding Code defined by a terminology system
...... system 1..1 uri Identity of the terminology system
...... code 1..1 code Symbol in syntax defined by the system
...... display 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
.... network 0..* Reference(Organization) What networks provide coverage
.... benefit S 1..* BackboneElement List of benefits e.g. consultation, oxygen, robotic surgery etc.
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:claim-condition 0..* (Complex) Outlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance product.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition
...... extension:claimSupportingInfoRequirement 0..* (Complex) Enumerates essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
..... type 1..1 CodeableConcept Type of benefit
Binding: Benefit Type (example)
...... coding 0..1 Coding Code defined by a terminology system
....... system 1..1 uri Identity of the terminology system
....... code 1..1 code Symbol in syntax defined by the system
....... display 1..1 string Representation defined by the system
...... text S 0..1 string Plain text representation of the concept
... plan S 0..* BackboneElement Cost sharing details for the plan offered to a consumer.
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:claim-exclusion 0..* (Complex) Excluded coverage details within a plan. It outlines services, treatments or conditions not covered. e.g. pre-existing disease, specific disease/procedure waiting period etc.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion
..... extension:claimCondition 0..* (Complex) Outlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance product.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition
..... extension:claimSupportingInfoRequirement 0..* (Complex) Enumerates essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
.... type S 1..1 CodeableConcept Type of plan
Binding: Plan Type (example)
..... coding 0..1 Coding Code defined by a terminology system
...... system 1..1 uri Identity of the terminology system
...... code 1..1 code Symbol in syntax defined by the system
...... display 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
.... coverageArea S 0..* Reference(Location) Where product applies
.... network 0..* Reference(Organization) What networks provide coverage
.... generalCost S 0..* BackboneElement Sum insured amount associated with the plan.
.... specificCost S 0..* BackboneElement Specific costs
..... category S 1..1 CodeableConcept General category of benefit
Binding: Benefit Category (example)
...... coding 0..1 Coding Code defined by a terminology system
....... system 1..1 uri Identity of the terminology system
....... code 1..1 code Symbol in syntax defined by the system
....... display 1..1 string Representation defined by the system
...... text S 0..1 string Plain text representation of the concept
..... benefit
...... type 1..1 CodeableConcept Type of specific benefit
Binding: ProductorService (example)
....... coding 0..1 Coding Code defined by a terminology system
........ system 1..1 uri Identity of the terminology system
........ code 1..1 code Symbol in syntax defined by the system
........ display 1..1 string Representation defined by the system
....... text S 0..1 string Plain text representation of the concept

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
InsurancePlan.type Base example InsurancePlan Type 📦7.0.0 This IG
InsurancePlan.coverage.​type Base example Coverage Type 📦7.0.0 This IG
InsurancePlan.coverage.​benefit.type Base example Benefit Type 📦7.0.0 This IG
InsurancePlan.plan.type Base example Plan Type 📦7.0.0 This IG
InsurancePlan.plan.specificCost.​category Base example Benefit Category 📦7.0.0 This IG
InsurancePlan.plan.specificCost.​benefit.type Base example ProductorService 📦7.0.0 This IG
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. InsurancePlan C 0..* InsurancePlan Details of a Health Insurance product/plan provided by an organization
Constraints: ipn-1
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:claim-exclusion 0..* (Complex) Excluded coverage details within a health insurance product. It outlines services, treatments or conditions not covered. e.g. pre-existing disease, specific disease/procedure waiting period etc.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion
.... extension:claim-supportingInfoRequirement 0..* (Complex) Essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier SΣC 1..1 Identifier Identifier provided by payer to uniquely identify the product covering a list of combinations offered to consumers under this particular insurance plan.
... status ?!SΣ 1..1 code draft | active | retired | unknown
Binding: PublicationStatus (required): The lifecycle status of an artifact.
... type SΣ 1..1 CodeableConcept Type of product that indicates the predominant type.
Binding: InsurancePlan Type (example): The valueset is created by referring the Health Insurance Data Reporting Manual provided by the Insurance Information Bureau of India (IIB). For more information, visit IIB's official website: https://iib.gov.in or access the manual directly at: https://healthapp.iib.gov.in/IIB/datamanuals/hidmanual08.pdf.
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... coding Σ 0..1 Coding Code defined by a terminology system
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... system Σ 1..1 uri Identity of the terminology system
..... version Σ 0..1 string Version of the system - if relevant
..... code Σ 1..1 code Symbol in syntax defined by the system
..... display Σ 1..1 string Representation defined by the system
..... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text SΣ 0..1 string Plain text representation of the concept
... name SΣC 1..1 string Official name of the product
... alias S 0..* string Alternate names
... period S 1..1 Period When the product is available
... ownedBy SΣ 1..1 Reference(Organization) Plan issuer
... administeredBy SΣ 0..1 Reference(Organization) Product administrator
... coverageArea SΣ 0..* Reference(Location) Where product applies
... contact S 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 S 0..* Reference(Organization) Network included in the health insurance product.
... coverage S 1..* BackboneElement Coverage details for e.g. In-Patient Hospitalization, Day Care etc.
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:claim-condition 0..* (Complex) Outlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance product.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition
..... extension:claim-supportingInfoRequirement 0..* (Complex) Essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 CodeableConcept Type of coverage
Binding: Coverage Type (example)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding Σ 0..1 Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system Σ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code Σ 1..1 code Symbol in syntax defined by the system
...... display Σ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... network 0..* Reference(Organization) What networks provide coverage
.... benefit S 1..* BackboneElement List of benefits e.g. consultation, oxygen, robotic surgery etc.
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:claim-condition 0..* (Complex) Outlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance product.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition
...... extension:claimSupportingInfoRequirement 0..* (Complex) Enumerates essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type 1..1 CodeableConcept Type of benefit
Binding: Benefit Type (example)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding Σ 0..1 Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system Σ 1..1 uri Identity of the terminology system
....... version Σ 0..1 string Version of the system - if relevant
....... code Σ 1..1 code Symbol in syntax defined by the system
....... display Σ 1..1 string Representation defined by the system
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text SΣ 0..1 string Plain text representation of the concept
..... 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 S 0..* BackboneElement Cost sharing details for the plan offered to a consumer.
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:claim-exclusion 0..* (Complex) Excluded coverage details within a plan. It outlines services, treatments or conditions not covered. e.g. pre-existing disease, specific disease/procedure waiting period etc.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion
..... extension:claimCondition 0..* (Complex) Outlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance product.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition
..... extension:claimSupportingInfoRequirement 0..* (Complex) Enumerates essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... identifier Σ 0..* Identifier Business Identifier for Product
.... type S 1..1 CodeableConcept Type of plan
Binding: Plan Type (example)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding Σ 0..1 Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system Σ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code Σ 1..1 code Symbol in syntax defined by the system
...... display Σ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... coverageArea SΣ 0..* Reference(Location) Where product applies
.... network 0..* Reference(Organization) What networks provide coverage
.... generalCost S 0..* BackboneElement Sum insured amount associated with the plan.
..... 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 S 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 S 1..1 CodeableConcept General category of benefit
Binding: Benefit Category (example)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding Σ 0..1 Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system Σ 1..1 uri Identity of the terminology system
....... version Σ 0..1 string Version of the system - if relevant
....... code Σ 1..1 code Symbol in syntax defined by the system
....... display Σ 1..1 string Representation defined by the system
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text SΣ 0..1 string Plain text representation of the concept
..... 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
Binding: ProductorService (example)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... coding Σ 0..1 Coding Code defined by a terminology system
........ id 0..1 string Unique id for inter-element referencing
........ extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
........ system Σ 1..1 uri Identity of the terminology system
........ version Σ 0..1 string Version of the system - if relevant
........ code Σ 1..1 code Symbol in syntax defined by the system
........ display Σ 1..1 string Representation defined by the system
........ userSelected Σ 0..1 boolean If this coding was chosen directly by the user
....... text SΣ 0..1 string Plain text representation of the concept
...... 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

Path Status Usage ValueSet Version Source
InsurancePlan.language Base preferred Common Languages 📍4.0.1 FHIR Std.
InsurancePlan.status Base required PublicationStatus 📍4.0.1 FHIR Std.
InsurancePlan.type Base example InsurancePlan Type 📦7.0.0 This IG
InsurancePlan.contact.​purpose Base extensible Contact entity type 📍4.0.1 FHIR Std.
InsurancePlan.coverage.​type Base example Coverage Type 📦7.0.0 This IG
InsurancePlan.coverage.​benefit.type Base example Benefit Type 📦7.0.0 This IG
InsurancePlan.plan.type Base example Plan Type 📦7.0.0 This IG
InsurancePlan.plan.specificCost.​category Base example Benefit Category 📦7.0.0 This IG
InsurancePlan.plan.specificCost.​benefit.type Base example ProductorService 📦7.0.0 This IG
InsurancePlan.plan.specificCost.​benefit.cost.applicability Base required Benefit cost applicability 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error InsurancePlan If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error InsurancePlan If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error InsurancePlan If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error InsurancePlan If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice InsurancePlan A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
ipn-1 error InsurancePlan The organization SHALL at least have a name or an idendtifier, and possibly more than one (identifier.count() + name.count()) > 0

This structure is derived from InsurancePlan

Summary

Mandatory: 7 elements(19 nested mandatory elements)
Must-Support: 25 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. InsurancePlan C 0..* InsurancePlan Details of a Health Insurance product/plan provided by an organization
Constraints: ipn-1
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:claim-exclusion 0..* (Complex) Excluded coverage details within a health insurance product. It outlines services, treatments or conditions not covered. e.g. pre-existing disease, specific disease/procedure waiting period etc.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion
.... extension:claim-supportingInfoRequirement 0..* (Complex) Essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... status ?!SΣ 1..1 code draft | active | retired | unknown
Binding: PublicationStatus (required): The lifecycle status of an artifact.
... type SΣ 1..1 CodeableConcept Type of product that indicates the predominant type.
Binding: InsurancePlan Type (example): The valueset is created by referring the Health Insurance Data Reporting Manual provided by the Insurance Information Bureau of India (IIB). For more information, visit IIB's official website: https://iib.gov.in or access the manual directly at: https://healthapp.iib.gov.in/IIB/datamanuals/hidmanual08.pdf.
.... coding Σ 0..1 Coding Code defined by a terminology system
..... system Σ 1..1 uri Identity of the terminology system
..... code Σ 1..1 code Symbol in syntax defined by the system
..... display Σ 1..1 string Representation defined by the system
.... text SΣ 0..1 string Plain text representation of the concept
... name SΣC 1..1 string Official name of the product
... alias S 0..* string Alternate names
... period S 1..1 Period When the product is available
... ownedBy SΣ 1..1 Reference(Organization) Plan issuer
... administeredBy SΣ 0..1 Reference(Organization) Product administrator
... coverageArea SΣ 0..* Reference(Location) Where product applies
... contact S 0..* BackboneElement Contact for the product
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
... network S 0..* Reference(Organization) Network included in the health insurance product.
... coverage S 1..* BackboneElement Coverage details for e.g. In-Patient Hospitalization, Day Care etc.
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:claim-condition 0..* (Complex) Outlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance product.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition
..... extension:claim-supportingInfoRequirement 0..* (Complex) Essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 CodeableConcept Type of coverage
Binding: Coverage Type (example)
..... coding Σ 0..1 Coding Code defined by a terminology system
...... system Σ 1..1 uri Identity of the terminology system
...... code Σ 1..1 code Symbol in syntax defined by the system
...... display Σ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
.... network 0..* Reference(Organization) What networks provide coverage
.... benefit S 1..* BackboneElement List of benefits e.g. consultation, oxygen, robotic surgery etc.
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:claim-condition 0..* (Complex) Outlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance product.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition
...... extension:claimSupportingInfoRequirement 0..* (Complex) Enumerates essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type 1..1 CodeableConcept Type of benefit
Binding: Benefit Type (example)
...... coding Σ 0..1 Coding Code defined by a terminology system
....... system Σ 1..1 uri Identity of the terminology system
....... code Σ 1..1 code Symbol in syntax defined by the system
....... display Σ 1..1 string Representation defined by the system
...... text SΣ 0..1 string Plain text representation of the concept
... plan S 0..* BackboneElement Cost sharing details for the plan offered to a consumer.
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:claim-exclusion 0..* (Complex) Excluded coverage details within a plan. It outlines services, treatments or conditions not covered. e.g. pre-existing disease, specific disease/procedure waiting period etc.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion
..... extension:claimCondition 0..* (Complex) Outlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance product.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition
..... extension:claimSupportingInfoRequirement 0..* (Complex) Enumerates essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type S 1..1 CodeableConcept Type of plan
Binding: Plan Type (example)
..... coding Σ 0..1 Coding Code defined by a terminology system
...... system Σ 1..1 uri Identity of the terminology system
...... code Σ 1..1 code Symbol in syntax defined by the system
...... display Σ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
.... coverageArea SΣ 0..* Reference(Location) Where product applies
.... network 0..* Reference(Organization) What networks provide coverage
.... generalCost S 0..* BackboneElement Sum insured amount associated with the plan.
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... specificCost S 0..* BackboneElement Specific costs
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category S 1..1 CodeableConcept General category of benefit
Binding: Benefit Category (example)
...... coding Σ 0..1 Coding Code defined by a terminology system
....... system Σ 1..1 uri Identity of the terminology system
....... code Σ 1..1 code Symbol in syntax defined by the system
....... display Σ 1..1 string Representation defined by the system
...... text SΣ 0..1 string Plain text representation of the concept
..... benefit 0..* BackboneElement Benefits list
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... type 1..1 CodeableConcept Type of specific benefit
Binding: ProductorService (example)
....... coding Σ 0..1 Coding Code defined by a terminology system
........ system Σ 1..1 uri Identity of the terminology system
........ code Σ 1..1 code Symbol in syntax defined by the system
........ display Σ 1..1 string Representation defined by the system
....... text SΣ 0..1 string Plain text representation of the concept

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
InsurancePlan.status Base required PublicationStatus 📍4.0.1 FHIR Std.
InsurancePlan.type Base example InsurancePlan Type 📦7.0.0 This IG
InsurancePlan.coverage.​type Base example Coverage Type 📦7.0.0 This IG
InsurancePlan.coverage.​benefit.type Base example Benefit Type 📦7.0.0 This IG
InsurancePlan.plan.type Base example Plan Type 📦7.0.0 This IG
InsurancePlan.plan.specificCost.​category Base example Benefit Category 📦7.0.0 This IG
InsurancePlan.plan.specificCost.​benefit.type Base example ProductorService 📦7.0.0 This IG

Constraints

Id Grade Path(s) Description Expression
dom-2 error InsurancePlan If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error InsurancePlan If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error InsurancePlan If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error InsurancePlan If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice InsurancePlan A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
ipn-1 error InsurancePlan The organization SHALL at least have a name or an idendtifier, and possibly more than one (identifier.count() + name.count()) > 0

Differential View

This structure is derived from InsurancePlan

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. InsurancePlan 0..* InsurancePlan Details of a Health Insurance product/plan provided by an organization
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:claim-exclusion 0..* (Complex) Excluded coverage details within a health insurance product. It outlines services, treatments or conditions not covered. e.g. pre-existing disease, specific disease/procedure waiting period etc.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion
.... extension:claim-supportingInfoRequirement 0..* (Complex) Essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
... identifier S 1..1 Identifier Identifier provided by payer to uniquely identify the product covering a list of combinations offered to consumers under this particular insurance plan.
... status S 1..1 code draft | active | retired | unknown
.... coding 0..1 Coding Code defined by a terminology system
..... system 1..1 uri Identity of the terminology system
..... code 1..1 code Symbol in syntax defined by the system
..... display 1..1 string Representation defined by the system
.... text S 0..1 string Plain text representation of the concept
... name S 1..1 string Official name of the product
... alias S 0..* string Alternate names
... period S 1..1 Period When the product is available
... ownedBy S 1..1 Reference(Organization) Plan issuer
... administeredBy S 0..1 Reference(Organization) Product administrator
... coverageArea S 0..* Reference(Location) Where product applies
... contact S 0..* BackboneElement Contact for the product
... network S 0..* Reference(Organization) Network included in the health insurance product.
... coverage S 1..* BackboneElement Coverage details for e.g. In-Patient Hospitalization, Day Care etc.
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:claim-condition 0..* (Complex) Outlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance product.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition
..... extension:claim-supportingInfoRequirement 0..* (Complex) Essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
.... type 1..1 CodeableConcept Type of coverage
Binding: Coverage Type (example)
..... coding 0..1 Coding Code defined by a terminology system
...... system 1..1 uri Identity of the terminology system
...... code 1..1 code Symbol in syntax defined by the system
...... display 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
.... network 0..* Reference(Organization) What networks provide coverage
.... benefit S 1..* BackboneElement List of benefits e.g. consultation, oxygen, robotic surgery etc.
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:claim-condition 0..* (Complex) Outlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance product.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition
...... extension:claimSupportingInfoRequirement 0..* (Complex) Enumerates essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
..... type 1..1 CodeableConcept Type of benefit
Binding: Benefit Type (example)
...... coding 0..1 Coding Code defined by a terminology system
....... system 1..1 uri Identity of the terminology system
....... code 1..1 code Symbol in syntax defined by the system
....... display 1..1 string Representation defined by the system
...... text S 0..1 string Plain text representation of the concept
... plan S 0..* BackboneElement Cost sharing details for the plan offered to a consumer.
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:claim-exclusion 0..* (Complex) Excluded coverage details within a plan. It outlines services, treatments or conditions not covered. e.g. pre-existing disease, specific disease/procedure waiting period etc.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion
..... extension:claimCondition 0..* (Complex) Outlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance product.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition
..... extension:claimSupportingInfoRequirement 0..* (Complex) Enumerates essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
.... type S 1..1 CodeableConcept Type of plan
Binding: Plan Type (example)
..... coding 0..1 Coding Code defined by a terminology system
...... system 1..1 uri Identity of the terminology system
...... code 1..1 code Symbol in syntax defined by the system
...... display 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
.... coverageArea S 0..* Reference(Location) Where product applies
.... network 0..* Reference(Organization) What networks provide coverage
.... generalCost S 0..* BackboneElement Sum insured amount associated with the plan.
.... specificCost S 0..* BackboneElement Specific costs
..... category S 1..1 CodeableConcept General category of benefit
Binding: Benefit Category (example)
...... coding 0..1 Coding Code defined by a terminology system
....... system 1..1 uri Identity of the terminology system
....... code 1..1 code Symbol in syntax defined by the system
....... display 1..1 string Representation defined by the system
...... text S 0..1 string Plain text representation of the concept
..... benefit
...... type 1..1 CodeableConcept Type of specific benefit
Binding: ProductorService (example)
....... coding 0..1 Coding Code defined by a terminology system
........ system 1..1 uri Identity of the terminology system
........ code 1..1 code Symbol in syntax defined by the system
........ display 1..1 string Representation defined by the system
....... text S 0..1 string Plain text representation of the concept

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
InsurancePlan.type Base example InsurancePlan Type 📦7.0.0 This IG
InsurancePlan.coverage.​type Base example Coverage Type 📦7.0.0 This IG
InsurancePlan.coverage.​benefit.type Base example Benefit Type 📦7.0.0 This IG
InsurancePlan.plan.type Base example Plan Type 📦7.0.0 This IG
InsurancePlan.plan.specificCost.​category Base example Benefit Category 📦7.0.0 This IG
InsurancePlan.plan.specificCost.​benefit.type Base example ProductorService 📦7.0.0 This IG

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. InsurancePlan C 0..* InsurancePlan Details of a Health Insurance product/plan provided by an organization
Constraints: ipn-1
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:claim-exclusion 0..* (Complex) Excluded coverage details within a health insurance product. It outlines services, treatments or conditions not covered. e.g. pre-existing disease, specific disease/procedure waiting period etc.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion
.... extension:claim-supportingInfoRequirement 0..* (Complex) Essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier SΣC 1..1 Identifier Identifier provided by payer to uniquely identify the product covering a list of combinations offered to consumers under this particular insurance plan.
... status ?!SΣ 1..1 code draft | active | retired | unknown
Binding: PublicationStatus (required): The lifecycle status of an artifact.
... type SΣ 1..1 CodeableConcept Type of product that indicates the predominant type.
Binding: InsurancePlan Type (example): The valueset is created by referring the Health Insurance Data Reporting Manual provided by the Insurance Information Bureau of India (IIB). For more information, visit IIB's official website: https://iib.gov.in or access the manual directly at: https://healthapp.iib.gov.in/IIB/datamanuals/hidmanual08.pdf.
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... coding Σ 0..1 Coding Code defined by a terminology system
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... system Σ 1..1 uri Identity of the terminology system
..... version Σ 0..1 string Version of the system - if relevant
..... code Σ 1..1 code Symbol in syntax defined by the system
..... display Σ 1..1 string Representation defined by the system
..... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text SΣ 0..1 string Plain text representation of the concept
... name SΣC 1..1 string Official name of the product
... alias S 0..* string Alternate names
... period S 1..1 Period When the product is available
... ownedBy SΣ 1..1 Reference(Organization) Plan issuer
... administeredBy SΣ 0..1 Reference(Organization) Product administrator
... coverageArea SΣ 0..* Reference(Location) Where product applies
... contact S 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 S 0..* Reference(Organization) Network included in the health insurance product.
... coverage S 1..* BackboneElement Coverage details for e.g. In-Patient Hospitalization, Day Care etc.
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:claim-condition 0..* (Complex) Outlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance product.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition
..... extension:claim-supportingInfoRequirement 0..* (Complex) Essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 CodeableConcept Type of coverage
Binding: Coverage Type (example)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding Σ 0..1 Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system Σ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code Σ 1..1 code Symbol in syntax defined by the system
...... display Σ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... network 0..* Reference(Organization) What networks provide coverage
.... benefit S 1..* BackboneElement List of benefits e.g. consultation, oxygen, robotic surgery etc.
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:claim-condition 0..* (Complex) Outlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance product.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition
...... extension:claimSupportingInfoRequirement 0..* (Complex) Enumerates essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type 1..1 CodeableConcept Type of benefit
Binding: Benefit Type (example)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding Σ 0..1 Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system Σ 1..1 uri Identity of the terminology system
....... version Σ 0..1 string Version of the system - if relevant
....... code Σ 1..1 code Symbol in syntax defined by the system
....... display Σ 1..1 string Representation defined by the system
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text SΣ 0..1 string Plain text representation of the concept
..... 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 S 0..* BackboneElement Cost sharing details for the plan offered to a consumer.
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:claim-exclusion 0..* (Complex) Excluded coverage details within a plan. It outlines services, treatments or conditions not covered. e.g. pre-existing disease, specific disease/procedure waiting period etc.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion
..... extension:claimCondition 0..* (Complex) Outlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance product.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition
..... extension:claimSupportingInfoRequirement 0..* (Complex) Enumerates essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... identifier Σ 0..* Identifier Business Identifier for Product
.... type S 1..1 CodeableConcept Type of plan
Binding: Plan Type (example)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding Σ 0..1 Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system Σ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code Σ 1..1 code Symbol in syntax defined by the system
...... display Σ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... coverageArea SΣ 0..* Reference(Location) Where product applies
.... network 0..* Reference(Organization) What networks provide coverage
.... generalCost S 0..* BackboneElement Sum insured amount associated with the plan.
..... 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 S 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 S 1..1 CodeableConcept General category of benefit
Binding: Benefit Category (example)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding Σ 0..1 Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system Σ 1..1 uri Identity of the terminology system
....... version Σ 0..1 string Version of the system - if relevant
....... code Σ 1..1 code Symbol in syntax defined by the system
....... display Σ 1..1 string Representation defined by the system
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text SΣ 0..1 string Plain text representation of the concept
..... 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
Binding: ProductorService (example)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... coding Σ 0..1 Coding Code defined by a terminology system
........ id 0..1 string Unique id for inter-element referencing
........ extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
........ system Σ 1..1 uri Identity of the terminology system
........ version Σ 0..1 string Version of the system - if relevant
........ code Σ 1..1 code Symbol in syntax defined by the system
........ display Σ 1..1 string Representation defined by the system
........ userSelected Σ 0..1 boolean If this coding was chosen directly by the user
....... text SΣ 0..1 string Plain text representation of the concept
...... 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

Path Status Usage ValueSet Version Source
InsurancePlan.language Base preferred Common Languages 📍4.0.1 FHIR Std.
InsurancePlan.status Base required PublicationStatus 📍4.0.1 FHIR Std.
InsurancePlan.type Base example InsurancePlan Type 📦7.0.0 This IG
InsurancePlan.contact.​purpose Base extensible Contact entity type 📍4.0.1 FHIR Std.
InsurancePlan.coverage.​type Base example Coverage Type 📦7.0.0 This IG
InsurancePlan.coverage.​benefit.type Base example Benefit Type 📦7.0.0 This IG
InsurancePlan.plan.type Base example Plan Type 📦7.0.0 This IG
InsurancePlan.plan.specificCost.​category Base example Benefit Category 📦7.0.0 This IG
InsurancePlan.plan.specificCost.​benefit.type Base example ProductorService 📦7.0.0 This IG
InsurancePlan.plan.specificCost.​benefit.cost.applicability Base required Benefit cost applicability 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error InsurancePlan If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error InsurancePlan If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error InsurancePlan If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error InsurancePlan If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice InsurancePlan A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
ipn-1 error InsurancePlan The organization SHALL at least have a name or an idendtifier, and possibly more than one (identifier.count() + name.count()) > 0

This structure is derived from InsurancePlan

Summary

Mandatory: 7 elements(19 nested mandatory elements)
Must-Support: 25 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

 

Other representations of profile: CSV, Excel, Schematron