FHIR IG analytics| Package | hl7.fhir.us.davinci-drug-formulary |
| Resource Type | InsurancePlan |
| Id | InsurancePlan-PayerInsurancePlanA3002.json |
| FHIR Version | R4 |
No resources found
No resources found
Note: links and images are rebased to the (stated) source
Generated Narrative: InsurancePlan PayerInsurancePlanA3002
Last updated: 2021-05-22 18:36:03+0000
Profile: Payer Insurance Plan
identifier: A3002
status: Active
type: Medicare Advantage
name: Sample Medicare Advantage Plan A3002
period: 2021-01-01 --> 2021-12-31
coverageArea: Location United States Area
contact
purpose: Patient
telecom: +1 (888) 555-3002
contact
purpose: Marketting
name: Sample Medicare Advantage Plan Marketing Website
contact
purpose: Summary
name: Sample Medicare Advantage Drug Plan Benefit Website
contact
purpose: Formulary
name: Sample Medicare Advantage Drug Plan Formulary Website
coverage
Formulary Reference: InsurancePlan Sample Medicare Advantage Part D Formulary D3002
type: drug policy
Benefits
Type Drug
plan
type: Drug
specificCost
category: 1 month in network retail
benefit
type: Generic
cost
type: Copay
qualifiers: Before Deductible
value: 10 $ (Details: unknown codeUSD = 'United States dollar')
cost
type: Coinsurance
qualifiers: After Deductible
value: 1 % (Details: UCUM code% = '%')
specificCost
category: 1 month out of network retail
benefit
type: Generic
cost
type: Copay
qualifiers: No Charge
value: 0 $ (Details: unknown codeUSD = 'United States dollar')
cost
type: Coinsurance
qualifiers: After Deductible
value: 0 % (Details: UCUM code% = '%')
specificCost
category: 3 month in network retail
benefit
type: Generic
cost
type: Copay
qualifiers: No Charge
value: 0 $ (Details: unknown codeUSD = 'United States dollar')
cost
type: Coinsurance
qualifiers: After Deductible
value: 0 % (Details: UCUM code% = '%')
specificCost
category: 3 month out of network retail
benefit
type: Generic
cost
type: Copay
qualifiers: No Charge
value: 0 $ (Details: unknown codeUSD = 'United States dollar')
cost
type: Coinsurance
qualifiers: After Deductible
value: 0 % (Details: UCUM code% = '%')
FHIR
FHIRsmith{
"resourceType": "InsurancePlan",
"id": "PayerInsurancePlanA3002",
"meta": {
"lastUpdated": "2021-05-22T18:36:03.000+00:00",
"profile": [
"http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PayerInsurancePlan"
]
},
"text": {
"status": "extensions",
"div": "<!-- snip (see above) -->"
},
"identifier": [
{
"value": "A3002"
}
],
"status": "active",
"type": [
{
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-pdex-plan-net/CodeSystem/InsuranceProductTypeCS",
"code": "mediadv"
}
]
}
],
"name": "Sample Medicare Advantage Plan A3002",
"period": {
"start": "2021-01-01",
"end": "2021-12-31"
},
"coverageArea": [
{
"reference": "Location/UnitedStatesLocation"
}
],
"contact": [
{
"purpose": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/contactentity-type",
"code": "PATINF"
}
]
},
"telecom": [
{
"system": "phone",
"value": "+1 (888) 555-3002"
}
]
},
{
"purpose": {
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PlanContactTypeCS-TEMPORARY-TRIAL-USE",
"code": "MARKETING"
}
]
},
"name": {
"text": "Sample Medicare Advantage Plan Marketing Website"
},
"telecom": [
{
"system": "url",
"value": "http://url/to/health/plan/information"
}
]
},
{
"purpose": {
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PlanContactTypeCS-TEMPORARY-TRIAL-USE",
"code": "SUMMARY"
}
]
},
"name": {
"text": "Sample Medicare Advantage Drug Plan Benefit Website"
},
"telecom": [
{
"system": "url",
"value": "http://url/to/health/plan/information"
}
]
},
{
"purpose": {
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PlanContactTypeCS-TEMPORARY-TRIAL-USE",
"code": "FORMULARY"
}
]
},
"name": {
"text": "Sample Medicare Advantage Drug Plan Formulary Website"
},
"telecom": [
{
"system": "url",
"value": "http://url/to/health/plan/information"
}
]
}
],
"coverage": [
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyReference-extension",
"valueReference": {
"reference": "InsurancePlan/FormularyD3002"
}
}
],
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "DRUGPOL"
}
]
},
"benefit": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/insurance-plan-type",
"code": "drug",
"display": "Drug"
}
]
}
}
]
}
],
"plan": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/insurance-plan-type",
"code": "drug",
"display": "Drug"
}
]
},
"specificCost": [
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PharmacyBenefitTypeCS-TEMPORARY-TRIAL-USE",
"code": "1-month-in-retail",
"display": "1 month in network retail"
}
]
},
"benefit": [
{
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE",
"code": "generic",
"display": "Generic"
}
]
},
"cost": [
{
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE",
"code": "copay",
"display": "Copay"
}
]
},
"qualifiers": [
{
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE",
"code": "before-deductible",
"display": "Before Deductible"
}
]
}
],
"value": {
"value": 10,
"unit": "[%content%]quot;,
"system": "urn:iso:std:iso:4217",
"code": "USD"
}
},
{
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE",
"code": "coinsurance",
"display": "Coinsurance"
}
]
},
"qualifiers": [
{
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE",
"code": "after-deductible",
"display": "After Deductible"
}
]
}
],
"value": {
"value": 1,
"system": "http://unitsofmeasure.org",
"code": "%"
}
}
]
}
]
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PharmacyBenefitTypeCS-TEMPORARY-TRIAL-USE",
"code": "1-month-out-retail",
"display": "1 month out of network retail"
}
]
},
"benefit": [
{
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE",
"code": "generic",
"display": "Generic"
}
]
},
"cost": [
{
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE",
"code": "copay",
"display": "Copay"
}
]
},
"qualifiers": [
{
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE",
"code": "no-charge",
"display": "No Charge"
}
]
}
],
"value": {
"value": 0,
"unit": "[%content%]quot;,
"system": "urn:iso:std:iso:4217",
"code": "USD"
}
},
{
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE",
"code": "coinsurance",
"display": "Coinsurance"
}
]
},
"qualifiers": [
{
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE",
"code": "after-deductible",
"display": "After Deductible"
}
]
}
],
"value": {
"value": 0,
"system": "http://unitsofmeasure.org",
"code": "%"
}
}
]
}
]
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PharmacyBenefitTypeCS-TEMPORARY-TRIAL-USE",
"code": "3-month-in-retail",
"display": "3 month in network retail"
}
]
},
"benefit": [
{
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE",
"code": "generic",
"display": "Generic"
}
]
},
"cost": [
{
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE",
"code": "copay",
"display": "Copay"
}
]
},
"qualifiers": [
{
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE",
"code": "no-charge",
"display": "No Charge"
}
]
}
],
"value": {
"value": 0,
"unit": "[%content%]quot;,
"system": "urn:iso:std:iso:4217",
"code": "USD"
}
},
{
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE",
"code": "coinsurance",
"display": "Coinsurance"
}
]
},
"qualifiers": [
{
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE",
"code": "after-deductible",
"display": "After Deductible"
}
]
}
],
"value": {
"value": 0,
"system": "http://unitsofmeasure.org",
"code": "%"
}
}
]
}
]
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PharmacyBenefitTypeCS-TEMPORARY-TRIAL-USE",
"code": "3-month-out-retail",
"display": "3 month out of network retail"
}
]
},
"benefit": [
{
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE",
"code": "generic",
"display": "Generic"
}
]
},
"cost": [
{
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE",
"code": "copay",
"display": "Copay"
}
]
},
"qualifiers": [
{
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE",
"code": "no-charge",
"display": "No Charge"
}
]
}
],
"value": {
"value": 0,
"unit": "[%content%]quot;,
"system": "urn:iso:std:iso:4217",
"code": "USD"
}
},
{
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE",
"code": "coinsurance",
"display": "Coinsurance"
}
]
},
"qualifiers": [
{
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE",
"code": "after-deductible",
"display": "After Deductible"
}
]
}
],
"value": {
"value": 0,
"system": "http://unitsofmeasure.org",
"code": "%"
}
}
]
}
]
}
]
}
]
}