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Packagehl7.fhir.us.insurance-card
Resource TypeStructureDefinition
IdStructureDefinition-benefit-limitation.json
FHIR VersionR4
Sourcehttps://build.fhir.org/ig/HL7/carin-digital-insurance-card/StructureDefinition-benefit-limitation.html
URLhttp://hl7.org/fhir/us/insurance-card/StructureDefinition/benefit-limitation
Version2.0.0
Statusdraft
Date2026-02-03T01:43:53+00:00
NameBenefitLimitation
TitleBenefit Limitation Extension
Realmus
Authorityhl7
DescriptionExtension for documenting limitations and exceptions that apply to specific benefits in the SBC
TypeExtension
Kindcomplex-type

Resources that use this resource

StructureDefinition
sbc-insurance-planSBC Insurance Plan Profile

Resources that this resource uses

No resources found


Examples of Use for Extension

ResourceVersion
hl7.fhir.us.insurance-card#current:InsurancePlan/SBCExampleHMOR4

Narrative

Note: links and images are rebased to the (stated) source

Generated Narrative: StructureDefinition benefit-limitation

NameFlagsCard.TypeDescription & Constraintsdoco
.. Extension 0..*ExtensionBenefit Limitation Extension
... extension 0..0Extension
... url 1..1uri"http://hl7.org/fhir/us/insurance-card/StructureDefinition/benefit-limitation"
... value[x] 0..1stringLimitation or Exception

doco Documentation for this format

Source1

{
  "resourceType": "StructureDefinition",
  "id": "benefit-limitation",
  "text": {
    "status": "extensions",
    "div": "<!-- snip (see above) -->"
  },
  "extension": [
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode": "claims"
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
      "valueCode": "informative",
      "_valueCode": {
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
            "valueCanonical": "http://hl7.org/fhir/us/insurance-card/ImplementationGuide/hl7.fhir.us.insurance-card"
          }
        ]
      }
    }
  ],
  "url": "http://hl7.org/fhir/us/insurance-card/StructureDefinition/benefit-limitation",
  "version": "2.0.0",
  "name": "BenefitLimitation",
  "title": "Benefit Limitation Extension",
  "status": "draft",
  "experimental": true,
  "date": "2026-02-03T01:43:53+00:00",
  "publisher": "HL7 International / Payer/Provider Information Exchange Work Group",
  "contact": [
    {
      "name": "HL7 International / Payer/Provider Information Exchange Work Group",
      "telecom": [
        {
          "system": "url",
          "value": "http://www.hl7.org/Special/committees/claims"
        },
        {
          "system": "email",
          "value": "pie@lists.HL7.org"
        }
      ]
    }
  ],
  "description": "Extension for documenting limitations and exceptions that apply to specific benefits in the SBC",
  "jurisdiction": [
    {
      "coding": [
        {
          "system": "urn:iso:std:iso:3166",
          "code": "US"
        }
      ]
    }
  ],
  "fhirVersion": "4.0.1",
  "mapping": [
    {
      "identity": "rim",
      "uri": "http://hl7.org/v3",
      "name": "RIM Mapping"
    }
  ],
  "kind": "complex-type",
  "abstract": false,
  "context": [
    {
      "type": "element",
      "expression": "InsurancePlan.coverage.benefit"
    },
    {
      "type": "element",
      "expression": "InsurancePlan.plan.specificCost.benefit"
    }
  ],
  "type": "Extension",
  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Extension",
  "derivation": "constraint",
  "snapshot": {
    "extension": [
      {
        "url": "http://hl7.org/fhir/tools/StructureDefinition/snapshot-base-version",
        "valueString": "4.0.1"
      }
    ],
    "element": [
      {
        "id": "Extension",
        "path": "Extension",
        "short": "Benefit Limitation Extension",
        "definition": "Extension for documenting limitations and exceptions that apply to specific benefits in the SBC",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Extension",
          "min": 0,
          "max": "*"
        },
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "isModifier": false
      },
      {
        "id": "Extension.id",
        "path": "Extension.id",
        "representation": [
          "xmlAttr"
        ],
        "short": "Unique id for inter-element referencing",
        "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Element.id",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
                "valueUrl": "string"
              }
            ],
            "code": "http://hl7.org/fhirpath/System.String"
          }
        ],
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Extension.extension",
        "path": "Extension.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "description": "Extensions are always sliced by (at least) url",
          "rules": "open"
        },
        "short": "Extension",
        "definition": "An Extension",
        "min": 0,
        "max": "0",
        "base": {
          "path": "Element.extension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "isModifier": false,
        "isSummary": false
      },
      {
        "id": "Extension.url",
        "path": "Extension.url",
        "representation": [
          "xmlAttr"
        ],
        "short": "identifies the meaning of the extension",
        "definition": "Source of the definition for the extension code - a logical name or a URL.",
        "comment": "The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Extension.url",
          "min": 1,
          "max": "1"
        },
        "type": [
          {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
                "valueUrl": "uri"
              }
            ],
            "code": "http://hl7.org/fhirpath/System.String"
          }
        ],
        "fixedUri": "http://hl7.org/fhir/us/insurance-card/StructureDefinition/benefit-limitation",
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Extension.value[x]",
        "path": "Extension.value[x]",
        "short": "Limitation or Exception",
        "definition": "Text describing limitations, exceptions, or additional requirements that apply to this benefit",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Extension.value[x]",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "string"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      }
    ]
  },
  "differential": {
    "element": [
      {
        "id": "Extension",
        "path": "Extension",
        "short": "Benefit Limitation Extension",
        "definition": "Extension for documenting limitations and exceptions that apply to specific benefits in the SBC"
      },
      {
        "id": "Extension.extension",
        "path": "Extension.extension",
        "max": "0"
      },
      {
        "id": "Extension.url",
        "path": "Extension.url",
        "fixedUri": "http://hl7.org/fhir/us/insurance-card/StructureDefinition/benefit-limitation"
      },
      {
        "id": "Extension.value[x]",
        "path": "Extension.value[x]",
        "short": "Limitation or Exception",
        "definition": "Text describing limitations, exceptions, or additional requirements that apply to this benefit",
        "type": [
          {
            "code": "string"
          }
        ]
      }
    ]
  }
}