FHIR IG analytics| Package | hl7.fhir.uv.vhdir |
| Resource Type | InsurancePlan |
| Id | InsurancePlan-insuranceplan1.json |
| FHIR Version | R4 |
No resources found
No resources found
Note: links and images are rebased to the (stated) source
Generated Narrative: InsurancePlan insuranceplan1
identifier: HIOS product ID/1234567891 (use: official, ) (status: active)
status: Active
type: Bronze
name: Patriot PPO Standard
alias: Patriot Plus
period: 2018-06-06 --> 2019-01-01
ownedBy: Homeland Health Insurance
administeredBy: Homeland Health Insurance
coverageArea: Washington, DC metro area
contact
purpose: General information
telecom: ph: 202-123-5555, info@homelandinc.org
endpoint: patriot plan endpoint hub
network:
coverage
type: Coverage related to medical inpatient, outpatient, diagnostic, and preventive care
network: Patriot Preferred Provider Network
benefit
type: Primary care visit to treat an injury or illness
requirement: N/A
Limits
Code unlimited
coverage
type: Coverage related to dental care
network: Patriot Dental Provider Network
benefit
type: Periodic oral checkup
requirement: N/A
Limits
Value Code 2 visit/yr biannual oral checkup
plan
identifier: HIOS plan ID/123456789101112 (use: official, )
type: Bronze
coverageArea: Washington, DC metro area
network: Patriot Dental Provider Network
generalCost
type: Deductible
groupSize: 1
Costs
Value Currency 6200 United States dollar comment: Includes all prescription and medical costs for in-network providers
specificCost
category: Medical
benefit
type: Primary care visit to treat an injury or illness
Costs
Type Applicability Qualifiers Value Copay In Network in-network preferred provider 50 dollars (Details: unknown codeUSD = 'United States dollar') specificCost
category: Dental
benefit
type: Basic Dental Care – Adult
Costs
Type Applicability Qualifiers Value Coinsurance In Network in-network provider 10 percent
FHIR
FHIRsmith{
"resourceType": "InsurancePlan",
"id": "insuranceplan1",
"meta": {
"profile": [
"http://hl7.org/fhir/uv/vhdir/StructureDefinition/vhdir-insuranceplan"
]
},
"text": {
"status": "extensions",
"div": "<!-- snip (see above) -->"
},
"identifier": [
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/vhdir/StructureDefinition/identifier-status",
"valueCode": "active"
}
],
"use": "official",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "NIIP",
"display": "National Insurance Payor Identifier (Payor)",
"userSelected": true
}
],
"text": "HIOS product ID"
},
"system": "https://www.cms.gov/CCIIO/",
"value": "1234567891",
"assigner": {
"display": "Centers for Medicare and Medicaid Services"
}
}
],
"status": "active",
"type": [
{
"coding": [
{
"system": "http://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristics",
"code": "bronze",
"display": "Bronze"
}
]
}
],
"name": "Patriot PPO Standard",
"alias": [
"Patriot Plus"
],
"period": {
"start": "2018-06-06",
"end": "2019-01-01"
},
"ownedBy": {
"reference": "Organization/homeland",
"display": "Homeland Health Insurance"
},
"administeredBy": {
"reference": "Organization/homeland",
"display": "Homeland Health Insurance"
},
"coverageArea": [
{
"reference": "Location/wash-dc-metro",
"display": "Washington, DC metro area"
}
],
"contact": [
{
"purpose": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/contactentity-type",
"code": "PATINF",
"display": "Patient"
}
],
"text": "General information"
},
"telecom": [
{
"system": "phone",
"value": "202-123-5555"
},
{
"system": "email",
"value": "info@homelandinc.org"
}
]
}
],
"endpoint": [
{
"display": "patriot plan endpoint hub"
}
],
"network": [
{
"reference": "Organization/patriotppo",
"display": "Patriot Preferred Provider Network"
},
{
"reference": "Organization/patriotdental",
"display": "Patriot Dental Provider Network"
}
],
"coverage": [
{
"type": {
"coding": [
{
"system": "http://example.org/coverage-type",
"code": "medical",
"display": "Medical"
}
],
"text": "Coverage related to medical inpatient, outpatient, diagnostic, and preventive care"
},
"network": [
{
"reference": "Organization/patriotppo",
"display": "Patriot Preferred Provider Network"
}
],
"benefit": [
{
"type": {
"coding": [
{
"system": "http://example.org/benefit-type",
"code": "001",
"display": "Primary care visit to treat an injury or illness"
}
]
},
"requirement": "N/A",
"limit": [
{
"code": {
"text": "unlimited"
}
}
]
}
]
},
{
"type": {
"coding": [
{
"system": "http://example.org/coverage-type",
"code": "dental",
"display": "Dental"
}
],
"text": "Coverage related to dental care"
},
"network": [
{
"reference": "Organization/patriotdental",
"display": "Patriot Dental Provider Network"
}
],
"benefit": [
{
"type": {
"coding": [
{
"system": "http://example.org/benefit-type",
"code": "052",
"display": "Basic Dental Care – Adult"
}
],
"text": "Periodic oral checkup"
},
"requirement": "N/A",
"limit": [
{
"value": {
"value": 2,
"unit": "visit/yr",
"system": "http://unitsofmeasure.org"
},
"code": {
"text": "biannual oral checkup"
}
}
]
}
]
}
],
"plan": [
{
"identifier": [
{
"use": "official",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "NIIP",
"display": "National Insurance Payor Identifier (Payor)",
"userSelected": true
}
],
"text": "HIOS plan ID"
},
"system": "https://www.cms.gov/CCIIO/",
"value": "123456789101112",
"assigner": {
"display": "Centers for Medicare and Medicaid Services"
}
}
],
"type": {
"coding": [
{
"system": "http://example.org/planlevel",
"code": "bronze",
"display": "Bronze"
}
],
"text": "Bronze"
},
"coverageArea": [
{
"reference": "Location/wash-dc-metro",
"display": "Washington, DC metro area"
}
],
"network": [
{
"reference": "Organization/patriotdental",
"display": "Patriot Dental Provider Network"
}
],
"generalCost": [
{
"type": {
"coding": [
{
"system": "http://example.org/cost-type",
"code": "deductible",
"display": "Deductible"
}
],
"text": "Deductible"
},
"groupSize": 1,
"cost": {
"value": 6200,
"currency": "USD"
},
"comment": "Includes all prescription and medical costs for in-network providers"
}
],
"specificCost": [
{
"category": {
"coding": [
{
"system": "http://example.org/cost-category",
"code": "medical",
"display": "Medical"
}
]
},
"benefit": [
{
"type": {
"coding": [
{
"system": "http://example.org/benefit-type",
"code": "001",
"display": "Primary care visit to treat an injury or illness"
}
]
},
"cost": [
{
"type": {
"coding": [
{
"system": "http://example.org/cost-type",
"code": "copay",
"display": "Copay"
}
]
},
"applicability": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/applicability",
"code": "in-network",
"display": "In Network"
}
]
},
"qualifiers": [
{
"text": "in-network preferred provider"
}
],
"value": {
"value": 50,
"unit": "dollars",
"system": "urn:iso:std:iso:4217",
"code": "USD"
}
}
]
}
]
},
{
"category": {
"coding": [
{
"system": "http://example.org/cost-category",
"code": "dental",
"display": "Dental"
}
]
},
"benefit": [
{
"type": {
"coding": [
{
"system": "http://example.org/cost-type",
"code": "052",
"display": "Basic Dental Care – Adult"
}
]
},
"cost": [
{
"type": {
"coding": [
{
"system": "http://example.org/costing",
"code": "coinsurance",
"display": "Coinsurance"
}
]
},
"applicability": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/applicability",
"code": "in-network",
"display": "In Network"
}
]
},
"qualifiers": [
{
"text": "in-network provider"
}
],
"value": {
"value": 10,
"unit": "percent"
}
}
]
}
]
}
]
}
]
}