PayerInsurancePlan

Payer Insurance Plan

activeDa Vinci Drug Formulary2.1.0resource35 key elements

The Payer InsurancePlan that defines the health insurance product, which include coverage benefits that are offered, and additional information about the offering, such as a coverage area, contact information, brochure locations, etc. The health insurance product offers one or more types of coverage, each of which may define a plan of covered benefits with the particular cost sharing structure offered to a consumer. Health insurance plans that include drug coverage reference a formulary that provides details about drugs that are covered under the plan including requirements and limitations of the coverage specific to each drug.

Metadata

hl7.org/fhir
Canonical URL
http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PayerInsurancePlan
ID
usdf-PayerInsurancePlan
Type
Base Definition
Derivation
constraint
Mandatory and Must-Support Elements

Elements with cardinality > 0 or marked as Must Support (S)

PathCard.TypeFlagsDescription
meta.lastUpdated
S1+
identifier
S1+
The business identifier for the plan. The same InsurancePlan may be present in multiple directories and if they have the same identifier they are assumed to be the same plan.
status
S1+
type1..1
S1+
Product type
name
S
period
S
coverageArea
Reference
S
contact.name
S
contact.name.text
S
contact.telecom
S
contact.telecom.system
S
contact.telecom.value
S
coverage
S1+
coverage.type
S
:drug-coverage1..*
S1+
coverage.extension
S1+
:usdf-FormularyReference-extension1..*
Extension
S1+
:drug-plan1..*
S1+
plan
S1+
:drug-plan1..*
S1+
Drug plan
plan.identifier
S
plan.type
1+
plan.specificCost
S1+
Pharmacy benefit type specific cost
plan.specificCost.category
S
Pharmacy Benefit Type
plan.specificCost.benefit
S1+
Drug tier benefit
plan.specificCost.benefit.type
S
plan.specificCost.benefit.cost
S1+
plan.specificCost.benefit.cost.qualifiers1..1
S1+
plan.specificCost.benefit.cost.value
S
:copay0..1
S
Copay costs
plan.specificCost.benefit.cost.value
Quantity
1+
plan.specificCost.benefit.cost.value.value
S1+
:coinsurance0..1
S
Coinsurance costs
plan.specificCost.benefit.cost.value
1+
plan.specificCost.benefit.cost.value.value
S1+