--- type: "resource" title: "InsurancePlan" resource: "InsurancePlan" --- # InsurancePlan ## Introduction ## Scope and Usage Insurance offerings will be fully described by the combination of both InsurancePlan (the costs) and InsuranceProduct (the benefits). However, some systems may only need to represent the InsurancePlan, so that Coverage resources can describe which plan is associated with a given beneficiary. In that case, there will be some other system that is responsible for tracking the benefits associated with the plan. An InsurancePlan pairs the health insurance coverage benefits under an InsuranceProduct with the particular cost sharing structure offered to a consumer. A given InsuranceProduct may comprise multiple InsurancePlans. > **Note to Balloters:** > > This resource is likely to be removed from the specification and moved to being an [Additional Resource](resource#additional) after this ballot due to concerns around it's readiness, and the thin implementation experience. Ballot comments on this subject are welcome. ## Boundaries and Relationships [InsuranceProduct](insuranceproduct) describes a list of covered benefits and networks as well as details about who administers the product and applicable coverage areas. InsurancePlan describes the costs to the subscriber or beneficiary associated with benefits, as well as additional information about the offering, such as who administers the plan, a coverage area, contact information, etc. The specific benefits covered by the plan are described in the InsuranceProduct referenced in InsurancePlan.product. A [Coverage](coverage) resource establishes the link between an InsurancePlan and a beneficiary and optionally a subscriber. ## Notes ## Notes: ## StructureDefinition ### Elements (Simplified) - **[InsurancePlan](/insuranceplan-definitions#InsurancePlan)** [0..*]: - Plan details - **[InsurancePlan.identifier](/insuranceplan-definitions#InsurancePlan.identifier)** [0..*]: [Identifier](/Identifier) Business Identifier for Plan - **[InsurancePlan.type](/insuranceplan-definitions#InsurancePlan.type)** [0..1]: [CodeableConcept](/CodeableConcept) Classification of Plan - **[InsurancePlan.product](/insuranceplan-definitions#InsurancePlan.product)** [0..1]: Reference([InsuranceProduct](/InsuranceProduct)) The product that this plan is available under - **[InsurancePlan.coverageArea](/insuranceplan-definitions#InsurancePlan.coverageArea)** [0..*]: Reference([Location](/Location)) Where product-plan applies - **[InsurancePlan.network](/insuranceplan-definitions#InsurancePlan.network)** [0..*]: Reference([Organization](/Organization)) What networks provide coverage - **[InsurancePlan.generalCost](/insuranceplan-definitions#InsurancePlan.generalCost)** [0..*]: [BackboneElement](/BackboneElement) Overall costs - **[InsurancePlan.generalCost.type](/insuranceplan-definitions#InsurancePlan.generalCost.type)** [0..1]: [CodeableConcept](/CodeableConcept) Classification of specific cost - **[InsurancePlan.generalCost.groupSize](/insuranceplan-definitions#InsurancePlan.generalCost.groupSize)** [0..1]: [positiveInt](/positiveInt) Number of enrollees - **[InsurancePlan.generalCost.cost](/insuranceplan-definitions#InsurancePlan.generalCost.cost)** [0..1]: [Money](/Money) Cost value - **[InsurancePlan.generalCost.comment](/insuranceplan-definitions#InsurancePlan.generalCost.comment)** [0..1]: [string](/string) Additional cost information - **[InsurancePlan.specificCost](/insuranceplan-definitions#InsurancePlan.specificCost)** [0..*]: [BackboneElement](/BackboneElement) Individual cost elements - **[InsurancePlan.specificCost.category](/insuranceplan-definitions#InsurancePlan.specificCost.category)** [1..1]: [CodeableConcept](/CodeableConcept) General category of benefit - **[InsurancePlan.specificCost.benefit](/insuranceplan-definitions#InsurancePlan.specificCost.benefit)** [0..*]: [BackboneElement](/BackboneElement) Benefits list - **[InsurancePlan.specificCost.benefit.type](/insuranceplan-definitions#InsurancePlan.specificCost.benefit.type)** [1..1]: [CodeableConcept](/CodeableConcept) Classification of benefit provided - **[InsurancePlan.specificCost.benefit.cost](/insuranceplan-definitions#InsurancePlan.specificCost.benefit.cost)** [0..*]: [BackboneElement](/BackboneElement) List of the costs - **[InsurancePlan.specificCost.benefit.cost.type](/insuranceplan-definitions#InsurancePlan.specificCost.benefit.cost.type)** [1..1]: [CodeableConcept](/CodeableConcept) Classification of specific cost - **[InsurancePlan.specificCost.benefit.cost.applicability](/insuranceplan-definitions#InsurancePlan.specificCost.benefit.cost.applicability)** [0..1]: [CodeableConcept](/CodeableConcept) required:[insuranceplan-applicability](/valueset-insuranceplan-applicability) in-network | out-of-network | other - **[InsurancePlan.specificCost.benefit.cost.qualifier](/insuranceplan-definitions#InsurancePlan.specificCost.benefit.cost.qualifier)** [0..*]: [CodeableConcept](/CodeableConcept) Additional information about the cost - **[InsurancePlan.specificCost.benefit.cost.value](/insuranceplan-definitions#InsurancePlan.specificCost.benefit.cost.value)** [0..1]: [Quantity](/Quantity) The actual cost value ## Mappings - [InsurancePlan Mappings](/insuranceplan-mappings) — 4 mapping entries ## Resource Packs ### list-InsurancePlan-packs.xml ```xml ``` ## Search Parameters - [identifier](/insuranceplan-search#identifier) — **token** — External identifiers for this item — `InsurancePlan.identifier` - [type](/insuranceplan-search#type) — **token** — A code for the type of insurance plan — `InsurancePlan.type` - [product](/insuranceplan-search#product) — **reference** — The product this plan is available to — `InsurancePlan.product` - [coverage-area](/insuranceplan-search#coverage-area) — **reference** — Location(s) insurance product is intended for/available to — `InsurancePlan.coverageArea` - [network](/insuranceplan-search#network) — **reference** — The product this plan is available to — `InsurancePlan.network` [Full Search Parameters](/insuranceplan-search) ## Examples - [example](/insuranceplan-example-example) — insuranceplan-example — A general insurance plan example - [insuranceplan-example](/insuranceplan-example-insuranceplan-example) — insuranceplan-example - [insuranceplan-example-onc](/insuranceplan-example-insuranceplan-example-onc) — insuranceplan-example-onc - [insuranceplan-example1](/insuranceplan-example-insuranceplan-example1) — insuranceplan-example1 - [insuranceplan-examples-header](/insuranceplan-example-insuranceplan-examples-header) — insuranceplan-examples-header [Full Examples](/insuranceplan-examples) ## Mapping Exceptions ### insuranceplan-fivews-mapping-exceptions.xml ### Unmapped Elements - **FiveWs.what** — Unknown - **FiveWs.recorded** — Unknown - **FiveWs.author** — Unknown - **FiveWs.actor** — Unknown - **FiveWs.cause** — Unknown - **FiveWs.version** — Unknown - **FiveWs.witness** — Unknown - **FiveWs.class** — Unknown - **FiveWs.where** — Unknown - **FiveWs.context** — Unknown - **FiveWs.init** — Unknown - **FiveWs.why** — Unknown - **FiveWs.source** — Unknown - **FiveWs.who** — Unknown - **FiveWs.grade** — Unknown - **FiveWs.status** — Unknown - **FiveWs.planned** — Unknown - **FiveWs.done** — Unknown - **FiveWs.subject** — Unknown