InsuranceProduct

Introduction

Scope and Usage

Insurance offerings will be fully described by the combination of both InsurancePlan (the costs) and InsuranceProduct (the benefits). A given payer’s products typically differ by network type and/or coverage benefits.

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 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

Insurance Product 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 resource establishes the link between an InsurancePlan and a beneficiary and optionally a subscriber.

Notes

Notes:

StructureDefinition

Elements (Simplified)

• InsuranceProduct [0..*]: - Details of a Health Insurance product provided by an organization
• InsuranceProduct.identifier [0..*]: Identifier Business Identifier for Product
• InsuranceProduct.status [0..1]: code required:publication-status draft | active | retired | unknown
• InsuranceProduct.type [0..*]: CodeableConcept example:insuranceproduct-type Kind of product
• InsuranceProduct.name [0..1]: string Official name
• InsuranceProduct.alias [0..*]: string Alternate names
• InsuranceProduct.period [0..1]: Period When the product is available
• InsuranceProduct.ownedBy [0..1]: Reference(Organization) Product issuer
• InsuranceProduct.administeredBy [0..1]: Reference(Organization) Product administrator
• InsuranceProduct.coverageArea [0..*]: Reference(Location) Where product applies
• InsuranceProduct.contact [0..*]: ExtendedContactDetail Official contact details relevant to the health insurance product
• InsuranceProduct.endpoint [0..*]: Reference(Endpoint) Technical endpoint
• InsuranceProduct.network [0..*]: Reference(Organization) What networks are Included
• InsuranceProduct.coverage [0..*]: BackboneElement Coverage details
• InsuranceProduct.coverage.type [1..1]: CodeableConcept Classification of Coverage
• InsuranceProduct.coverage.network [0..*]: Reference(Organization) What networks provide coverage
• InsuranceProduct.coverage.benefit [1..*]: BackboneElement List of benefits
• InsuranceProduct.coverage.benefit.type [1..1]: CodeableConcept Classification of benefit provided
• InsuranceProduct.coverage.benefit.requirement [0..1]: string Referral requirements
• InsuranceProduct.coverage.benefit.limit [0..*]: BackboneElement Limits on the provided benefits
• InsuranceProduct.coverage.benefit.limit.value [0..1]: Quantity Maximum value allowed
• InsuranceProduct.coverage.benefit.limit.code [0..1]: CodeableConcept Benefit limit details
• InsuranceProduct.related [0..*]: BackboneElement Associated insurance product
• InsuranceProduct.related.product [0..1]: Reference(InsuranceProduct) Related Product reference
• InsuranceProduct.related.relationship [0..1]: CodeableConcept Relationship of this product to the related product
• InsuranceProduct.related.period [0..1]: Period Period that this Relationship is valid

Mappings

• InsuranceProduct Mappings — 11 mapping entries

Resource Packs

list-InsuranceProduct-packs.xml

<?xml version="1.0" encoding="UTF-8"?>

<List xmlns="http://hl7.org/fhir">
  <id value="InsuranceProduct-packs"/>
  <status value="current"/>
  <mode value="working"/>
</List>

Search Parameters

• contact-address — string — A server defined search that may match any of the string fields in the Address, including line, city, district, state, country, postalCode, and/or text — InsuranceProduct.contact.address
• contact-address-city — string — A city specified in an address — InsuranceProduct.contact.address.city
• contact-address-country — string — A country specified in an address — InsuranceProduct.contact.address.country
• contact-address-postalcode — string — A postal code specified in an address — InsuranceProduct.contact.address.postalCode
• contact-address-state — string — A state specified in an address — InsuranceProduct.contact.address.state
• contact-address-use — token — A use code specified in an address — InsuranceProduct.contact.address.use
• administered-by — reference — Product administrator — InsuranceProduct.administeredBy
• endpoint — reference — Technical endpoint — InsuranceProduct.endpoint
• identifier — token — Any identifier for the product (not the accreditation issuer's identifier) — InsuranceProduct.identifier
• name — string — A portion of the insurance product's name or alias — InsuranceProduct.name | InsuranceProduct.alias
• owned-by — reference — The issuer of the insurance product — InsuranceProduct.ownedBy
• phonetic — string — A portion of the product's name using some kind of phonetic matching algorithm — InsuranceProduct.name
• status — token — Is the Product record active — InsuranceProduct.status
• type — token — A code for the type of insurance product — InsuranceProduct.type
• endpoint — reference — The endpoint(s) applicable to this product — InsuranceProduct.endpoint

Full Search Parameters

Examples

• example — insuranceproduct-example — A general insurance product example
• insuranceproduct-example — insuranceproduct-example
• insuranceproduct-example-onc — insuranceproduct-example-onc
• insuranceproduct-example1 — insuranceproduct-example1
• insuranceproduct-examples-header — insuranceproduct-examples-header

Full Examples

Mapping Exceptions

insuranceproduct-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.where — Unknown
• FiveWs.context — Unknown
• FiveWs.init — Unknown
• FiveWs.why — Unknown
• FiveWs.source — Unknown
• FiveWs.who — Unknown
• FiveWs.grade — Unknown
• FiveWs.planned — Unknown
• FiveWs.done — Unknown
• FiveWs.subject — Unknown