---
type: "resource-definitions"
title: "InsurancePlan Definitions"
resource: "InsurancePlan"
---

# InsurancePlan Definitions

<a id="InsurancePlan"></a>

## InsurancePlan
Plan details

**Definition:** 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`.

**Cardinality:** 0..*

**Mappings:** w5=administrative.entity


<a id="InsurancePlan.identifier"></a>

## InsurancePlan.identifier
Business Identifier for Plan

**Definition:** Identifiers, such as the plan ID and/or group ID associated with the insurance plan.

**Comments:** In some markets, the combination of a plan ID and a group ID are needed to uniquely identify an InsurancePlan.  For example, if a single plan (Bronze) is offered to two employer groups (Boilermakers and Aviation), you would represent that using two InsurancePlan resources, as shown below:
```
InsurancePlan.identifier  0..*  (Boilermakers)   InsurancePlan/bm
     [0].value = 1234   (bronze plan)
     [0].type = Plan
     [0].system = https://insurance-payer.com/plan-numbers

     [1].value = Boilermakers
     [1].type = Group
     [1].system = https:// insurance-payer.com /group-numbers
```
```
InsurancePlan.identifier  0..*  (Aviation)   InsurancePlan/av
     [0].value = 1234  (bronze plan)
     [0].type = Plan
     [0].system = https:// insurance-payer.com /plan-numbers

     [1].value = Aviation
     [1].type = Group
     [1].system = https:// insurance-payer.com /group-numbers
```

**Cardinality:** 0..*

**Type:** [Identifier](/Identifier)

**Summary:** true

**Mappings:** w5=FiveWs.identifier; rim=.scopes[Role](classCode=IDENT)


<a id="InsurancePlan.type"></a>

## InsurancePlan.type
Classification of Plan

**Definition:** Type of plan. For example, "Platinum" or "High Deductable".

**Cardinality:** 0..1

**Type:** [CodeableConcept](/CodeableConcept)


<a id="InsurancePlan.product"></a>

## InsurancePlan.product
The product that this plan is available under

**Definition:** The product that this plan is available under.

**Cardinality:** 0..1

**Type:** Reference([InsuranceProduct](/InsuranceProduct))

**Summary:** true

**Mappings:** rim=N/A


<a id="InsurancePlan.coverageArea"></a>

## InsurancePlan.coverageArea
Where product-plan applies

**Definition:** The geographic region in which a health insurance plan's benefits apply.

**Cardinality:** 0..*

**Type:** Reference([Location](/Location))

**Summary:** true


<a id="InsurancePlan.network"></a>

## InsurancePlan.network
What networks provide coverage

**Definition:** Reference to the network that providing the type of coverage.

**Comments:** Networks are represented as a hierarchy of organization resources.

**Cardinality:** 0..*

**Type:** Reference([Organization](/Organization))


<a id="InsurancePlan.generalCost"></a>

## InsurancePlan.generalCost
Overall costs

**Definition:** Overall costs associated with the plan.

**Cardinality:** 0..*

**Type:** [BackboneElement](/BackboneElement)


<a id="InsurancePlan.generalCost.type"></a>

## InsurancePlan.generalCost.type
Classification of specific cost

**Definition:** Type of cost.

**Cardinality:** 0..1

**Type:** [CodeableConcept](/CodeableConcept)


<a id="InsurancePlan.generalCost.groupSize"></a>

## InsurancePlan.generalCost.groupSize
Number of enrollees

**Definition:** Number of participants enrolled in the plan.

**Cardinality:** 0..1

**Type:** [positiveInt](/positiveInt)


<a id="InsurancePlan.generalCost.cost"></a>

## InsurancePlan.generalCost.cost
Cost value

**Definition:** Value of the cost.

**Cardinality:** 0..1

**Type:** [Money](/Money)


<a id="InsurancePlan.generalCost.comment"></a>

## InsurancePlan.generalCost.comment
Additional cost information

**Definition:** Additional information about the general costs associated with this plan.

**Cardinality:** 0..1

**Type:** [string](/string)


<a id="InsurancePlan.specificCost"></a>

## InsurancePlan.specificCost
Individual cost elements

**Definition:** Costs associated with the coverage provided by the product-plan.

**Cardinality:** 0..*

**Type:** [BackboneElement](/BackboneElement)


<a id="InsurancePlan.specificCost.category"></a>

## InsurancePlan.specificCost.category
General category of benefit

**Definition:** General category of benefit (Medical; Dental; Vision; Drug; Mental Health; Substance Abuse; Hospice, Home Health).

**Cardinality:** 1..1

**Type:** [CodeableConcept](/CodeableConcept)


<a id="InsurancePlan.specificCost.benefit"></a>

## InsurancePlan.specificCost.benefit
Benefits list

**Definition:** List of the specific benefits under this category of benefit.

**Cardinality:** 0..*

**Type:** [BackboneElement](/BackboneElement)


<a id="InsurancePlan.specificCost.benefit.type"></a>

## InsurancePlan.specificCost.benefit.type
Classification of benefit provided

**Definition:** Type of specific benefit (preventative; primary care office visit; speciality office visit; hospitalization; emergency room; urgent care).

**Cardinality:** 1..1

**Type:** [CodeableConcept](/CodeableConcept)


<a id="InsurancePlan.specificCost.benefit.cost"></a>

## InsurancePlan.specificCost.benefit.cost
List of the costs

**Definition:** List of the costs associated with a specific benefit.

**Cardinality:** 0..*

**Type:** [BackboneElement](/BackboneElement)


<a id="InsurancePlan.specificCost.benefit.cost.type"></a>

## InsurancePlan.specificCost.benefit.cost.type
Classification of specific cost

**Definition:** Type of cost (copay; individual cap; family cap; coinsurance; deductible).

**Cardinality:** 1..1

**Type:** [CodeableConcept](/CodeableConcept)


<a id="InsurancePlan.specificCost.benefit.cost.applicability"></a>

## InsurancePlan.specificCost.benefit.cost.applicability
in-network | out-of-network | other

**Definition:** Whether the cost applies to in-network or out-of-network providers (in-network; out-of-network; other).

**Cardinality:** 0..1

**Type:** [CodeableConcept](/CodeableConcept)

**Binding:** required:[insuranceplan-applicability](/valueset-insuranceplan-applicability)


<a id="InsurancePlan.specificCost.benefit.cost.qualifier"></a>

## InsurancePlan.specificCost.benefit.cost.qualifier
Additional information about the cost

**Definition:** Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA).

**Cardinality:** 0..*

**Type:** [CodeableConcept](/CodeableConcept)


<a id="InsurancePlan.specificCost.benefit.cost.value"></a>

## InsurancePlan.specificCost.benefit.cost.value
The actual cost value

**Definition:** The actual cost value. (some of the costs may be represented as percentages rather than currency, e.g. 10% coinsurance).

**Cardinality:** 0..1

**Type:** [Quantity](/Quantity)