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

# InsuranceProduct Definitions

<a id="InsuranceProduct"></a>

## InsuranceProduct
Details of a Health Insurance product provided by an organization

**Definition:** A product is a discrete package of health insurance coverage benefits that are offered under a particular network, by an organization (payer) and additional information about the offering, such as who it is owned and administered by, a coverage area, contact information, etc.

**Cardinality:** 0..*

**Constraints:** ipn-1 | error | The organization SHALL at least have a name or an identifier, and possibly more than one | (identifier.count() + name.count()) > 0

**Mappings:** w5=administrative.entity


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

## InsuranceProduct.identifier
Business Identifier for Product

**Definition:** Business identifiers assigned to this health insurance product which remain constant as the resource is updated and propagates from server to server.

**Conditions:** ipn-1

**Cardinality:** 0..*

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

**Summary:** true

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


<a id="InsuranceProduct.status"></a>

## InsuranceProduct.status
draft | active | retired | unknown

**Definition:** The current state of the health insurance product.

**Requirements:** Need a flag to indicate a record is no longer to be used and should generally be hidden for the user in the UI.

**Meaning if Missing:** Default interpretation is active.

**Cardinality:** 0..1

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

**Binding:** required:[publication-status](/valueset-publication-status)

**Summary:** true

**Is Modifier:** true (Reason: This element is labeled as a modifier because it is a status element that contains codes which means that the resource should not be treated as valid)

**Mappings:** w5=FiveWs.status; rim=.status


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

## InsuranceProduct.type
Kind of product

**Definition:** The kind of health insurance product.

**Cardinality:** 0..*

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

**Binding:** example:[insuranceproduct-type](/valueset-insuranceproduct-type)

**Summary:** true

**Mappings:** w5=FiveWs.class; rim=.code


<a id="InsuranceProduct.name"></a>

## InsuranceProduct.name
Official name

**Definition:** Official name of the health insurance product as designated by the owner.

**Comments:** If the name of the product changes, consider putting the old name in the alias column so that it can still be located through searches.

**Conditions:** ipn-1

**Cardinality:** 0..1

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

**Summary:** true

**Mappings:** rim=.name


<a id="InsuranceProduct.alias"></a>

## InsuranceProduct.alias
Alternate names

**Definition:** A list of alternate names that the product is known as, or was known as in the past.

**Comments:** There are no dates associated with the alias/historic names, as this is not intended to track when names were used, but to assist in searching so that older names can still result in identifying the product.

**Requirements:** Over time products go through many changes and can be known by different names.

For searching knowing previous names that the product was known by can be very useful.

**Cardinality:** 0..*

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

**Mappings:** rim=.name


<a id="InsuranceProduct.period"></a>

## InsuranceProduct.period
When the product is available

**Definition:** The period of time that the health insurance product is available.

**Cardinality:** 0..1

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


<a id="InsuranceProduct.ownedBy"></a>

## InsuranceProduct.ownedBy
Product issuer

**Definition:** The entity that is providing  the health insurance product and underwriting the risk.  This is typically an insurance carriers, other third-party payers, or health plan sponsors comonly referred to as 'payers'.

**Aliases:** Payer

**Cardinality:** 0..1

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

**Summary:** true


<a id="InsuranceProduct.administeredBy"></a>

## InsuranceProduct.administeredBy
Product administrator

**Definition:** An organization which administer other services such as underwriting, customer service and/or claims processing on behalf of the health insurance product owner.

**Cardinality:** 0..1

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

**Summary:** true


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

## InsuranceProduct.coverageArea
Where product applies

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

**Cardinality:** 0..*

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

**Summary:** true


<a id="InsuranceProduct.contact"></a>

## InsuranceProduct.contact
Official contact details relevant to the health insurance product

**Definition:** The contact details of communication devices available relevant to the specific Insurance Product. This can include addresses, phone numbers, fax numbers, mobile numbers, email addresses and web sites.

**Comments:** The address/telecom use code 'home' are not to be used.

**Requirements:** Need to keep track of both simple contact details and also assigned contacts within larger organizations.

**Cardinality:** 0..*

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

**Mappings:** rim=.contactParty


<a id="InsuranceProduct.endpoint"></a>

## InsuranceProduct.endpoint
Technical endpoint

**Definition:** The technical endpoints providing access to services operated for the health insurance product.

**Requirements:** Organizations have multiple systems that provide various services and need to be able to define the technical connection details for how to connect to them, and for what purpose.

**Cardinality:** 0..*

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

**Mappings:** rim=n/a


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

## InsuranceProduct.network
What networks are Included

**Definition:** Reference to the network included in the health insurance product.

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

**Cardinality:** 0..*

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


<a id="InsuranceProduct.coverage"></a>

## InsuranceProduct.coverage
Coverage details

**Definition:** Details about the coverage offered by the insurance product.

**Cardinality:** 0..*

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


<a id="InsuranceProduct.coverage.type"></a>

## InsuranceProduct.coverage.type
Classification of Coverage

**Definition:** Type of coverage  (Medical; Dental; Mental Health; Substance Abuse; Vision; Drug; Short Term; Long Term Care; Hospice; Home Health).

**Cardinality:** 1..1

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


<a id="InsuranceProduct.coverage.network"></a>

## InsuranceProduct.coverage.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="InsuranceProduct.coverage.benefit"></a>

## InsuranceProduct.coverage.benefit
List of benefits

**Definition:** Specific benefits under this type of coverage.

**Cardinality:** 1..*

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


<a id="InsuranceProduct.coverage.benefit.type"></a>

## InsuranceProduct.coverage.benefit.type
Classification of benefit provided

**Definition:** Type of benefit (primary care; specialty care; inpatient; outpatient).

**Cardinality:** 1..1

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


<a id="InsuranceProduct.coverage.benefit.requirement"></a>

## InsuranceProduct.coverage.benefit.requirement
Referral requirements

**Definition:** The referral requirements to have access/coverage for this benefit.

**Cardinality:** 0..1

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


<a id="InsuranceProduct.coverage.benefit.limit"></a>

## InsuranceProduct.coverage.benefit.limit
Limits on the provided benefits

**Definition:** The specific limits on the benefit.

**Cardinality:** 0..*

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


<a id="InsuranceProduct.coverage.benefit.limit.value"></a>

## InsuranceProduct.coverage.benefit.limit.value
Maximum value allowed

**Definition:** The maximum amount of a service item a plan will pay for a covered benefit.  For examples. wellness visits, or eyeglasses.

**Comments:** May also be called “eligible expense,” “payment allowance,” or “negotiated rate.”.

**Cardinality:** 0..1

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


<a id="InsuranceProduct.coverage.benefit.limit.code"></a>

## InsuranceProduct.coverage.benefit.limit.code
Benefit limit details

**Definition:** The specific limit on the benefit.

**Comments:** Use `CodeableConcept.text` element if the data is free (uncoded) text.

**Cardinality:** 0..1

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


<a id="InsuranceProduct.related"></a>

## InsuranceProduct.related
Associated insurance product

**Definition:** Another product that is related to this product. Often used to create relationships to parents or families of products.

**Cardinality:** 0..*

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


<a id="InsuranceProduct.related.product"></a>

## InsuranceProduct.related.product
Related Product reference

**Definition:** The Related Product reference.

**Cardinality:** 0..1

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


<a id="InsuranceProduct.related.relationship"></a>

## InsuranceProduct.related.relationship
Relationship of this product to the related product

**Definition:** The relationship of this product to the related product. an example would be 'sub-plan' where this product is a sub-plan of the related.product.

**Comments:** Use `CodeableConcept.text` element if the data is free (uncoded) text.

**Cardinality:** 0..1

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


<a id="InsuranceProduct.related.period"></a>

## InsuranceProduct.related.period
Period that this Relationship is valid

**Definition:** Period of time that the product relationship is valid. The start and/or end dates can be empty if this is an open ended relationship.

**Cardinality:** 0..1

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