{ "resourceType" : "InsurancePlan", "id" : "H2406-013-000", "meta" : { "profile" : ["https://haau3.com/fhir/StructureDefinition/haau3-insurance-plan", "http://hl7.org/fhir/us/insurance-card/StructureDefinition/sbc-insurance-plan|2.0.0-ballot"] }, "text" : { "status" : "extensions", "div" : "

Generated Narrative: InsurancePlan H2406-013-000

Profiles: haau3 Insurance Plan (Plan Benefits), http://hl7.org/fhir/us/insurance-card/StructureDefinition/sbc-insurance-plan|2.0.0-ballot

Plan Benefits Source Release

url

release

value: ma-2027-2026-10-01

downloadUrl: https://www.cms.gov/files/zip/pbp-benefits-2027.zip

lastModified: 2026-10-01

sha256: 6d8430e2ecb51acf3cc8547f12dd73506aa73f0dccf034cc3c3393868576ff47

url

file

Plan Benefits Plan Facts

identifier: CMSMAPlanId/H2406-013-000, CMSMABidId/H2406_013_0

status: Active

type: Medicare Advantage

name: AARP Medicare Advantage from UHC FL-0021 (PPO)

period: 2027 --> 2027

ownedBy: UnitedHealthcare

coverageArea: Unnamed Location

contact

purpose: General Questions

telecom: ph: (866)627-7806, AARPMedicarePlans.com

contact

purpose: Provider directory

telecom: AARPMedicarePlans.com

coverage

type: health insurance plan policy

benefit

type: Primary Care Visit

benefit

type: Specialist Visit

benefit

type: Urgent Care

benefit

type: Emergency Room Care

benefit

type: Hospital Inpatient Care

benefit

type: Hospital Outpatient Care

benefit

type: Facility Fee

benefit

type: Imaging (CT/PET/MRI)

benefit

type: Rehabilitation Services

benefit

type: Mental/Behavioral Health Outpatient Services

benefit

type: Emergency Medical Transportation

benefit

type: Skilled Nursing Care

plan

Plan Benefits Additional Benefit

url

category

value: Lab Services

type: Copayment

applicability: In Network

amount: 0 USD (Details: unknown codeUSD = 'United States dollar')

url

cost

type: Copayment

applicability: Out of Network

amount: 0 USD (Details: unknown codeUSD = 'United States dollar')

url

cost

Plan Benefits Additional Benefit

url

category

value: Observation Services

type: Copayment

applicability: In Network

qualifier: Per day

amount: 550 USD (Details: unknown codeUSD = 'United States dollar')

url

cost

type: Coinsurance

applicability: Out of Network

amount: 40 % (Details: UCUM code% = '%')

url

cost

Plan Benefits Additional Benefit

url

category

value: Home Health Services

type: Copayment

applicability: In Network

amount: 0 USD (Details: unknown codeUSD = 'United States dollar')

url

cost

type: Coinsurance

applicability: Out of Network

amount: 50 % (Details: UCUM code% = '%')

url

cost

type: Local PPO

coverageArea: Unnamed Location

generalCost

type: Monthly premium

Costs

-ValueCurrency
*0United States dollar

generalCost

type: Part B premium reduction

comment: None

generalCost

Plan Benefits Cost Scope

type: Individual Deductible

Costs

-ValueCurrency
*1000United States dollar

comment: Out of network, for medical care

generalCost

Plan Benefits Cost Scope

type: Individual Out-of-Pocket Maximum

Costs

-ValueCurrency
*7150United States dollar

comment: In network, for medical care

generalCost

Plan Benefits Cost Scope

type: Individual Out-of-Pocket Maximum

comment: Out of network, for medical care: none

generalCost

Plan Benefits Cost Scope

type: Individual Out-of-Pocket Maximum

Costs

-ValueCurrency
*10750United States dollar

comment: In and out of network combined, for medical care

specificCost

category: Primary Care Visit

benefit

type: Primary Care Visit

cost

type: Copayment

applicability: In Network

value: 0 USD (Details: unknown codeUSD = 'United States dollar')

cost

type: Copayment

applicability: Out of Network

value: 45 USD (Details: unknown codeUSD = 'United States dollar')

specificCost

category: Specialist Visit

benefit

type: Specialist Visit

cost

Plan Benefits Cost Range: 0-65 USD

type: Copayment

applicability: In Network

value: <=65 USD (Details: unknown codeUSD = 'United States dollar')

cost

type: Copayment

applicability: Out of Network

value: 100 USD (Details: unknown codeUSD = 'United States dollar')

specificCost

category: Urgent Care

benefit

type: Urgent Care

cost

Plan Benefits Cost Range: 0-50 USD

type: Copayment

applicability: In Network

qualifiers: One price in and out of network

value: <=50 USD (Details: unknown codeUSD = 'United States dollar')

cost

Plan Benefits Cost Range: 0-50 USD

type: Copayment

applicability: Out of Network

qualifiers: One price in and out of network

value: <=50 USD (Details: unknown codeUSD = 'United States dollar')

specificCost

category: Emergency Room Care

benefit

org/fhir/us/insurance-card/StructureDefinition/benefit-limitation

  • limitText: Copay waived if admitted to the hospital within 24 hours

type: Emergency Room Care

cost

type: Copayment

applicability: In Network

qualifiers: One price in and out of network

value: 130 USD (Details: unknown codeUSD = 'United States dollar')

cost

type: Copayment

applicability: Out of Network

qualifiers: One price in and out of network

value: 130 USD (Details: unknown codeUSD = 'United States dollar')

specificCost

category: Hospital Inpatient Care

benefit

org/fhir/us/insurance-card/StructureDefinition/benefit-limitation

  • limitText: Benefit period (in network): Per Admission or Per Stay

type: Hospital Inpatient Care

cost

Plan Benefits Day Range: 1-5 d

type: Copayment

applicability: In Network

qualifiers: Per day

value: 550 USD (Details: unknown codeUSD = 'United States dollar')

cost

Plan Benefits Day Range: 6-90 d

type: Copayment

applicability: In Network

qualifiers: Per day

value: 0 USD (Details: unknown codeUSD = 'United States dollar')

cost

type: Copayment

applicability: In Network

qualifiers: Per stay

value: 0 USD (Details: unknown codeUSD = 'United States dollar')

cost

type: Coinsurance

applicability: Out of Network

qualifiers: Per stay

value: 40 % (Details: UCUM code% = '%')

specificCost

category: Hospital Outpatient Care

benefit

type: Hospital Outpatient Care

cost

Plan Benefits Cost Range: 0-550 USD

type: Copayment

applicability: In Network

value: <=550 USD (Details: unknown codeUSD = 'United States dollar')

cost

type: Coinsurance

applicability: Out of Network

value: 40 % (Details: UCUM code% = '%')

specificCost

category: Facility Fee

benefit

type: Facility Fee

cost

Plan Benefits Cost Range: 0-500 USD

type: Copayment

applicability: In Network

value: <=500 USD (Details: unknown codeUSD = 'United States dollar')

cost

type: Coinsurance

applicability: Out of Network

value: 40 % (Details: UCUM code% = '%')

specificCost

category: Imaging (CT/PET/MRI)

benefit

type: Imaging (CT/PET/MRI)

cost

Plan Benefits Cost Range: 0-320 USD

type: Copayment

applicability: In Network

value: <=320 USD (Details: unknown codeUSD = 'United States dollar')

cost

type: Coinsurance

applicability: Out of Network

value: 40 % (Details: UCUM code% = '%')

specificCost

category: Rehabilitation Services

benefit

type: Rehabilitation Services

cost

type: Copayment

applicability: In Network

value: 65 USD (Details: unknown codeUSD = 'United States dollar')

cost

type: Copayment

applicability: Out of Network

value: 100 USD (Details: unknown codeUSD = 'United States dollar')

specificCost

category: Mental/Behavioral Health Outpatient Services

benefit

type: Mental/Behavioral Health Outpatient Services

cost

Plan Benefits Cost Range: 0-25 USD

type: Copayment

applicability: In Network

value: <=25 USD (Details: unknown codeUSD = 'United States dollar')

cost

type: Copayment

applicability: Out of Network

value: 40 USD (Details: unknown codeUSD = 'United States dollar')

specificCost

category: Emergency Medical Transportation

benefit

type: Emergency Medical Transportation

cost

type: Copayment

applicability: In Network

value: 380 USD (Details: unknown codeUSD = 'United States dollar')

cost

type: Copayment

applicability: Out of Network

value: 380 USD (Details: unknown codeUSD = 'United States dollar')

specificCost

category: Skilled Nursing Care

benefit

org/fhir/us/insurance-card/StructureDefinition/benefit-limitation

  • limitText: Benefit period (in network): Original Medicare

type: Skilled Nursing Care

cost

Plan Benefits Day Range: 1-20 d

type: Copayment

applicability: In Network

qualifiers: Per day

value: 0 USD (Details: unknown codeUSD = 'United States dollar')

cost

Plan Benefits Day Range: 21-100 d

type: Copayment

applicability: In Network

qualifiers: Per day

value: 221 USD (Details: unknown codeUSD = 'United States dollar')

cost

Plan Benefits Day Range: 1-100 d

type: Copayment

applicability: Out of Network

qualifiers: Per day

value: 250 USD (Details: unknown codeUSD = 'United States dollar')

cost

type: Copayment

applicability: Out of Network

qualifiers: Per stay

value: 0 USD (Details: unknown codeUSD = 'United States dollar')

Generated Narrative: Organization #issuer

UnitedHealthcare (CMS Contract ID: CMSMAContractId#H2406)

Alias:CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.

Generated Narrative: Location #state-FL

Unnamed Location

Form:Jurisdiction
Address:FL
" }, "contained" : [{ "resourceType" : "Organization", "id" : "issuer", "identifier" : [{ "type" : { "coding" : [{ "system" : "https://haau3.com/fhir/CodeSystem/payor-identifier-types-cs", "code" : "cms-contract-id", "display" : "CMS Contract ID" }] }, "system" : "https://haau3.com/fhir/NamingSystem/cms-ma-contract-id", "value" : "H2406" }], "name" : "UnitedHealthcare", "alias" : ["CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO."] }, { "resourceType" : "Location", "id" : "state-FL", "address" : { "state" : "FL" }, "physicalType" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/location-physical-type", "code" : "jdn", "display" : "Jurisdiction" }] } }], "extension" : [{ "extension" : [{ "url" : "release", "valueString" : "ma-2027-2026-10-01" }, { "extension" : [{ "url" : "downloadUrl", "valueUri" : "https://www.cms.gov/files/zip/pbp-benefits-2027.zip" }, { "url" : "lastModified", "valueDate" : "2026-10-01" }, { "url" : "sha256", "valueString" : "6d8430e2ecb51acf3cc8547f12dd73506aa73f0dccf034cc3c3393868576ff47" }], "url" : "file" }], "url" : "https://haau3.com/fhir/StructureDefinition/plan-benefits-source-release" }, { "extension" : [{ "url" : "specialNeeds", "valueBoolean" : false }, { "url" : "employerOnly", "valueBoolean" : false }, { "url" : "partBOnly", "valueBoolean" : false }, { "url" : "filesCostData", "valueBoolean" : true }, { "url" : "outOfNetworkBenefit", "valueBoolean" : true }, { "url" : "pointOfService", "valueBoolean" : false }], "url" : "https://haau3.com/fhir/StructureDefinition/plan-benefits-plan-facts" }], "identifier" : [{ "system" : "http://cms.gov/medicare/ma-plan-id", "value" : "H2406-013-000" }, { "system" : "https://haau3.com/fhir/NamingSystem/cms-ma-bid-id", "value" : "H2406_013_0" }], "status" : "active", "type" : [{ "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/insurance-product-type", "code" : "mediadv", "display" : "Medicare Advantage" }] }], "name" : "AARP Medicare Advantage from UHC FL-0021 (PPO)", "period" : { "start" : "2027", "end" : "2027" }, "ownedBy" : { "reference" : "#issuer", "display" : "UnitedHealthcare" }, "coverageArea" : [{ "reference" : "#state-FL" }], "contact" : [{ "purpose" : { "text" : "General Questions" }, "telecom" : [{ "system" : "phone", "value" : "(866)627-7806" }, { "system" : "url", "value" : "AARPMedicarePlans.com" }] }, { "purpose" : { "text" : "Provider directory" }, "telecom" : [{ "system" : "url", "value" : "AARPMedicarePlans.com" }] }], "coverage" : [{ "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code" : "HIP", "display" : "health insurance plan policy" }] }, "benefit" : [{ "type" : { "coding" : [{ "system" : "http://hl7.org/fhir/us/insurance-card/CodeSystem/sbc-benefit-category", "code" : "primary-care-visit", "display" : "Primary Care Visit" }, { "system" : "https://haau3.com/fhir/CodeSystem/cms-pbp-service-category", "code" : "7a", "display" : "Primary Care Physician Services" }] } }, { "type" : { "coding" : [{ "system" : "http://hl7.org/fhir/us/insurance-card/CodeSystem/sbc-benefit-category", "code" : "specialist-visit", "display" : "Specialist Visit" }, { "system" : "https://haau3.com/fhir/CodeSystem/cms-pbp-service-category", "code" : "7d", "display" : "Physician Specialist Services" }] } }, { "type" : { "coding" : [{ "system" : "http://hl7.org/fhir/us/insurance-card/CodeSystem/sbc-benefit-category", "code" : "urgent-care", "display" : "Urgent Care" }, { "system" : "https://haau3.com/fhir/CodeSystem/cms-pbp-service-category", "code" : "4b", "display" : "Urgently Needed Services" }] } }, { "type" : { "coding" : [{ "system" : "http://hl7.org/fhir/us/insurance-card/CodeSystem/sbc-benefit-category", "code" : "emergency-room-care", "display" : "Emergency Room Care" }, { "system" : "https://haau3.com/fhir/CodeSystem/cms-pbp-service-category", "code" : "4a", "display" : "Emergency Services" }] } }, { "type" : { "coding" : [{ "system" : "http://hl7.org/fhir/us/insurance-card/CodeSystem/sbc-benefit-category", "code" : "hospital-inpatient", "display" : "Hospital Inpatient Care" }, { "system" : "https://haau3.com/fhir/CodeSystem/cms-pbp-service-category", "code" : "1a", "display" : "Inpatient Hospital-Acute" }] } }, { "type" : { "coding" : [{ "system" : "http://hl7.org/fhir/us/insurance-card/CodeSystem/sbc-benefit-category", "code" : "hospital-outpatient", "display" : "Hospital Outpatient Care" }, { "system" : "https://haau3.com/fhir/CodeSystem/cms-pbp-service-category", "code" : "9a1", "display" : "Outpatient Hospital Services" }] } }, { "type" : { "coding" : [{ "system" : "http://hl7.org/fhir/us/insurance-card/CodeSystem/sbc-benefit-category", "code" : "facility-fee", "display" : "Facility Fee" }, { "system" : "https://haau3.com/fhir/CodeSystem/cms-pbp-service-category", "code" : "9b", "display" : "Ambulatory Surgical Center (ASC) Services" }] } }, { "type" : { "coding" : [{ "system" : "http://hl7.org/fhir/us/insurance-card/CodeSystem/sbc-benefit-category", "code" : "imaging", "display" : "Imaging (CT/PET/MRI)" }, { "system" : "https://haau3.com/fhir/CodeSystem/cms-pbp-service-category", "code" : "8b1", "display" : "Diagnostic Radiological Services" }] } }, { "type" : { "coding" : [{ "system" : "http://hl7.org/fhir/us/insurance-card/CodeSystem/sbc-benefit-category", "code" : "rehabilitation", "display" : "Rehabilitation Services" }, { "system" : "https://haau3.com/fhir/CodeSystem/cms-pbp-service-category", "code" : "7i", "display" : "Physical Therapy and Speech-Language Pathology Services" }] } }, { "type" : { "coding" : [{ "system" : "http://hl7.org/fhir/us/insurance-card/CodeSystem/sbc-benefit-category", "code" : "mental-health-outpatient", "display" : "Mental/Behavioral Health Outpatient Services" }, { "system" : "https://haau3.com/fhir/CodeSystem/cms-pbp-service-category", "code" : "7e1", "display" : "Individual Sessions for Mental Health Specialty Services" }] } }, { "type" : { "coding" : [{ "system" : "http://hl7.org/fhir/us/insurance-card/CodeSystem/sbc-benefit-category", "code" : "emergency-medical-transport", "display" : "Emergency Medical Transportation" }, { "system" : "https://haau3.com/fhir/CodeSystem/cms-pbp-service-category", "code" : "10a1", "display" : "Ground Ambulance Services" }] } }, { "type" : { "coding" : [{ "system" : "http://hl7.org/fhir/us/insurance-card/CodeSystem/sbc-benefit-category", "code" : "skilled-nursing", "display" : "Skilled Nursing Care" }, { "system" : "https://haau3.com/fhir/CodeSystem/cms-pbp-service-category", "code" : "2", "display" : "Skilled Nursing Facility (SNF)" }] } }] }], "plan" : [{ "extension" : [{ "extension" : [{ "url" : "category", "valueCodeableConcept" : { "coding" : [{ "system" : "https://haau3.com/fhir/CodeSystem/cms-pbp-service-category", "code" : "8a2", "display" : "Lab Services" }] } }, { "extension" : [{ "url" : "type", "valueCodeableConcept" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/benefit-type", "code" : "copay", "display" : "Copayment per service" }], "text" : "Copayment" } }, { "url" : "applicability", "valueCodeableConcept" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/applicability", "code" : "in-network", "display" : "In Network" }] } }, { "url" : "amount", "valueQuantity" : { "value" : 0, "unit" : "USD", "system" : "urn:iso:std:iso:4217", "code" : "USD" } }], "url" : "cost" }, { "extension" : [{ "url" : "type", "valueCodeableConcept" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/benefit-type", "code" : "copay", "display" : "Copayment per service" }], "text" : "Copayment" } }, { "url" : "applicability", "valueCodeableConcept" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/applicability", "code" : "out-of-network", "display" : "Out of Network" }] } }, { "url" : "amount", "valueQuantity" : { "value" : 0, "unit" : "USD", "system" : "urn:iso:std:iso:4217", "code" : "USD" } }], "url" : "cost" }], "url" : "https://haau3.com/fhir/StructureDefinition/plan-benefits-additional-benefit" }, { "extension" : [{ "url" : "category", "valueCodeableConcept" : { "coding" : [{ "system" : "https://haau3.com/fhir/CodeSystem/cms-pbp-service-category", "code" : "9a2", "display" : "Observation Services" }] } }, { "extension" : [{ "url" : "type", "valueCodeableConcept" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/benefit-type", "code" : "copay", "display" : "Copayment per service" }], "text" : "Copayment" } }, { "url" : "applicability", "valueCodeableConcept" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/applicability", "code" : "in-network", "display" : "In Network" }] } }, { "url" : "qualifier", "valueCodeableConcept" : { "coding" : [{ "system" : "https://haau3.com/fhir/CodeSystem/plan-benefits-cost-qualifier", "code" : "per-day", "display" : "Per day" }] } }, { "url" : "amount", "valueQuantity" : { "value" : 550, "unit" : "USD", "system" : "urn:iso:std:iso:4217", "code" : "USD" } }], "url" : "cost" }, { "extension" : [{ "url" : "type", "valueCodeableConcept" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/benefit-type", "code" : "copay-percent", "display" : "Copayment Percent per service" }], "text" : "Coinsurance" } }, { "url" : "applicability", "valueCodeableConcept" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/applicability", "code" : "out-of-network", "display" : "Out of Network" }] } }, { "url" : "amount", "valueQuantity" : { "value" : 40, "unit" : "%", "system" : "http://unitsofmeasure.org", "code" : "%" } }], "url" : "cost" }], "url" : "https://haau3.com/fhir/StructureDefinition/plan-benefits-additional-benefit" }, { "extension" : [{ "url" : "category", "valueCodeableConcept" : { "coding" : [{ "system" : "https://haau3.com/fhir/CodeSystem/cms-pbp-service-category", "code" : "6", "display" : "Home Health Services" }] } }, { "extension" : [{ "url" : "type", "valueCodeableConcept" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/benefit-type", "code" : "copay", "display" : "Copayment per service" }], "text" : "Copayment" } }, { "url" : "applicability", "valueCodeableConcept" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/applicability", "code" : "in-network", "display" : "In Network" }] } }, { "url" : "amount", "valueQuantity" : { "value" : 0, "unit" : "USD", "system" : "urn:iso:std:iso:4217", "code" : "USD" } }], "url" : "cost" }, { "extension" : [{ "url" : "type", "valueCodeableConcept" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/benefit-type", "code" : "copay-percent", "display" : "Copayment Percent per service" }], "text" : "Coinsurance" } }, { "url" : "applicability", "valueCodeableConcept" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/applicability", "code" : "out-of-network", "display" : "Out of Network" }] } }, { "url" : "amount", "valueQuantity" : { "value" : 50, "unit" : "%", "system" : "http://unitsofmeasure.org", "code" : "%" } }], "url" : "cost" }], "url" : "https://haau3.com/fhir/StructureDefinition/plan-benefits-additional-benefit" }], "type" : { "coding" : [{ "system" : "http://hl7.org/fhir/us/insurance-card/CodeSystem/sbc-plan-type", "code" : "PPO", "display" : "Preferred Provider Organization (PPO)" }], "text" : "Local PPO" }, "coverageArea" : [{ "reference" : "#state-FL" }], "generalCost" : [{ "type" : { "coding" : [{ "system" : "https://haau3.com/fhir/CodeSystem/plan-benefits-general-cost-type", "code" : "monthly-premium", "display" : "Monthly premium" }], "text" : "Monthly premium" }, "cost" : { "value" : 0, "currency" : "USD" } }, { "type" : { "coding" : [{ "system" : "https://haau3.com/fhir/CodeSystem/plan-benefits-general-cost-type", "code" : "part-b-premium-reduction", "display" : "Part B premium reduction" }], "text" : "Part B premium reduction" }, "comment" : "None" }, { "extension" : [{ 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