haau3 FHIR Implementation Guide (HFIG)
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haau3 FHIR Implementation Guide (HFIG) - Local Development build (v1.0.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: Haau3InsurancePlan - Detailed Descriptions

Draft as of 2026-10-14

Definitions for the haau3-insurance-plan resource profile.

See the documentation on how to interpret the contents of this table

0. InsurancePlan
Definition

Details of a Health Insurance product/plan provided by an organization.

ShortDetails of a Health Insurance product/plan provided by an organization
Control0..*
Is Modifierfalse
Summaryfalse
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
ipn-1: The organization SHALL at least have a name or an idendtifier, and possibly more than one ((identifier.count() + name.count()) > 0)
ipn-1: The organization SHALL at least have a name or an idendtifier, and possibly more than one ((identifier.count() + name.count()) > 0)
2. InsurancePlan.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

ShortA set of rules under which this content was created
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Control0..1
Typeuri
Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. InsurancePlan.extension
Definition

An Extension


May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortExtensionAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control20..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on InsurancePlan.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

    6. InsurancePlan.extension:sourceRelease
    Slice NamesourceRelease
    Definition

    The CMS release a Plan Benefits plan was read from: the release's name, and for each of CMS's files in it, the address CMS publishes it at, the date CMS last changed it and its SHA-256, so anyone can fetch the same file and check it. The SBC guide has no element for the source of a plan's data; haau3 publishes this extension until it does.

    ShortPlan Benefits Source Release
    Control1..1
    This element is affected by the following invariants: ele-1
    TypeExtension(Plan Benefits Source Release) (Complex Extension)
    Is Modifierfalse
    Must Supporttrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    8. InsurancePlan.extension:planFacts
    Slice NameplanFacts
    Definition

    Facts about a Plan Benefits plan that CMS's files state and InsurancePlan has no element for: the facts each program files about its plans. Each part is present only where it applies to the plan's program, which InsurancePlan.type names. The SBC guide has no elements for these; haau3 publishes this extension until it does.

    ShortPlan Benefits Plan Facts
    Control1..1
    This element is affected by the following invariants: ele-1
    TypeExtension(Plan Benefits Plan Facts) (Complex Extension)
    Is Modifierfalse
    Must Supporttrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    10. InsurancePlan.modifierExtension
    Definition

    May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

    ShortExtensions that cannot be ignored
    Comments

    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

    Control0..*
    TypeExtension
    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
    Summaryfalse
    Requirements

    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

    Alternate Namesextensions, user content
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    12. InsurancePlan.identifier
    Definition

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

    ShortBusiness Identifier for Product
    NoteThis is a business identifier, not a resource identifier (see discussion)
    Control10..*
    This element is affected by the following invariants: ipn-1
    TypeIdentifier
    Is Modifierfalse
    Must Supporttrue
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    SlicingThis element introduces a set of slices on InsurancePlan.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ system
    • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

      14. InsurancePlan.identifier:maPlanId
      Slice NamemaPlanId
      Definition

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

      ShortBusiness Identifier for Product
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control0..1*
      This element is affected by the following invariants: ipn-1
      TypeIdentifier
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      16. InsurancePlan.identifier:maPlanId.use
      Definition

      The purpose of this identifier.

      Shortusual | official | temp | secondary | old (If known)
      Comments

      Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

      Control0..1
      BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
      (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

      Identifies the purpose for this identifier, if known .

      Typecode
      Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      18. InsurancePlan.identifier:maPlanId.system
      Definition

      Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

      ShortThe namespace for the identifier value
      Comments

      Identifier.system is always case sensitive.

      Control10..1
      Typeuri
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

      Pattern Valuehttp://cms.gov/medicare/ma-plan-id
      ExampleGeneral: http://www.acme.com/identifiers/patient
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      20. InsurancePlan.identifier:maPlanId.value
      Definition

      The portion of the identifier typically relevant to the user and which is unique within the context of the system.

      ShortThe value that is unique
      Comments

      If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

      Control10..1
      Typestring
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      ExampleGeneral: 123456
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      plan-benefits-4: CMS's ma-plan-id is the contract, plan and segment joined with hyphens, the segment three digits: H2406-013-000. (matches('^[A-Z][0-9]{4}-[0-9]{3}-[0-9]{3}$'))
      22. InsurancePlan.identifier:bidId
      Slice NamebidId
      Definition

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

      ShortBusiness Identifier for Product
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control0..1*
      This element is affected by the following invariants: ipn-1
      TypeIdentifier
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      24. InsurancePlan.identifier:bidId.use
      Definition

      The purpose of this identifier.

      Shortusual | official | temp | secondary | old (If known)
      Comments

      Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

      Control0..1
      BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
      (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

      Identifies the purpose for this identifier, if known .

      Typecode
      Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      26. InsurancePlan.identifier:bidId.system
      Definition

      Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

      ShortThe namespace for the identifier value
      Comments

      Identifier.system is always case sensitive.

      Control10..1
      Typeuri
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

      Pattern Valuehttps://haau3.com/fhir/NamingSystem/cms-ma-bid-id
      ExampleGeneral: http://www.acme.com/identifiers/patient
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      28. InsurancePlan.identifier:bidId.value
      Definition

      The portion of the identifier typically relevant to the user and which is unique within the context of the system.

      ShortThe value that is unique
      Comments

      If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

      Control10..1
      Typestring
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      ExampleGeneral: 123456
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      30. InsurancePlan.identifier:hiosPlanId
      Slice NamehiosPlanId
      Definition

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

      ShortBusiness Identifier for Product
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control0..1*
      This element is affected by the following invariants: ipn-1
      TypeIdentifier
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      32. InsurancePlan.identifier:hiosPlanId.use
      Definition

      The purpose of this identifier.

      Shortusual | official | temp | secondary | old (If known)
      Comments

      Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

      Control0..1
      BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
      (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

      Identifies the purpose for this identifier, if known .

      Typecode
      Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      34. InsurancePlan.identifier:hiosPlanId.system
      Definition

      Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

      ShortThe namespace for the identifier value
      Comments

      Identifier.system is always case sensitive.

      Control10..1
      Typeuri
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

      Pattern Valuehttps://haau3.com/fhir/NamingSystem/hios-plan-id
      ExampleGeneral: http://www.acme.com/identifiers/patient
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      36. InsurancePlan.identifier:hiosPlanId.value
      Definition

      The portion of the identifier typically relevant to the user and which is unique within the context of the system.

      ShortThe value that is unique
      Comments

      If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

      Control10..1
      Typestring
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      ExampleGeneral: 123456
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      plan-benefits-5: A HIOS plan id is the 14-character standard component, a hyphen and a two-digit variant: 19898FL0340001-01. (matches('^[0-9]{5}[A-Z]{2}[0-9]{7}-[0-9]{2}$'))
      38. InsurancePlan.identifier:hiosStandardComponentId
      Slice NamehiosStandardComponentId
      Definition

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

      ShortBusiness Identifier for Product
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control0..1*
      This element is affected by the following invariants: ipn-1
      TypeIdentifier
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      40. InsurancePlan.identifier:hiosStandardComponentId.use
      Definition

      The purpose of this identifier.

      Shortusual | official | temp | secondary | old (If known)
      Comments

      Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

      Control0..1
      BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
      (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

      Identifies the purpose for this identifier, if known .

      Typecode
      Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      42. InsurancePlan.identifier:hiosStandardComponentId.system
      Definition

      Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

      ShortThe namespace for the identifier value
      Comments

      Identifier.system is always case sensitive.

      Control10..1
      Typeuri
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

      Pattern Valuehttps://haau3.com/fhir/NamingSystem/hios-standard-component-id
      ExampleGeneral: http://www.acme.com/identifiers/patient
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      44. InsurancePlan.identifier:hiosStandardComponentId.value
      Definition

      The portion of the identifier typically relevant to the user and which is unique within the context of the system.

      ShortThe value that is unique
      Comments

      If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

      Control10..1
      Typestring
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      ExampleGeneral: 123456
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      46. InsurancePlan.status
      Definition

      The current state of the health insurance product.

      Shortdraft | active | retired | unknown
      Control10..1
      BindingThe codes SHALL be taken from PublicationStatushttp://hl7.org/fhir/ValueSet/publication-status|4.0.1
      (required to http://hl7.org/fhir/ValueSet/publication-status|4.0.1)

      The lifecycle status of an artifact.

      Typecode
      Is Modifiertrue because 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
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      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 MissingDefault interpretation is active.
      Pattern Valueactive
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      48. InsurancePlan.type
      Definition

      The kind of health insurance product.

      ShortKind of product
      Control10..1*
      BindingUnless not suitable, these codes SHALL be taken from For example codes, see Insurance Product Typehttp://hl7.org/fhir/ValueSet/insuranceplan-type|4.0.1
      (extensible to http://terminology.hl7.org/ValueSet/insurance-product-type)
      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      50. InsurancePlan.name
      Definition

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

      ShortOfficial name
      Comments

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

      Control10..1
      This element is affected by the following invariants: ipn-1
      Typestring
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      52. InsurancePlan.period
      Definition

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

      ShortWhen the product is available
      Control10..1
      TypePeriod
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      54. InsurancePlan.ownedBy
      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'.

      ShortPlan issuer
      Control10..1
      TypeReference(Organization)
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Alternate NamesPayer
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      56. InsurancePlan.coverageArea
      Definition

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

      ShortWhere product applies
      Control0..*
      TypeReference(Location)
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      58. InsurancePlan.contact
      Definition

      The contact for the health insurance product for a certain purpose.

      ShortContact for the product
      Comments

      Where multiple contacts for the same purpose are provided there is a standard extension that can be used to determine which one is the preferred contact to use.

      Control10..*
      TypeBackboneElement
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Requirements

      Need to keep track of assigned contact points within bigger organization.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      60. InsurancePlan.contact.modifierExtension
      Definition

      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
      Summarytrue
      Requirements

      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

      Alternate Namesextensions, user content, modifiers
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      62. InsurancePlan.coverage
      Definition

      Details about the coverage offered by the insurance product.

      ShortCoverage details
      Control10..*
      TypeBackboneElement
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      64. InsurancePlan.coverage.modifierExtension
      Definition

      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
      Summarytrue
      Requirements

      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

      Alternate Namesextensions, user content, modifiers
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      66. InsurancePlan.coverage.type
      Definition

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

      ShortType of coverage
      Control1..1
      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      68. InsurancePlan.coverage.benefit
      Definition

      Specific benefits under this type of coverage.

      ShortList of benefits
      Control1..*
      TypeBackboneElement
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      70. InsurancePlan.coverage.benefit.modifierExtension
      Definition

      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
      Summarytrue
      Requirements

      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

      Alternate Namesextensions, user content, modifiers
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      72. InsurancePlan.coverage.benefit.type
      Definition

      Type of benefit (primary care; speciality care; inpatient; outpatient).

      ShortType of benefit
      Control1..1
      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      74. InsurancePlan.coverage.benefit.requirement
      Definition

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

      ShortReferral requirements
      Control0..1
      Typestring
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      76. InsurancePlan.plan
      Definition

      Details about an insurance plan.

      ShortPlan details
      Control10..1*
      TypeBackboneElement
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      78. InsurancePlan.plan.extension
      Definition

      An Extension


      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

      ShortExtensionAdditional content defined by implementations
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..*
      TypeExtension
      Is Modifierfalse
      Summaryfalse
      Alternate Namesextensions, user content
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      SlicingThis element introduces a set of slices on InsurancePlan.plan.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

        80. InsurancePlan.plan.extension:additionalBenefit
        Slice NameadditionalBenefit
        Definition

        A service CMS's files price that has no code in the SBC benefit categories, such as lab tests, home health care, hospital observation and a visit to a nurse or physician assistant, with its costs. Its parts mirror plan.specificCost.benefit and its cost, so the service reads like any other. The SBC benefit categories bind plan.specificCost as required, so these services cannot appear there; haau3 publishes this extension until the SBC guide codes them.

        ShortPlan Benefits Additional Benefit
        Control0..*
        This element is affected by the following invariants: ele-1
        TypeExtension(Plan Benefits Additional Benefit) (Complex Extension)
        Is Modifierfalse
        Must Supporttrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        82. InsurancePlan.plan.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        ShortExtensions that cannot be ignored even if unrecognized
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
        Summarytrue
        Requirements

        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

        Alternate Namesextensions, user content, modifiers
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        84. InsurancePlan.plan.type
        Definition

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

        ShortType of plan
        Control0..1
        TypeCodeableConcept
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        86. InsurancePlan.plan.coverageArea
        Definition

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

        ShortWhere product applies
        Control0..*
        TypeReference(Location)
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        88. InsurancePlan.plan.generalCost
        Definition

        Overall costs associated with the plan.

        ShortOverall costs
        Control0..*
        TypeBackboneElement
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        90. InsurancePlan.plan.generalCost.extension
        Definition

        An Extension


        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

        ShortExtensionAdditional content defined by implementations
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifierfalse
        Summaryfalse
        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        SlicingThis element introduces a set of slices on InsurancePlan.plan.generalCost.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

          92. InsurancePlan.plan.generalCost.extension:scope
          Slice Namescope
          Definition

          Which network a deductible or out-of-pocket maximum belongs to, whom it covers (one member, each person in a family, or the whole family) and what it applies to (medical care, drugs, or both). generalCost.type says whether it is a deductible or a maximum, in the SBC guide's words. The SBC profile writes these as text only; haau3 publishes this extension until the SBC guide codes them.

          ShortPlan Benefits Cost Scope
          Control0..1
          This element is affected by the following invariants: ele-1
          TypeExtension(Plan Benefits Cost Scope) (Complex Extension)
          Is Modifierfalse
          Must Supporttrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          94. InsurancePlan.plan.generalCost.extension:medicareDefined
          Slice NamemedicareDefined
          Definition

          A Medicare Advantage plan files this amount as Original Medicare's own, with no number of its own: a deductible, or hospital or skilled nursing cost sharing. The part says which. Where haau3 holds Original Medicare's published amounts, they come with the year they belong to and their source. If that year is not the plan's year (CMS publishes each year's amounts in mid-November of the year before), the cost's value carries a data-absent reason and the amounts here are the latest published, which may change. The SBC profile has no way to say an amount is Medicare's; haau3 publishes this extension until the SBC guide does.

          ShortPlan Benefits Medicare-Defined Amount
          Control0..1
          This element is affected by the following invariants: ele-1
          TypeExtension(Plan Benefits Medicare-Defined Amount) (Complex Extension)
          Is Modifierfalse
          Must Supporttrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          plan-benefits-3: An Original Medicare amount comes with the year it belongs to and its source. (extension('amount').exists() implies (extension('year').exists() and extension('source').exists()))
          96. InsurancePlan.plan.generalCost.extension:sourceText
          Slice NamesourceText
          Definition

          The cell of CMS's Marketplace file that a cost, deductible or maximum was read from, exactly as the file writes it ("$850.00 Copay per Stay after deductible", "$4000 per group", "Not Applicable"). The amount beside it is haau3's reading of this text. The SBC profile has no element for source text; haau3 publishes this extension until the SBC guide does.

          ShortPlan Benefits Source Text
          Control0..1
          This element is affected by the following invariants: ele-1
          TypeExtension(Plan Benefits Source Text) (Extension Type: string)
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          98. InsurancePlan.plan.generalCost.modifierExtension
          Definition

          May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

          ShortExtensions that cannot be ignored even if unrecognized
          Comments

          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

          Control0..*
          TypeExtension
          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
          Summarytrue
          Requirements

          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

          Alternate Namesextensions, user content, modifiers
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          100. InsurancePlan.plan.generalCost.type
          Definition

          Type of cost.

          ShortType of cost
          Control10..1
          TypeCodeableConcept
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          102. InsurancePlan.plan.generalCost.cost
          Definition

          Value of the cost.

          ShortCost value
          Control0..1
          TypeMoney
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          104. InsurancePlan.plan.generalCost.comment
          Definition

          Additional information about the general costs associated with this plan.

          ShortAdditional cost information
          Control0..1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          106. InsurancePlan.plan.specificCost
          Definition

          Costs associated with the coverage provided by the product.

          ShortSpecific costs
          Control10..*
          TypeBackboneElement
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          108. InsurancePlan.plan.specificCost.modifierExtension
          Definition

          May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

          ShortExtensions that cannot be ignored even if unrecognized
          Comments

          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

          Control0..*
          TypeExtension
          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
          Summarytrue
          Requirements

          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

          Alternate Namesextensions, user content, modifiers
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          110. InsurancePlan.plan.specificCost.category
          Definition

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

          ShortGeneral category of benefit
          Control1..1
          TypeCodeableConcept
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          112. InsurancePlan.plan.specificCost.benefit
          Definition

          List of the specific benefits under this category of benefit.

          ShortBenefits list
          Control10..*
          TypeBackboneElement
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          114. InsurancePlan.plan.specificCost.benefit.modifierExtension
          Definition

          May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

          ShortExtensions that cannot be ignored even if unrecognized
          Comments

          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

          Control0..*
          TypeExtension
          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
          Summarytrue
          Requirements

          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

          Alternate Namesextensions, user content, modifiers
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          116. InsurancePlan.plan.specificCost.benefit.type
          Definition

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

          ShortType of specific benefit
          Control1..1
          TypeCodeableConcept
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          118. InsurancePlan.plan.specificCost.benefit.cost
          Definition

          List of the costs associated with a specific benefit.

          ShortList of the costs
          Control20..*
          TypeBackboneElement
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          plan-benefits-6: A cost has an amount, or a data-absent reason instead of one, never both. (value.value.exists() xor value.extension('http://hl7.org/fhir/StructureDefinition/data-absent-reason').exists())
          plan-benefits-7: A cost whose type says it has no amount (not covered, not in the public files, not stated, not part of this plan, no cost data) carries no number. (type.coding.where(system = 'https://haau3.com/fhir/CodeSystem/plan-benefits-cost-type' and (code = 'not-covered' or code = 'not-filed' or code = 'not-stated' or code = 'not-part-of-plan' or code = 'no-cost-data')).exists() implies value.value.empty())
          120. InsurancePlan.plan.specificCost.benefit.cost.extension
          Definition

          An Extension


          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

          ShortExtensionAdditional content defined by implementations
          Comments

          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

          Control0..*
          TypeExtension
          Is Modifierfalse
          Summaryfalse
          Alternate Namesextensions, user content
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          SlicingThis element introduces a set of slices on InsurancePlan.plan.specificCost.benefit.cost.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

            122. InsurancePlan.plan.specificCost.benefit.cost.extension:range
            Slice Namerange
            Definition

            The lowest and the highest of a cost the plan files as a range, as Medicare Advantage plans file every copay and coinsurance. The cost's value carries the highest with the comparator <=. Present only when the lowest and the highest differ. The SBC profile allows one value per cost; haau3 publishes this extension until the SBC guide carries a range.

            ShortPlan Benefits Cost Range
            Control0..1
            This element is affected by the following invariants: ele-1
            TypeExtension(Plan Benefits Cost Range) (Extension Type: Range)
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            124. InsurancePlan.plan.specificCost.benefit.cost.extension:days
            Slice Namedays
            Definition

            The days of a stay a per-day cost covers, as Medicare Advantage plans file hospital and skilled nursing costs by day range ($550 a day for days 1 to 5, then $0 a day for days 6 to 90). The cost carries the per-day qualifier. The SBC profile has no element for days; haau3 publishes this extension until the SBC guide does.

            ShortPlan Benefits Day Range
            Control0..1
            This element is affected by the following invariants: ele-1
            TypeExtension(Plan Benefits Day Range) (Extension Type: Range)
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            126. InsurancePlan.plan.specificCost.benefit.cost.extension:medicareDefined
            Slice NamemedicareDefined
            Definition

            A Medicare Advantage plan files this amount as Original Medicare's own, with no number of its own: a deductible, or hospital or skilled nursing cost sharing. The part says which. Where haau3 holds Original Medicare's published amounts, they come with the year they belong to and their source. If that year is not the plan's year (CMS publishes each year's amounts in mid-November of the year before), the cost's value carries a data-absent reason and the amounts here are the latest published, which may change. The SBC profile has no way to say an amount is Medicare's; haau3 publishes this extension until the SBC guide does.

            ShortPlan Benefits Medicare-Defined Amount
            Control0..1
            This element is affected by the following invariants: ele-1
            TypeExtension(Plan Benefits Medicare-Defined Amount) (Complex Extension)
            Is Modifierfalse
            Must Supporttrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            plan-benefits-3: An Original Medicare amount comes with the year it belongs to and its source. (extension('amount').exists() implies (extension('year').exists() and extension('source').exists()))
            128. InsurancePlan.plan.specificCost.benefit.cost.extension:sourceText
            Slice NamesourceText
            Definition

            The cell of CMS's Marketplace file that a cost, deductible or maximum was read from, exactly as the file writes it ("$850.00 Copay per Stay after deductible", "$4000 per group", "Not Applicable"). The amount beside it is haau3's reading of this text. The SBC profile has no element for source text; haau3 publishes this extension until the SBC guide does.

            ShortPlan Benefits Source Text
            Control0..1
            This element is affected by the following invariants: ele-1
            TypeExtension(Plan Benefits Source Text) (Extension Type: string)
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            130. InsurancePlan.plan.specificCost.benefit.cost.modifierExtension
            Definition

            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

            ShortExtensions that cannot be ignored even if unrecognized
            Comments

            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

            Control0..*
            TypeExtension
            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
            Summarytrue
            Requirements

            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

            Alternate Namesextensions, user content, modifiers
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            132. InsurancePlan.plan.specificCost.benefit.cost.type
            Definition

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

            ShortType of cost
            Control1..1
            BindingUnless not suitable, these codes SHALL be taken from For codes, see Plan Benefits Cost Type
            (extensible to https://haau3.com/fhir/ValueSet/plan-benefits-cost-type)
            TypeCodeableConcept
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            134. InsurancePlan.plan.specificCost.benefit.cost.applicability
            Definition

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

            Shortin-network | out-of-network | other
            Control10..1
            BindingThe codes SHALL be taken from BenefitCostApplicabilityhttp://hl7.org/fhir/ValueSet/insuranceplan-applicability|4.0.1
            (required to http://hl7.org/fhir/ValueSet/insuranceplan-applicability|4.0.1)

            Whether the cost applies to in-network or out-of-network providers.

            TypeCodeableConcept
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            136. InsurancePlan.plan.specificCost.benefit.cost.qualifiers
            Definition

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

            ShortAdditional information about the cost
            Control0..*
            BindingUnless not suitable, these codes SHALL be taken from For codes, see Plan Benefits Cost Qualifier
            (extensible to https://haau3.com/fhir/ValueSet/plan-benefits-cost-qualifier)
            TypeCodeableConcept
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            138. InsurancePlan.plan.specificCost.benefit.cost.value
            Definition

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

            ShortThe actual cost value
            Control10..1
            TypeQuantity
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

            See the documentation on how to interpret the contents of this table

            0. InsurancePlan
            2. InsurancePlan.extension
            Control2..?
            SlicingThis element introduces a set of slices on InsurancePlan.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

              4. InsurancePlan.extension:sourceRelease
              Slice NamesourceRelease
              Control1..1
              TypeExtension(Plan Benefits Source Release) (Complex Extension)
              Must Supporttrue
              6. InsurancePlan.extension:planFacts
              Slice NameplanFacts
              Control1..1
              TypeExtension(Plan Benefits Plan Facts) (Complex Extension)
              Must Supporttrue
              8. InsurancePlan.identifier
              NoteThis is a business identifier, not a resource identifier (see discussion)
              Control1..?
              Must Supporttrue
              SlicingThis element introduces a set of slices on InsurancePlan.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ system
              • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

                10. InsurancePlan.identifier:maPlanId
                Slice NamemaPlanId
                NoteThis is a business identifier, not a resource identifier (see discussion)
                Control0..1
                Must Supporttrue
                12. InsurancePlan.identifier:maPlanId.system
                Control1..?
                Pattern Valuehttp://cms.gov/medicare/ma-plan-id
                14. InsurancePlan.identifier:maPlanId.value
                Control1..?
                Invariantsplan-benefits-4: CMS's ma-plan-id is the contract, plan and segment joined with hyphens, the segment three digits: H2406-013-000. (matches('^[A-Z][0-9]{4}-[0-9]{3}-[0-9]{3}$'))
                16. InsurancePlan.identifier:bidId
                Slice NamebidId
                NoteThis is a business identifier, not a resource identifier (see discussion)
                Control0..1
                Must Supporttrue
                18. InsurancePlan.identifier:bidId.system
                Control1..?
                Pattern Valuehttps://haau3.com/fhir/NamingSystem/cms-ma-bid-id
                20. InsurancePlan.identifier:bidId.value
                Control1..?
                22. InsurancePlan.identifier:hiosPlanId
                Slice NamehiosPlanId
                NoteThis is a business identifier, not a resource identifier (see discussion)
                Control0..1
                Must Supporttrue
                24. InsurancePlan.identifier:hiosPlanId.system
                Control1..?
                Pattern Valuehttps://haau3.com/fhir/NamingSystem/hios-plan-id
                26. InsurancePlan.identifier:hiosPlanId.value
                Control1..?
                Invariantsplan-benefits-5: A HIOS plan id is the 14-character standard component, a hyphen and a two-digit variant: 19898FL0340001-01. (matches('^[0-9]{5}[A-Z]{2}[0-9]{7}-[0-9]{2}$'))
                28. InsurancePlan.identifier:hiosStandardComponentId
                Slice NamehiosStandardComponentId
                NoteThis is a business identifier, not a resource identifier (see discussion)
                Control0..1
                Must Supporttrue
                30. InsurancePlan.identifier:hiosStandardComponentId.system
                Control1..?
                Pattern Valuehttps://haau3.com/fhir/NamingSystem/hios-standard-component-id
                32. InsurancePlan.identifier:hiosStandardComponentId.value
                Control1..?
                34. InsurancePlan.status
                Control1..?
                Must Supporttrue
                Pattern Valueactive
                36. InsurancePlan.type
                Control1..1
                BindingUnless not suitable, these codes SHALL be taken from Insurance Product Type
                (extensible to http://terminology.hl7.org/ValueSet/insurance-product-type)
                Must Supporttrue
                38. InsurancePlan.name
                Control1..?
                Must Supporttrue
                40. InsurancePlan.period
                Control1..?
                Must Supporttrue
                42. InsurancePlan.ownedBy
                Control1..?
                Must Supporttrue
                44. InsurancePlan.coverageArea
                Must Supporttrue
                46. InsurancePlan.contact
                Control1..?
                Must Supporttrue
                48. InsurancePlan.coverage
                Control1..?
                Must Supporttrue
                50. InsurancePlan.coverage.type
                Must Supporttrue
                52. InsurancePlan.coverage.benefit
                Must Supporttrue
                54. InsurancePlan.coverage.benefit.type
                Must Supporttrue
                56. InsurancePlan.coverage.benefit.requirement
                Must Supporttrue
                58. InsurancePlan.plan
                Control1..1
                Must Supporttrue
                60. InsurancePlan.plan.extension
                SlicingThis element introduces a set of slices on InsurancePlan.plan.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ url
                • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

                  62. InsurancePlan.plan.extension:additionalBenefit
                  Slice NameadditionalBenefit
                  Control0..*
                  TypeExtension(Plan Benefits Additional Benefit) (Complex Extension)
                  Must Supporttrue
                  64. InsurancePlan.plan.type
                  Must Supporttrue
                  66. InsurancePlan.plan.coverageArea
                  Must Supporttrue
                  68. InsurancePlan.plan.generalCost
                  Must Supporttrue
                  70. InsurancePlan.plan.generalCost.extension
                  SlicingThis element introduces a set of slices on InsurancePlan.plan.generalCost.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ url
                  • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

                    72. InsurancePlan.plan.generalCost.extension:scope
                    Slice Namescope
                    Control0..1
                    TypeExtension(Plan Benefits Cost Scope) (Complex Extension)
                    Must Supporttrue
                    74. InsurancePlan.plan.generalCost.extension:medicareDefined
                    Slice NamemedicareDefined
                    Control0..1
                    TypeExtension(Plan Benefits Medicare-Defined Amount) (Complex Extension)
                    Must Supporttrue
                    76. InsurancePlan.plan.generalCost.extension:sourceText
                    Slice NamesourceText
                    Control0..1
                    TypeExtension(Plan Benefits Source Text) (Extension Type: string)
                    Must Supporttrue
                    78. InsurancePlan.plan.generalCost.type
                    Control1..?
                    Must Supporttrue
                    80. InsurancePlan.plan.generalCost.cost
                    Must Supporttrue
                    82. InsurancePlan.plan.generalCost.comment
                    Must Supporttrue
                    84. InsurancePlan.plan.specificCost
                    Control1..?
                    Must Supporttrue
                    86. InsurancePlan.plan.specificCost.category
                    Must Supporttrue
                    88. InsurancePlan.plan.specificCost.benefit
                    Control1..?
                    Must Supporttrue
                    90. InsurancePlan.plan.specificCost.benefit.type
                    Must Supporttrue
                    92. InsurancePlan.plan.specificCost.benefit.cost
                    Control2..?
                    Must Supporttrue
                    Invariantsplan-benefits-6: A cost has an amount, or a data-absent reason instead of one, never both. (value.value.exists() xor value.extension('http://hl7.org/fhir/StructureDefinition/data-absent-reason').exists())
                    plan-benefits-7: A cost whose type says it has no amount (not covered, not in the public files, not stated, not part of this plan, no cost data) carries no number. (type.coding.where(system = 'https://haau3.com/fhir/CodeSystem/plan-benefits-cost-type' and (code = 'not-covered' or code = 'not-filed' or code = 'not-stated' or code = 'not-part-of-plan' or code = 'no-cost-data')).exists() implies value.value.empty())
                    94. InsurancePlan.plan.specificCost.benefit.cost.extension
                    SlicingThis element introduces a set of slices on InsurancePlan.plan.specificCost.benefit.cost.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • value @ url
                    • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

                      96. InsurancePlan.plan.specificCost.benefit.cost.extension:range
                      Slice Namerange
                      Control0..1
                      TypeExtension(Plan Benefits Cost Range) (Extension Type: Range)
                      Must Supporttrue
                      98. InsurancePlan.plan.specificCost.benefit.cost.extension:days
                      Slice Namedays
                      Control0..1
                      TypeExtension(Plan Benefits Day Range) (Extension Type: Range)
                      Must Supporttrue
                      100. InsurancePlan.plan.specificCost.benefit.cost.extension:medicareDefined
                      Slice NamemedicareDefined
                      Control0..1
                      TypeExtension(Plan Benefits Medicare-Defined Amount) (Complex Extension)
                      Must Supporttrue
                      102. InsurancePlan.plan.specificCost.benefit.cost.extension:sourceText
                      Slice NamesourceText
                      Control0..1
                      TypeExtension(Plan Benefits Source Text) (Extension Type: string)
                      Must Supporttrue
                      104. InsurancePlan.plan.specificCost.benefit.cost.type
                      BindingUnless not suitable, these codes SHALL be taken from Plan Benefits Cost Type
                      (extensible to https://haau3.com/fhir/ValueSet/plan-benefits-cost-type)
                      Must Supporttrue
                      106. InsurancePlan.plan.specificCost.benefit.cost.applicability
                      Control1..?
                      Must Supporttrue
                      108. InsurancePlan.plan.specificCost.benefit.cost.qualifiers
                      BindingUnless not suitable, these codes SHALL be taken from Plan Benefits Cost Qualifier
                      (extensible to https://haau3.com/fhir/ValueSet/plan-benefits-cost-qualifier)
                      Must Supporttrue
                      110. InsurancePlan.plan.specificCost.benefit.cost.value
                      Control1..?
                      Must Supporttrue

                      See the documentation on how to interpret the contents of this table

                      0. InsurancePlan
                      Definition

                      Details of a Health Insurance product/plan provided by an organization.

                      ShortDetails of a Health Insurance product/plan provided by an organization
                      Control0..*
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
                      dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
                      dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
                      dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
                      dom-6: A resource should have narrative for robust management (text.`div`.exists())
                      ipn-1: The organization SHALL at least have a name or an idendtifier, and possibly more than one ((identifier.count() + name.count()) > 0)
                      2. InsurancePlan.id
                      Definition

                      The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

                      ShortLogical id of this artifact
                      Comments

                      The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

                      Control0..1
                      Typeid
                      Is Modifierfalse
                      Summarytrue
                      4. InsurancePlan.meta
                      Definition

                      The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

                      ShortMetadata about the resource
                      Control0..1
                      TypeMeta
                      Is Modifierfalse
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      6. InsurancePlan.implicitRules
                      Definition

                      A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

                      ShortA set of rules under which this content was created
                      Comments

                      Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

                      Control0..1
                      Typeuri
                      Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      8. InsurancePlan.language
                      Definition

                      The base language in which the resource is written.

                      ShortLanguage of the resource content
                      Comments

                      Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

                      Control0..1
                      BindingThe codes SHOULD be taken from CommonLanguages
                      (preferred to http://hl7.org/fhir/ValueSet/languages|4.0.1)

                      A human language.

                      Additional BindingsPurpose
                      AllLanguagesMax Binding
                      Typecode
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      10. InsurancePlan.text
                      Definition

                      A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

                      ShortText summary of the resource, for human interpretation
                      Comments

                      Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

                      Control0..1
                      TypeNarrative
                      Is Modifierfalse
                      Summaryfalse
                      Alternate Namesnarrative, html, xhtml, display
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      12. InsurancePlan.contained
                      Definition

                      These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

                      ShortContained, inline Resources
                      Comments

                      This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

                      Control0..*
                      TypeResource
                      Is Modifierfalse
                      Summaryfalse
                      Alternate Namesinline resources, anonymous resources, contained resources
                      14. InsurancePlan.extension
                      Definition

                      An Extension

                      ShortExtension
                      Control2..*
                      TypeExtension
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      SlicingThis element introduces a set of slices on InsurancePlan.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                      • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

                        16. InsurancePlan.extension:sourceRelease
                        Slice NamesourceRelease
                        Definition

                        The CMS release a Plan Benefits plan was read from: the release's name, and for each of CMS's files in it, the address CMS publishes it at, the date CMS last changed it and its SHA-256, so anyone can fetch the same file and check it. The SBC guide has no element for the source of a plan's data; haau3 publishes this extension until it does.

                        ShortPlan Benefits Source Release
                        Control1..1
                        This element is affected by the following invariants: ele-1
                        TypeExtension(Plan Benefits Source Release) (Complex Extension)
                        Is Modifierfalse
                        Must Supporttrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        18. InsurancePlan.extension:planFacts
                        Slice NameplanFacts
                        Definition

                        Facts about a Plan Benefits plan that CMS's files state and InsurancePlan has no element for: the facts each program files about its plans. Each part is present only where it applies to the plan's program, which InsurancePlan.type names. The SBC guide has no elements for these; haau3 publishes this extension until it does.

                        ShortPlan Benefits Plan Facts
                        Control1..1
                        This element is affected by the following invariants: ele-1
                        TypeExtension(Plan Benefits Plan Facts) (Complex Extension)
                        Is Modifierfalse
                        Must Supporttrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        20. InsurancePlan.modifierExtension
                        Definition

                        May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                        ShortExtensions that cannot be ignored
                        Comments

                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                        Control0..*
                        TypeExtension
                        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
                        Summaryfalse
                        Requirements

                        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                        Alternate Namesextensions, user content
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        22. InsurancePlan.identifier
                        Definition

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

                        ShortBusiness Identifier for Product
                        NoteThis is a business identifier, not a resource identifier (see discussion)
                        Control1..*
                        This element is affected by the following invariants: ipn-1
                        TypeIdentifier
                        Is Modifierfalse
                        Must Supporttrue
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        SlicingThis element introduces a set of slices on InsurancePlan.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                        • value @ system
                        • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

                          24. InsurancePlan.identifier:maPlanId
                          Slice NamemaPlanId
                          Definition

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

                          ShortBusiness Identifier for Product
                          NoteThis is a business identifier, not a resource identifier (see discussion)
                          Control0..1
                          This element is affected by the following invariants: ipn-1
                          TypeIdentifier
                          Is Modifierfalse
                          Must Supporttrue
                          Summarytrue
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          26. InsurancePlan.identifier:maPlanId.id
                          Definition

                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                          ShortUnique id for inter-element referencing
                          Control0..1
                          Typestring
                          Is Modifierfalse
                          XML FormatIn the XML format, this property is represented as an attribute.
                          Summaryfalse
                          28. InsurancePlan.identifier:maPlanId.extension
                          Definition

                          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                          ShortAdditional content defined by implementations
                          Comments

                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                          Control0..*
                          TypeExtension
                          Is Modifierfalse
                          Summaryfalse
                          Alternate Namesextensions, user content
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          SlicingThis element introduces a set of slices on InsurancePlan.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                          • value @ url
                          • 30. InsurancePlan.identifier:maPlanId.use
                            Definition

                            The purpose of this identifier.

                            Shortusual | official | temp | secondary | old (If known)
                            Comments

                            Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                            Control0..1
                            BindingThe codes SHALL be taken from IdentifierUse
                            (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                            Identifies the purpose for this identifier, if known .

                            Typecode
                            Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            Requirements

                            Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            32. InsurancePlan.identifier:maPlanId.type
                            Definition

                            A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

                            ShortDescription of identifier
                            Comments

                            This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

                            Control0..1
                            BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
                            (extensible to http://hl7.org/fhir/ValueSet/identifier-type|4.0.1)

                            A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

                            TypeCodeableConcept
                            Is Modifierfalse
                            Summarytrue
                            Requirements

                            Allows users to make use of identifiers when the identifier system is not known.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            34. InsurancePlan.identifier:maPlanId.system
                            Definition

                            Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

                            ShortThe namespace for the identifier value
                            Comments

                            Identifier.system is always case sensitive.

                            Control1..1
                            Typeuri
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            Requirements

                            There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

                            Pattern Valuehttp://cms.gov/medicare/ma-plan-id
                            ExampleGeneral: http://www.acme.com/identifiers/patient
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            36. InsurancePlan.identifier:maPlanId.value
                            Definition

                            The portion of the identifier typically relevant to the user and which is unique within the context of the system.

                            ShortThe value that is unique
                            Comments

                            If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

                            Control1..1
                            Typestring
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            ExampleGeneral: 123456
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            plan-benefits-4: CMS's ma-plan-id is the contract, plan and segment joined with hyphens, the segment three digits: H2406-013-000. (matches('^[A-Z][0-9]{4}-[0-9]{3}-[0-9]{3}$'))
                            38. InsurancePlan.identifier:maPlanId.period
                            Definition

                            Time period during which identifier is/was valid for use.

                            ShortTime period when id is/was valid for use
                            Control0..1
                            TypePeriod
                            Is Modifierfalse
                            Summarytrue
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            40. InsurancePlan.identifier:maPlanId.assigner
                            Definition

                            Organization that issued/manages the identifier.

                            ShortOrganization that issued id (may be just text)
                            Comments

                            The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

                            Control0..1
                            TypeReference(Organization)
                            Is Modifierfalse
                            Summarytrue
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            42. InsurancePlan.identifier:bidId
                            Slice NamebidId
                            Definition

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

                            ShortBusiness Identifier for Product
                            NoteThis is a business identifier, not a resource identifier (see discussion)
                            Control0..1
                            This element is affected by the following invariants: ipn-1
                            TypeIdentifier
                            Is Modifierfalse
                            Must Supporttrue
                            Summarytrue
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            44. InsurancePlan.identifier:bidId.id
                            Definition

                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                            ShortUnique id for inter-element referencing
                            Control0..1
                            Typestring
                            Is Modifierfalse
                            XML FormatIn the XML format, this property is represented as an attribute.
                            Summaryfalse
                            46. InsurancePlan.identifier:bidId.extension
                            Definition

                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                            ShortAdditional content defined by implementations
                            Comments

                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                            Control0..*
                            TypeExtension
                            Is Modifierfalse
                            Summaryfalse
                            Alternate Namesextensions, user content
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            SlicingThis element introduces a set of slices on InsurancePlan.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                            • value @ url
                            • 48. InsurancePlan.identifier:bidId.use
                              Definition

                              The purpose of this identifier.

                              Shortusual | official | temp | secondary | old (If known)
                              Comments

                              Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                              Control0..1
                              BindingThe codes SHALL be taken from IdentifierUse
                              (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                              Identifies the purpose for this identifier, if known .

                              Typecode
                              Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              Requirements

                              Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              50. InsurancePlan.identifier:bidId.type
                              Definition

                              A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

                              ShortDescription of identifier
                              Comments

                              This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

                              Control0..1
                              BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
                              (extensible to http://hl7.org/fhir/ValueSet/identifier-type|4.0.1)

                              A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

                              TypeCodeableConcept
                              Is Modifierfalse
                              Summarytrue
                              Requirements

                              Allows users to make use of identifiers when the identifier system is not known.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              52. InsurancePlan.identifier:bidId.system
                              Definition

                              Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

                              ShortThe namespace for the identifier value
                              Comments

                              Identifier.system is always case sensitive.

                              Control1..1
                              Typeuri
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              Requirements

                              There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

                              Pattern Valuehttps://haau3.com/fhir/NamingSystem/cms-ma-bid-id
                              ExampleGeneral: http://www.acme.com/identifiers/patient
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              54. InsurancePlan.identifier:bidId.value
                              Definition

                              The portion of the identifier typically relevant to the user and which is unique within the context of the system.

                              ShortThe value that is unique
                              Comments

                              If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

                              Control1..1
                              Typestring
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              ExampleGeneral: 123456
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              56. InsurancePlan.identifier:bidId.period
                              Definition

                              Time period during which identifier is/was valid for use.

                              ShortTime period when id is/was valid for use
                              Control0..1
                              TypePeriod
                              Is Modifierfalse
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              58. InsurancePlan.identifier:bidId.assigner
                              Definition

                              Organization that issued/manages the identifier.

                              ShortOrganization that issued id (may be just text)
                              Comments

                              The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

                              Control0..1
                              TypeReference(Organization)
                              Is Modifierfalse
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              60. InsurancePlan.identifier:hiosPlanId
                              Slice NamehiosPlanId
                              Definition

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

                              ShortBusiness Identifier for Product
                              NoteThis is a business identifier, not a resource identifier (see discussion)
                              Control0..1
                              This element is affected by the following invariants: ipn-1
                              TypeIdentifier
                              Is Modifierfalse
                              Must Supporttrue
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              62. InsurancePlan.identifier:hiosPlanId.id
                              Definition

                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                              ShortUnique id for inter-element referencing
                              Control0..1
                              Typestring
                              Is Modifierfalse
                              XML FormatIn the XML format, this property is represented as an attribute.
                              Summaryfalse
                              64. InsurancePlan.identifier:hiosPlanId.extension
                              Definition

                              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                              ShortAdditional content defined by implementations
                              Comments

                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                              Control0..*
                              TypeExtension
                              Is Modifierfalse
                              Summaryfalse
                              Alternate Namesextensions, user content
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              SlicingThis element introduces a set of slices on InsurancePlan.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                              • value @ url
                              • 66. InsurancePlan.identifier:hiosPlanId.use
                                Definition

                                The purpose of this identifier.

                                Shortusual | official | temp | secondary | old (If known)
                                Comments

                                Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                                Control0..1
                                BindingThe codes SHALL be taken from IdentifierUse
                                (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                                Identifies the purpose for this identifier, if known .

                                Typecode
                                Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                Summarytrue
                                Requirements

                                Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                68. InsurancePlan.identifier:hiosPlanId.type
                                Definition

                                A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

                                ShortDescription of identifier
                                Comments

                                This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

                                Control0..1
                                BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
                                (extensible to http://hl7.org/fhir/ValueSet/identifier-type|4.0.1)

                                A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

                                TypeCodeableConcept
                                Is Modifierfalse
                                Summarytrue
                                Requirements

                                Allows users to make use of identifiers when the identifier system is not known.

                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                70. InsurancePlan.identifier:hiosPlanId.system
                                Definition

                                Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

                                ShortThe namespace for the identifier value
                                Comments

                                Identifier.system is always case sensitive.

                                Control1..1
                                Typeuri
                                Is Modifierfalse
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                Summarytrue
                                Requirements

                                There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

                                Pattern Valuehttps://haau3.com/fhir/NamingSystem/hios-plan-id
                                ExampleGeneral: http://www.acme.com/identifiers/patient
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                72. InsurancePlan.identifier:hiosPlanId.value
                                Definition

                                The portion of the identifier typically relevant to the user and which is unique within the context of the system.

                                ShortThe value that is unique
                                Comments

                                If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

                                Control1..1
                                Typestring
                                Is Modifierfalse
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                Summarytrue
                                ExampleGeneral: 123456
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                plan-benefits-5: A HIOS plan id is the 14-character standard component, a hyphen and a two-digit variant: 19898FL0340001-01. (matches('^[0-9]{5}[A-Z]{2}[0-9]{7}-[0-9]{2}$'))
                                74. InsurancePlan.identifier:hiosPlanId.period
                                Definition

                                Time period during which identifier is/was valid for use.

                                ShortTime period when id is/was valid for use
                                Control0..1
                                TypePeriod
                                Is Modifierfalse
                                Summarytrue
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                76. InsurancePlan.identifier:hiosPlanId.assigner
                                Definition

                                Organization that issued/manages the identifier.

                                ShortOrganization that issued id (may be just text)
                                Comments

                                The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

                                Control0..1
                                TypeReference(Organization)
                                Is Modifierfalse
                                Summarytrue
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                78. InsurancePlan.identifier:hiosStandardComponentId
                                Slice NamehiosStandardComponentId
                                Definition

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

                                ShortBusiness Identifier for Product
                                NoteThis is a business identifier, not a resource identifier (see discussion)
                                Control0..1
                                This element is affected by the following invariants: ipn-1
                                TypeIdentifier
                                Is Modifierfalse
                                Must Supporttrue
                                Summarytrue
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                80. InsurancePlan.identifier:hiosStandardComponentId.id
                                Definition

                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                ShortUnique id for inter-element referencing
                                Control0..1
                                Typestring
                                Is Modifierfalse
                                XML FormatIn the XML format, this property is represented as an attribute.
                                Summaryfalse
                                82. InsurancePlan.identifier:hiosStandardComponentId.extension
                                Definition

                                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                ShortAdditional content defined by implementations
                                Comments

                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                Control0..*
                                TypeExtension
                                Is Modifierfalse
                                Summaryfalse
                                Alternate Namesextensions, user content
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                SlicingThis element introduces a set of slices on InsurancePlan.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                • value @ url
                                • 84. InsurancePlan.identifier:hiosStandardComponentId.use
                                  Definition

                                  The purpose of this identifier.

                                  Shortusual | official | temp | secondary | old (If known)
                                  Comments

                                  Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                                  Control0..1
                                  BindingThe codes SHALL be taken from IdentifierUse
                                  (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                                  Identifies the purpose for this identifier, if known .

                                  Typecode
                                  Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  Requirements

                                  Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  86. InsurancePlan.identifier:hiosStandardComponentId.type
                                  Definition

                                  A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

                                  ShortDescription of identifier
                                  Comments

                                  This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

                                  Control0..1
                                  BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
                                  (extensible to http://hl7.org/fhir/ValueSet/identifier-type|4.0.1)

                                  A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

                                  TypeCodeableConcept
                                  Is Modifierfalse
                                  Summarytrue
                                  Requirements

                                  Allows users to make use of identifiers when the identifier system is not known.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  88. InsurancePlan.identifier:hiosStandardComponentId.system
                                  Definition

                                  Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

                                  ShortThe namespace for the identifier value
                                  Comments

                                  Identifier.system is always case sensitive.

                                  Control1..1
                                  Typeuri
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  Requirements

                                  There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

                                  Pattern Valuehttps://haau3.com/fhir/NamingSystem/hios-standard-component-id
                                  ExampleGeneral: http://www.acme.com/identifiers/patient
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  90. InsurancePlan.identifier:hiosStandardComponentId.value
                                  Definition

                                  The portion of the identifier typically relevant to the user and which is unique within the context of the system.

                                  ShortThe value that is unique
                                  Comments

                                  If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

                                  Control1..1
                                  Typestring
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  ExampleGeneral: 123456
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  92. InsurancePlan.identifier:hiosStandardComponentId.period
                                  Definition

                                  Time period during which identifier is/was valid for use.

                                  ShortTime period when id is/was valid for use
                                  Control0..1
                                  TypePeriod
                                  Is Modifierfalse
                                  Summarytrue
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  94. InsurancePlan.identifier:hiosStandardComponentId.assigner
                                  Definition

                                  Organization that issued/manages the identifier.

                                  ShortOrganization that issued id (may be just text)
                                  Comments

                                  The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

                                  Control0..1
                                  TypeReference(Organization)
                                  Is Modifierfalse
                                  Summarytrue
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  96. InsurancePlan.status
                                  Definition

                                  The current state of the health insurance product.

                                  Shortdraft | active | retired | unknown
                                  Control1..1
                                  BindingThe codes SHALL be taken from PublicationStatus
                                  (required to http://hl7.org/fhir/ValueSet/publication-status|4.0.1)

                                  The lifecycle status of an artifact.

                                  Typecode
                                  Is Modifiertrue because 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
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Must Supporttrue
                                  Summarytrue
                                  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 MissingDefault interpretation is active.
                                  Pattern Valueactive
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  98. InsurancePlan.type
                                  Definition

                                  The kind of health insurance product.

                                  ShortKind of product
                                  Control1..1
                                  BindingUnless not suitable, these codes SHALL be taken from Insurance Product Type
                                  (extensible to http://terminology.hl7.org/ValueSet/insurance-product-type)
                                  TypeCodeableConcept
                                  Is Modifierfalse
                                  Must Supporttrue
                                  Summarytrue
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  100. InsurancePlan.name
                                  Definition

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

                                  ShortOfficial name
                                  Comments

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

                                  Control1..1
                                  This element is affected by the following invariants: ipn-1
                                  Typestring
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Must Supporttrue
                                  Summarytrue
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  102. InsurancePlan.alias
                                  Definition

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

                                  ShortAlternate names
                                  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/plan.

                                  Control0..*
                                  Typestring
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summaryfalse
                                  Requirements

                                  Over time products/plans go through many changes and can be known by different names.

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

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  104. InsurancePlan.period
                                  Definition

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

                                  ShortWhen the product is available
                                  Control1..1
                                  TypePeriod
                                  Is Modifierfalse
                                  Must Supporttrue
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  106. InsurancePlan.ownedBy
                                  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'.

                                  ShortPlan issuer
                                  Control1..1
                                  TypeReference(Organization)
                                  Is Modifierfalse
                                  Must Supporttrue
                                  Summarytrue
                                  Alternate NamesPayer
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  108. InsurancePlan.administeredBy
                                  Definition

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

                                  ShortProduct administrator
                                  Control0..1
                                  TypeReference(Organization)
                                  Is Modifierfalse
                                  Summarytrue
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  110. InsurancePlan.coverageArea
                                  Definition

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

                                  ShortWhere product applies
                                  Control0..*
                                  TypeReference(Location)
                                  Is Modifierfalse
                                  Must Supporttrue
                                  Summarytrue
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  112. InsurancePlan.contact
                                  Definition

                                  The contact for the health insurance product for a certain purpose.

                                  ShortContact for the product
                                  Comments

                                  Where multiple contacts for the same purpose are provided there is a standard extension that can be used to determine which one is the preferred contact to use.

                                  Control1..*
                                  TypeBackboneElement
                                  Is Modifierfalse
                                  Must Supporttrue
                                  Summaryfalse
                                  Requirements

                                  Need to keep track of assigned contact points within bigger organization.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  114. InsurancePlan.contact.id
                                  Definition

                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                  ShortUnique id for inter-element referencing
                                  Control0..1
                                  Typestring
                                  Is Modifierfalse
                                  XML FormatIn the XML format, this property is represented as an attribute.
                                  Summaryfalse
                                  116. InsurancePlan.contact.extension
                                  Definition

                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                  ShortAdditional content defined by implementations
                                  Comments

                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                  Control0..*
                                  TypeExtension
                                  Is Modifierfalse
                                  Summaryfalse
                                  Alternate Namesextensions, user content
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                  118. InsurancePlan.contact.modifierExtension
                                  Definition

                                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                  ShortExtensions that cannot be ignored even if unrecognized
                                  Comments

                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                  Control0..*
                                  TypeExtension
                                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                  Summarytrue
                                  Requirements

                                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                  Alternate Namesextensions, user content, modifiers
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                  120. InsurancePlan.contact.purpose
                                  Definition

                                  Indicates a purpose for which the contact can be reached.

                                  ShortThe type of contact
                                  Control0..1
                                  BindingUnless not suitable, these codes SHALL be taken from ContactEntityType
                                  (extensible to http://hl7.org/fhir/ValueSet/contactentity-type|4.0.1)

                                  The purpose for which you would contact a contact party.

                                  TypeCodeableConcept
                                  Is Modifierfalse
                                  Summaryfalse
                                  Requirements

                                  Need to distinguish between multiple contact persons.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  122. InsurancePlan.contact.name
                                  Definition

                                  A name associated with the contact.

                                  ShortA name associated with the contact
                                  Control0..1
                                  TypeHumanName
                                  Is Modifierfalse
                                  Summaryfalse
                                  Requirements

                                  Need to be able to track the person by name.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  124. InsurancePlan.contact.telecom
                                  Definition

                                  A contact detail (e.g. a telephone number or an email address) by which the party may be contacted.

                                  ShortContact details (telephone, email, etc.) for a contact
                                  Control0..*
                                  TypeContactPoint
                                  Is Modifierfalse
                                  Summaryfalse
                                  Requirements

                                  People have (primary) ways to contact them in some way such as phone, email.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  126. InsurancePlan.contact.address
                                  Definition

                                  Visiting or postal addresses for the contact.

                                  ShortVisiting or postal addresses for the contact
                                  Control0..1
                                  TypeAddress
                                  Is Modifierfalse
                                  Summaryfalse
                                  Requirements

                                  May need to keep track of a contact party's address for contacting, billing or reporting requirements.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  128. InsurancePlan.endpoint
                                  Definition

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

                                  ShortTechnical endpoint
                                  Control0..*
                                  TypeReference(Endpoint)
                                  Is Modifierfalse
                                  Summaryfalse
                                  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.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  130. InsurancePlan.network
                                  Definition

                                  Reference to the network included in the health insurance product.

                                  ShortWhat networks are Included
                                  Comments

                                  Networks are represented as a hierarchy of organization resources.

                                  Control0..*
                                  TypeReference(Organization)
                                  Is Modifierfalse
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  132. InsurancePlan.coverage
                                  Definition

                                  Details about the coverage offered by the insurance product.

                                  ShortCoverage details
                                  Control1..*
                                  TypeBackboneElement
                                  Is Modifierfalse
                                  Must Supporttrue
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  134. InsurancePlan.coverage.id
                                  Definition

                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                  ShortUnique id for inter-element referencing
                                  Control0..1
                                  Typestring
                                  Is Modifierfalse
                                  XML FormatIn the XML format, this property is represented as an attribute.
                                  Summaryfalse
                                  136. InsurancePlan.coverage.extension
                                  Definition

                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                  ShortAdditional content defined by implementations
                                  Comments

                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                  Control0..*
                                  TypeExtension
                                  Is Modifierfalse
                                  Summaryfalse
                                  Alternate Namesextensions, user content
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                  138. InsurancePlan.coverage.modifierExtension
                                  Definition

                                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                  ShortExtensions that cannot be ignored even if unrecognized
                                  Comments

                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                  Control0..*
                                  TypeExtension
                                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                  Summarytrue
                                  Requirements

                                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                  Alternate Namesextensions, user content, modifiers
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                  140. InsurancePlan.coverage.type
                                  Definition

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

                                  ShortType of coverage
                                  Control1..1
                                  TypeCodeableConcept
                                  Is Modifierfalse
                                  Must Supporttrue
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  142. InsurancePlan.coverage.network
                                  Definition

                                  Reference to the network that providing the type of coverage.

                                  ShortWhat networks provide coverage
                                  Comments

                                  Networks are represented as a hierarchy of organization resources.

                                  Control0..*
                                  TypeReference(Organization)
                                  Is Modifierfalse
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  144. InsurancePlan.coverage.benefit
                                  Definition

                                  Specific benefits under this type of coverage.

                                  ShortList of benefits
                                  Control1..*
                                  TypeBackboneElement
                                  Is Modifierfalse
                                  Must Supporttrue
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  146. InsurancePlan.coverage.benefit.id
                                  Definition

                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                  ShortUnique id for inter-element referencing
                                  Control0..1
                                  Typestring
                                  Is Modifierfalse
                                  XML FormatIn the XML format, this property is represented as an attribute.
                                  Summaryfalse
                                  148. InsurancePlan.coverage.benefit.extension
                                  Definition

                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                  ShortAdditional content defined by implementations
                                  Comments

                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                  Control0..*
                                  TypeExtension
                                  Is Modifierfalse
                                  Summaryfalse
                                  Alternate Namesextensions, user content
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                  150. InsurancePlan.coverage.benefit.modifierExtension
                                  Definition

                                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                  ShortExtensions that cannot be ignored even if unrecognized
                                  Comments

                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                  Control0..*
                                  TypeExtension
                                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                  Summarytrue
                                  Requirements

                                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                  Alternate Namesextensions, user content, modifiers
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                  152. InsurancePlan.coverage.benefit.type
                                  Definition

                                  Type of benefit (primary care; speciality care; inpatient; outpatient).

                                  ShortType of benefit
                                  Control1..1
                                  TypeCodeableConcept
                                  Is Modifierfalse
                                  Must Supporttrue
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  154. InsurancePlan.coverage.benefit.requirement
                                  Definition

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

                                  ShortReferral requirements
                                  Control0..1
                                  Typestring
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Must Supporttrue
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  156. InsurancePlan.coverage.benefit.limit
                                  Definition

                                  The specific limits on the benefit.

                                  ShortBenefit limits
                                  Control0..*
                                  TypeBackboneElement
                                  Is Modifierfalse
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  158. InsurancePlan.coverage.benefit.limit.id
                                  Definition

                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                  ShortUnique id for inter-element referencing
                                  Control0..1
                                  Typestring
                                  Is Modifierfalse
                                  XML FormatIn the XML format, this property is represented as an attribute.
                                  Summaryfalse
                                  160. InsurancePlan.coverage.benefit.limit.extension
                                  Definition

                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                  ShortAdditional content defined by implementations
                                  Comments

                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                  Control0..*
                                  TypeExtension
                                  Is Modifierfalse
                                  Summaryfalse
                                  Alternate Namesextensions, user content
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                  162. InsurancePlan.coverage.benefit.limit.modifierExtension
                                  Definition

                                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                  ShortExtensions that cannot be ignored even if unrecognized
                                  Comments

                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                  Control0..*
                                  TypeExtension
                                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                  Summarytrue
                                  Requirements

                                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                  Alternate Namesextensions, user content, modifiers
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                  164. InsurancePlan.coverage.benefit.limit.value
                                  Definition

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

                                  ShortMaximum value allowed
                                  Comments

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

                                  Control0..1
                                  TypeQuantity
                                  Is Modifierfalse
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  166. InsurancePlan.coverage.benefit.limit.code
                                  Definition

                                  The specific limit on the benefit.

                                  ShortBenefit limit details
                                  Comments

                                  Use CodeableConcept.text element if the data is free (uncoded) text.

                                  Control0..1
                                  TypeCodeableConcept
                                  Is Modifierfalse
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  168. InsurancePlan.plan
                                  Definition

                                  Details about an insurance plan.

                                  ShortPlan details
                                  Control1..1
                                  TypeBackboneElement
                                  Is Modifierfalse
                                  Must Supporttrue
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  170. InsurancePlan.plan.id
                                  Definition

                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                  ShortUnique id for inter-element referencing
                                  Control0..1
                                  Typestring
                                  Is Modifierfalse
                                  XML FormatIn the XML format, this property is represented as an attribute.
                                  Summaryfalse
                                  172. InsurancePlan.plan.extension
                                  Definition

                                  An Extension

                                  ShortExtension
                                  Control0..*
                                  TypeExtension
                                  Is Modifierfalse
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                  SlicingThis element introduces a set of slices on InsurancePlan.plan.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                  • value @ url
                                  • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

                                    174. InsurancePlan.plan.extension:additionalBenefit
                                    Slice NameadditionalBenefit
                                    Definition

                                    A service CMS's files price that has no code in the SBC benefit categories, such as lab tests, home health care, hospital observation and a visit to a nurse or physician assistant, with its costs. Its parts mirror plan.specificCost.benefit and its cost, so the service reads like any other. The SBC benefit categories bind plan.specificCost as required, so these services cannot appear there; haau3 publishes this extension until the SBC guide codes them.

                                    ShortPlan Benefits Additional Benefit
                                    Control0..*
                                    This element is affected by the following invariants: ele-1
                                    TypeExtension(Plan Benefits Additional Benefit) (Complex Extension)
                                    Is Modifierfalse
                                    Must Supporttrue
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    176. InsurancePlan.plan.modifierExtension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                    ShortExtensions that cannot be ignored even if unrecognized
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                    Summarytrue
                                    Requirements

                                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                    Alternate Namesextensions, user content, modifiers
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    178. InsurancePlan.plan.identifier
                                    Definition

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

                                    ShortBusiness Identifier for Product
                                    NoteThis is a business identifier, not a resource identifier (see discussion)
                                    Control0..*
                                    TypeIdentifier
                                    Is Modifierfalse
                                    Summarytrue
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    180. InsurancePlan.plan.type
                                    Definition

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

                                    ShortType of plan
                                    Control0..1
                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Must Supporttrue
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    182. InsurancePlan.plan.coverageArea
                                    Definition

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

                                    ShortWhere product applies
                                    Control0..*
                                    TypeReference(Location)
                                    Is Modifierfalse
                                    Must Supporttrue
                                    Summarytrue
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    184. InsurancePlan.plan.network
                                    Definition

                                    Reference to the network that providing the type of coverage.

                                    ShortWhat networks provide coverage
                                    Comments

                                    Networks are represented as a hierarchy of organization resources.

                                    Control0..*
                                    TypeReference(Organization)
                                    Is Modifierfalse
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    186. InsurancePlan.plan.generalCost
                                    Definition

                                    Overall costs associated with the plan.

                                    ShortOverall costs
                                    Control0..*
                                    TypeBackboneElement
                                    Is Modifierfalse
                                    Must Supporttrue
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    188. InsurancePlan.plan.generalCost.id
                                    Definition

                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                    ShortUnique id for inter-element referencing
                                    Control0..1
                                    Typestring
                                    Is Modifierfalse
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    Summaryfalse
                                    190. InsurancePlan.plan.generalCost.extension
                                    Definition

                                    An Extension

                                    ShortExtension
                                    Control0..*
                                    TypeExtension
                                    Is Modifierfalse
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    SlicingThis element introduces a set of slices on InsurancePlan.plan.generalCost.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                    • value @ url
                                    • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

                                      192. InsurancePlan.plan.generalCost.extension:scope
                                      Slice Namescope
                                      Definition

                                      Which network a deductible or out-of-pocket maximum belongs to, whom it covers (one member, each person in a family, or the whole family) and what it applies to (medical care, drugs, or both). generalCost.type says whether it is a deductible or a maximum, in the SBC guide's words. The SBC profile writes these as text only; haau3 publishes this extension until the SBC guide codes them.

                                      ShortPlan Benefits Cost Scope
                                      Control0..1
                                      This element is affected by the following invariants: ele-1
                                      TypeExtension(Plan Benefits Cost Scope) (Complex Extension)
                                      Is Modifierfalse
                                      Must Supporttrue
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      194. InsurancePlan.plan.generalCost.extension:medicareDefined
                                      Slice NamemedicareDefined
                                      Definition

                                      A Medicare Advantage plan files this amount as Original Medicare's own, with no number of its own: a deductible, or hospital or skilled nursing cost sharing. The part says which. Where haau3 holds Original Medicare's published amounts, they come with the year they belong to and their source. If that year is not the plan's year (CMS publishes each year's amounts in mid-November of the year before), the cost's value carries a data-absent reason and the amounts here are the latest published, which may change. The SBC profile has no way to say an amount is Medicare's; haau3 publishes this extension until the SBC guide does.

                                      ShortPlan Benefits Medicare-Defined Amount
                                      Control0..1
                                      This element is affected by the following invariants: ele-1
                                      TypeExtension(Plan Benefits Medicare-Defined Amount) (Complex Extension)
                                      Is Modifierfalse
                                      Must Supporttrue
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      plan-benefits-3: An Original Medicare amount comes with the year it belongs to and its source. (extension('amount').exists() implies (extension('year').exists() and extension('source').exists()))
                                      196. InsurancePlan.plan.generalCost.extension:sourceText
                                      Slice NamesourceText
                                      Definition

                                      The cell of CMS's Marketplace file that a cost, deductible or maximum was read from, exactly as the file writes it ("$850.00 Copay per Stay after deductible", "$4000 per group", "Not Applicable"). The amount beside it is haau3's reading of this text. The SBC profile has no element for source text; haau3 publishes this extension until the SBC guide does.

                                      ShortPlan Benefits Source Text
                                      Control0..1
                                      This element is affected by the following invariants: ele-1
                                      TypeExtension(Plan Benefits Source Text) (Extension Type: string)
                                      Is Modifierfalse
                                      Must Supporttrue
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      198. InsurancePlan.plan.generalCost.modifierExtension
                                      Definition

                                      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                      ShortExtensions that cannot be ignored even if unrecognized
                                      Comments

                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                      Control0..*
                                      TypeExtension
                                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                      Summarytrue
                                      Requirements

                                      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                      Alternate Namesextensions, user content, modifiers
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      200. InsurancePlan.plan.generalCost.type
                                      Definition

                                      Type of cost.

                                      ShortType of cost
                                      Control1..1
                                      TypeCodeableConcept
                                      Is Modifierfalse
                                      Must Supporttrue
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      202. InsurancePlan.plan.generalCost.groupSize
                                      Definition

                                      Number of participants enrolled in the plan.

                                      ShortNumber of enrollees
                                      Control0..1
                                      TypepositiveInt
                                      Is Modifierfalse
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      204. InsurancePlan.plan.generalCost.cost
                                      Definition

                                      Value of the cost.

                                      ShortCost value
                                      Control0..1
                                      TypeMoney
                                      Is Modifierfalse
                                      Must Supporttrue
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      206. InsurancePlan.plan.generalCost.comment
                                      Definition

                                      Additional information about the general costs associated with this plan.

                                      ShortAdditional cost information
                                      Control0..1
                                      Typestring
                                      Is Modifierfalse
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Must Supporttrue
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      208. InsurancePlan.plan.specificCost
                                      Definition

                                      Costs associated with the coverage provided by the product.

                                      ShortSpecific costs
                                      Control1..*
                                      TypeBackboneElement
                                      Is Modifierfalse
                                      Must Supporttrue
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      210. InsurancePlan.plan.specificCost.id
                                      Definition

                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                      ShortUnique id for inter-element referencing
                                      Control0..1
                                      Typestring
                                      Is Modifierfalse
                                      XML FormatIn the XML format, this property is represented as an attribute.
                                      Summaryfalse
                                      212. InsurancePlan.plan.specificCost.extension
                                      Definition

                                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                      ShortAdditional content defined by implementations
                                      Comments

                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                      Control0..*
                                      TypeExtension
                                      Is Modifierfalse
                                      Summaryfalse
                                      Alternate Namesextensions, user content
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      214. InsurancePlan.plan.specificCost.modifierExtension
                                      Definition

                                      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                      ShortExtensions that cannot be ignored even if unrecognized
                                      Comments

                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                      Control0..*
                                      TypeExtension
                                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                      Summarytrue
                                      Requirements

                                      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                      Alternate Namesextensions, user content, modifiers
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      216. InsurancePlan.plan.specificCost.category
                                      Definition

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

                                      ShortGeneral category of benefit
                                      Control1..1
                                      TypeCodeableConcept
                                      Is Modifierfalse
                                      Must Supporttrue
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      218. InsurancePlan.plan.specificCost.benefit
                                      Definition

                                      List of the specific benefits under this category of benefit.

                                      ShortBenefits list
                                      Control1..*
                                      TypeBackboneElement
                                      Is Modifierfalse
                                      Must Supporttrue
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      220. InsurancePlan.plan.specificCost.benefit.id
                                      Definition

                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                      ShortUnique id for inter-element referencing
                                      Control0..1
                                      Typestring
                                      Is Modifierfalse
                                      XML FormatIn the XML format, this property is represented as an attribute.
                                      Summaryfalse
                                      222. InsurancePlan.plan.specificCost.benefit.extension
                                      Definition

                                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                      ShortAdditional content defined by implementations
                                      Comments

                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                      Control0..*
                                      TypeExtension
                                      Is Modifierfalse
                                      Summaryfalse
                                      Alternate Namesextensions, user content
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      224. InsurancePlan.plan.specificCost.benefit.modifierExtension
                                      Definition

                                      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                      ShortExtensions that cannot be ignored even if unrecognized
                                      Comments

                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                      Control0..*
                                      TypeExtension
                                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                      Summarytrue
                                      Requirements

                                      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                      Alternate Namesextensions, user content, modifiers
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      226. InsurancePlan.plan.specificCost.benefit.type
                                      Definition

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

                                      ShortType of specific benefit
                                      Control1..1
                                      TypeCodeableConcept
                                      Is Modifierfalse
                                      Must Supporttrue
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      228. InsurancePlan.plan.specificCost.benefit.cost
                                      Definition

                                      List of the costs associated with a specific benefit.

                                      ShortList of the costs
                                      Control2..*
                                      TypeBackboneElement
                                      Is Modifierfalse
                                      Must Supporttrue
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      plan-benefits-6: A cost has an amount, or a data-absent reason instead of one, never both. (value.value.exists() xor value.extension('http://hl7.org/fhir/StructureDefinition/data-absent-reason').exists())
                                      plan-benefits-7: A cost whose type says it has no amount (not covered, not in the public files, not stated, not part of this plan, no cost data) carries no number. (type.coding.where(system = 'https://haau3.com/fhir/CodeSystem/plan-benefits-cost-type' and (code = 'not-covered' or code = 'not-filed' or code = 'not-stated' or code = 'not-part-of-plan' or code = 'no-cost-data')).exists() implies value.value.empty())
                                      230. InsurancePlan.plan.specificCost.benefit.cost.id
                                      Definition

                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                      ShortUnique id for inter-element referencing
                                      Control0..1
                                      Typestring
                                      Is Modifierfalse
                                      XML FormatIn the XML format, this property is represented as an attribute.
                                      Summaryfalse
                                      232. InsurancePlan.plan.specificCost.benefit.cost.extension
                                      Definition

                                      An Extension

                                      ShortExtension
                                      Control0..*
                                      TypeExtension
                                      Is Modifierfalse
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      SlicingThis element introduces a set of slices on InsurancePlan.plan.specificCost.benefit.cost.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                      • value @ url
                                      • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

                                        234. InsurancePlan.plan.specificCost.benefit.cost.extension:range
                                        Slice Namerange
                                        Definition

                                        The lowest and the highest of a cost the plan files as a range, as Medicare Advantage plans file every copay and coinsurance. The cost's value carries the highest with the comparator <=. Present only when the lowest and the highest differ. The SBC profile allows one value per cost; haau3 publishes this extension until the SBC guide carries a range.

                                        ShortPlan Benefits Cost Range
                                        Control0..1
                                        This element is affected by the following invariants: ele-1
                                        TypeExtension(Plan Benefits Cost Range) (Extension Type: Range)
                                        Is Modifierfalse
                                        Must Supporttrue
                                        Summaryfalse
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                        236. InsurancePlan.plan.specificCost.benefit.cost.extension:days
                                        Slice Namedays
                                        Definition

                                        The days of a stay a per-day cost covers, as Medicare Advantage plans file hospital and skilled nursing costs by day range ($550 a day for days 1 to 5, then $0 a day for days 6 to 90). The cost carries the per-day qualifier. The SBC profile has no element for days; haau3 publishes this extension until the SBC guide does.

                                        ShortPlan Benefits Day Range
                                        Control0..1
                                        This element is affected by the following invariants: ele-1
                                        TypeExtension(Plan Benefits Day Range) (Extension Type: Range)
                                        Is Modifierfalse
                                        Must Supporttrue
                                        Summaryfalse
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                        238. InsurancePlan.plan.specificCost.benefit.cost.extension:medicareDefined
                                        Slice NamemedicareDefined
                                        Definition

                                        A Medicare Advantage plan files this amount as Original Medicare's own, with no number of its own: a deductible, or hospital or skilled nursing cost sharing. The part says which. Where haau3 holds Original Medicare's published amounts, they come with the year they belong to and their source. If that year is not the plan's year (CMS publishes each year's amounts in mid-November of the year before), the cost's value carries a data-absent reason and the amounts here are the latest published, which may change. The SBC profile has no way to say an amount is Medicare's; haau3 publishes this extension until the SBC guide does.

                                        ShortPlan Benefits Medicare-Defined Amount
                                        Control0..1
                                        This element is affected by the following invariants: ele-1
                                        TypeExtension(Plan Benefits Medicare-Defined Amount) (Complex Extension)
                                        Is Modifierfalse
                                        Must Supporttrue
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                        plan-benefits-3: An Original Medicare amount comes with the year it belongs to and its source. (extension('amount').exists() implies (extension('year').exists() and extension('source').exists()))
                                        240. InsurancePlan.plan.specificCost.benefit.cost.extension:sourceText
                                        Slice NamesourceText
                                        Definition

                                        The cell of CMS's Marketplace file that a cost, deductible or maximum was read from, exactly as the file writes it ("$850.00 Copay per Stay after deductible", "$4000 per group", "Not Applicable"). The amount beside it is haau3's reading of this text. The SBC profile has no element for source text; haau3 publishes this extension until the SBC guide does.

                                        ShortPlan Benefits Source Text
                                        Control0..1
                                        This element is affected by the following invariants: ele-1
                                        TypeExtension(Plan Benefits Source Text) (Extension Type: string)
                                        Is Modifierfalse
                                        Must Supporttrue
                                        Summaryfalse
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                        242. InsurancePlan.plan.specificCost.benefit.cost.modifierExtension
                                        Definition

                                        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                        ShortExtensions that cannot be ignored even if unrecognized
                                        Comments

                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                        Control0..*
                                        TypeExtension
                                        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                        Summarytrue
                                        Requirements

                                        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                        Alternate Namesextensions, user content, modifiers
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                        244. InsurancePlan.plan.specificCost.benefit.cost.type
                                        Definition

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

                                        ShortType of cost
                                        Control1..1
                                        BindingUnless not suitable, these codes SHALL be taken from Plan Benefits Cost Type
                                        (extensible to https://haau3.com/fhir/ValueSet/plan-benefits-cost-type)
                                        TypeCodeableConcept
                                        Is Modifierfalse
                                        Must Supporttrue
                                        Summaryfalse
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        246. InsurancePlan.plan.specificCost.benefit.cost.applicability
                                        Definition

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

                                        Shortin-network | out-of-network | other
                                        Control1..1
                                        BindingThe codes SHALL be taken from BenefitCostApplicability
                                        (required to http://hl7.org/fhir/ValueSet/insuranceplan-applicability|4.0.1)

                                        Whether the cost applies to in-network or out-of-network providers.

                                        TypeCodeableConcept
                                        Is Modifierfalse
                                        Must Supporttrue
                                        Summaryfalse
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        248. InsurancePlan.plan.specificCost.benefit.cost.qualifiers
                                        Definition

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

                                        ShortAdditional information about the cost
                                        Control0..*
                                        BindingUnless not suitable, these codes SHALL be taken from Plan Benefits Cost Qualifier
                                        (extensible to https://haau3.com/fhir/ValueSet/plan-benefits-cost-qualifier)
                                        TypeCodeableConcept
                                        Is Modifierfalse
                                        Must Supporttrue
                                        Summaryfalse
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        250. InsurancePlan.plan.specificCost.benefit.cost.value
                                        Definition

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

                                        ShortThe actual cost value
                                        Control1..1
                                        TypeQuantity
                                        Is Modifierfalse
                                        Must Supporttrue
                                        Summaryfalse
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))