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

Extension: Plan Benefits Additional Benefit

Official URL: https://haau3.com/fhir/StructureDefinition/plan-benefits-additional-benefit Version: 1.0.0
Draft as of 2026-10-14 Computable Name: PlanBenefitsAdditionalBenefit

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.

Context of Use

Usage info

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Extension Content

Description of Profiles, Differentials, Snapshots, and how the XML and JSON presentations work.

This structure is derived from Extension

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Extension 0..* Extension Plan Benefits Additional Benefit
Extension.extension 3..* Extension Extension
Extension.Slices for extension Content/Rules for all slices
Extension.Slices for extension.extension:category 1..1 Extension The service, as CMS's files name it
Extension.Slices for extension.extension:category.extension 0..0 Extension
Extension.Slices for extension.extension:category.url 1..1 uri "category"
Extension.Slices for extension.extension:category.value[x] 0..1 CodeableConcept Value of extension
Extension.Slices for extension.extension:limitation 0..* Extension Text about this service's limits and terms
Extension.Slices for extension.extension:limitation.extension 0..0 Extension
Extension.Slices for extension.extension:limitation.url 1..1 uri "limitation"
Extension.Slices for extension.extension:limitation.value[x] 0..1 string Value of extension
Extension.Slices for extension.extension:cost 2..* Extension A cost of this service, as plan.specificCost.benefit.cost
Extension.Slices for extension.extension:cost.extension 3..* Extension Extension
Extension.Slices for extension.extension:cost.Slices for extension Content/Rules for all slices
Extension.Slices for extension.extension:cost.Slices for extension.extension:type 1..1 Extension As cost.type
Extension.Slices for extension.extension:cost.Slices for extension.extension:type.extension 0..0 Extension
Extension.Slices for extension.extension:cost.Slices for extension.extension:type.url 1..1 uri "type"
Extension.Slices for extension.extension:cost.Slices for extension.extension:type.value[x] 0..1 CodeableConcept Value of extension
Binding: Plan Benefits Cost Type (extensible)
Extension.Slices for extension.extension:cost.Slices for extension.extension:applicability 1..1 Extension As cost.applicability: in-network, out-of-network or other
Extension.Slices for extension.extension:cost.Slices for extension.extension:applicability.extension 0..0 Extension
Extension.Slices for extension.extension:cost.Slices for extension.extension:applicability.url 1..1 uri "applicability"
Extension.Slices for extension.extension:cost.Slices for extension.extension:applicability.value[x] 0..1 CodeableConcept Value of extension
Binding: BenefitCostApplicability (required)
Extension.Slices for extension.extension:cost.Slices for extension.extension:qualifier 0..* Extension As cost.qualifiers
Extension.Slices for extension.extension:cost.Slices for extension.extension:qualifier.extension 0..0 Extension
Extension.Slices for extension.extension:cost.Slices for extension.extension:qualifier.url 1..1 uri "qualifier"
Extension.Slices for extension.extension:cost.Slices for extension.extension:qualifier.value[x] 0..1 CodeableConcept Value of extension
Binding: Plan Benefits Cost Qualifier (extensible)
Extension.Slices for extension.extension:cost.Slices for extension.extension:amount 1..1 Extension As cost.value: the amount, or a data-absent reason saying there is none
Extension.Slices for extension.extension:cost.Slices for extension.extension:amount.extension 0..0 Extension
Extension.Slices for extension.extension:cost.Slices for extension.extension:amount.url 1..1 uri "amount"
Extension.Slices for extension.extension:cost.Slices for extension.extension:amount.value[x] 0..1 Quantity Value of extension
Extension.Slices for extension.extension:cost.Slices for extension.extension:deductibleApplies 0..1 Extension As SBC's deductible-applies on a cost
Extension.Slices for extension.extension:cost.Slices for extension.extension:deductibleApplies.extension 0..0 Extension
Extension.Slices for extension.extension:cost.Slices for extension.extension:deductibleApplies.url 1..1 uri "deductibleApplies"
Extension.Slices for extension.extension:cost.Slices for extension.extension:deductibleApplies.value[x] 0..1 boolean Value of extension
Extension.Slices for extension.extension:cost.url 1..1 uri "cost"
Extension.Slices for extension.extension:cost.value[x] 0..0 Value of extension
Extension.url 1..1 uri "https://haau3.com/fhir/StructureDefinition/plan-benefits-additional-benefit"

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraints    Filter: doco
Extension 0..* Extension Plan Benefits Additional Benefit
Extension.id 0..1 string Unique id for inter-element referencing
Extension.Slices for extension 3..* Extension Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Extension.Slices for extension.extension:category 1..1 Extension The service, as CMS's files name it
Extension.Slices for extension.extension:category.id 0..1 string Unique id for inter-element referencing
Extension.Slices for extension.extension:category.extension 0..0 Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Extension.Slices for extension.extension:category.url 1..1 uri "category"
Extension.Slices for extension.extension:category.value[x] 0..1 CodeableConcept Value of extension
Extension.Slices for extension.extension:limitation 0..* Extension Text about this service's limits and terms
Extension.Slices for extension.extension:limitation.id 0..1 string Unique id for inter-element referencing
Extension.Slices for extension.extension:limitation.extension 0..0 Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Extension.Slices for extension.extension:limitation.url 1..1 uri "limitation"
Extension.Slices for extension.extension:limitation.value[x] 0..1 string Value of extension
Extension.Slices for extension.extension:cost 2..* Extension A cost of this service, as plan.specificCost.benefit.cost
Extension.Slices for extension.extension:cost.id 0..1 string Unique id for inter-element referencing
Extension.Slices for extension.extension:cost.Slices for extension 3..* Extension Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Extension.Slices for extension.extension:cost.Slices for extension Content/Rules for all slices
Extension.Slices for extension.extension:cost.Slices for extension.extension:type 1..1 Extension As cost.type
Extension.Slices for extension.extension:cost.Slices for extension.extension:type.id 0..1 string Unique id for inter-element referencing
Extension.Slices for extension.extension:cost.Slices for extension.extension:type.extension 0..0 Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Extension.Slices for extension.extension:cost.Slices for extension.extension:type.url 1..1 uri "type"
Extension.Slices for extension.extension:cost.Slices for extension.extension:type.value[x] 0..1 CodeableConcept Value of extension
Binding: Plan Benefits Cost Type (extensible)
Extension.Slices for extension.extension:cost.Slices for extension.extension:applicability 1..1 Extension As cost.applicability: in-network, out-of-network or other
Extension.Slices for extension.extension:cost.Slices for extension.extension:applicability.id 0..1 string Unique id for inter-element referencing
Extension.Slices for extension.extension:cost.Slices for extension.extension:applicability.extension 0..0 Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Extension.Slices for extension.extension:cost.Slices for extension.extension:applicability.url 1..1 uri "applicability"
Extension.Slices for extension.extension:cost.Slices for extension.extension:applicability.value[x] 0..1 CodeableConcept Value of extension
Binding: BenefitCostApplicability (required)
Extension.Slices for extension.extension:cost.Slices for extension.extension:qualifier 0..* Extension As cost.qualifiers
Extension.Slices for extension.extension:cost.Slices for extension.extension:qualifier.id 0..1 string Unique id for inter-element referencing
Extension.Slices for extension.extension:cost.Slices for extension.extension:qualifier.extension 0..0 Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Extension.Slices for extension.extension:cost.Slices for extension.extension:qualifier.url 1..1 uri "qualifier"
Extension.Slices for extension.extension:cost.Slices for extension.extension:qualifier.value[x] 0..1 CodeableConcept Value of extension
Binding: Plan Benefits Cost Qualifier (extensible)
Extension.Slices for extension.extension:cost.Slices for extension.extension:amount 1..1 Extension As cost.value: the amount, or a data-absent reason saying there is none
Extension.Slices for extension.extension:cost.Slices for extension.extension:amount.id 0..1 string Unique id for inter-element referencing
Extension.Slices for extension.extension:cost.Slices for extension.extension:amount.extension 0..0 Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Extension.Slices for extension.extension:cost.Slices for extension.extension:amount.url 1..1 uri "amount"
Extension.Slices for extension.extension:cost.Slices for extension.extension:amount.value[x] 0..1 Quantity Value of extension
Extension.Slices for extension.extension:cost.Slices for extension.extension:deductibleApplies 0..1 Extension As SBC's deductible-applies on a cost
Extension.Slices for extension.extension:cost.Slices for extension.extension:deductibleApplies.id 0..1 string Unique id for inter-element referencing
Extension.Slices for extension.extension:cost.Slices for extension.extension:deductibleApplies.extension 0..0 Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Extension.Slices for extension.extension:cost.Slices for extension.extension:deductibleApplies.url 1..1 uri "deductibleApplies"
Extension.Slices for extension.extension:cost.Slices for extension.extension:deductibleApplies.value[x] 0..1 boolean Value of extension
Extension.Slices for extension.extension:cost.url 1..1 uri "cost"
Extension.url 1..1 uri "https://haau3.com/fhir/StructureDefinition/plan-benefits-additional-benefit"

doco Documentation for this format

This structure is derived from Extension

Summary

Complex Extension: 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.

  • category: CodeableConcept: The service, as CMS's files name it: the PBP service category for Medicare Advantage, the exact benefit name for the Marketplace.
  • limitation: string: Text about the service's limits and terms, as SBC's benefit-limitation limitText carries it for an SBC-coded service: for the Marketplace, the plan's explanation verbatim.
  • type: CodeableConcept: An Extension
  • applicability: CodeableConcept: An Extension
  • qualifier: CodeableConcept: An Extension
  • amount: Quantity: An Extension
  • deductibleApplies: boolean: An Extension

Differential View

This structure is derived from Extension

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Extension 0..* Extension Plan Benefits Additional Benefit
Extension.extension 3..* Extension Extension
Extension.Slices for extension Content/Rules for all slices
Extension.Slices for extension.extension:category 1..1 Extension The service, as CMS's files name it
Extension.Slices for extension.extension:category.extension 0..0 Extension
Extension.Slices for extension.extension:category.url 1..1 uri "category"
Extension.Slices for extension.extension:category.value[x] 0..1 CodeableConcept Value of extension
Extension.Slices for extension.extension:limitation 0..* Extension Text about this service's limits and terms
Extension.Slices for extension.extension:limitation.extension 0..0 Extension
Extension.Slices for extension.extension:limitation.url 1..1 uri "limitation"
Extension.Slices for extension.extension:limitation.value[x] 0..1 string Value of extension
Extension.Slices for extension.extension:cost 2..* Extension A cost of this service, as plan.specificCost.benefit.cost
Extension.Slices for extension.extension:cost.extension 3..* Extension Extension
Extension.Slices for extension.extension:cost.Slices for extension Content/Rules for all slices
Extension.Slices for extension.extension:cost.Slices for extension.extension:type 1..1 Extension As cost.type
Extension.Slices for extension.extension:cost.Slices for extension.extension:type.extension 0..0 Extension
Extension.Slices for extension.extension:cost.Slices for extension.extension:type.url 1..1 uri "type"
Extension.Slices for extension.extension:cost.Slices for extension.extension:type.value[x] 0..1 CodeableConcept Value of extension
Binding: Plan Benefits Cost Type (extensible)
Extension.Slices for extension.extension:cost.Slices for extension.extension:applicability 1..1 Extension As cost.applicability: in-network, out-of-network or other
Extension.Slices for extension.extension:cost.Slices for extension.extension:applicability.extension 0..0 Extension
Extension.Slices for extension.extension:cost.Slices for extension.extension:applicability.url 1..1 uri "applicability"
Extension.Slices for extension.extension:cost.Slices for extension.extension:applicability.value[x] 0..1 CodeableConcept Value of extension
Binding: BenefitCostApplicability (required)
Extension.Slices for extension.extension:cost.Slices for extension.extension:qualifier 0..* Extension As cost.qualifiers
Extension.Slices for extension.extension:cost.Slices for extension.extension:qualifier.extension 0..0 Extension
Extension.Slices for extension.extension:cost.Slices for extension.extension:qualifier.url 1..1 uri "qualifier"
Extension.Slices for extension.extension:cost.Slices for extension.extension:qualifier.value[x] 0..1 CodeableConcept Value of extension
Binding: Plan Benefits Cost Qualifier (extensible)
Extension.Slices for extension.extension:cost.Slices for extension.extension:amount 1..1 Extension As cost.value: the amount, or a data-absent reason saying there is none
Extension.Slices for extension.extension:cost.Slices for extension.extension:amount.extension 0..0 Extension
Extension.Slices for extension.extension:cost.Slices for extension.extension:amount.url 1..1 uri "amount"
Extension.Slices for extension.extension:cost.Slices for extension.extension:amount.value[x] 0..1 Quantity Value of extension
Extension.Slices for extension.extension:cost.Slices for extension.extension:deductibleApplies 0..1 Extension As SBC's deductible-applies on a cost
Extension.Slices for extension.extension:cost.Slices for extension.extension:deductibleApplies.extension 0..0 Extension
Extension.Slices for extension.extension:cost.Slices for extension.extension:deductibleApplies.url 1..1 uri "deductibleApplies"
Extension.Slices for extension.extension:cost.Slices for extension.extension:deductibleApplies.value[x] 0..1 boolean Value of extension
Extension.Slices for extension.extension:cost.url 1..1 uri "cost"
Extension.Slices for extension.extension:cost.value[x] 0..0 Value of extension
Extension.url 1..1 uri "https://haau3.com/fhir/StructureDefinition/plan-benefits-additional-benefit"
Extension.value[x] 0..0 Value of extension

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Extension 0..* Extension Plan Benefits Additional Benefit
Extension.id 0..1 string Unique id for inter-element referencing
Extension.Slices for extension 3..* Extension Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Extension.Slices for extension.extension:category 1..1 Extension The service, as CMS's files name it
Extension.Slices for extension.extension:category.id 0..1 string Unique id for inter-element referencing
Extension.Slices for extension.extension:category.extension 0..0 Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Extension.Slices for extension.extension:category.url 1..1 uri "category"
Extension.Slices for extension.extension:category.value[x] 0..1 CodeableConcept Value of extension
Extension.Slices for extension.extension:limitation 0..* Extension Text about this service's limits and terms
Extension.Slices for extension.extension:limitation.id 0..1 string Unique id for inter-element referencing
Extension.Slices for extension.extension:limitation.extension 0..0 Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Extension.Slices for extension.extension:limitation.url 1..1 uri "limitation"
Extension.Slices for extension.extension:limitation.value[x] 0..1 string Value of extension
Extension.Slices for extension.extension:cost 2..* Extension A cost of this service, as plan.specificCost.benefit.cost
Extension.Slices for extension.extension:cost.id 0..1 string Unique id for inter-element referencing
Extension.Slices for extension.extension:cost.Slices for extension 3..* Extension Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Extension.Slices for extension.extension:cost.Slices for extension Content/Rules for all slices
Extension.Slices for extension.extension:cost.Slices for extension.extension:type 1..1 Extension As cost.type
Extension.Slices for extension.extension:cost.Slices for extension.extension:type.id 0..1 string Unique id for inter-element referencing
Extension.Slices for extension.extension:cost.Slices for extension.extension:type.extension 0..0 Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Extension.Slices for extension.extension:cost.Slices for extension.extension:type.url 1..1 uri "type"
Extension.Slices for extension.extension:cost.Slices for extension.extension:type.value[x] 0..1 CodeableConcept Value of extension
Binding: Plan Benefits Cost Type (extensible)
Extension.Slices for extension.extension:cost.Slices for extension.extension:applicability 1..1 Extension As cost.applicability: in-network, out-of-network or other
Extension.Slices for extension.extension:cost.Slices for extension.extension:applicability.id 0..1 string Unique id for inter-element referencing
Extension.Slices for extension.extension:cost.Slices for extension.extension:applicability.extension 0..0 Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Extension.Slices for extension.extension:cost.Slices for extension.extension:applicability.url 1..1 uri "applicability"
Extension.Slices for extension.extension:cost.Slices for extension.extension:applicability.value[x] 0..1 CodeableConcept Value of extension
Binding: BenefitCostApplicability (required)
Extension.Slices for extension.extension:cost.Slices for extension.extension:qualifier 0..* Extension As cost.qualifiers
Extension.Slices for extension.extension:cost.Slices for extension.extension:qualifier.id 0..1 string Unique id for inter-element referencing
Extension.Slices for extension.extension:cost.Slices for extension.extension:qualifier.extension 0..0 Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Extension.Slices for extension.extension:cost.Slices for extension.extension:qualifier.url 1..1 uri "qualifier"
Extension.Slices for extension.extension:cost.Slices for extension.extension:qualifier.value[x] 0..1 CodeableConcept Value of extension
Binding: Plan Benefits Cost Qualifier (extensible)
Extension.Slices for extension.extension:cost.Slices for extension.extension:amount 1..1 Extension As cost.value: the amount, or a data-absent reason saying there is none
Extension.Slices for extension.extension:cost.Slices for extension.extension:amount.id 0..1 string Unique id for inter-element referencing
Extension.Slices for extension.extension:cost.Slices for extension.extension:amount.extension 0..0 Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Extension.Slices for extension.extension:cost.Slices for extension.extension:amount.url 1..1 uri "amount"
Extension.Slices for extension.extension:cost.Slices for extension.extension:amount.value[x] 0..1 Quantity Value of extension
Extension.Slices for extension.extension:cost.Slices for extension.extension:deductibleApplies 0..1 Extension As SBC's deductible-applies on a cost
Extension.Slices for extension.extension:cost.Slices for extension.extension:deductibleApplies.id 0..1 string Unique id for inter-element referencing
Extension.Slices for extension.extension:cost.Slices for extension.extension:deductibleApplies.extension 0..0 Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Extension.Slices for extension.extension:cost.Slices for extension.extension:deductibleApplies.url 1..1 uri "deductibleApplies"
Extension.Slices for extension.extension:cost.Slices for extension.extension:deductibleApplies.value[x] 0..1 boolean Value of extension
Extension.Slices for extension.extension:cost.url 1..1 uri "cost"
Extension.url 1..1 uri "https://haau3.com/fhir/StructureDefinition/plan-benefits-additional-benefit"

doco Documentation for this format

This structure is derived from Extension

Summary

Complex Extension: 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.

  • category: CodeableConcept: The service, as CMS's files name it: the PBP service category for Medicare Advantage, the exact benefit name for the Marketplace.
  • limitation: string: Text about the service's limits and terms, as SBC's benefit-limitation limitText carries it for an SBC-coded service: for the Marketplace, the plan's explanation verbatim.
  • type: CodeableConcept: An Extension
  • applicability: CodeableConcept: An Extension
  • qualifier: CodeableConcept: An Extension
  • amount: Quantity: An Extension
  • deductibleApplies: boolean: An Extension

 

Other representations of profile: CSV, Excel, Schematron

Terminology Bindings

Path Status Usage ValueSet Version Source
Extension.extension:cost.​extension:type.value[x] Base extensible Plan Benefits Cost Type 📦1.0.0 This IG
Extension.extension:cost.​extension:applicability.​value[x] Base required Benefit cost applicability 📍4.0.1 FHIR Std.
Extension.extension:cost.​extension:qualifier.​value[x] Base extensible Plan Benefits Cost Qualifier 📦1.0.0 This IG

Constraints

Id Grade Path(s) Description Expression
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()