haau3 FHIR Implementation Guide (HFIG)
1.0.0 - ci-build
haau3 FHIR Implementation Guide (HFIG)
1.0.0 - ci-build
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
| Official URL: https://haau3.com/fhir/StructureDefinition/plan-benefits-cost-scope | Version: 1.0.0 | |||
| Draft as of 2026-10-14 | Computable Name: PlanBenefitsCostScope | |||
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.
Context of Use
This extension may be used on the following element(s)
InsurancePlan.plan.generalCost
Usage info
Usages:
You can also check for usages in the FHIR IG Statistics
Description of Profiles, Differentials, Snapshots, and how the XML and JSON presentations work.
This structure is derived from Extension
| Name | Flags | Card. | Type | Description & Constraints Filter:  |
|---|---|---|---|---|
  Extension |
0..* | Extension | Plan Benefits Cost Scope | |
  extension |
3..* | Extension | Extension | |
  Slices for extension |
Content/Rules for all slices | |||
   extension:network |
1..1 | Extension | Extension | |
  extension |
0..0 | Extension | ||
| url |
1..1 | uri | "network" | |
  value[x] |
0..1 | Coding | Value of extension Binding: Plan Benefits Cost Scope: Network (required) | |
| extension:member |
1..1 | Extension | Extension | |
| extension |
0..0 | Extension | ||
| url |
1..1 | uri | "member" | |
| value[x] |
0..1 | Coding | Value of extension Binding: Plan Benefits Cost Scope: Member (required) | |
 extension:appliesTo |
1..1 | Extension | Extension | |
 extension |
0..0 | Extension | ||
| url |
1..1 | uri | "appliesTo" | |
| value[x] |
0..1 | Coding | Value of extension Binding: Plan Benefits Cost Scope: Applies To (required) | |
| url |
1..1 | uri | "https://haau3.com/fhir/StructureDefinition/plan-benefits-cost-scope" | |
 value[x] |
0..0 | Value of extension | ||
| Documentation for this format | ||||
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| Extension |
0..* | Extension | Plan Benefits Cost Scope | |
 id |
0..1 | string | Unique id for inter-element referencing | |
| 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:network |
1..1 | Extension | Extension | |
| id |
0..1 | string | Unique id for inter-element referencing | |
| 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 | ||
| url |
1..1 | uri | "network" | |
| value[x] |
0..1 | Coding | Value of extension Binding: Plan Benefits Cost Scope: Network (required) | |
| extension:member |
1..1 | Extension | Extension | |
| id |
0..1 | string | Unique id for inter-element referencing | |
| 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 | ||
| url |
1..1 | uri | "member" | |
| value[x] |
0..1 | Coding | Value of extension Binding: Plan Benefits Cost Scope: Member (required) | |
| extension:appliesTo |
1..1 | Extension | Extension | |
| id |
0..1 | string | Unique id for inter-element referencing | |
| 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 | ||
| url |
1..1 | uri | "appliesTo" | |
| value[x] |
0..1 | Coding | Value of extension Binding: Plan Benefits Cost Scope: Applies To (required) | |
| url |
1..1 | uri | "https://haau3.com/fhir/StructureDefinition/plan-benefits-cost-scope" | |
| Documentation for this format | ||||
This structure is derived from Extension
Summary
Complex Extension: 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.
Differential View
This structure is derived from Extension
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| Extension |
0..* | Extension | Plan Benefits Cost Scope | |
| extension |
3..* | Extension | Extension | |
| Slices for extension |
Content/Rules for all slices | |||
| extension:network |
1..1 | Extension | Extension | |
| extension |
0..0 | Extension | ||
| url |
1..1 | uri | "network" | |
| value[x] |
0..1 | Coding | Value of extension Binding: Plan Benefits Cost Scope: Network (required) | |
| extension:member |
1..1 | Extension | Extension | |
| extension |
0..0 | Extension | ||
| url |
1..1 | uri | "member" | |
| value[x] |
0..1 | Coding | Value of extension Binding: Plan Benefits Cost Scope: Member (required) | |
| extension:appliesTo |
1..1 | Extension | Extension | |
| extension |
0..0 | Extension | ||
| url |
1..1 | uri | "appliesTo" | |
| value[x] |
0..1 | Coding | Value of extension Binding: Plan Benefits Cost Scope: Applies To (required) | |
| url |
1..1 | uri | "https://haau3.com/fhir/StructureDefinition/plan-benefits-cost-scope" | |
| value[x] |
0..0 | Value of extension | ||
| Documentation for this format | ||||
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| Extension |
0..* | Extension | Plan Benefits Cost Scope | |
| id |
0..1 | string | Unique id for inter-element referencing | |
| 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:network |
1..1 | Extension | Extension | |
| id |
0..1 | string | Unique id for inter-element referencing | |
| 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 | ||
| url |
1..1 | uri | "network" | |
| value[x] |
0..1 | Coding | Value of extension Binding: Plan Benefits Cost Scope: Network (required) | |
| extension:member |
1..1 | Extension | Extension | |
| id |
0..1 | string | Unique id for inter-element referencing | |
| 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 | ||
| url |
1..1 | uri | "member" | |
| value[x] |
0..1 | Coding | Value of extension Binding: Plan Benefits Cost Scope: Member (required) | |
| extension:appliesTo |
1..1 | Extension | Extension | |
| id |
0..1 | string | Unique id for inter-element referencing | |
| 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 | ||
| url |
1..1 | uri | "appliesTo" | |
| value[x] |
0..1 | Coding | Value of extension Binding: Plan Benefits Cost Scope: Applies To (required) | |
| url |
1..1 | uri | "https://haau3.com/fhir/StructureDefinition/plan-benefits-cost-scope" | |
| Documentation for this format | ||||
This structure is derived from Extension
Summary
Complex Extension: 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.
Other representations of profile: CSV, Excel, Schematron
| Path | Status | Usage | ValueSet | Version | Source |
| Extension.extension:network.value[x] | Base | required | Plan Benefits Cost Scope: Network | 📦1.0.0 | This IG |
| Extension.extension:member.value[x] | Base | required | Plan Benefits Cost Scope: Member | 📦1.0.0 | This IG |
| Extension.extension:appliesTo.value[x] | Base | required | Plan Benefits Cost Scope: Applies To | 📦1.0.0 | This IG |
| 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()
|