Plan Benefits Plan Facts - haau3 FHIR Implementation Guide (HFIG) v1.0.0

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 Plan Facts

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

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.

Context of Use

This extension may be used on the following element(s)

Element ID: InsurancePlan

Usage info

Usages:

Use this Extension: haau3 Insurance Plan (Plan Benefits)
Examples for this Extension: AvMed Entrust Gold 125 (2026) and AARP Medicare Advantage from UHC FL-0021 (PPO)

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.

Differential Table
Snapshot Table
Statistics/References
All

This structure is derived from Extension

Name	Card.	Type	Description & Constraints Filter: Bindings Constraints Obligations
Extension	0..*	Extension	Plan Benefits Plan Facts
Extension.Slices for extension			Content/Rules for all slices
Extension.Slices for extension.extension:specialNeeds	0..1	Extension	Medicare Advantage: whether the plan is a special needs plan
Extension.Slices for extension.extension:specialNeeds.extension	0..0		Extension
Extension.Slices for extension.extension:specialNeeds.url	1..1	uri	"specialNeeds"
Extension.Slices for extension.extension:specialNeeds.value[x]	0..1	boolean	Value of extension
Extension.Slices for extension.extension:specialNeedsType	0..1	Extension	Medicare Advantage: the special needs plan's type, as CMS's dictionary names it
Extension.Slices for extension.extension:specialNeedsType.extension	0..0		Extension
Extension.Slices for extension.extension:specialNeedsType.url	1..1	uri	"specialNeedsType"
Extension.Slices for extension.extension:specialNeedsType.value[x]	0..1	string	Value of extension
Extension.Slices for extension.extension:employerOnly	0..1	Extension	Medicare Advantage: whether only an employer or union group can enroll
Extension.Slices for extension.extension:employerOnly.extension	0..0		Extension
Extension.Slices for extension.extension:employerOnly.url	1..1	uri	"employerOnly"
Extension.Slices for extension.extension:employerOnly.value[x]	0..1	boolean	Value of extension
Extension.Slices for extension.extension:partBOnly	0..1	Extension	Medicare Advantage: whether the plan covers Part B services only
Extension.Slices for extension.extension:partBOnly.extension	0..0		Extension
Extension.Slices for extension.extension:partBOnly.url	1..1	uri	"partBOnly"
Extension.Slices for extension.extension:partBOnly.value[x]	0..1	boolean	Value of extension
Extension.Slices for extension.extension:filesCostData	0..1	Extension	Medicare Advantage: whether the plan files cost data in CMS's public files
Extension.Slices for extension.extension:filesCostData.extension	0..0		Extension
Extension.Slices for extension.extension:filesCostData.url	1..1	uri	"filesCostData"
Extension.Slices for extension.extension:filesCostData.value[x]	0..1	boolean	Value of extension
Extension.Slices for extension.extension:outOfNetworkBenefit	0..1	Extension	Medicare Advantage: whether the plan covers care out of network
Extension.Slices for extension.extension:outOfNetworkBenefit.extension	0..0		Extension
Extension.Slices for extension.extension:outOfNetworkBenefit.url	1..1	uri	"outOfNetworkBenefit"
Extension.Slices for extension.extension:outOfNetworkBenefit.value[x]	0..1	boolean	Value of extension
Extension.Slices for extension.extension:pointOfService	0..1	Extension	Medicare Advantage: whether the HMO has a point-of-service option
Extension.Slices for extension.extension:pointOfService.extension	0..0		Extension
Extension.Slices for extension.extension:pointOfService.url	1..1	uri	"pointOfService"
Extension.Slices for extension.extension:pointOfService.value[x]	0..1	boolean	Value of extension
Extension.Slices for extension.extension:metalLevel	0..1	Extension	Marketplace: the metal level, coded, with CMS's words as text
Extension.Slices for extension.extension:metalLevel.extension	0..0		Extension
Extension.Slices for extension.extension:metalLevel.url	1..1	uri	"metalLevel"
Extension.Slices for extension.extension:metalLevel.value[x]	0..1	CodeableConcept	Value of extension Binding: Plan Benefits Metal Level (extensible)
Extension.Slices for extension.extension:metalLevel.value[x].text	1..1	string	Plain text representation of the concept
Extension.Slices for extension.extension:csrVariation	0..1	Extension	Marketplace: the cost-sharing reduction variant, as CMS's file writes it
Extension.Slices for extension.extension:csrVariation.extension	0..0		Extension
Extension.Slices for extension.extension:csrVariation.url	1..1	uri	"csrVariation"
Extension.Slices for extension.extension:csrVariation.value[x]	0..1	string	Value of extension
Extension.Slices for extension.extension:market	0..1	Extension	Marketplace: individual or small group (SHOP), as CMS's file writes it
Extension.Slices for extension.extension:market.extension	0..0		Extension
Extension.Slices for extension.extension:market.url	1..1	uri	"market"
Extension.Slices for extension.extension:market.value[x]	0..1	string	Value of extension
Extension.Slices for extension.extension:hsaEligible	0..1	Extension	Marketplace: whether the plan is eligible for a health savings account
Extension.Slices for extension.extension:hsaEligible.extension	0..0		Extension
Extension.Slices for extension.extension:hsaEligible.url	1..1	uri	"hsaEligible"
Extension.Slices for extension.extension:hsaEligible.value[x]	0..1	boolean	Value of extension
Extension.Slices for extension.extension:effectiveDate	0..1	Extension	Marketplace: the date the plan takes effect
Extension.Slices for extension.extension:effectiveDate.extension	0..0		Extension
Extension.Slices for extension.extension:effectiveDate.url	1..1	uri	"effectiveDate"
Extension.Slices for extension.extension:effectiveDate.value[x]	0..1	date	Value of extension
Extension.Slices for extension.extension:enrollmentEnd	0..1	Extension	Marketplace: the end of plan selection for enrollment
Extension.Slices for extension.extension:enrollmentEnd.extension	0..0		Extension
Extension.Slices for extension.extension:enrollmentEnd.url	1..1	uri	"enrollmentEnd"
Extension.Slices for extension.extension:enrollmentEnd.value[x]	0..1	date	Value of extension
Extension.Slices for extension.extension:outOfServiceAreaCoverage	0..1	Extension	Marketplace: whether the plan covers care outside its service area
Extension.Slices for extension.extension:outOfServiceAreaCoverage.extension	0..0		Extension
Extension.Slices for extension.extension:outOfServiceAreaCoverage.url	1..1	uri	"outOfServiceAreaCoverage"
Extension.Slices for extension.extension:outOfServiceAreaCoverage.value[x]	0..1	boolean	Value of extension
Extension.Slices for extension.extension:outOfServiceAreaDescription	0..1	Extension	Marketplace: what the plan covers outside its service area, as CMS's file writes it
Extension.Slices for extension.extension:outOfServiceAreaDescription.extension	0..0		Extension
Extension.Slices for extension.extension:outOfServiceAreaDescription.url	1..1	uri	"outOfServiceAreaDescription"
Extension.Slices for extension.extension:outOfServiceAreaDescription.value[x]	0..1	string	Value of extension
Extension.Slices for extension.extension:outOfCountryCoverage	0..1	Extension	Marketplace: whether the plan covers care outside the country
Extension.Slices for extension.extension:outOfCountryCoverage.extension	0..0		Extension
Extension.Slices for extension.extension:outOfCountryCoverage.url	1..1	uri	"outOfCountryCoverage"
Extension.Slices for extension.extension:outOfCountryCoverage.value[x]	0..1	boolean	Value of extension
Extension.Slices for extension.extension:outOfCountryDescription	0..1	Extension	Marketplace: what the plan covers outside the country, as CMS's file writes it
Extension.Slices for extension.extension:outOfCountryDescription.extension	0..0		Extension
Extension.Slices for extension.extension:outOfCountryDescription.url	1..1	uri	"outOfCountryDescription"
Extension.Slices for extension.extension:outOfCountryDescription.value[x]	0..1	string	Value of extension
Extension.Slices for extension.extension:multipleInNetworkTiers	0..1	Extension	Marketplace: whether the plan has two in-network tiers
Extension.Slices for extension.extension:multipleInNetworkTiers.extension	0..0		Extension
Extension.Slices for extension.extension:multipleInNetworkTiers.url	1..1	uri	"multipleInNetworkTiers"
Extension.Slices for extension.extension:multipleInNetworkTiers.value[x]	0..1	boolean	Value of extension
Extension.Slices for extension.extension:deductiblesIntegrated	0..1	Extension	Marketplace: whether one deductible covers medical care and drugs together
Extension.Slices for extension.extension:deductiblesIntegrated.extension	0..0		Extension
Extension.Slices for extension.extension:deductiblesIntegrated.url	1..1	uri	"deductiblesIntegrated"
Extension.Slices for extension.extension:deductiblesIntegrated.value[x]	0..1	boolean	Value of extension
Extension.Slices for extension.extension:maximumIntegrated	0..1	Extension	Marketplace: whether one out-of-pocket maximum covers medical care and drugs together
Extension.Slices for extension.extension:maximumIntegrated.extension	0..0		Extension
Extension.Slices for extension.extension:maximumIntegrated.url	1..1	uri	"maximumIntegrated"
Extension.Slices for extension.extension:maximumIntegrated.value[x]	0..1	boolean	Value of extension
Extension.Slices for extension.extension:primaryCareVisitsBeforeCostSharing	0..1	Extension	Marketplace: primary care visits fully covered before cost sharing begins
Extension.Slices for extension.extension:primaryCareVisitsBeforeCostSharing.extension	0..0		Extension
Extension.Slices for extension.extension:primaryCareVisitsBeforeCostSharing.url	1..1	uri	"primaryCareVisitsBeforeCostSharing"
Extension.Slices for extension.extension:primaryCareVisitsBeforeCostSharing.value[x]	0..1	unsignedInt	Value of extension
Extension.Slices for extension.extension:primaryCareCopaysBeforeDeductible	0..1	Extension	Marketplace: primary care copays charged before the deductible applies
Extension.Slices for extension.extension:primaryCareCopaysBeforeDeductible.extension	0..0		Extension
Extension.Slices for extension.extension:primaryCareCopaysBeforeDeductible.url	1..1	uri	"primaryCareCopaysBeforeDeductible"
Extension.Slices for extension.extension:primaryCareCopaysBeforeDeductible.value[x]	0..1	unsignedInt	Value of extension
Extension.Slices for extension.extension:inpatientCopayMaxDays	0..1	Extension	Marketplace: the most days of a stay a per-day hospital copay is charged for
Extension.Slices for extension.extension:inpatientCopayMaxDays.extension	0..0		Extension
Extension.Slices for extension.extension:inpatientCopayMaxDays.url	1..1	uri	"inpatientCopayMaxDays"
Extension.Slices for extension.extension:inpatientCopayMaxDays.value[x]	0..1	unsignedInt	Value of extension
Extension.url	1..1	uri	"https://haau3.com/fhir/StructureDefinition/plan-benefits-plan-facts"
Extension.value[x]	0..0		Value of extension
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints Filter: Bindings Constraints Obligations
Extension		0..*	Extension	Plan Benefits Plan Facts
Extension.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Extension.Slices for extension.extension:specialNeeds		0..1	Extension	Medicare Advantage: whether the plan is a special needs plan
Extension.Slices for extension.extension:specialNeeds.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:specialNeeds.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:specialNeeds.url		1..1	uri	"specialNeeds"
Extension.Slices for extension.extension:specialNeeds.value[x]		0..1	boolean	Value of extension
Extension.Slices for extension.extension:specialNeedsType		0..1	Extension	Medicare Advantage: the special needs plan's type, as CMS's dictionary names it
Extension.Slices for extension.extension:specialNeedsType.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:specialNeedsType.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:specialNeedsType.url		1..1	uri	"specialNeedsType"
Extension.Slices for extension.extension:specialNeedsType.value[x]		0..1	string	Value of extension
Extension.Slices for extension.extension:employerOnly		0..1	Extension	Medicare Advantage: whether only an employer or union group can enroll
Extension.Slices for extension.extension:employerOnly.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:employerOnly.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:employerOnly.url		1..1	uri	"employerOnly"
Extension.Slices for extension.extension:employerOnly.value[x]		0..1	boolean	Value of extension
Extension.Slices for extension.extension:partBOnly		0..1	Extension	Medicare Advantage: whether the plan covers Part B services only
Extension.Slices for extension.extension:partBOnly.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:partBOnly.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:partBOnly.url		1..1	uri	"partBOnly"
Extension.Slices for extension.extension:partBOnly.value[x]		0..1	boolean	Value of extension
Extension.Slices for extension.extension:filesCostData		0..1	Extension	Medicare Advantage: whether the plan files cost data in CMS's public files
Extension.Slices for extension.extension:filesCostData.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:filesCostData.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:filesCostData.url		1..1	uri	"filesCostData"
Extension.Slices for extension.extension:filesCostData.value[x]		0..1	boolean	Value of extension
Extension.Slices for extension.extension:outOfNetworkBenefit		0..1	Extension	Medicare Advantage: whether the plan covers care out of network
Extension.Slices for extension.extension:outOfNetworkBenefit.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:outOfNetworkBenefit.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:outOfNetworkBenefit.url		1..1	uri	"outOfNetworkBenefit"
Extension.Slices for extension.extension:outOfNetworkBenefit.value[x]		0..1	boolean	Value of extension
Extension.Slices for extension.extension:pointOfService		0..1	Extension	Medicare Advantage: whether the HMO has a point-of-service option
Extension.Slices for extension.extension:pointOfService.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:pointOfService.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:pointOfService.url		1..1	uri	"pointOfService"
Extension.Slices for extension.extension:pointOfService.value[x]		0..1	boolean	Value of extension
Extension.Slices for extension.extension:metalLevel		0..1	Extension	Marketplace: the metal level, coded, with CMS's words as text
Extension.Slices for extension.extension:metalLevel.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:metalLevel.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:metalLevel.url		1..1	uri	"metalLevel"
Extension.Slices for extension.extension:metalLevel.value[x]		0..1	CodeableConcept	Value of extension Binding: Plan Benefits Metal Level (extensible)
Extension.Slices for extension.extension:metalLevel.value[x].id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:metalLevel.value[x].extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Extension.Slices for extension.extension:metalLevel.value[x].coding	This element is included in summaries.	0..*	Coding	Code defined by a terminology system
Extension.Slices for extension.extension:metalLevel.value[x].text	This element is included in summaries.	1..1	string	Plain text representation of the concept
Extension.Slices for extension.extension:csrVariation		0..1	Extension	Marketplace: the cost-sharing reduction variant, as CMS's file writes it
Extension.Slices for extension.extension:csrVariation.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:csrVariation.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:csrVariation.url		1..1	uri	"csrVariation"
Extension.Slices for extension.extension:csrVariation.value[x]		0..1	string	Value of extension
Extension.Slices for extension.extension:market		0..1	Extension	Marketplace: individual or small group (SHOP), as CMS's file writes it
Extension.Slices for extension.extension:market.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:market.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:market.url		1..1	uri	"market"
Extension.Slices for extension.extension:market.value[x]		0..1	string	Value of extension
Extension.Slices for extension.extension:hsaEligible		0..1	Extension	Marketplace: whether the plan is eligible for a health savings account
Extension.Slices for extension.extension:hsaEligible.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:hsaEligible.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:hsaEligible.url		1..1	uri	"hsaEligible"
Extension.Slices for extension.extension:hsaEligible.value[x]		0..1	boolean	Value of extension
Extension.Slices for extension.extension:effectiveDate		0..1	Extension	Marketplace: the date the plan takes effect
Extension.Slices for extension.extension:effectiveDate.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:effectiveDate.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:effectiveDate.url		1..1	uri	"effectiveDate"
Extension.Slices for extension.extension:effectiveDate.value[x]		0..1	date	Value of extension
Extension.Slices for extension.extension:enrollmentEnd		0..1	Extension	Marketplace: the end of plan selection for enrollment
Extension.Slices for extension.extension:enrollmentEnd.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:enrollmentEnd.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:enrollmentEnd.url		1..1	uri	"enrollmentEnd"
Extension.Slices for extension.extension:enrollmentEnd.value[x]		0..1	date	Value of extension
Extension.Slices for extension.extension:outOfServiceAreaCoverage		0..1	Extension	Marketplace: whether the plan covers care outside its service area
Extension.Slices for extension.extension:outOfServiceAreaCoverage.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:outOfServiceAreaCoverage.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:outOfServiceAreaCoverage.url		1..1	uri	"outOfServiceAreaCoverage"
Extension.Slices for extension.extension:outOfServiceAreaCoverage.value[x]		0..1	boolean	Value of extension
Extension.Slices for extension.extension:outOfServiceAreaDescription		0..1	Extension	Marketplace: what the plan covers outside its service area, as CMS's file writes it
Extension.Slices for extension.extension:outOfServiceAreaDescription.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:outOfServiceAreaDescription.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:outOfServiceAreaDescription.url		1..1	uri	"outOfServiceAreaDescription"
Extension.Slices for extension.extension:outOfServiceAreaDescription.value[x]		0..1	string	Value of extension
Extension.Slices for extension.extension:outOfCountryCoverage		0..1	Extension	Marketplace: whether the plan covers care outside the country
Extension.Slices for extension.extension:outOfCountryCoverage.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:outOfCountryCoverage.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:outOfCountryCoverage.url		1..1	uri	"outOfCountryCoverage"
Extension.Slices for extension.extension:outOfCountryCoverage.value[x]		0..1	boolean	Value of extension
Extension.Slices for extension.extension:outOfCountryDescription		0..1	Extension	Marketplace: what the plan covers outside the country, as CMS's file writes it
Extension.Slices for extension.extension:outOfCountryDescription.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:outOfCountryDescription.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:outOfCountryDescription.url		1..1	uri	"outOfCountryDescription"
Extension.Slices for extension.extension:outOfCountryDescription.value[x]		0..1	string	Value of extension
Extension.Slices for extension.extension:multipleInNetworkTiers		0..1	Extension	Marketplace: whether the plan has two in-network tiers
Extension.Slices for extension.extension:multipleInNetworkTiers.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:multipleInNetworkTiers.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:multipleInNetworkTiers.url		1..1	uri	"multipleInNetworkTiers"
Extension.Slices for extension.extension:multipleInNetworkTiers.value[x]		0..1	boolean	Value of extension
Extension.Slices for extension.extension:deductiblesIntegrated		0..1	Extension	Marketplace: whether one deductible covers medical care and drugs together
Extension.Slices for extension.extension:deductiblesIntegrated.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:deductiblesIntegrated.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:deductiblesIntegrated.url		1..1	uri	"deductiblesIntegrated"
Extension.Slices for extension.extension:deductiblesIntegrated.value[x]		0..1	boolean	Value of extension
Extension.Slices for extension.extension:maximumIntegrated		0..1	Extension	Marketplace: whether one out-of-pocket maximum covers medical care and drugs together
Extension.Slices for extension.extension:maximumIntegrated.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:maximumIntegrated.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:maximumIntegrated.url		1..1	uri	"maximumIntegrated"
Extension.Slices for extension.extension:maximumIntegrated.value[x]		0..1	boolean	Value of extension
Extension.Slices for extension.extension:primaryCareVisitsBeforeCostSharing		0..1	Extension	Marketplace: primary care visits fully covered before cost sharing begins
Extension.Slices for extension.extension:primaryCareVisitsBeforeCostSharing.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:primaryCareVisitsBeforeCostSharing.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:primaryCareVisitsBeforeCostSharing.url		1..1	uri	"primaryCareVisitsBeforeCostSharing"
Extension.Slices for extension.extension:primaryCareVisitsBeforeCostSharing.value[x]		0..1	unsignedInt	Value of extension
Extension.Slices for extension.extension:primaryCareCopaysBeforeDeductible		0..1	Extension	Marketplace: primary care copays charged before the deductible applies
Extension.Slices for extension.extension:primaryCareCopaysBeforeDeductible.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:primaryCareCopaysBeforeDeductible.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:primaryCareCopaysBeforeDeductible.url		1..1	uri	"primaryCareCopaysBeforeDeductible"
Extension.Slices for extension.extension:primaryCareCopaysBeforeDeductible.value[x]		0..1	unsignedInt	Value of extension
Extension.Slices for extension.extension:inpatientCopayMaxDays		0..1	Extension	Marketplace: the most days of a stay a per-day hospital copay is charged for
Extension.Slices for extension.extension:inpatientCopayMaxDays.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:inpatientCopayMaxDays.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:inpatientCopayMaxDays.url		1..1	uri	"inpatientCopayMaxDays"
Extension.Slices for extension.extension:inpatientCopayMaxDays.value[x]		0..1	unsignedInt	Value of extension
Extension.url		1..1	uri	"https://haau3.com/fhir/StructureDefinition/plan-benefits-plan-facts"
Documentation for this format

This structure is derived from Extension

Summary

Complex Extension: 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.

specialNeeds: boolean: An Extension
specialNeedsType: string: An Extension
employerOnly: boolean: An Extension
partBOnly: boolean: Whether the plan covers Part B services only. Hospital and skilled nursing care are then not part of the plan, and say so.
filesCostData: boolean: Whether the plan files cost data in CMS's public files. PACE, medical savings account and cost plans file none, and each of their costs says so.
outOfNetworkBenefit: boolean: An Extension
pointOfService: boolean: An Extension
metalLevel: CodeableConcept: The metal level: HL7's insuranceplan-plan-type code, with the level as CMS's file writes it as text. An Expanded Bronze plan carries HL7's bronze and haau3's expanded-bronze.
csrVariation: string: An Extension
market: string: An Extension
hsaEligible: boolean: An Extension
effectiveDate: date: The plan's effective date, as CMS's file writes it (PlanEffectiveDate). period carries the plan year; a plan that takes effect after the year starts says so here.
enrollmentEnd: date: The end date of plan selection for enrollment, as CMS's dictionary defines PlanExpirationDate. It is not the end of coverage: period carries the plan year.
outOfServiceAreaCoverage: boolean: An Extension
outOfServiceAreaDescription: string: An Extension
outOfCountryCoverage: boolean: An Extension
outOfCountryDescription: string: An Extension
multipleInNetworkTiers: boolean: An Extension
deductiblesIntegrated: boolean: An Extension
maximumIntegrated: boolean: An Extension
primaryCareVisitsBeforeCostSharing: unsignedInt: How many primary care visits the plan covers in full before the primary care cost applies. The primary care cost is stated as filed; this count changes when it starts.
primaryCareCopaysBeforeDeductible: unsignedInt: How many primary care visits are charged a copay before the deductible and coinsurance apply. The primary care cost is stated as filed; this count changes when it applies.
inpatientCopayMaxDays: unsignedInt: The most days of a hospital stay for which a per-day copay is charged. The hospital cost is stated as filed; this count limits it.

Differential View

This structure is derived from Extension

Name	Card.	Type	Description & Constraints Filter: Bindings Constraints Obligations
Extension	0..*	Extension	Plan Benefits Plan Facts
Extension.Slices for extension			Content/Rules for all slices
Extension.Slices for extension.extension:specialNeeds	0..1	Extension	Medicare Advantage: whether the plan is a special needs plan
Extension.Slices for extension.extension:specialNeeds.extension	0..0		Extension
Extension.Slices for extension.extension:specialNeeds.url	1..1	uri	"specialNeeds"
Extension.Slices for extension.extension:specialNeeds.value[x]	0..1	boolean	Value of extension
Extension.Slices for extension.extension:specialNeedsType	0..1	Extension	Medicare Advantage: the special needs plan's type, as CMS's dictionary names it
Extension.Slices for extension.extension:specialNeedsType.extension	0..0		Extension
Extension.Slices for extension.extension:specialNeedsType.url	1..1	uri	"specialNeedsType"
Extension.Slices for extension.extension:specialNeedsType.value[x]	0..1	string	Value of extension
Extension.Slices for extension.extension:employerOnly	0..1	Extension	Medicare Advantage: whether only an employer or union group can enroll
Extension.Slices for extension.extension:employerOnly.extension	0..0		Extension
Extension.Slices for extension.extension:employerOnly.url	1..1	uri	"employerOnly"
Extension.Slices for extension.extension:employerOnly.value[x]	0..1	boolean	Value of extension
Extension.Slices for extension.extension:partBOnly	0..1	Extension	Medicare Advantage: whether the plan covers Part B services only
Extension.Slices for extension.extension:partBOnly.extension	0..0		Extension
Extension.Slices for extension.extension:partBOnly.url	1..1	uri	"partBOnly"
Extension.Slices for extension.extension:partBOnly.value[x]	0..1	boolean	Value of extension
Extension.Slices for extension.extension:filesCostData	0..1	Extension	Medicare Advantage: whether the plan files cost data in CMS's public files
Extension.Slices for extension.extension:filesCostData.extension	0..0		Extension
Extension.Slices for extension.extension:filesCostData.url	1..1	uri	"filesCostData"
Extension.Slices for extension.extension:filesCostData.value[x]	0..1	boolean	Value of extension
Extension.Slices for extension.extension:outOfNetworkBenefit	0..1	Extension	Medicare Advantage: whether the plan covers care out of network
Extension.Slices for extension.extension:outOfNetworkBenefit.extension	0..0		Extension
Extension.Slices for extension.extension:outOfNetworkBenefit.url	1..1	uri	"outOfNetworkBenefit"
Extension.Slices for extension.extension:outOfNetworkBenefit.value[x]	0..1	boolean	Value of extension
Extension.Slices for extension.extension:pointOfService	0..1	Extension	Medicare Advantage: whether the HMO has a point-of-service option
Extension.Slices for extension.extension:pointOfService.extension	0..0		Extension
Extension.Slices for extension.extension:pointOfService.url	1..1	uri	"pointOfService"
Extension.Slices for extension.extension:pointOfService.value[x]	0..1	boolean	Value of extension
Extension.Slices for extension.extension:metalLevel	0..1	Extension	Marketplace: the metal level, coded, with CMS's words as text
Extension.Slices for extension.extension:metalLevel.extension	0..0		Extension
Extension.Slices for extension.extension:metalLevel.url	1..1	uri	"metalLevel"
Extension.Slices for extension.extension:metalLevel.value[x]	0..1	CodeableConcept	Value of extension Binding: Plan Benefits Metal Level (extensible)
Extension.Slices for extension.extension:metalLevel.value[x].text	1..1	string	Plain text representation of the concept
Extension.Slices for extension.extension:csrVariation	0..1	Extension	Marketplace: the cost-sharing reduction variant, as CMS's file writes it
Extension.Slices for extension.extension:csrVariation.extension	0..0		Extension
Extension.Slices for extension.extension:csrVariation.url	1..1	uri	"csrVariation"
Extension.Slices for extension.extension:csrVariation.value[x]	0..1	string	Value of extension
Extension.Slices for extension.extension:market	0..1	Extension	Marketplace: individual or small group (SHOP), as CMS's file writes it
Extension.Slices for extension.extension:market.extension	0..0		Extension
Extension.Slices for extension.extension:market.url	1..1	uri	"market"
Extension.Slices for extension.extension:market.value[x]	0..1	string	Value of extension
Extension.Slices for extension.extension:hsaEligible	0..1	Extension	Marketplace: whether the plan is eligible for a health savings account
Extension.Slices for extension.extension:hsaEligible.extension	0..0		Extension
Extension.Slices for extension.extension:hsaEligible.url	1..1	uri	"hsaEligible"
Extension.Slices for extension.extension:hsaEligible.value[x]	0..1	boolean	Value of extension
Extension.Slices for extension.extension:effectiveDate	0..1	Extension	Marketplace: the date the plan takes effect
Extension.Slices for extension.extension:effectiveDate.extension	0..0		Extension
Extension.Slices for extension.extension:effectiveDate.url	1..1	uri	"effectiveDate"
Extension.Slices for extension.extension:effectiveDate.value[x]	0..1	date	Value of extension
Extension.Slices for extension.extension:enrollmentEnd	0..1	Extension	Marketplace: the end of plan selection for enrollment
Extension.Slices for extension.extension:enrollmentEnd.extension	0..0		Extension
Extension.Slices for extension.extension:enrollmentEnd.url	1..1	uri	"enrollmentEnd"
Extension.Slices for extension.extension:enrollmentEnd.value[x]	0..1	date	Value of extension
Extension.Slices for extension.extension:outOfServiceAreaCoverage	0..1	Extension	Marketplace: whether the plan covers care outside its service area
Extension.Slices for extension.extension:outOfServiceAreaCoverage.extension	0..0		Extension
Extension.Slices for extension.extension:outOfServiceAreaCoverage.url	1..1	uri	"outOfServiceAreaCoverage"
Extension.Slices for extension.extension:outOfServiceAreaCoverage.value[x]	0..1	boolean	Value of extension
Extension.Slices for extension.extension:outOfServiceAreaDescription	0..1	Extension	Marketplace: what the plan covers outside its service area, as CMS's file writes it
Extension.Slices for extension.extension:outOfServiceAreaDescription.extension	0..0		Extension
Extension.Slices for extension.extension:outOfServiceAreaDescription.url	1..1	uri	"outOfServiceAreaDescription"
Extension.Slices for extension.extension:outOfServiceAreaDescription.value[x]	0..1	string	Value of extension
Extension.Slices for extension.extension:outOfCountryCoverage	0..1	Extension	Marketplace: whether the plan covers care outside the country
Extension.Slices for extension.extension:outOfCountryCoverage.extension	0..0		Extension
Extension.Slices for extension.extension:outOfCountryCoverage.url	1..1	uri	"outOfCountryCoverage"
Extension.Slices for extension.extension:outOfCountryCoverage.value[x]	0..1	boolean	Value of extension
Extension.Slices for extension.extension:outOfCountryDescription	0..1	Extension	Marketplace: what the plan covers outside the country, as CMS's file writes it
Extension.Slices for extension.extension:outOfCountryDescription.extension	0..0		Extension
Extension.Slices for extension.extension:outOfCountryDescription.url	1..1	uri	"outOfCountryDescription"
Extension.Slices for extension.extension:outOfCountryDescription.value[x]	0..1	string	Value of extension
Extension.Slices for extension.extension:multipleInNetworkTiers	0..1	Extension	Marketplace: whether the plan has two in-network tiers
Extension.Slices for extension.extension:multipleInNetworkTiers.extension	0..0		Extension
Extension.Slices for extension.extension:multipleInNetworkTiers.url	1..1	uri	"multipleInNetworkTiers"
Extension.Slices for extension.extension:multipleInNetworkTiers.value[x]	0..1	boolean	Value of extension
Extension.Slices for extension.extension:deductiblesIntegrated	0..1	Extension	Marketplace: whether one deductible covers medical care and drugs together
Extension.Slices for extension.extension:deductiblesIntegrated.extension	0..0		Extension
Extension.Slices for extension.extension:deductiblesIntegrated.url	1..1	uri	"deductiblesIntegrated"
Extension.Slices for extension.extension:deductiblesIntegrated.value[x]	0..1	boolean	Value of extension
Extension.Slices for extension.extension:maximumIntegrated	0..1	Extension	Marketplace: whether one out-of-pocket maximum covers medical care and drugs together
Extension.Slices for extension.extension:maximumIntegrated.extension	0..0		Extension
Extension.Slices for extension.extension:maximumIntegrated.url	1..1	uri	"maximumIntegrated"
Extension.Slices for extension.extension:maximumIntegrated.value[x]	0..1	boolean	Value of extension
Extension.Slices for extension.extension:primaryCareVisitsBeforeCostSharing	0..1	Extension	Marketplace: primary care visits fully covered before cost sharing begins
Extension.Slices for extension.extension:primaryCareVisitsBeforeCostSharing.extension	0..0		Extension
Extension.Slices for extension.extension:primaryCareVisitsBeforeCostSharing.url	1..1	uri	"primaryCareVisitsBeforeCostSharing"
Extension.Slices for extension.extension:primaryCareVisitsBeforeCostSharing.value[x]	0..1	unsignedInt	Value of extension
Extension.Slices for extension.extension:primaryCareCopaysBeforeDeductible	0..1	Extension	Marketplace: primary care copays charged before the deductible applies
Extension.Slices for extension.extension:primaryCareCopaysBeforeDeductible.extension	0..0		Extension
Extension.Slices for extension.extension:primaryCareCopaysBeforeDeductible.url	1..1	uri	"primaryCareCopaysBeforeDeductible"
Extension.Slices for extension.extension:primaryCareCopaysBeforeDeductible.value[x]	0..1	unsignedInt	Value of extension
Extension.Slices for extension.extension:inpatientCopayMaxDays	0..1	Extension	Marketplace: the most days of a stay a per-day hospital copay is charged for
Extension.Slices for extension.extension:inpatientCopayMaxDays.extension	0..0		Extension
Extension.Slices for extension.extension:inpatientCopayMaxDays.url	1..1	uri	"inpatientCopayMaxDays"
Extension.Slices for extension.extension:inpatientCopayMaxDays.value[x]	0..1	unsignedInt	Value of extension
Extension.url	1..1	uri	"https://haau3.com/fhir/StructureDefinition/plan-benefits-plan-facts"
Extension.value[x]	0..0		Value of extension
Documentation for this format

Snapshot View

Name	Flags	Card.	Type	Description & Constraints Filter: Bindings Constraints Obligations
Extension		0..*	Extension	Plan Benefits Plan Facts
Extension.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Extension.Slices for extension.extension:specialNeeds		0..1	Extension	Medicare Advantage: whether the plan is a special needs plan
Extension.Slices for extension.extension:specialNeeds.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:specialNeeds.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:specialNeeds.url		1..1	uri	"specialNeeds"
Extension.Slices for extension.extension:specialNeeds.value[x]		0..1	boolean	Value of extension
Extension.Slices for extension.extension:specialNeedsType		0..1	Extension	Medicare Advantage: the special needs plan's type, as CMS's dictionary names it
Extension.Slices for extension.extension:specialNeedsType.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:specialNeedsType.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:specialNeedsType.url		1..1	uri	"specialNeedsType"
Extension.Slices for extension.extension:specialNeedsType.value[x]		0..1	string	Value of extension
Extension.Slices for extension.extension:employerOnly		0..1	Extension	Medicare Advantage: whether only an employer or union group can enroll
Extension.Slices for extension.extension:employerOnly.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:employerOnly.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:employerOnly.url		1..1	uri	"employerOnly"
Extension.Slices for extension.extension:employerOnly.value[x]		0..1	boolean	Value of extension
Extension.Slices for extension.extension:partBOnly		0..1	Extension	Medicare Advantage: whether the plan covers Part B services only
Extension.Slices for extension.extension:partBOnly.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:partBOnly.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:partBOnly.url		1..1	uri	"partBOnly"
Extension.Slices for extension.extension:partBOnly.value[x]		0..1	boolean	Value of extension
Extension.Slices for extension.extension:filesCostData		0..1	Extension	Medicare Advantage: whether the plan files cost data in CMS's public files
Extension.Slices for extension.extension:filesCostData.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:filesCostData.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:filesCostData.url		1..1	uri	"filesCostData"
Extension.Slices for extension.extension:filesCostData.value[x]		0..1	boolean	Value of extension
Extension.Slices for extension.extension:outOfNetworkBenefit		0..1	Extension	Medicare Advantage: whether the plan covers care out of network
Extension.Slices for extension.extension:outOfNetworkBenefit.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:outOfNetworkBenefit.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:outOfNetworkBenefit.url		1..1	uri	"outOfNetworkBenefit"
Extension.Slices for extension.extension:outOfNetworkBenefit.value[x]		0..1	boolean	Value of extension
Extension.Slices for extension.extension:pointOfService		0..1	Extension	Medicare Advantage: whether the HMO has a point-of-service option
Extension.Slices for extension.extension:pointOfService.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:pointOfService.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:pointOfService.url		1..1	uri	"pointOfService"
Extension.Slices for extension.extension:pointOfService.value[x]		0..1	boolean	Value of extension
Extension.Slices for extension.extension:metalLevel		0..1	Extension	Marketplace: the metal level, coded, with CMS's words as text
Extension.Slices for extension.extension:metalLevel.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:metalLevel.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:metalLevel.url		1..1	uri	"metalLevel"
Extension.Slices for extension.extension:metalLevel.value[x]		0..1	CodeableConcept	Value of extension Binding: Plan Benefits Metal Level (extensible)
Extension.Slices for extension.extension:metalLevel.value[x].id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:metalLevel.value[x].extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Extension.Slices for extension.extension:metalLevel.value[x].coding	This element is included in summaries.	0..*	Coding	Code defined by a terminology system
Extension.Slices for extension.extension:metalLevel.value[x].text	This element is included in summaries.	1..1	string	Plain text representation of the concept
Extension.Slices for extension.extension:csrVariation		0..1	Extension	Marketplace: the cost-sharing reduction variant, as CMS's file writes it
Extension.Slices for extension.extension:csrVariation.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:csrVariation.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:csrVariation.url		1..1	uri	"csrVariation"
Extension.Slices for extension.extension:csrVariation.value[x]		0..1	string	Value of extension
Extension.Slices for extension.extension:market		0..1	Extension	Marketplace: individual or small group (SHOP), as CMS's file writes it
Extension.Slices for extension.extension:market.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:market.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:market.url		1..1	uri	"market"
Extension.Slices for extension.extension:market.value[x]		0..1	string	Value of extension
Extension.Slices for extension.extension:hsaEligible		0..1	Extension	Marketplace: whether the plan is eligible for a health savings account
Extension.Slices for extension.extension:hsaEligible.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:hsaEligible.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:hsaEligible.url		1..1	uri	"hsaEligible"
Extension.Slices for extension.extension:hsaEligible.value[x]		0..1	boolean	Value of extension
Extension.Slices for extension.extension:effectiveDate		0..1	Extension	Marketplace: the date the plan takes effect
Extension.Slices for extension.extension:effectiveDate.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:effectiveDate.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:effectiveDate.url		1..1	uri	"effectiveDate"
Extension.Slices for extension.extension:effectiveDate.value[x]		0..1	date	Value of extension
Extension.Slices for extension.extension:enrollmentEnd		0..1	Extension	Marketplace: the end of plan selection for enrollment
Extension.Slices for extension.extension:enrollmentEnd.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:enrollmentEnd.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:enrollmentEnd.url		1..1	uri	"enrollmentEnd"
Extension.Slices for extension.extension:enrollmentEnd.value[x]		0..1	date	Value of extension
Extension.Slices for extension.extension:outOfServiceAreaCoverage		0..1	Extension	Marketplace: whether the plan covers care outside its service area
Extension.Slices for extension.extension:outOfServiceAreaCoverage.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:outOfServiceAreaCoverage.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:outOfServiceAreaCoverage.url		1..1	uri	"outOfServiceAreaCoverage"
Extension.Slices for extension.extension:outOfServiceAreaCoverage.value[x]		0..1	boolean	Value of extension
Extension.Slices for extension.extension:outOfServiceAreaDescription		0..1	Extension	Marketplace: what the plan covers outside its service area, as CMS's file writes it
Extension.Slices for extension.extension:outOfServiceAreaDescription.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:outOfServiceAreaDescription.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:outOfServiceAreaDescription.url		1..1	uri	"outOfServiceAreaDescription"
Extension.Slices for extension.extension:outOfServiceAreaDescription.value[x]		0..1	string	Value of extension
Extension.Slices for extension.extension:outOfCountryCoverage		0..1	Extension	Marketplace: whether the plan covers care outside the country
Extension.Slices for extension.extension:outOfCountryCoverage.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:outOfCountryCoverage.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:outOfCountryCoverage.url		1..1	uri	"outOfCountryCoverage"
Extension.Slices for extension.extension:outOfCountryCoverage.value[x]		0..1	boolean	Value of extension
Extension.Slices for extension.extension:outOfCountryDescription		0..1	Extension	Marketplace: what the plan covers outside the country, as CMS's file writes it
Extension.Slices for extension.extension:outOfCountryDescription.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:outOfCountryDescription.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:outOfCountryDescription.url		1..1	uri	"outOfCountryDescription"
Extension.Slices for extension.extension:outOfCountryDescription.value[x]		0..1	string	Value of extension
Extension.Slices for extension.extension:multipleInNetworkTiers		0..1	Extension	Marketplace: whether the plan has two in-network tiers
Extension.Slices for extension.extension:multipleInNetworkTiers.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:multipleInNetworkTiers.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:multipleInNetworkTiers.url		1..1	uri	"multipleInNetworkTiers"
Extension.Slices for extension.extension:multipleInNetworkTiers.value[x]		0..1	boolean	Value of extension
Extension.Slices for extension.extension:deductiblesIntegrated		0..1	Extension	Marketplace: whether one deductible covers medical care and drugs together
Extension.Slices for extension.extension:deductiblesIntegrated.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:deductiblesIntegrated.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:deductiblesIntegrated.url		1..1	uri	"deductiblesIntegrated"
Extension.Slices for extension.extension:deductiblesIntegrated.value[x]		0..1	boolean	Value of extension
Extension.Slices for extension.extension:maximumIntegrated		0..1	Extension	Marketplace: whether one out-of-pocket maximum covers medical care and drugs together
Extension.Slices for extension.extension:maximumIntegrated.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:maximumIntegrated.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:maximumIntegrated.url		1..1	uri	"maximumIntegrated"
Extension.Slices for extension.extension:maximumIntegrated.value[x]		0..1	boolean	Value of extension
Extension.Slices for extension.extension:primaryCareVisitsBeforeCostSharing		0..1	Extension	Marketplace: primary care visits fully covered before cost sharing begins
Extension.Slices for extension.extension:primaryCareVisitsBeforeCostSharing.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:primaryCareVisitsBeforeCostSharing.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:primaryCareVisitsBeforeCostSharing.url		1..1	uri	"primaryCareVisitsBeforeCostSharing"
Extension.Slices for extension.extension:primaryCareVisitsBeforeCostSharing.value[x]		0..1	unsignedInt	Value of extension
Extension.Slices for extension.extension:primaryCareCopaysBeforeDeductible		0..1	Extension	Marketplace: primary care copays charged before the deductible applies
Extension.Slices for extension.extension:primaryCareCopaysBeforeDeductible.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:primaryCareCopaysBeforeDeductible.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:primaryCareCopaysBeforeDeductible.url		1..1	uri	"primaryCareCopaysBeforeDeductible"
Extension.Slices for extension.extension:primaryCareCopaysBeforeDeductible.value[x]		0..1	unsignedInt	Value of extension
Extension.Slices for extension.extension:inpatientCopayMaxDays		0..1	Extension	Marketplace: the most days of a stay a per-day hospital copay is charged for
Extension.Slices for extension.extension:inpatientCopayMaxDays.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:inpatientCopayMaxDays.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:inpatientCopayMaxDays.url		1..1	uri	"inpatientCopayMaxDays"
Extension.Slices for extension.extension:inpatientCopayMaxDays.value[x]		0..1	unsignedInt	Value of extension
Extension.url		1..1	uri	"https://haau3.com/fhir/StructureDefinition/plan-benefits-plan-facts"
Documentation for this format

This structure is derived from Extension

Summary

specialNeeds: boolean: An Extension
specialNeedsType: string: An Extension
employerOnly: boolean: An Extension
partBOnly: boolean: Whether the plan covers Part B services only. Hospital and skilled nursing care are then not part of the plan, and say so.
filesCostData: boolean: Whether the plan files cost data in CMS's public files. PACE, medical savings account and cost plans file none, and each of their costs says so.
outOfNetworkBenefit: boolean: An Extension
pointOfService: boolean: An Extension
metalLevel: CodeableConcept: The metal level: HL7's insuranceplan-plan-type code, with the level as CMS's file writes it as text. An Expanded Bronze plan carries HL7's bronze and haau3's expanded-bronze.
csrVariation: string: An Extension
market: string: An Extension
hsaEligible: boolean: An Extension
effectiveDate: date: The plan's effective date, as CMS's file writes it (PlanEffectiveDate). period carries the plan year; a plan that takes effect after the year starts says so here.
enrollmentEnd: date: The end date of plan selection for enrollment, as CMS's dictionary defines PlanExpirationDate. It is not the end of coverage: period carries the plan year.
outOfServiceAreaCoverage: boolean: An Extension
outOfServiceAreaDescription: string: An Extension
outOfCountryCoverage: boolean: An Extension
outOfCountryDescription: string: An Extension
multipleInNetworkTiers: boolean: An Extension
deductiblesIntegrated: boolean: An Extension
maximumIntegrated: boolean: An Extension
primaryCareVisitsBeforeCostSharing: unsignedInt: How many primary care visits the plan covers in full before the primary care cost applies. The primary care cost is stated as filed; this count changes when it starts.
primaryCareCopaysBeforeDeductible: unsignedInt: How many primary care visits are charged a copay before the deductible and coinsurance apply. The primary care cost is stated as filed; this count changes when it applies.
inpatientCopayMaxDays: unsignedInt: The most days of a hospital stay for which a per-day copay is charged. The hospital cost is stated as filed; this count limits it.

Other representations of profile: CSV, Excel, Schematron

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Extension.extension:metalLevel.value[x]	Base	extensible	Plan Benefits Metal Level	📦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()`