### ----------------------------------------------------
### -- FHIR
### -- Licenses: Artistic-2.0
### -- Authors: Hugh Simpson
### -- File: t/resources/structureDefinition/InsurancePlan.json
### ----------------------------------------------------
### -- Chunk 12 of 12
"
      },
      "type" : [{
        "code" : "CodeableConcept"
      }],
      "isModifier" : false,
      "isSummary" : false,
      "binding" : {
        "extension" : [{
          "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString" : "BenefitCostApplicability"
        }],
        "strength" : "required",
        "description" : "Whether the cost applies to in-network or out-of-network providers.",
        "valueSet" : "http://hl7.org/fhir/ValueSet/insuranceplan-applicability|4.0.0"
      }
    },
    {
      "id" : "InsurancePlan.plan.specificCost.benefit.cost.qualifiers",
      "path" : "InsurancePlan.plan.specificCost.benefit.cost.qualifiers",
      "short" : "Additional information about the cost",
      "definition" : "Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA).",
      "min" : 0,
      "max" : "*",
      "base" : {
        "path" : "InsurancePlan.plan.specificCost.benefit.cost.qualifiers",
        "min" : 0,
        "max" : "*"
      },
      "type" : [{
        "code" : "CodeableConcept"
      }],
      "isModifier" : false,
      "isSummary" : false
    },
    {
      "id" : "InsurancePlan.plan.specificCost.benefit.cost.value",
      "path" : "InsurancePlan.plan.specificCost.benefit.cost.value",
      "short" : "The actual cost value",
      "definition" : "The actual cost value. (some of the costs may be represented as percentages rather than currency, e.g. 10% coinsurance).",
      "min" : 0,
      "max" : "1",
      "base" : {
        "path" : "InsurancePlan.plan.specificCost.benefit.cost.value",
        "min" : 0,
        "max" : "1"
      },
      "type" : [{
        "code" : "Quantity"
      }],
      "isModifier" : false,
      "isSummary" : false
    }]
  },
  "differential" : {
    "element" : [{
      "id" : "InsurancePlan",
      "path" : "InsurancePlan",
      "short" : "Details of a Health Insurance product/plan provided by an organization",
      "definition" : "Details of a Health Insurance product/plan provided by an organization.",
      "min" : 0,
      "max" : "*",
      "constraint" : [{
        "key" : "ipn-1",
        "severity" : "error",
        "human" : "The organization SHALL at least have a name or an idendtifier, and possibly more than one",
        "expression" : "(identifier.count() + name.count()) > 0",
        "xpath" : "count(f:identifier | f:name) > 0"
      }]
    },
    {
      "id" : "InsurancePlan.identifier",
      "path" : "InsurancePlan.identifier",
      "short" : "Business Identifier for Product",
      "definition" : "Business identifiers assigned to this health insurance product which remain constant as the resource is updated and propagates from server to server.",
      "min" : 0,
      "max" : "*",
      "type" : [{
        "code" : "Identifier"
      }],
      "condition" : ["ipn-1"],
      "isSummary" : true,
      "mapping" : [{
        "identity" : "w5",
        "map" : "FiveWs.identifier"
      },
      {
        "identity" : "rim",
        "map" : ".scopes[Role](classCode=IDENT)"
      }]
    },
    {
      "id" : "InsurancePlan.status",
      "path" : "InsurancePlan.status",
      "short" : "draft | active | retired | unknown",
      "definition" : "The current state of the health insurance product.",
      "requirements" : "Need a flag to indicate a record is no longer to be used and should generally be hidden for the user in the UI.",
      "min" : 0,
      "max" : "1",
      "type" : [{
        "code" : "code"
      }],
      "meaningWhenMissing" : "Default interpretation is active.",
      "isModifier" : true,
      "isModifierReason" : "This element is labeled as a modifier because it is a status element that contains codes which means that the resource should not be treated as valid",
      "isSummary" : true,
      "binding" : {
        "extension" : [{
          "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString" : "PublicationStatus"
        },
        {
          "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
          "valueBoolean" : true
        }],
        "strength" : "required",
        "description" : "The lifecycle status of an artifact.",
        "valueSet" : "http://hl7.org/fhir/ValueSet/publication-status|4.0.0"
      },
      "mapping" : [{
        "identity" : "w5",
        "map" : "FiveWs.status"
      },
      {
        "identity" : "rim",
        "map" : ".status"
      }]
    },
    {
      "id" : "InsurancePlan.type",
      "path" : "InsurancePlan.type",
      "short" : "Kind of product",
      "definition" : "The kind of health insurance product.",
      "min" : 0,
      "max" : "*",
      "type" : [{
        "code" : "CodeableConcept"
      }],
      "isSummary" : true,
      "binding" : {
        "extension" : [{
          "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString" : "InsurancePlanType"
        }],
        "strength" : "example",
        "description" : "Used to categorize the product/plan.",
        "valueSet" : "http://hl7.org/fhir/ValueSet/insuranceplan-type"
      },
      "mapping" : [{
        "identity" : "w5",
        "map" : "FiveWs.class"
      },
      {
        "identity" : "rim",
        "map" : ".code"
      }]
    },
    {
      "id" : "InsurancePlan.name",
      "path" : "InsurancePlan.name",
      "short" : "Official name",
      "definition" : "Official name of the health insurance product as designated by the owner.",
      "comment" : "If the name of the product/plan changes, consider putting the old name in the alias column so that it can still be located through searches.",
      "min" : 0,
      "max" : "1",
      "type" : [{
        "code" : "string"
      }],
      "condition" : ["ipn-1"],
      "isSummary" : true,
      "mapping" : [{
        "identity" : "rim",
        "map" : ".name"
      }]
    },
    {
      "id" : "InsurancePlan.alias",
      "path" : "InsurancePlan.alias",
      "short" : "Alternate names",
      "definition" : "A list of alternate names that the product is known as, or was known as in the past.",
      "comment" : "There are no dates associated with the alias/historic names, as this is not intended to track when names were used, but to assist in searching so that older names can still result in identifying the product/plan.",
      "requirements" : "Over time products/plans go through many changes and can be known by different names.\n\nFor searching knowing previous names that the product/plan was known by can be very useful.",
      "min" : 0,
      "max" : "*",
      "type" : [{
        "code" : "string"
      }],
      "mapping" : [{
        "identity" : "rim",
        "map" : ".name"
      }]
    },
    {
      "id" : "InsurancePlan.period",
      "path" : "InsurancePlan.period",
      "short" : "When the product is available",
      "definition" : "The period of time that the health insurance product is available.",
      "min" : 0,
      "max" : "1",
      "type" : [{
        "code" : "Period"
      }]
    },
    {
      "id" : "InsurancePlan.ownedBy",
      "path" : "InsurancePlan.ownedBy",
      "short" : "Plan issuer",
      "definition" : "The entity that is providing  the health insurance product and underwriting the risk.  This is typically an insurance carriers, other third-party payers, or health plan sponsors comonly referred to as 'payers'.",
      "alias" : ["Payer"],
      "min" : 0,
      "max" : "1",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://hl7.org/fhir/StructureDefinition/Organization"]
      }],
      "isSummary" : true
    },
    {
      "id" : "InsurancePlan.administeredBy",
      "path" : "InsurancePlan.administeredBy",
      "short" : "Product administrator",
      "definition" : "An organization which administer other services such as underwriting, customer service and/or claims processing on behalf of the health insurance product owner.",
      "min" : 0,
      "max" : "1",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://hl7.org/fhir/StructureDefinition/Organization"]
      }],
      "isSummary" : true
    },
    {
      "id" : "InsurancePlan.coverageArea",
      "path" : "InsurancePlan.coverageArea",
      "short" : "Where product applies",
      "definition" : "The geographic region in which a health insurance product's benefits apply.",
      "min" : 0,
      "max" : "*",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://hl7.org/fhir/StructureDefinition/Location"]
      }],
      "isSummary" : true
    },
    {
      "id" : "InsurancePlan.contact",
      "path" : "InsurancePlan.contact",
      "short" : "Contact for the product",
      "definition" : "The contact for the health insurance product for a certain purpose.",
      "comment" : "Where multiple contacts for the same purpose are provided there is a standard extension that can be used to determine which one is the preferred contact to use.",
      "requirements" : "Need to keep track of assigned contact points within bigger organization.",
      "min" : 0,
      "max" : "*",
      "type" : [{
        "code" : "BackboneElement"
      }],
      "mapping" : [{
        "identity" : "rim",
        "map" : ".contactParty"
      }]
    },
    {
      "id" : "InsurancePlan.contact.purpose",
      "path" : "InsurancePlan.contact.purpose",
      "short" : "The type of contact",
      "definition" : "Indicates a purpose for which the contact can be reached.",
      "requirements" : "Need to distinguish between multiple contact persons.",
      "min" : 0,
      "max" : "1",
      "type" : [{
        "code" : "CodeableConcept"
      }],
      "binding" : {
        "extension" : [{
          "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString" : "ContactPartyType"
        }],
        "strength" : "extensible",
        "description" : "The purpose for which you would contact a contact party.",
        "valueSet" : "http://hl7.org/fhir/ValueSet/contactentity-type"
      },
      "mapping" : [{
        "identity" : "rim",
        "map" : "./type"
      }]
    },
    {
      "id" : "InsurancePlan.contact.name",
      "path" : "InsurancePlan.contact.name",
      "short" : "A name associated with the contact",
      "definition" : "A name associated with the contact.",
      "requirements" : "Need to be able to track the person by name.",
      "min" : 0,
      "max" : "1",
      "type" : [{
        "code" : "HumanName"
      }],
      "mapping" : [{
        "identity" : "rim",
        "map" : "./name"
      }]
    },
    {
      "id" : "InsurancePlan.contact.telecom",
      "path" : "InsurancePlan.contact.telecom",
      "short" : "Contact details (telephone, email, etc.)  for a contact",
      "definition" : "A contact detail (e.g. a telephone number or an email address) by which the party may be contacted.",
      "requirements" : "People have (primary) ways to contact them in some way such as phone, email.",
      "min" : 0,
      "max" : "*",
      "type" : [{
        "code" : "ContactPoint"
      }],
      "mapping" : [{
        "identity" : "rim",
        "map" : "./telecom"
      }]
    },
    {
      "id" : "InsurancePlan.contact.address",
      "path" : "InsurancePlan.contact.address",
      "short" : "Visiting or postal addresses for the contact",
      "definition" : "Visiting or postal addresses for the contact.",
      "requirements" : "May need to keep track of a contact party's address for contacting, billing or reporting requirements.",
      "min" : 0,
      "max" : "1",
      "type" : [{
        "code" : "Address"
      }],
      "mapping" : [{
        "identity" : "rim",
        "map" : "./addr"
      }]
    },
    {
      "id" : "InsurancePlan.endpoint",
      "path" : "InsurancePlan.endpoint",
      "short" : "Technical endpoint",
      "definition" : "The technical endpoints providing access to services operated for the health insurance product.",
      "requirements" : "Organizations have multiple systems that provide various services and need to be able to define the technical connection details for how to connect to them, and for what purpose.",
      "min" : 0,
      "max" : "*",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://hl7.org/fhir/StructureDefinition/Endpoint"]
      }],
      "mapping" : [{
        "identity" : "rim",
        "map" : "n/a"
      }]
    },
    {
      "id" : "InsurancePlan.network",
      "path" : "InsurancePlan.network",
      "short" : "What networks are Included",
      "definition" : "Reference to the network included in the health insurance product.",
      "comment" : "Networks are represented as a hierarchy of organization resources.",
      "min" : 0,
      "max" : "*",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://hl7.org/fhir/StructureDefinition/Organization"]
      }]
    },
    {
      "id" : "InsurancePlan.coverage",
      "path" : "InsurancePlan.coverage",
      "short" : "Coverage details",
      "definition" : "Details about the coverage offered by the insurance product.",
      "min" : 0,
      "max" : "*",
      "type" : [{
        "code" : "BackboneElement"
      }]
    },
    {
      "id" : "InsurancePlan.coverage.type",
      "path" : "InsurancePlan.coverage.type",
      "short" : "Type of coverage",
      "definition" : "Type of coverage  (Medical; Dental; Mental Health; Substance Abuse; Vision; Drug; Short Term; Long Term Care; Hospice; Home Health).",
      "min" : 1,
      "max" : "1",
      "type" : [{
        "code" : "CodeableConcept"
      }]
    },
    {
      "id" : "InsurancePlan.coverage.network",
      "path" : "InsurancePlan.coverage.network",
      "short" : "What networks provide coverage",
      "definition" : "Reference to the network that providing the type of coverage.",
      "comment" : "Networks are represented as a hierarchy of organization resources.",
      "min" : 0,
      "max" : "*",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://hl7.org/fhir/StructureDefinition/Organization"]
      }]
    },
    {
      "id" : "InsurancePlan.coverage.benefit",
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
        "valueString" : "CoverageBenefit"
      }],
      "path" : "InsurancePlan.coverage.benefit",
      "short" : "List of benefits",
      "definition" : "Specific benefits under this type of coverage.",
      "min" : 1,
      "max" : "*",
      "type" : [{
        "code" : "BackboneElement"
      }]
    },
    {
      "id" : "InsurancePlan.coverage.benefit.type",
      "path" : "InsurancePlan.coverage.benefit.type",
      "short" : "Type of benefit",
      "definition" : "Type of benefit (primary care; speciality care; inpatient; outpatient).",
      "min" : 1,
      "max" : "1",
      "type" : [{
        "code" : "CodeableConcept"
      }]
    },
    {
      "id" : "InsurancePlan.coverage.benefit.requirement",
      "path" : "InsurancePlan.coverage.benefit.requirement",
      "short" : "Referral requirements",
      "definition" : "The referral requirements to have access/coverage for this benefit.",
      "min" : 0,
      "max" : "1",
      "type" : [{
        "code" : "string"
      }]
    },
    {
      "id" : "InsurancePlan.coverage.benefit.limit",
      "path" : "InsurancePlan.coverage.benefit.limit",
      "short" : "Benefit limits",
      "definition" : "The specific limits on the benefit.",
      "min" : 0,
      "max" : "*",
      "type" : [{
        "code" : "BackboneElement"
      }]
    },
    {
      "id" : "InsurancePlan.coverage.benefit.limit.value",
      "path" : "InsurancePlan.coverage.benefit.limit.value",
      "short" : "Maximum value allowed",
      "definition" : "The maximum amount of a service item a plan will pay for a covered benefit.  For examples. wellness visits, or eyeglasses.",
      "comment" : "May also be called “eligible expense,” “payment allowance,” or “negotiated rate.”.",
      "min" : 0,
      "max" : "1",
      "type" : [{
        "code" : "Quantity"
      }]
    },
    {
      "id" : "InsurancePlan.coverage.benefit.limit.code",
      "path" : "InsurancePlan.coverage.benefit.limit.code",
      "short" : "Benefit limit details",
      "definition" : "The specific limit on the benefit.",
      "comment" : "Use `CodeableConcept.text` element if the data is free (uncoded) text.",
      "min" : 0,
      "max" : "1",
      "type" : [{
        "code" : "CodeableConcept"
      }]
    },
    {
      "id" : "InsurancePlan.plan",
      "path" : "InsurancePlan.plan",
      "short" : "Plan details",
      "definition" : "Details about an insurance plan.",
      "min" : 0,
      "max" : "*",
      "type" : [{
        "code" : "BackboneElement"
      }]
    },
    {
      "id" : "InsurancePlan.plan.identifier",
      "path" : "InsurancePlan.plan.identifier",
      "short" : "Business Identifier for Product",
      "definition" : "Business identifiers assigned to this health insurance plan which remain constant as the resource is updated and propagates from server to server.",
      "min" : 0,
      "max" : "*",
      "type" : [{
        "code" : "Identifier"
      }],
      "isSummary" : true,
      "mapping" : [{
        "identity" : "w5",
        "map" : "FiveWs.identifier"
      },
      {
        "identity" : "rim",
        "map" : ".scopes[Role](classCode=IDENT)"
      }]
    },
    {
      "id" : "InsurancePlan.plan.type",
      "path" : "InsurancePlan.plan.type",
      "short" : "Type of plan",
      "definition" : "Type of plan. For example, \"Platinum\" or \"High Deductable\".",
      "min" : 0,
      "max" : "1",
      "type" : [{
        "code" : "CodeableConcept"
      }]
    },
    {
      "id" : "InsurancePlan.plan.coverageArea",
      "path" : "InsurancePlan.plan.coverageArea",
      "short" : "Where product applies",
      "definition" : "The geographic region in which a health insurance plan's benefits apply.",
      "min" : 0,
      "max" : "*",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://hl7.org/fhir/StructureDefinition/Location"]
      }],
      "isSummary" : true
    },
    {
      "id" : "InsurancePlan.plan.network",
      "path" : "InsurancePlan.plan.network",
      "short" : "What networks provide coverage",
      "definition" : "Reference to the network that providing the type of coverage.",
      "comment" : "Networks are represented as a hierarchy of organization resources.",
      "min" : 0,
      "max" : "*",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://hl7.org/fhir/StructureDefinition/Organization"]
      }]
    },
    {
      "id" : "InsurancePlan.plan.generalCost",
      "path" : "InsurancePlan.plan.generalCost",
      "short" : "Overall costs",
      "definition" : "Overall costs associated with the plan.",
      "min" : 0,
      "max" : "*",
      "type" : [{
        "code" : "BackboneElement"
      }]
    },
    {
      "id" : "InsurancePlan.plan.generalCost.type",
      "path" : "InsurancePlan.plan.generalCost.type",
      "short" : "Type of cost",
      "definition" : "Type of cost.",
      "min" : 0,
      "max" : "1",
      "type" : [{
        "code" : "CodeableConcept"
      }]
    },
    {
      "id" : "InsurancePlan.plan.generalCost.groupSize",
      "path" : "InsurancePlan.plan.generalCost.groupSize",
      "short" : "Number of enrollees",
      "definition" : "Number of participants enrolled in the plan.",
      "min" : 0,
      "max" : "1",
      "type" : [{
        "code" : "positiveInt"
      }]
    },
    {
      "id" : "InsurancePlan.plan.generalCost.cost",
      "path" : "InsurancePlan.plan.generalCost.cost",
      "short" : "Cost value",
      "definition" : "Value of the cost.",
      "min" : 0,
      "max" : "1",
      "type" : [{
        "code" : "Money"
      }]
    },
    {
      "id" : "InsurancePlan.plan.generalCost.comment",
      "path" : "InsurancePlan.plan.generalCost.comment",
      "short" : "Additional cost information",
      "definition" : "Additional information about the general costs associated with this plan.",
      "min" : 0,
      "max" : "1",
      "type" : [{
        "code" : "string"
      }]
    },
    {
      "id" : "InsurancePlan.plan.specificCost",
      "path" : "InsurancePlan.plan.specificCost",
      "short" : "Specific costs",
      "definition" : "Costs associated with the coverage provided by the product.",
      "min" : 0,
      "max" : "*",
      "type" : [{
        "code" : "BackboneElement"
      }]
    },
    {
      "id" : "InsurancePlan.plan.specificCost.category",
      "path" : "InsurancePlan.plan.specificCost.category",
      "short" : "General category of benefit",
      "definition" : "General category of benefit (Medical; Dental; Vision; Drug; Mental Health; Substance Abuse; Hospice, Home Health).",
      "min" : 1,
      "max" : "1",
      "type" : [{
        "code" : "CodeableConcept"
      }]
    },
    {
      "id" : "InsurancePlan.plan.specificCost.benefit",
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
        "valueString" : "PlanBenefit"
      }],
      "path" : "InsurancePlan.plan.specificCost.benefit",
      "short" : "Benefits list",
      "definition" : "List of the specific benefits under this category of benefit.",
      "min" : 0,
      "max" : "*",
      "type" : [{
        "code" : "BackboneElement"
      }]
    },
    {
      "id" : "InsurancePlan.plan.specificCost.benefit.type",
      "path" : "InsurancePlan.plan.specificCost.benefit.type",
      "short" : "Type of specific benefit",
      "definition" : "Type of specific benefit (preventative; primary care office visit; speciality office visit; hospitalization; emergency room; urgent care).",
      "min" : 1,
      "max" : "1",
      "type" : [{
        "code" : "CodeableConcept"
      }]
    },
    {
      "id" : "InsurancePlan.plan.specificCost.benefit.cost",
      "path" : "InsurancePlan.plan.specificCost.benefit.cost",
      "short" : "List of the costs",
      "definition" : "List of the costs associated with a specific benefit.",
      "min" : 0,
      "max" : "*",
      "type" : [{
        "code" : "BackboneElement"
      }]
    },
    {
      "id" : "InsurancePlan.plan.specificCost.benefit.cost.type",
      "path" : "InsurancePlan.plan.specificCost.benefit.cost.type",
      "short" : "Type of cost",
      "definition" : "Type of cost (copay; individual cap; family cap; coinsurance; deductible).",
      "min" : 1,
      "max" : "1",
      "type" : [{
        "code" : "CodeableConcept"
      }]
    },
    {
      "id" : "InsurancePlan.plan.specificCost.benefit.cost.applicability",
      "path" : "InsurancePlan.plan.specificCost.benefit.cost.applicability",
      "short" : "in-network | out-of-network | other",
      "definition" : "Whether the cost applies to in-network or out-of-network providers (in-network; out-of-network; other).",
      "min" : 0,
      "max" : "1",
      "type" : [{
        "code" : "CodeableConcept"
      }],
      "binding" : {
        "extension" : [{
          "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString" : "BenefitCostApplicability"
        }],
        "strength" : "required",
        "description" : "Whether the cost applies to in-network or out-of-network providers.",
        "valueSet" : "http://hl7.org/fhir/ValueSet/insuranceplan-applicability|4.0.0"
      }
    },
    {
      "id" : "InsurancePlan.plan.specificCost.benefit.cost.qualifiers",
      "path" : "InsurancePlan.plan.specificCost.benefit.cost.qualifiers",
      "short" : "Additional information about the cost",
      "definition" : "Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA).",
      "min" : 0,
      "max" : "*",
      "type" : [{
        "code" : "CodeableConcept"
      }]
    },
    {
      "id" : "InsurancePlan.plan.specificCost.benefit.cost.value",
      "path" : "InsurancePlan.plan.specificCost.benefit.cost.value",
      "short" : "The actual cost value",
      "definition" : "The actual cost value. (some of the costs may be represented as percentages rather than currency, e.g. 10% coinsurance).",
      "min" : 0,
      "max" : "1",
      "type" : [{
        "code" : "Quantity"
      }]
    }]
  }
}


