An Insurance Policy is a contract between an benefits provider (e.g. an insurance company or a government agency) and an individual or his/her sponsor (e.g. an employer or union).

A Payer will generally offer one or more pre-defined sets of benefits, to which we assigned the generic term, "Health Plan". An Insurance Policy is an instance of a Health Plan. For example, Payer A might offer a Gold Plan and a Silver Plan. John Smith may have a Gold Plan Policy number 123, and Jane Doe may have Gold Plan Policy number 456. ABC Motors may purchase the Silver Plan (Policy number 789) for their employees.

Claims for reimbursement will cite the Insurance Policy number, and sometimes a Group Number, if applicable. In the above example, ABC Motors' Insurance Policy is a Group Policy, so individual employees will cite the Group Number.

Attributes
HealthPlan	healthPlan	Pointer to the Plan which defines the set of benefits available to the Policy.
«II» Id	policyId	A unique identifier that the payer or information source uses to identify the Policy Holder as belonging to a specific Plan. "Business identifiers assigned to this health insurance product which remain constant as the resource is updated and propagates from server to server." - HL7 FHIR, InsurancePlan.identifier
«IVL_TS» Period	policyTerm	The time period during which the Healthcare Policy is / will be in effect.
Subscriber	subscriber	Pointer to (a Role of) the Person who is named as a beneficiary of a Health Policy.

Attributes inherited from  FHIM::EnrollEligCOB::PlanOrPolicy

administeredBy,  network,  payer

 healthPlan

Public HealthPlan healthPlan

Pointer to the Plan which defines the set of benefits available to the Policy.

Constraints:

Properties:

Aggregation	None
Alias
Association	healthcarePolicy_healthPlan
Association End
Class	HealthcarePolicy
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	1
Lower Value	(1)
Multiplicity	1
Name	healthPlan
Name Expression
Namespace	HealthcarePolicy
Opposite	healthcarePolicy
Owner	HealthcarePolicy
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::HealthcarePolicy::healthPlan
Stereotype
Template Parameter
Type	HealthPlan
Upper	1
Upper Value	(1)
Visibility	Public

 policyId

Public «II» Id policyId

A unique identifier that the payer or information source uses to identify the Policy Holder as belonging to a specific Plan.
"Business identifiers assigned to this health insurance product which remain constant as the resource is updated and propagates from server to server." - HL7 FHIR, InsurancePlan.identifier

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	HealthcarePolicy
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	1
Lower Value	(1)
Multiplicity	1
Name	policyId
Name Expression
Namespace	HealthcarePolicy
Opposite
Owner	HealthcarePolicy
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::HealthcarePolicy::policyId
Stereotype
Template Parameter
Type	«II» Id
Upper	1
Upper Value	(1)
Visibility	Public

 policyTerm

Public «IVL_TS» Period policyTerm

The time period during which the Healthcare Policy is / will be in effect.

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	HealthcarePolicy
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	0..1
Name	policyTerm
Name Expression
Namespace	HealthcarePolicy
Opposite
Owner	HealthcarePolicy
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::HealthcarePolicy::policyTerm
Stereotype
Template Parameter
Type	«IVL_TS» Period
Upper	1
Upper Value	(1)
Visibility	Public

 subscriber

Public Subscriber subscriber

Pointer to (a Role of) the Person who is named as a beneficiary of a Health Policy.

Constraints:

Properties:

Aggregation	None
Alias
Association	subscriber_healthcarePolicy
Association End
Class	HealthcarePolicy
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	*
Name	subscriber
Name Expression
Namespace	HealthcarePolicy
Opposite	healthcarePolicy
Owner	HealthcarePolicy
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::HealthcarePolicy::subscriber
Stereotype
Template Parameter
Type	Subscriber
Upper	*
Upper Value	(*)
Visibility	Public