EnrollEligCOB
Class HealthcarePolicy

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 healthPlan

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

«II» Id policyId 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 policyTerm

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

Subscriber 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 FHIM::EnrollEligCOB::PlanOrPolicy
administeredBy administeredBy, network network, payer payer

Properties:

Alias
Classifier Behavior
Is Abstractfalse
Is Activefalse
Is Leaffalse
Keywords
NameHealthcarePolicy
Name Expression
NamespaceEnrollEligCOB
Owned Template Signature
OwnerEnrollEligCOB
Owning Template Parameter
PackageEnrollEligCOB
Qualified NameFHIM::EnrollEligCOB::HealthcarePolicy
Representation
Stereotype
Template Parameter
VisibilityPublic

Attribute Details

 healthPlan
Public HealthPlan healthPlan

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

Constraints:
Properties:

AggregationNone
Alias
AssociationhealthcarePolicy_healthPlan
Association End
ClassHealthcarePolicy
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower1
Lower Value(1)
Multiplicity1
NamehealthPlan
Name Expression
NamespaceHealthcarePolicy
OppositehealthcarePolicy
OwnerHealthcarePolicy
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::HealthcarePolicy::healthPlan
Stereotype
Template Parameter
TypeHealthPlan
Upper1
Upper Value(1)
VisibilityPublic


 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:

AggregationNone
Alias
Association
Association End
ClassHealthcarePolicy
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower1
Lower Value(1)
Multiplicity1
NamepolicyId
Name Expression
NamespaceHealthcarePolicy
Opposite
OwnerHealthcarePolicy
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::HealthcarePolicy::policyId
Stereotype
Template Parameter
Type«II» Id
Upper1
Upper Value(1)
VisibilityPublic


 policyTerm
Public «IVL_TS» Period policyTerm

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

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassHealthcarePolicy
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity0..1
NamepolicyTerm
Name Expression
NamespaceHealthcarePolicy
Opposite
OwnerHealthcarePolicy
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::HealthcarePolicy::policyTerm
Stereotype
Template Parameter
Type«IVL_TS» Period
Upper1
Upper Value(1)
VisibilityPublic


 subscriber
Public Subscriber subscriber

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

Constraints:
Properties:

AggregationNone
Alias
Associationsubscriber_healthcarePolicy
Association End
ClassHealthcarePolicy
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity*
Namesubscriber
Name Expression
NamespaceHealthcarePolicy
OppositehealthcarePolicy
OwnerHealthcarePolicy
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::HealthcarePolicy::subscriber
Stereotype
Template Parameter
TypeSubscriber
Upper*
Upper Value(*)
VisibilityPublic