A healthcare-related procedure or service, to include medications and durable equipment, that is anticipated to be funded, in full or in part, by a given Healthcare Policy. This class was called CoveredBenefit but was renamed to Specific Cost in 2019 for compatibility with FHIR.
"Costs associated with the coverage provided by the product." - HL7 FHIR, InsurancePlan.plan.specificCost
"List of the specific benefits under this category of benefit." - HL7 FHIR, InsurancePlan.plan.specificCost.benefit
"List of the costs associated with a specific benefit." - HL7 FHIR, InsurancePlan.plan.specificCost.benefit.cost
Note that FHIR uses three classes to categorize the cost, while FHIM uses one. The resulting FHIM class therefore contains two categorization codes in addition to the code defining what is covered.

Attributes
«CS» Code	applicability	"Whether the cost applies to in-network or out-of-network providers (in-network; out-of-network; other)." - HL7 FHIR, InsurancePlan.plan.specificCost.benefit.cost.applicability
«CS» Code	benefitType	Identifies a healthcare-related procedure or service, to include medications and durable equipment, that is anticipated to be funded, in full or in part, by a given Healthcare Policy. "Type of specific benefit (preventative; primary care office visit; speciality office visit; hospitalization; emergency room; urgent care)." - HL7 FHIR, InsurancePlan.plan.specificCost.benefit.type
«CS» Code	category	"General category of benefit (Medical; Dental; Vision; Drug; Mental Health; Substance Abuse; Hospice, Home Health)." - HL7 FHIR, InsurancePlan.plan.specificCost.category
«CS» Code	kind	"Type of cost (copay; individual cap; family cap; coinsurance; deductible)." - HL7 FHIR, InsurancePlan.plan.specificCost.benefit.cost.type
«CS» Code	qualifiers	"Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA)." - HL7 FHIR, InsurancePlan.plan.specificCost.benefit.cost.qualifiers
«PQ» Quantity	value	"The actual cost value. (some of the costs may be represented as percentages rather than currency, e.g. 10% coinsurance)." - HL7 FHIR, InsurancePlan.plan.specificCost.benefit.cost.value Note that the FHIM previously had two separate properties, coinsuranceAmount and copaymentAmount, which have been replaced by this property (when the kind property is "coinsurance" or "copayment"). The FHIR construct is more flexible as it allows for other kinds of payment types as well.

 applicability

Public «CS» Code applicability

"Whether the cost applies to in-network or out-of-network providers (in-network; out-of-network; other)." - HL7 FHIR, InsurancePlan.plan.specificCost.benefit.cost.applicability

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	PlanSpecificCost
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	applicability
Name Expression
Namespace	PlanSpecificCost
Opposite
Owner	PlanSpecificCost
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::PlanSpecificCost::applicability
Stereotype
Template Parameter
Type	«CS» Code
Upper	1
Upper Value	(1)
Visibility	Public

 benefitType

Public «CS» Code benefitType

Identifies a healthcare-related procedure or service, to include medications and durable equipment, that is anticipated to be funded, in full or in part, by a given Healthcare Policy.
"Type of specific benefit (preventative; primary care office visit; speciality office visit; hospitalization; emergency room; urgent care)." - HL7 FHIR, InsurancePlan.plan.specificCost.benefit.type

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	PlanSpecificCost
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	benefitType
Name Expression
Namespace	PlanSpecificCost
Opposite
Owner	PlanSpecificCost
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::PlanSpecificCost::benefitType
Stereotype
Template Parameter
Type	«CS» Code
Upper	1
Upper Value	(1)
Visibility	Public

 category

Public «CS» Code category

"General category of benefit (Medical; Dental; Vision; Drug; Mental Health; Substance Abuse; Hospice, Home Health)." - HL7 FHIR, InsurancePlan.plan.specificCost.category

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	PlanSpecificCost
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	category
Name Expression
Namespace	PlanSpecificCost
Opposite
Owner	PlanSpecificCost
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::PlanSpecificCost::category
Stereotype
Template Parameter
Type	«CS» Code
Upper	1
Upper Value	(1)
Visibility	Public

 kind

Public «CS» Code kind

"Type of cost (copay; individual cap; family cap; coinsurance; deductible)." - HL7 FHIR, InsurancePlan.plan.specificCost.benefit.cost.type

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	PlanSpecificCost
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	kind
Name Expression
Namespace	PlanSpecificCost
Opposite
Owner	PlanSpecificCost
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::PlanSpecificCost::kind
Stereotype
Template Parameter
Type	«CS» Code
Upper	1
Upper Value	(1)
Visibility	Public

 qualifiers

Public «CS» Code qualifiers

"Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA)." - HL7 FHIR, InsurancePlan.plan.specificCost.benefit.cost.qualifiers

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	PlanSpecificCost
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	qualifiers
Name Expression
Namespace	PlanSpecificCost
Opposite
Owner	PlanSpecificCost
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::PlanSpecificCost::qualifiers
Stereotype
Template Parameter
Type	«CS» Code
Upper	*
Upper Value	(*)
Visibility	Public

 value

Public «PQ» Quantity value

"The actual cost value. (some of the costs may be represented as percentages rather than currency, e.g. 10% coinsurance)." - HL7 FHIR, InsurancePlan.plan.specificCost.benefit.cost.value
Note that the FHIM previously had two separate properties, coinsuranceAmount and copaymentAmount, which have been replaced by this property (when the kind property is "coinsurance" or "copayment"). The FHIR construct is more flexible as it allows for other kinds of payment types as well.

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	PlanSpecificCost
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	value
Name Expression
Namespace	PlanSpecificCost
Opposite
Owner	PlanSpecificCost
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::PlanSpecificCost::value
Stereotype
Template Parameter
Type	«PQ» Quantity
Upper	1
Upper Value	(1)
Visibility	Public