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| EnrollEligCOB UML Documentation |
EnrollEligCOB
Class HealthPlan
A Health Plan 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). The type and amount of health care costs that will be covered by the health insurance provider are specified in writing, in a member contract or "Evidence of Coverage" booklet for private insurance, or in a national health policy for public insurance. For example, the Department of Veterans Affairs (VA) annually publishes the "Federal Benefits for Veterans and Dependents," describing the benefits available during that year. An insurance company will often offer multiple Health Plans.This class represents the contract, or the defined set of benefits that are promised by the benefits provider. It is noted that we had difficulty finding a single generic term for the concept defined by this class, as many commonly used terms have specific meanings in different settings. In some settings, this might be called an Insurance Plan, but that term doesn't fit government benefit programs, or Health Mainenance Organizations (HMOs).While the set of benefits may be very closely associated with the organization that offers it (e.g., "Medicare"), the organization is a separate concept (for which we have chosen the generic term, "Payer"). The term Health Plan includes not only Private Insurance Plans, but also Public Health Plans, Military Health Programs, and State Health Insurance Programs.Note that Private Insurance Plan, Public Health Plan, Military Health Program, and State Health Insurance Program were once modeled as subclasses of Health Plan, but were removed as these might be better represented by a type code instead."Details of a Health Insurance product/plan provided by an organization." - HL7 FHIR, InsurancePlan"Details about an insurance plan." - HL7 FHIR, InsurancePlan.planNote that FHIR uses two classes to represent a generic plan and various flavors of it (e.g., Acme's "Total Health Plan" and the Gold, Siver, and Bronze version of it), while the FHIM uses one class to handle both. The practical implication is that FHIM would have three instances of this class (one each for Acme's "Gold Total Health Plan", "Silver Total Health Plan", and "Bronze Total Health Plan", while FHIR would have one instance of this class and three instances of the FHIR "Plan" class. The information conveyed is identical, the merely the structures are different.
| Attributes |
| String |  alias |
"A list of alternate names that the product is known as, or was known as in the past." - HL7 FHIR, InsurancePlan.alias
|
| PointOfContact | contact |
"The contact for the health insurance product for a certain purpose." - HL7 FHIR, InsurancePlan.contact
|
| PlanCoverage | coverage |
"Details about the coverage offered by the insurance product." - HL7 FHIR, InsurancePlan.coverage
|
| Location | coverageArea |
"The geographic region in which a health insurance product's benefits apply." - HL7 FHIR, InsurancePlan.coverageArea"The geographic region in which a health insurance plan's benefits apply." - HL7 FHIR, InsurancePlan.plan.coverageArea
|
| «MO» MonetaryAmount | deductibleAmount |
Represents the amount of money for which patient is responsible for the provision of a medical product, procedure, or service, expressed as a periodic (usually annual) monetary limit. For example, a plan may cover all doctor's visits after the first $200. In this example, this property would contain $200.
|
| «IVL_TS» Period | effectivePeriod |
"Contains the date that the insurance goes into effect." - HL7 Version 2.8, IN1-12."Indicates the last date of service that the insurance will cover or be responsible for." - HL7 Version 2.8, IN1-13.
|
| ElectronicServiceEndpoint | endpoint |
"The technical endpoints providing access to services operated for the health insurance product." - HL7 FHIR, InsurancePlan.endpoint
|
| FinancialArrangement | financialArrangement |
Pointer to a predefined scheme(s) for payment or reimbursement to healthcare providers that are applicable to the owning Health Plan.
|
| PlanGeneralCost | generalCost |
"Overall costs associated with the plan." - HL7 FHIR, InsurancePlan.plan.generalCost
|
| GroupCoverage | group |
Pointer to the Group Health Insurance Policies established for a particular Health Plan.
|
| HealthcarePolicy | healthcarePolicy |
Pointer to the Healthcare Policies written against the Health Plan.
|
| String | homePlan |
"Code identifying the Blue Cross or Blue Shield plan ID which indicates where the member’s coverage has been designated. Usually where the member lives or purchased their coverage. This field is used for interstate processing between Blue Cross and Blue Shield plans." - NCPDP Telecommunication (Field 314-CE, Data Dictionary 201104).
|
| «CS» Code | insuranceType |
Such as HMO, PPO, Medicare, etc.
|
| «CS» Code | kind |
"The kind of health insurance product." Possible values include: Medical; Dental; Mental Health; Substance Abuse; Vision; Drug; Short Term; Long Term Care; Hospice; Home Health. - HL7 FHIR, InsurancePlan.type"Type of plan. For example, "Platinum" or "High Deductable"." - HL7 FHIR, InsurancePlan.plan.type
|
| «IVL_TS» Period | period |
"The period of time that the health insurance product is available." - HL7 FHIR, InsurancePlan.period
|
| String | planId |
A unique identifier that the payer or information source uses to identify the Health Plan."Contains a unique identifier for the insurance plan." - HL7 Version 2.8, IN1-2."Identifies a style or collective of coverage issued by the underwriter, for example may be used to identify a collection of benefits provided to employees. May be referred to as a Section or Division ID." - HL7 FHIR 3, Coverage.grouping.planFHIR 4: Coverage.class.value where Coverage.class.type = 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"Business identifiers assigned to this health insurance plan which remain constant as the resource is updated and propagates from server to server." - HL7 FHIR, InsurancePlan.plan.identifier"Assigned by the processor to identify a set of parameters, benefit, or coverage criteria used to adjudicate a claim." - NCPDP Telecommunication (Field 524-FO, Data Dictionary 201104).
|
| String | planName |
The name of the Plan as assigned by the Payer."A short description for the plan." - HL7 FHIR 3, Coverage.grouping.planDisplayFHIR 4: Coverage.class.name where Coverage.class.type = plan"Official name of the health insurance product as designated by the owner." - HL7 FHIR, InsurancePlan.name
|
| PlanNetworkAffliliation | planNetworkAffliliation |
Pointer to the Network with which the Health Plan has some contractual relationship.
|
| ProviderPlanParticipation | providerPlanParticipation |
Pointer to a collection of Healthcare Providers (both Individual and Organizational Providers) participating in a given Health Plan.
|
| Boolean | requiresNoticeOfAdmission |
"Indicates whether the insurance company requires a written notice of admission from the healthcare provider." - HL7 Version 2.8, IN1-23.
|
| Boolean | sendsReportOfEligibility |
"Indicates whether this insurance carrier sends a report that indicates that the patient is eligible for benefits and whether it identifies those benefits." - HL7 Version 2.8, IN1-25.
|
| PlanSpecificCost | specificCost |
Pointer to a set of healthcare-related procedures or services, to include medications and durable equipment, that is anticipated to be funded, in full or in part, by a given Health Plan on behalf of holders of Policies written against that Plan.
|
| «CS» Code | status |
"The current state of the health insurance product." Possible values are: Draft; Active; Retired; Unknown. - HL7 FHIR, InsurancePlan.status
|
| String | subPlanId |
"Identifies a sub-style or sub-collective of coverage issued by the underwriter, for example may be used to identify a subset of a collection of benefits provided to employees." - HL7 FHIR 3, Coverage.grouping.subPlanFHIR 4: Coverage.class.value where Coverage.class.type = subplan
|
| String | subPlanName |
"A short description for the subplan." - HL7 FHIR 3, Coverage.grouping.subPlanDisplayFHIR 4: Coverage.class.name where Coverage.class.type = subplan
|
Properties:
| Alias | |
| Classifier Behavior | |
| Is Abstract | false |
| Is Active | false |
| Is Leaf | false |
| Keywords | |
| Name | HealthPlan |
| Name Expression | |
| Namespace | EnrollEligCOB |
| Owned Template Signature | |
| Owner | EnrollEligCOB |
| Owning Template Parameter | |
| Package | EnrollEligCOB |
| Qualified Name | FHIM::EnrollEligCOB::HealthPlan |
| Representation | |
| Stereotype | |
| Template Parameter | |
| Visibility | Public |
alias
Public String alias
-
"A list of alternate names that the product is known as, or was known as in the past." - HL7 FHIR, InsurancePlan.alias
-
Constraints:
-
Properties:
-
| Aggregation | None |
| Alias | |
| Association | |
| Association End | |
| Class | HealthPlan |
| 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 | alias |
| Name Expression | |
| Namespace | HealthPlan |
| Opposite | |
| Owner | HealthPlan |
| Owning Association | |
| Owning Template Parameter | |
| Qualified Name | FHIM::EnrollEligCOB::HealthPlan::alias |
| Stereotype | |
| Template Parameter | |
| Type | String |
| Upper | * |
| Upper Value | (*) |
| Visibility | Public |
contact
Public PointOfContact contact
-
"The contact for the health insurance product for a certain purpose." - HL7 FHIR, InsurancePlan.contact
-
Constraints:
-
Properties:
-
| Aggregation | None |
| Alias | |
| Association | healthPlan_contact |
| Association End | |
| Class | HealthPlan |
| 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 | contact |
| Name Expression | |
| Namespace | HealthPlan |
| Opposite | |
| Owner | HealthPlan |
| Owning Association | |
| Owning Template Parameter | |
| Qualified Name | FHIM::EnrollEligCOB::HealthPlan::contact |
| Stereotype | |
| Template Parameter | |
| Type | PointOfContact |
| Upper | * |
| Upper Value | (*) |
| Visibility | Public |
coverage
Public PlanCoverage coverage
-
"Details about the coverage offered by the insurance product." - HL7 FHIR, InsurancePlan.coverage
-
Constraints:
-
Properties:
-
| Aggregation | None |
| Alias | |
| Association | healthPlan_coverage |
| Association End | |
| Class | HealthPlan |
| 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 | coverage |
| Name Expression | |
| Namespace | HealthPlan |
| Opposite | |
| Owner | HealthPlan |
| Owning Association | |
| Owning Template Parameter | |
| Qualified Name | FHIM::EnrollEligCOB::HealthPlan::coverage |
| Stereotype | |
| Template Parameter | |
| Type | PlanCoverage |
| Upper | * |
| Upper Value | (*) |
| Visibility | Public |
coverageArea
Public Location coverageArea
-
"The geographic region in which a health insurance product's benefits apply." - HL7 FHIR, InsurancePlan.coverageArea"The geographic region in which a health insurance plan's benefits apply." - HL7 FHIR, InsurancePlan.plan.coverageArea
-
Constraints:
-
Properties:
-
| Aggregation | None |
| Alias | |
| Association | |
| Association End | |
| Class | HealthPlan |
| 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 | coverageArea |
| Name Expression | |
| Namespace | HealthPlan |
| Opposite | |
| Owner | HealthPlan |
| Owning Association | |
| Owning Template Parameter | |
| Qualified Name | FHIM::EnrollEligCOB::HealthPlan::coverageArea |
| Stereotype | |
| Template Parameter | |
| Type | Location |
| Upper | * |
| Upper Value | (*) |
| Visibility | Public |
deductibleAmount
Public «MO» MonetaryAmount deductibleAmount
-
Represents the amount of money for which patient is responsible for the provision of a medical product, procedure, or service, expressed as a periodic (usually annual) monetary limit. For example, a plan may cover all doctor's visits after the first $200. In this example, this property would contain $200.
-
Constraints:
-
Properties:
-
| Aggregation | None |
| Alias | |
| Association | |
| Association End | |
| Class | HealthPlan |
| 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 | deductibleAmount |
| Name Expression | |
| Namespace | HealthPlan |
| Opposite | |
| Owner | HealthPlan |
| Owning Association | |
| Owning Template Parameter | |
| Qualified Name | FHIM::EnrollEligCOB::HealthPlan::deductibleAmount |
| Stereotype | |
| Template Parameter | |
| Type | «MO» MonetaryAmount |
| Upper | 1 |
| Upper Value | (1) |
| Visibility | Public |
effectivePeriod
Public «IVL_TS» Period effectivePeriod
-
"Contains the date that the insurance goes into effect." - HL7 Version 2.8, IN1-12."Indicates the last date of service that the insurance will cover or be responsible for." - HL7 Version 2.8, IN1-13.
-
Constraints:
-
Properties:
-
| Aggregation | None |
| Alias | |
| Association | |
| Association End | |
| Class | HealthPlan |
| 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 | effectivePeriod |
| Name Expression | |
| Namespace | HealthPlan |
| Opposite | |
| Owner | HealthPlan |
| Owning Association | |
| Owning Template Parameter | |
| Qualified Name | FHIM::EnrollEligCOB::HealthPlan::effectivePeriod |
| Stereotype | |
| Template Parameter | |
| Type | «IVL_TS» Period |
| Upper | 1 |
| Upper Value | (1) |
| Visibility | Public |
endpoint
Public ElectronicServiceEndpoint endpoint
-
"The technical endpoints providing access to services operated for the health insurance product." - HL7 FHIR, InsurancePlan.endpoint
-
Constraints:
-
Properties:
-
| Aggregation | None |
| Alias | |
| Association | healthPlan_endpoint |
| Association End | |
| Class | HealthPlan |
| 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 | endpoint |
| Name Expression | |
| Namespace | HealthPlan |
| Opposite | |
| Owner | HealthPlan |
| Owning Association | |
| Owning Template Parameter | |
| Qualified Name | FHIM::EnrollEligCOB::HealthPlan::endpoint |
| Stereotype | |
| Template Parameter | |
| Type | ElectronicServiceEndpoint |
| Upper | * |
| Upper Value | (*) |
| Visibility | Public |
financialArrangement
Public FinancialArrangement financialArrangement
-
Pointer to a predefined scheme(s) for payment or reimbursement to healthcare providers that are applicable to the owning Health Plan.
-
Constraints:
-
Properties:
-
| Aggregation | None |
| Alias | |
| Association | financialArrangement_healthPlan |
| Association End | |
| Class | HealthPlan |
| 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 | financialArrangement |
| Name Expression | |
| Namespace | HealthPlan |
| Opposite | healthPlan |
| Owner | HealthPlan |
| Owning Association | |
| Owning Template Parameter | |
| Qualified Name | FHIM::EnrollEligCOB::HealthPlan::financialArrangement |
| Stereotype | |
| Template Parameter | |
| Type | FinancialArrangement |
| Upper | * |
| Upper Value | (*) |
| Visibility | Public |
generalCost
Public PlanGeneralCost generalCost
-
"Overall costs associated with the plan." - HL7 FHIR, InsurancePlan.plan.generalCost
-
Constraints:
-
Properties:
-
| Aggregation | Shared |
| Alias | |
| Association | healthPlan_generalCost |
| Association End | |
| Class | HealthPlan |
| 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 | generalCost |
| Name Expression | |
| Namespace | HealthPlan |
| Opposite | |
| Owner | HealthPlan |
| Owning Association | |
| Owning Template Parameter | |
| Qualified Name | FHIM::EnrollEligCOB::HealthPlan::generalCost |
| Stereotype | |
| Template Parameter | |
| Type | PlanGeneralCost |
| Upper | * |
| Upper Value | (*) |
| Visibility | Public |
group
Public GroupCoverage group
-
Pointer to the Group Health Insurance Policies established for a particular Health Plan.
-
Constraints:
-
Properties:
-
| Aggregation | None |
| Alias | |
| Association | group_healthPlan |
| Association End | |
| Class | HealthPlan |
| 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 | group |
| Name Expression | |
| Namespace | HealthPlan |
| Opposite | healthPlan |
| Owner | HealthPlan |
| Owning Association | |
| Owning Template Parameter | |
| Qualified Name | FHIM::EnrollEligCOB::HealthPlan::group |
| Stereotype | |
| Template Parameter | |
| Type | GroupCoverage |
| Upper | 1 |
| Upper Value | (1) |
| Visibility | Public |
healthcarePolicy
Public HealthcarePolicy healthcarePolicy
-
Pointer to the Healthcare Policies written against the Health Plan.
-
Constraints:
-
Properties:
-
| Aggregation | None |
| Alias | |
| Association | healthcarePolicy_healthPlan |
| Association End | |
| Class | HealthPlan |
| 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 | healthcarePolicy |
| Name Expression | |
| Namespace | HealthPlan |
| Opposite | healthPlan |
| Owner | HealthPlan |
| Owning Association | |
| Owning Template Parameter | |
| Qualified Name | FHIM::EnrollEligCOB::HealthPlan::healthcarePolicy |
| Stereotype | |
| Template Parameter | |
| Type | HealthcarePolicy |
| Upper | * |
| Upper Value | (*) |
| Visibility | Public |
homePlan
Public String homePlan
-
"Code identifying the Blue Cross or Blue Shield plan ID which indicates where the member’s coverage has been designated. Usually where the member lives or purchased their coverage. This field is used for interstate processing between Blue Cross and Blue Shield plans." - NCPDP Telecommunication (Field 314-CE, Data Dictionary 201104).
-
Constraints:
-
Properties:
-
| Aggregation | None |
| Alias | |
| Association | |
| Association End | |
| Class | HealthPlan |
| 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 | homePlan |
| Name Expression | |
| Namespace | HealthPlan |
| Opposite | |
| Owner | HealthPlan |
| Owning Association | |
| Owning Template Parameter | |
| Qualified Name | FHIM::EnrollEligCOB::HealthPlan::homePlan |
| Stereotype | |
| Template Parameter | |
| Type | String |
| Upper | 1 |
| Upper Value | (1) |
| Visibility | Public |
insuranceType
Public «CS» Code insuranceType
-
Such as HMO, PPO, Medicare, etc.
-
Constraints:
-
Properties:
-
| Aggregation | None |
| Alias | |
| Association | |
| Association End | |
| Class | HealthPlan |
| 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 | insuranceType |
| Name Expression | |
| Namespace | HealthPlan |
| Opposite | |
| Owner | HealthPlan |
| Owning Association | |
| Owning Template Parameter | |
| Qualified Name | FHIM::EnrollEligCOB::HealthPlan::insuranceType |
| Stereotype | |
| Template Parameter | |
| Type | «CS» Code |
| Upper | 1 |
| Upper Value | (1) |
| Visibility | Public |
kind
Public «CS» Code kind
-
"The kind of health insurance product." Possible values include: Medical; Dental; Mental Health; Substance Abuse; Vision; Drug; Short Term; Long Term Care; Hospice; Home Health. - HL7 FHIR, InsurancePlan.type"Type of plan. For example, "Platinum" or "High Deductable"." - HL7 FHIR, InsurancePlan.plan.type
-
Constraints:
-
Properties:
-
| Aggregation | None |
| Alias | |
| Association | |
| Association End | |
| Class | HealthPlan |
| Terminologies | [
HL7_FHIR_R4 Insurance plan type http://hl7.org/fhir/ValueSet/insuranceplan-type
] |
| 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 | kind |
| Name Expression | |
| Namespace | HealthPlan |
| Opposite | |
| Owner | HealthPlan |
| Owning Association | |
| Owning Template Parameter | |
| Qualified Name | FHIM::EnrollEligCOB::HealthPlan::kind |
| Stereotype | ValueSetConstraints |
| Template Parameter | |
| Type | «CS» Code |
| Upper | * |
| Upper Value | (*) |
| Visibility | Public |
period
Public «IVL_TS» Period period
-
"The period of time that the health insurance product is available." - HL7 FHIR, InsurancePlan.period
-
Constraints:
-
Properties:
-
| Aggregation | None |
| Alias | |
| Association | |
| Association End | |
| Class | HealthPlan |
| 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 | period |
| Name Expression | |
| Namespace | HealthPlan |
| Opposite | |
| Owner | HealthPlan |
| Owning Association | |
| Owning Template Parameter | |
| Qualified Name | FHIM::EnrollEligCOB::HealthPlan::period |
| Stereotype | |
| Template Parameter | |
| Type | «IVL_TS» Period |
| Upper | 1 |
| Upper Value | (1) |
| Visibility | Public |
planId
Public String planId
-
A unique identifier that the payer or information source uses to identify the Health Plan."Contains a unique identifier for the insurance plan." - HL7 Version 2.8, IN1-2."Identifies a style or collective of coverage issued by the underwriter, for example may be used to identify a collection of benefits provided to employees. May be referred to as a Section or Division ID." - HL7 FHIR 3, Coverage.grouping.planFHIR 4: Coverage.class.value where Coverage.class.type = 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"Business identifiers assigned to this health insurance plan which remain constant as the resource is updated and propagates from server to server." - HL7 FHIR, InsurancePlan.plan.identifier"Assigned by the processor to identify a set of parameters, benefit, or coverage criteria used to adjudicate a claim." - NCPDP Telecommunication (Field 524-FO, Data Dictionary 201104).
-
Constraints:
-
Properties:
-
| Aggregation | None |
| Alias | |
| Association | |
| Association End | |
| Class | HealthPlan |
| 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 | planId |
| Name Expression | |
| Namespace | HealthPlan |
| Opposite | |
| Owner | HealthPlan |
| Owning Association | |
| Owning Template Parameter | |
| Qualified Name | FHIM::EnrollEligCOB::HealthPlan::planId |
| Stereotype | |
| Template Parameter | |
| Type | String |
| Upper | 1 |
| Upper Value | (1) |
| Visibility | Public |
planName
Public String planName
-
The name of the Plan as assigned by the Payer."A short description for the plan." - HL7 FHIR 3, Coverage.grouping.planDisplayFHIR 4: Coverage.class.name where Coverage.class.type = plan"Official name of the health insurance product as designated by the owner." - HL7 FHIR, InsurancePlan.name
-
Constraints:
-
Properties:
-
| Aggregation | None |
| Alias | |
| Association | |
| Association End | |
| Class | HealthPlan |
| 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 | planName |
| Name Expression | |
| Namespace | HealthPlan |
| Opposite | |
| Owner | HealthPlan |
| Owning Association | |
| Owning Template Parameter | |
| Qualified Name | FHIM::EnrollEligCOB::HealthPlan::planName |
| Stereotype | |
| Template Parameter | |
| Type | String |
| Upper | 1 |
| Upper Value | (1) |
| Visibility | Public |
planNetworkAffliliation
Public PlanNetworkAffliliation planNetworkAffliliation
-
Pointer to the Network with which the Health Plan has some contractual relationship.
-
Constraints:
-
Properties:
-
| Aggregation | None |
| Alias | |
| Association | planNetworkAffliliation_healthPlan |
| Association End | |
| Class | HealthPlan |
| 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 | planNetworkAffliliation |
| Name Expression | |
| Namespace | HealthPlan |
| Opposite | healthPlan |
| Owner | HealthPlan |
| Owning Association | |
| Owning Template Parameter | |
| Qualified Name | FHIM::EnrollEligCOB::HealthPlan::planNetworkAffliliation |
| Stereotype | |
| Template Parameter | |
| Type | PlanNetworkAffliliation |
| Upper | * |
| Upper Value | (*) |
| Visibility | Public |
providerPlanParticipation
Public ProviderPlanParticipation providerPlanParticipation
-
Pointer to a collection of Healthcare Providers (both Individual and Organizational Providers) participating in a given Health Plan.
-
Constraints:
-
Properties:
-
| Aggregation | None |
| Alias | |
| Association | providerPlanParticipation_healthPlan |
| Association End | |
| Class | HealthPlan |
| 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 | providerPlanParticipation |
| Name Expression | |
| Namespace | HealthPlan |
| Opposite | healthPlan |
| Owner | HealthPlan |
| Owning Association | |
| Owning Template Parameter | |
| Qualified Name | FHIM::EnrollEligCOB::HealthPlan::providerPlanParticipation |
| Stereotype | |
| Template Parameter | |
| Type | ProviderPlanParticipation |
| Upper | * |
| Upper Value | (*) |
| Visibility | Public |
requiresNoticeOfAdmission
Public Boolean requiresNoticeOfAdmission
-
"Indicates whether the insurance company requires a written notice of admission from the healthcare provider." - HL7 Version 2.8, IN1-23.
-
Constraints:
-
Properties:
-
| Aggregation | None |
| Alias | |
| Association | |
| Association End | |
| Class | HealthPlan |
| 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 | requiresNoticeOfAdmission |
| Name Expression | |
| Namespace | HealthPlan |
| Opposite | |
| Owner | HealthPlan |
| Owning Association | |
| Owning Template Parameter | |
| Qualified Name | FHIM::EnrollEligCOB::HealthPlan::requiresNoticeOfAdmission |
| Stereotype | |
| Template Parameter | |
| Type | Boolean |
| Upper | 1 |
| Upper Value | (1) |
| Visibility | Public |
sendsReportOfEligibility
Public Boolean sendsReportOfEligibility
-
"Indicates whether this insurance carrier sends a report that indicates that the patient is eligible for benefits and whether it identifies those benefits." - HL7 Version 2.8, IN1-25.
-
Constraints:
-
Properties:
-
| Aggregation | None |
| Alias | |
| Association | |
| Association End | |
| Class | HealthPlan |
| 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 | sendsReportOfEligibility |
| Name Expression | |
| Namespace | HealthPlan |
| Opposite | |
| Owner | HealthPlan |
| Owning Association | |
| Owning Template Parameter | |
| Qualified Name | FHIM::EnrollEligCOB::HealthPlan::sendsReportOfEligibility |
| Stereotype | |
| Template Parameter | |
| Type | Boolean |
| Upper | 1 |
| Upper Value | (1) |
| Visibility | Public |
specificCost
Public PlanSpecificCost specificCost
-
Pointer to a set of healthcare-related procedures or services, to include medications and durable equipment, that is anticipated to be funded, in full or in part, by a given Health Plan on behalf of holders of Policies written against that Plan.
-
Constraints:
-
Properties:
-
| Aggregation | Shared |
| Alias | |
| Association | healthPlan_specificCost |
| Association End | |
| Class | HealthPlan |
| 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 | specificCost |
| Name Expression | |
| Namespace | HealthPlan |
| Opposite | |
| Owner | HealthPlan |
| Owning Association | |
| Owning Template Parameter | |
| Qualified Name | FHIM::EnrollEligCOB::HealthPlan::specificCost |
| Stereotype | |
| Template Parameter | |
| Type | PlanSpecificCost |
| Upper | * |
| Upper Value | (*) |
| Visibility | Public |
status
Public «CS» Code status
-
"The current state of the health insurance product." Possible values are: Draft; Active; Retired; Unknown. - HL7 FHIR, InsurancePlan.status
-
Constraints:
-
Properties:
-
| Aggregation | None |
| Alias | |
| Association | |
| Association End | |
| Class | HealthPlan |
| Terminologies | [
HL7_FHIR_R4 PublicationStatus http://hl7.org/fhir/ValueSet/publication-status
] |
| 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 | status |
| Name Expression | |
| Namespace | HealthPlan |
| Opposite | |
| Owner | HealthPlan |
| Owning Association | |
| Owning Template Parameter | |
| Qualified Name | FHIM::EnrollEligCOB::HealthPlan::status |
| Stereotype | ValueSetConstraints |
| Template Parameter | |
| Type | «CS» Code |
| Upper | 1 |
| Upper Value | (1) |
| Visibility | Public |
subPlanId
Public String subPlanId
-
"Identifies a sub-style or sub-collective of coverage issued by the underwriter, for example may be used to identify a subset of a collection of benefits provided to employees." - HL7 FHIR 3, Coverage.grouping.subPlanFHIR 4: Coverage.class.value where Coverage.class.type = subplan
-
Constraints:
-
Properties:
-
| Aggregation | None |
| Alias | |
| Association | |
| Association End | |
| Class | HealthPlan |
| 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 | subPlanId |
| Name Expression | |
| Namespace | HealthPlan |
| Opposite | |
| Owner | HealthPlan |
| Owning Association | |
| Owning Template Parameter | |
| Qualified Name | FHIM::EnrollEligCOB::HealthPlan::subPlanId |
| Stereotype | |
| Template Parameter | |
| Type | String |
| Upper | 1 |
| Upper Value | (1) |
| Visibility | Public |
subPlanName
Public String subPlanName
-
"A short description for the subplan." - HL7 FHIR 3, Coverage.grouping.subPlanDisplayFHIR 4: Coverage.class.name where Coverage.class.type = subplan
-
Constraints:
-
Properties:
-
| Aggregation | None |
| Alias | |
| Association | |
| Association End | |
| Class | HealthPlan |
| 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 | subPlanName |
| Name Expression | |
| Namespace | HealthPlan |
| Opposite | |
| Owner | HealthPlan |
| Owning Association | |
| Owning Template Parameter | |
| Qualified Name | FHIM::EnrollEligCOB::HealthPlan::subPlanName |
| Stereotype | |
| Template Parameter | |
| Type | String |
| Upper | 1 |
| Upper Value | (1) |
| Visibility | Public |
|
| EnrollEligCOB UML Documentation |
