Stream: implementers
Topic: InsurancePlan - Association of cost sharing to benefits
David Riddle (Aug 16 2018 at 15:55):
The InsurancePlan resource Scope and Usage section 8.33.1 [1] indicates “A plan pairs the health insurance coverage benefits under a product with the particular cost sharing structure offered to a consumer” and “InsurancePlan describes a health insurance offering comprised of a list of covered benefits (i.e. the product), costs associated with those benefits (i.e. the plan)…”. However, I am struggling to understand if the individual cost sharing structures represented under InsurancePlan.plan are ever explicitly associated with individual coverage benefits represented under InsurancePlan.type and/or InsurancePlan.coverage. i.e., Is it always inferred that all of the cost sharing structures found in InsurancePlan.plan are associated with all of the coverage benefits found in InsurancePlan.type and/or InsurancePlan.coverage? If so, is the notion of a given InsurancePlan having a different mix of cost sharing structures (instances of InsurancePlan.plan) associated with only a subset of its coverage benefits (instances of InsurancePlan.coverage) vs. the mix associated with another subset of its coverage benefits not something encountered in the real world?
[1] http://build.fhir.org/insuranceplan.html#scope
@Brian Postlethwaite
Last updated: Apr 12 2022 at 19:14 UTC
