Stream: Da+Vinci+PDex+Plan-Net
Topic: InsurancePlan.plan.type
Joe Brunner (Jul 23 2021 at 19:32):
If a health plan is struggling to categorize their insurance plans into the value set supplied in the IG, is there any guidance as to what should be done. Mapping Insurance Plans to the product type is pretty straightforward, but we're struggling with the plan type. I see that it is noted as extensible, but we're fairly new to FHIR, and extensible value sets are new to us. If we have the concept of three tiers of medicare plans, say premium/select/standard, would it be OK to map them to platinum/gold/silver? Thanks in advance!
Dave Hill (Aug 06 2021 at 14:25):
Hi Joseph, we would like to discuss this topic during today's Da Vinci PDex use case call and it would be great if you could join us! You can join the call through https://global.gotomeeting.com/join/514633709, which starts at 12 Noon ET. Hope to see you there!
Dave Hill (Aug 06 2021 at 16:44):
Hi Joseph, we discussed this issue on the PDex use case call and have the following question: Do the premium/select/standard refer to different cost-sharing options on the same benefits or do these tiers have different benefits? If the tiers have different benefits, they would be considered different products. The plan refers to the different cost-sharing options within the same product (same benefits). Thanks!
Sean Mahoney (Aug 13 2021 at 16:49):
Joseph Brunner said:
If a health plan is struggling to categorize their insurance plans into the value set supplied in the IG, is there any guidance as to what should be done. Mapping Insurance Plans to the product type is pretty straightforward, but we're struggling with the plan type. I see that it is noted as extensible, but we're fairly new to FHIR, and extensible value sets are new to us. If we have the concept of three tiers of medicare plans, say premium/select/standard, would it be OK to map them to platinum/gold/silver? Thanks in advance!
Also, Joseph, if the plans do not meet the QHP definitions of platinum/gold/silver then those should not be used. In that case, the plan type should be extended to include premium/select/standard
Joe Brunner (Aug 18 2021 at 19:18):
Thanks for your replies gentlemen. I will review with my business counterpart, and will jump on Friday's call hopefully armed with additional information.
Last updated: Apr 12 2022 at 19:14 UTC
