German Practice Management FHIR Profiles (R4)
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: Debeka — PKV Tarif mit GOÄ-Faktor 2.3 - JSON Representation

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{
  "resourceType" : "InsurancePlan",
  "id" : "example-debeka-plus",
  "meta" : {
    "profile" : [
      🔗 "https://fhir.cognovis.de/praxis/StructureDefinition/insurance-plan-de"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: InsurancePlan example-debeka-plus</b></p><a name=\"example-debeka-plus\"> </a><a name=\"hcexample-debeka-plus\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-insurance-plan-de.html\">InsurancePlan DE</a></p></div><p><b>identifier</b>: <a href=\"NamingSystem-insurance-plan-id.html\" title=\"PVS-interner Identifier fuer InsurancePlan-Ressourcen (Kassentarife, PKV-Tarife)\">InsurancePlanId</a>/debeka-plus</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v3-ActCode EHCPOL}\">extended healthcare</span></p><p><b>name</b>: Debeka Premium Plus</p><blockquote><p><b>coverage</b></p><p><b>type</b>: <span title=\"Codes:\">Aerztliche Leistungen</span></p><h3>Benefits</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:\">GOÄ-Positionen bis Faktor 2.3</span></td></tr></table></blockquote><blockquote><p><b>plan</b></p><p><b>type</b>: <span title=\"Codes:{https://fhir.cognovis.de/praxis/CodeSystem/insurance-plan-type pkv}\">PKV</span></p><blockquote><p><b>specificCost</b></p><p><b>category</b>: <span title=\"Codes:\">GOÄ-Faktor-Limit</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:\">GOÄ-Faktor 2.3</span></p><h3>Costs</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Value</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:\">Maximaler GOÄ-Faktor</span></td><td>2.3 1<span style=\"background: LightGoldenRodYellow\"> (Details: UCUM  code1 = '1')</span></td></tr></table></blockquote></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: <span title=\"Codes:\">Implantate</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:\">Implantatversorgung</span></p><h3>Costs</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Value</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:\">Erstattung</span></td><td>100 %<span style=\"background: LightGoldenRodYellow\"> (Details: UCUM  code% = '%')</span></td></tr></table></blockquote></blockquote></blockquote></div>"
  },
  "identifier" : [
    {
      "system" : "https://fhir.cognovis.de/praxis/sid/insurance-plan-id",
      "value" : "debeka-plus"
    }
  ],
  "status" : "active",
  "type" : [
    {
      "coding" : [
        {
          "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
          "code" : "EHCPOL",
          "display" : "extended healthcare"
        }
      ]
    }
  ],
  "name" : "Debeka Premium Plus",
  "coverage" : [
    {
      "type" : {
        "text" : "Aerztliche Leistungen"
      },
      "benefit" : [
        {
          "type" : {
            "text" : "GOÄ-Positionen bis Faktor 2.3"
          }
        }
      ]
    }
  ],
  "plan" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "https://fhir.cognovis.de/praxis/CodeSystem/insurance-plan-type",
            "code" : "pkv",
            "display" : "PKV"
          }
        ]
      },
      "specificCost" : [
        {
          "category" : {
            "text" : "GOÄ-Faktor-Limit"
          },
          "benefit" : [
            {
              "type" : {
                "text" : "GOÄ-Faktor 2.3"
              },
              "cost" : [
                {
                  "type" : {
                    "text" : "Maximaler GOÄ-Faktor"
                  },
                  "value" : {
                    "value" : 2.3,
                    "system" : "http://unitsofmeasure.org",
                    "code" : "1"
                  }
                }
              ]
            }
          ]
        },
        {
          "category" : {
            "text" : "Implantate"
          },
          "benefit" : [
            {
              "type" : {
                "text" : "Implantatversorgung"
              },
              "cost" : [
                {
                  "type" : {
                    "text" : "Erstattung"
                  },
                  "value" : {
                    "value" : 100,
                    "system" : "http://unitsofmeasure.org",
                    "code" : "%"
                  }
                }
              ]
            }
          ]
        }
      ]
    }
  ]
}