German Practice Management FHIR Profiles (R4)
0.49.0 - STU1 Germany flag

German Practice Management FHIR Profiles (R4) - Local Development build (v0.49.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: InsurancePlan DE

Official URL: https://fhir.cognovis.de/praxis/StructureDefinition/insurance-plan-de Version: 0.49.0
Active as of 2026-05-04 Computable Name: InsurancePlanDE
Other Identifiers: OID:2.16.840.1.113883.3.7985.42.108

Profil fuer kassenspezifische und tarifspezifische Leistungsregeln (GKV/PKV) in der deutschen ambulanten Versorgung.

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. InsurancePlan C 0..* InsurancePlan Details of a Health Insurance product/plan provided by an organization
Constraints: ipn-1
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier SΣC 0..* Identifier Business Identifier for Product
... type SΣ 0..* CodeableConcept Kind of product
Binding: InsurancePlanType (example): Used to categorize the product/plan.
... name SΣC 0..1 string Official name
... coverageArea SΣ 0..* Reference(Location) Where product applies
... coverage S 0..* BackboneElement Coverage details
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 CodeableConcept Type of coverage
.... benefit S 1..* BackboneElement List of benefits
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type S 1..1 CodeableConcept Type of benefit
... Slices for plan 0..* BackboneElement Plan details
Slice: Unordered, Open by pattern:type
.... plan:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... specificCost S 0..* BackboneElement Specific costs
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... category S 1..1 CodeableConcept General category of benefit
...... benefit S 0..* BackboneElement Benefits list
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
....... type S 1..1 CodeableConcept Type of specific benefit
.... plan:gkv 0..* BackboneElement Plan details
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type S 1..1 CodeableConcept Type of plan
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://fhir.cognovis.de/praxis/CodeSystem/insurance-plan-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: gkv
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... specificCost S 0..* BackboneElement Specific costs
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... category S 1..1 CodeableConcept General category of benefit
...... benefit S 0..* BackboneElement Benefits list
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
....... type S 1..1 CodeableConcept Type of specific benefit
.... plan:pkv 0..* BackboneElement Plan details
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type S 1..1 CodeableConcept Type of plan
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://fhir.cognovis.de/praxis/CodeSystem/insurance-plan-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: pkv
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... specificCost S 0..* BackboneElement Specific costs
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... category S 1..1 CodeableConcept General category of benefit
...... benefit S 0..* BackboneElement Benefits list
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
....... type S 1..1 CodeableConcept Type of specific benefit

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
InsurancePlan.status Base required PublicationStatus 📍4.0.1 FHIR Std.
InsurancePlan.type Base example Insurance plan type 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error InsurancePlan If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error InsurancePlan If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error InsurancePlan If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error InsurancePlan If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice InsurancePlan A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
ipn-1 error InsurancePlan The organization SHALL at least have a name or an idendtifier, and possibly more than one (identifier.count() + name.count()) > 0

This structure is derived from InsurancePlan

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. InsurancePlan 0..* InsurancePlan Details of a Health Insurance product/plan provided by an organization
... identifier S 0..* Identifier Business Identifier for Product
... status S 1..1 code draft | active | retired | unknown
... type S 0..* CodeableConcept Kind of product
... coverageArea S 0..* Reference(Location) Where product applies
... coverage S 0..* BackboneElement Coverage details
.... benefit S 1..* BackboneElement List of benefits
..... type S 1..1 CodeableConcept Type of benefit
... Slices for plan 0..* BackboneElement Plan details
Slice: Unordered, Open by pattern:type
.... plan:All Slices Content/Rules for all slices
..... specificCost S 0..* BackboneElement Specific costs
...... category S 1..1 CodeableConcept General category of benefit
...... benefit S 0..* BackboneElement Benefits list
....... type S 1..1 CodeableConcept Type of specific benefit
.... plan:gkv 0..* BackboneElement Plan details
..... type S 1..1 CodeableConcept Type of plan
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://fhir.cognovis.de/praxis/CodeSystem/insurance-plan-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: gkv
..... specificCost S 0..* BackboneElement Specific costs
...... category S 1..1 CodeableConcept General category of benefit
...... benefit S 0..* BackboneElement Benefits list
....... type S 1..1 CodeableConcept Type of specific benefit
.... plan:pkv 0..* BackboneElement Plan details
..... type S 1..1 CodeableConcept Type of plan
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://fhir.cognovis.de/praxis/CodeSystem/insurance-plan-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: pkv
..... specificCost S 0..* BackboneElement Specific costs
...... category S 1..1 CodeableConcept General category of benefit
...... benefit S 0..* BackboneElement Benefits list
....... type S 1..1 CodeableConcept Type of specific benefit

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. InsurancePlan C 0..* InsurancePlan Details of a Health Insurance product/plan provided by an organization
Constraints: ipn-1
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier SΣC 0..* Identifier Business Identifier for Product
... status ?!SΣ 1..1 code draft | active | retired | unknown
Binding: PublicationStatus (required): The lifecycle status of an artifact.
... type SΣ 0..* CodeableConcept Kind of product
Binding: InsurancePlanType (example): Used to categorize the product/plan.
... name SΣC 0..1 string Official name
... alias 0..* string Alternate names
... period 0..1 Period When the product is available
... ownedBy Σ 0..1 Reference(Organization) Plan issuer
... administeredBy Σ 0..1 Reference(Organization) Product administrator
... coverageArea SΣ 0..* Reference(Location) Where product applies
... contact 0..* BackboneElement Contact for the product
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... purpose 0..1 CodeableConcept The type of contact
Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party.
.... name 0..1 HumanName A name associated with the contact
.... telecom 0..* ContactPoint Contact details (telephone, email, etc.) for a contact
.... address 0..1 Address Visiting or postal addresses for the contact
... endpoint 0..* Reference(Endpoint) Technical endpoint
... network 0..* Reference(Organization) What networks are Included
... coverage S 0..* BackboneElement Coverage details
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 CodeableConcept Type of coverage
.... network 0..* Reference(Organization) What networks provide coverage
.... benefit S 1..* BackboneElement List of benefits
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type S 1..1 CodeableConcept Type of benefit
..... requirement 0..1 string Referral requirements
..... limit 0..* BackboneElement Benefit limits
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... value 0..1 Quantity Maximum value allowed
...... code 0..1 CodeableConcept Benefit limit details
... Slices for plan 0..* BackboneElement Plan details
Slice: Unordered, Open by pattern:type
.... plan:All Slices Content/Rules for all slices
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... identifier Σ 0..* Identifier Business Identifier for Product
..... type 0..1 CodeableConcept Type of plan
..... coverageArea Σ 0..* Reference(Location) Where product applies
..... network 0..* Reference(Organization) What networks provide coverage
..... generalCost 0..* BackboneElement Overall costs
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... type 0..1 CodeableConcept Type of cost
...... groupSize 0..1 positiveInt Number of enrollees
...... cost 0..1 Money Cost value
...... comment 0..1 string Additional cost information
..... specificCost S 0..* BackboneElement Specific costs
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... category S 1..1 CodeableConcept General category of benefit
...... benefit S 0..* BackboneElement Benefits list
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
....... type S 1..1 CodeableConcept Type of specific benefit
....... cost 0..* BackboneElement List of the costs
........ id 0..1 string Unique id for inter-element referencing
........ extension 0..* Extension Additional content defined by implementations
........ modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
........ type 1..1 CodeableConcept Type of cost
........ applicability 0..1 CodeableConcept in-network | out-of-network | other
Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.
........ qualifiers 0..* CodeableConcept Additional information about the cost
........ value 0..1 Quantity The actual cost value
.... plan:gkv 0..* BackboneElement Plan details
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... identifier Σ 0..* Identifier Business Identifier for Product
..... type S 1..1 CodeableConcept Type of plan
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://fhir.cognovis.de/praxis/CodeSystem/insurance-plan-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: gkv
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... coverageArea Σ 0..* Reference(Location) Where product applies
..... network 0..* Reference(Organization) What networks provide coverage
..... generalCost 0..* BackboneElement Overall costs
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... type 0..1 CodeableConcept Type of cost
...... groupSize 0..1 positiveInt Number of enrollees
...... cost 0..1 Money Cost value
...... comment 0..1 string Additional cost information
..... specificCost S 0..* BackboneElement Specific costs
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... category S 1..1 CodeableConcept General category of benefit
...... benefit S 0..* BackboneElement Benefits list
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
....... type S 1..1 CodeableConcept Type of specific benefit
....... cost 0..* BackboneElement List of the costs
........ id 0..1 string Unique id for inter-element referencing
........ extension 0..* Extension Additional content defined by implementations
........ modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
........ type 1..1 CodeableConcept Type of cost
........ applicability 0..1 CodeableConcept in-network | out-of-network | other
Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.
........ qualifiers 0..* CodeableConcept Additional information about the cost
........ value 0..1 Quantity The actual cost value
.... plan:pkv 0..* BackboneElement Plan details
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... identifier Σ 0..* Identifier Business Identifier for Product
..... type S 1..1 CodeableConcept Type of plan
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://fhir.cognovis.de/praxis/CodeSystem/insurance-plan-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: pkv
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... coverageArea Σ 0..* Reference(Location) Where product applies
..... network 0..* Reference(Organization) What networks provide coverage
..... generalCost 0..* BackboneElement Overall costs
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... type 0..1 CodeableConcept Type of cost
...... groupSize 0..1 positiveInt Number of enrollees
...... cost 0..1 Money Cost value
...... comment 0..1 string Additional cost information
..... specificCost S 0..* BackboneElement Specific costs
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... category S 1..1 CodeableConcept General category of benefit
...... benefit S 0..* BackboneElement Benefits list
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
....... type S 1..1 CodeableConcept Type of specific benefit
....... cost 0..* BackboneElement List of the costs
........ id 0..1 string Unique id for inter-element referencing
........ extension 0..* Extension Additional content defined by implementations
........ modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
........ type 1..1 CodeableConcept Type of cost
........ applicability 0..1 CodeableConcept in-network | out-of-network | other
Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.
........ qualifiers 0..* CodeableConcept Additional information about the cost
........ value 0..1 Quantity The actual cost value

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
InsurancePlan.language Base preferred Common Languages 📍4.0.1 FHIR Std.
InsurancePlan.status Base required PublicationStatus 📍4.0.1 FHIR Std.
InsurancePlan.type Base example Insurance plan type 📍4.0.1 FHIR Std.
InsurancePlan.contact.​purpose Base extensible Contact entity type 📍4.0.1 FHIR Std.
InsurancePlan.plan.specificCost.​benefit.cost.applicability Base required Benefit cost applicability 📍4.0.1 FHIR Std.
InsurancePlan.plan:gkv.​specificCost.benefit.​cost.applicability Base required Benefit cost applicability 📍4.0.1 FHIR Std.
InsurancePlan.plan:pkv.​specificCost.benefit.​cost.applicability Base required Benefit cost applicability 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error InsurancePlan If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error InsurancePlan If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error InsurancePlan If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error InsurancePlan If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice InsurancePlan A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
ipn-1 error InsurancePlan The organization SHALL at least have a name or an idendtifier, and possibly more than one (identifier.count() + name.count()) > 0

This structure is derived from InsurancePlan

Summary

Mandatory: 1 element(2 nested mandatory elements)
Must-Support: 22 elements

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of InsurancePlan.plan

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. InsurancePlan C 0..* InsurancePlan Details of a Health Insurance product/plan provided by an organization
Constraints: ipn-1
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier SΣC 0..* Identifier Business Identifier for Product
... type SΣ 0..* CodeableConcept Kind of product
Binding: InsurancePlanType (example): Used to categorize the product/plan.
... name SΣC 0..1 string Official name
... coverageArea SΣ 0..* Reference(Location) Where product applies
... coverage S 0..* BackboneElement Coverage details
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 CodeableConcept Type of coverage
.... benefit S 1..* BackboneElement List of benefits
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type S 1..1 CodeableConcept Type of benefit
... Slices for plan 0..* BackboneElement Plan details
Slice: Unordered, Open by pattern:type
.... plan:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... specificCost S 0..* BackboneElement Specific costs
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... category S 1..1 CodeableConcept General category of benefit
...... benefit S 0..* BackboneElement Benefits list
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
....... type S 1..1 CodeableConcept Type of specific benefit
.... plan:gkv 0..* BackboneElement Plan details
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type S 1..1 CodeableConcept Type of plan
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://fhir.cognovis.de/praxis/CodeSystem/insurance-plan-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: gkv
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... specificCost S 0..* BackboneElement Specific costs
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... category S 1..1 CodeableConcept General category of benefit
...... benefit S 0..* BackboneElement Benefits list
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
....... type S 1..1 CodeableConcept Type of specific benefit
.... plan:pkv 0..* BackboneElement Plan details
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type S 1..1 CodeableConcept Type of plan
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://fhir.cognovis.de/praxis/CodeSystem/insurance-plan-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: pkv
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... specificCost S 0..* BackboneElement Specific costs
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... category S 1..1 CodeableConcept General category of benefit
...... benefit S 0..* BackboneElement Benefits list
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
....... type S 1..1 CodeableConcept Type of specific benefit

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
InsurancePlan.status Base required PublicationStatus 📍4.0.1 FHIR Std.
InsurancePlan.type Base example Insurance plan type 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error InsurancePlan If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error InsurancePlan If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error InsurancePlan If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error InsurancePlan If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice InsurancePlan A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
ipn-1 error InsurancePlan The organization SHALL at least have a name or an idendtifier, and possibly more than one (identifier.count() + name.count()) > 0

Differential View

This structure is derived from InsurancePlan

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. InsurancePlan 0..* InsurancePlan Details of a Health Insurance product/plan provided by an organization
... identifier S 0..* Identifier Business Identifier for Product
... status S 1..1 code draft | active | retired | unknown
... type S 0..* CodeableConcept Kind of product
... coverageArea S 0..* Reference(Location) Where product applies
... coverage S 0..* BackboneElement Coverage details
.... benefit S 1..* BackboneElement List of benefits
..... type S 1..1 CodeableConcept Type of benefit
... Slices for plan 0..* BackboneElement Plan details
Slice: Unordered, Open by pattern:type
.... plan:All Slices Content/Rules for all slices
..... specificCost S 0..* BackboneElement Specific costs
...... category S 1..1 CodeableConcept General category of benefit
...... benefit S 0..* BackboneElement Benefits list
....... type S 1..1 CodeableConcept Type of specific benefit
.... plan:gkv 0..* BackboneElement Plan details
..... type S 1..1 CodeableConcept Type of plan
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://fhir.cognovis.de/praxis/CodeSystem/insurance-plan-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: gkv
..... specificCost S 0..* BackboneElement Specific costs
...... category S 1..1 CodeableConcept General category of benefit
...... benefit S 0..* BackboneElement Benefits list
....... type S 1..1 CodeableConcept Type of specific benefit
.... plan:pkv 0..* BackboneElement Plan details
..... type S 1..1 CodeableConcept Type of plan
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://fhir.cognovis.de/praxis/CodeSystem/insurance-plan-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: pkv
..... specificCost S 0..* BackboneElement Specific costs
...... category S 1..1 CodeableConcept General category of benefit
...... benefit S 0..* BackboneElement Benefits list
....... type S 1..1 CodeableConcept Type of specific benefit

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. InsurancePlan C 0..* InsurancePlan Details of a Health Insurance product/plan provided by an organization
Constraints: ipn-1
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier SΣC 0..* Identifier Business Identifier for Product
... status ?!SΣ 1..1 code draft | active | retired | unknown
Binding: PublicationStatus (required): The lifecycle status of an artifact.
... type SΣ 0..* CodeableConcept Kind of product
Binding: InsurancePlanType (example): Used to categorize the product/plan.
... name SΣC 0..1 string Official name
... alias 0..* string Alternate names
... period 0..1 Period When the product is available
... ownedBy Σ 0..1 Reference(Organization) Plan issuer
... administeredBy Σ 0..1 Reference(Organization) Product administrator
... coverageArea SΣ 0..* Reference(Location) Where product applies
... contact 0..* BackboneElement Contact for the product
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... purpose 0..1 CodeableConcept The type of contact
Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party.
.... name 0..1 HumanName A name associated with the contact
.... telecom 0..* ContactPoint Contact details (telephone, email, etc.) for a contact
.... address 0..1 Address Visiting or postal addresses for the contact
... endpoint 0..* Reference(Endpoint) Technical endpoint
... network 0..* Reference(Organization) What networks are Included
... coverage S 0..* BackboneElement Coverage details
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 CodeableConcept Type of coverage
.... network 0..* Reference(Organization) What networks provide coverage
.... benefit S 1..* BackboneElement List of benefits
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type S 1..1 CodeableConcept Type of benefit
..... requirement 0..1 string Referral requirements
..... limit 0..* BackboneElement Benefit limits
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... value 0..1 Quantity Maximum value allowed
...... code 0..1 CodeableConcept Benefit limit details
... Slices for plan 0..* BackboneElement Plan details
Slice: Unordered, Open by pattern:type
.... plan:All Slices Content/Rules for all slices
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... identifier Σ 0..* Identifier Business Identifier for Product
..... type 0..1 CodeableConcept Type of plan
..... coverageArea Σ 0..* Reference(Location) Where product applies
..... network 0..* Reference(Organization) What networks provide coverage
..... generalCost 0..* BackboneElement Overall costs
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... type 0..1 CodeableConcept Type of cost
...... groupSize 0..1 positiveInt Number of enrollees
...... cost 0..1 Money Cost value
...... comment 0..1 string Additional cost information
..... specificCost S 0..* BackboneElement Specific costs
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... category S 1..1 CodeableConcept General category of benefit
...... benefit S 0..* BackboneElement Benefits list
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
....... type S 1..1 CodeableConcept Type of specific benefit
....... cost 0..* BackboneElement List of the costs
........ id 0..1 string Unique id for inter-element referencing
........ extension 0..* Extension Additional content defined by implementations
........ modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
........ type 1..1 CodeableConcept Type of cost
........ applicability 0..1 CodeableConcept in-network | out-of-network | other
Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.
........ qualifiers 0..* CodeableConcept Additional information about the cost
........ value 0..1 Quantity The actual cost value
.... plan:gkv 0..* BackboneElement Plan details
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... identifier Σ 0..* Identifier Business Identifier for Product
..... type S 1..1 CodeableConcept Type of plan
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://fhir.cognovis.de/praxis/CodeSystem/insurance-plan-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: gkv
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... coverageArea Σ 0..* Reference(Location) Where product applies
..... network 0..* Reference(Organization) What networks provide coverage
..... generalCost 0..* BackboneElement Overall costs
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... type 0..1 CodeableConcept Type of cost
...... groupSize 0..1 positiveInt Number of enrollees
...... cost 0..1 Money Cost value
...... comment 0..1 string Additional cost information
..... specificCost S 0..* BackboneElement Specific costs
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... category S 1..1 CodeableConcept General category of benefit
...... benefit S 0..* BackboneElement Benefits list
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
....... type S 1..1 CodeableConcept Type of specific benefit
....... cost 0..* BackboneElement List of the costs
........ id 0..1 string Unique id for inter-element referencing
........ extension 0..* Extension Additional content defined by implementations
........ modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
........ type 1..1 CodeableConcept Type of cost
........ applicability 0..1 CodeableConcept in-network | out-of-network | other
Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.
........ qualifiers 0..* CodeableConcept Additional information about the cost
........ value 0..1 Quantity The actual cost value
.... plan:pkv 0..* BackboneElement Plan details
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... identifier Σ 0..* Identifier Business Identifier for Product
..... type S 1..1 CodeableConcept Type of plan
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://fhir.cognovis.de/praxis/CodeSystem/insurance-plan-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: pkv
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... coverageArea Σ 0..* Reference(Location) Where product applies
..... network 0..* Reference(Organization) What networks provide coverage
..... generalCost 0..* BackboneElement Overall costs
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... type 0..1 CodeableConcept Type of cost
...... groupSize 0..1 positiveInt Number of enrollees
...... cost 0..1 Money Cost value
...... comment 0..1 string Additional cost information
..... specificCost S 0..* BackboneElement Specific costs
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... category S 1..1 CodeableConcept General category of benefit
...... benefit S 0..* BackboneElement Benefits list
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
....... type S 1..1 CodeableConcept Type of specific benefit
....... cost 0..* BackboneElement List of the costs
........ id 0..1 string Unique id for inter-element referencing
........ extension 0..* Extension Additional content defined by implementations
........ modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
........ type 1..1 CodeableConcept Type of cost
........ applicability 0..1 CodeableConcept in-network | out-of-network | other
Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.
........ qualifiers 0..* CodeableConcept Additional information about the cost
........ value 0..1 Quantity The actual cost value

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
InsurancePlan.language Base preferred Common Languages 📍4.0.1 FHIR Std.
InsurancePlan.status Base required PublicationStatus 📍4.0.1 FHIR Std.
InsurancePlan.type Base example Insurance plan type 📍4.0.1 FHIR Std.
InsurancePlan.contact.​purpose Base extensible Contact entity type 📍4.0.1 FHIR Std.
InsurancePlan.plan.specificCost.​benefit.cost.applicability Base required Benefit cost applicability 📍4.0.1 FHIR Std.
InsurancePlan.plan:gkv.​specificCost.benefit.​cost.applicability Base required Benefit cost applicability 📍4.0.1 FHIR Std.
InsurancePlan.plan:pkv.​specificCost.benefit.​cost.applicability Base required Benefit cost applicability 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error InsurancePlan If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error InsurancePlan If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error InsurancePlan If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error InsurancePlan If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice InsurancePlan A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
ipn-1 error InsurancePlan The organization SHALL at least have a name or an idendtifier, and possibly more than one (identifier.count() + name.count()) > 0

This structure is derived from InsurancePlan

Summary

Mandatory: 1 element(2 nested mandatory elements)
Must-Support: 22 elements

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of InsurancePlan.plan

 

Other representations of profile: CSV, Excel, Schematron