Difference between revisions of "ProductPlan Resource Proposal"

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==Scope of coverage==
 
==Scope of coverage==
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A product is a discrete package of health insurance coverage benefits that are offered under a particular network type. A given payer’s products typically differ by network type and/or coverage benefits. A plan pairs the health insurance coverage benefits under a product with the particular cost sharing structure offered to a consumer. A given product may comprise multiple plans.
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ProductPlan 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), and additional information about the offering, such as who it is owned and administered by, a coverage area, contact information, etc.
  
 
<!-- Define the full scope of coverage for the resource.  The scope must be clearly delineated such that it does not overlap with any other existing or expected resource.  The scope will be used to govern "what is the set of potential applications to consider when evaluating what elements are 'core' – i.e. in the 80%"
 
<!-- Define the full scope of coverage for the resource.  The scope must be clearly delineated such that it does not overlap with any other existing or expected resource.  The scope will be used to govern "what is the set of potential applications to consider when evaluating what elements are 'core' – i.e. in the 80%"

Revision as of 11:28, 14 May 2018

ProductPlan

Owning work group name

Patient Administration

Committee Approval Date:

Contributing or Reviewing Work Groups

  • Financial Management
  • Seeking interested workgroups

FHIR Resource Development Project Insight ID

1345

Scope of coverage

A product is a discrete package of health insurance coverage benefits that are offered under a particular network type. A given payer’s products typically differ by network type and/or coverage benefits. A plan pairs the health insurance coverage benefits under a product with the particular cost sharing structure offered to a consumer. A given product may comprise multiple plans.

ProductPlan 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), and additional information about the offering, such as who it is owned and administered by, a coverage area, contact information, etc.


RIM scope

unknown

Resource appropriateness

Expected implementations

The ONC has indicated that they desire to create a service that uses this capability where they will be distributing aggregated healthcare directory data from a central service to Organizations for local usage (based on a specific data usage agreement)


Content sources

Example Scenarios

  • Centralized Healthcare Directory service
  • Distributed/Federated Provider Directory service
  • Aggregated Directory Service

Resource Relationships

Reference(any) - Our initial requirements are needed against:

  • Organization
  • Location

We do not currently expect other resources to specifically reference ProductPlan

Timelines

Sept Ballot 2018 - draft was in Jan 2018 Comment ballot

gForge Users

  • brian_pos
  • Cooper Thompson
  • Andrew Torres

When Resource Proposal Is Complete

When you have completed your proposal, please send an email to FMGcontact@HL7.org

FMG Notes