ProductPlan Resource Proposal

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ProductPlan

Owning work group name

Patient Administration

Committee Approval Date:

Contributing or Reviewing Work Groups

  • Financial Management
  • Seeking other 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.

The ProductPlan does not represent the details for a specific patient, that is the Coverage resource.

RIM scope

unknown

Resource appropriateness

A catalog to discover providers that provide specific insurance products is useful for both patients/consumers, and also for providers to verify details.

The information from the catalog will also be able to be utilized in Patient Coverage resources.

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