EnrollEligCOB
Class PlanSpecificCost

A healthcare-related procedure or service, to include medications and durable equipment, that is anticipated to be funded, in full or in part, by a given Healthcare Policy. This class was called CoveredBenefit but was renamed to Specific Cost in 2019 for compatibility with FHIR.
"Costs associated with the coverage provided by the product." - HL7 FHIR, InsurancePlan.plan.specificCost
"List of the specific benefits under this category of benefit." - HL7 FHIR, InsurancePlan.plan.specificCost.benefit
"List of the costs associated with a specific benefit." - HL7 FHIR, InsurancePlan.plan.specificCost.benefit.cost
Note that FHIR uses three classes to categorize the cost, while FHIM uses one. The resulting FHIM class therefore contains two categorization codes in addition to the code defining what is covered.

Attributes
«CS» Code applicability applicability

"Whether the cost applies to in-network or out-of-network providers (in-network; out-of-network; other)." - HL7 FHIR, InsurancePlan.plan.specificCost.benefit.cost.applicability

«CS» Code benefitType benefitType

Identifies a healthcare-related procedure or service, to include medications and durable equipment, that is anticipated to be funded, in full or in part, by a given Healthcare Policy.
"Type of specific benefit (preventative; primary care office visit; speciality office visit; hospitalization; emergency room; urgent care)." - HL7 FHIR, InsurancePlan.plan.specificCost.benefit.type

«CS» Code category category

"General category of benefit (Medical; Dental; Vision; Drug; Mental Health; Substance Abuse; Hospice, Home Health)." - HL7 FHIR, InsurancePlan.plan.specificCost.category

«CS» Code kind kind

"Type of cost (copay; individual cap; family cap; coinsurance; deductible)." - HL7 FHIR, InsurancePlan.plan.specificCost.benefit.cost.type

«CS» Code qualifiers qualifiers

"Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA)." - HL7 FHIR, InsurancePlan.plan.specificCost.benefit.cost.qualifiers

«PQ» Quantity value value

"The actual cost value. (some of the costs may be represented as percentages rather than currency, e.g. 10% coinsurance)." - HL7 FHIR, InsurancePlan.plan.specificCost.benefit.cost.value
Note that the FHIM previously had two separate properties, coinsuranceAmount and copaymentAmount, which have been replaced by this property (when the kind property is "coinsurance" or "copayment"). The FHIR construct is more flexible as it allows for other kinds of payment types as well.


Properties:

Alias
Classifier Behavior
Is Abstractfalse
Is Activefalse
Is Leaffalse
Keywords
NamePlanSpecificCost
Name Expression
NamespaceEnrollEligCOB
Owned Template Signature
OwnerEnrollEligCOB
Owning Template Parameter
PackageEnrollEligCOB
Qualified NameFHIM::EnrollEligCOB::PlanSpecificCost
Representation
Stereotype
Template Parameter
VisibilityPublic

Attribute Details

 applicability
Public «CS» Code applicability

"Whether the cost applies to in-network or out-of-network providers (in-network; out-of-network; other)." - HL7 FHIR, InsurancePlan.plan.specificCost.benefit.cost.applicability

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassPlanSpecificCost
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity0..1
Nameapplicability
Name Expression
NamespacePlanSpecificCost
Opposite
OwnerPlanSpecificCost
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::PlanSpecificCost::applicability
Stereotype
Template Parameter
Type«CS» Code
Upper1
Upper Value(1)
VisibilityPublic


 benefitType
Public «CS» Code benefitType

Identifies a healthcare-related procedure or service, to include medications and durable equipment, that is anticipated to be funded, in full or in part, by a given Healthcare Policy.
"Type of specific benefit (preventative; primary care office visit; speciality office visit; hospitalization; emergency room; urgent care)." - HL7 FHIR, InsurancePlan.plan.specificCost.benefit.type

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassPlanSpecificCost
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower1
Lower Value(1)
Multiplicity1
NamebenefitType
Name Expression
NamespacePlanSpecificCost
Opposite
OwnerPlanSpecificCost
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::PlanSpecificCost::benefitType
Stereotype
Template Parameter
Type«CS» Code
Upper1
Upper Value(1)
VisibilityPublic


 category
Public «CS» Code category

"General category of benefit (Medical; Dental; Vision; Drug; Mental Health; Substance Abuse; Hospice, Home Health)." - HL7 FHIR, InsurancePlan.plan.specificCost.category

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassPlanSpecificCost
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower1
Lower Value(1)
Multiplicity1
Namecategory
Name Expression
NamespacePlanSpecificCost
Opposite
OwnerPlanSpecificCost
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::PlanSpecificCost::category
Stereotype
Template Parameter
Type«CS» Code
Upper1
Upper Value(1)
VisibilityPublic


 kind
Public «CS» Code kind

"Type of cost (copay; individual cap; family cap; coinsurance; deductible)." - HL7 FHIR, InsurancePlan.plan.specificCost.benefit.cost.type

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassPlanSpecificCost
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower1
Lower Value(1)
Multiplicity1
Namekind
Name Expression
NamespacePlanSpecificCost
Opposite
OwnerPlanSpecificCost
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::PlanSpecificCost::kind
Stereotype
Template Parameter
Type«CS» Code
Upper1
Upper Value(1)
VisibilityPublic


 qualifiers
Public «CS» Code qualifiers

"Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA)." - HL7 FHIR, InsurancePlan.plan.specificCost.benefit.cost.qualifiers

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassPlanSpecificCost
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity*
Namequalifiers
Name Expression
NamespacePlanSpecificCost
Opposite
OwnerPlanSpecificCost
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::PlanSpecificCost::qualifiers
Stereotype
Template Parameter
Type«CS» Code
Upper*
Upper Value(*)
VisibilityPublic


 value
Public «PQ» Quantity value

"The actual cost value. (some of the costs may be represented as percentages rather than currency, e.g. 10% coinsurance)." - HL7 FHIR, InsurancePlan.plan.specificCost.benefit.cost.value
Note that the FHIM previously had two separate properties, coinsuranceAmount and copaymentAmount, which have been replaced by this property (when the kind property is "coinsurance" or "copayment"). The FHIR construct is more flexible as it allows for other kinds of payment types as well.

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassPlanSpecificCost
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity0..1
Namevalue
Name Expression
NamespacePlanSpecificCost
Opposite
OwnerPlanSpecificCost
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::PlanSpecificCost::value
Stereotype
Template Parameter
Type«PQ» Quantity
Upper1
Upper Value(1)
VisibilityPublic