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  1. FHIR Specification Feedback
  2. FHIR-34679

Expectations for use of PlanBeneficiaries extension

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    • Change Request
    • Status: Resolved - No Change (View Workflow)
    • Highest
    • Resolution: Not Persuasive
    • US CARIN Digital Insurance Card (DIC) (FHIR)
    • 0.1.0
    • Payer/Provider Information Exchange
    • Plan Beneficiaries
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      The definition of the C4DIC-PlanBeneficiaries-extension outlines the expectation of its use: "This extension allows for the representation of all of the members on the plan with corresponding Names and MemberIDs. This enables health plans to pass this information along with the Coverage resources to align with how this content is printed on physical insurance cards." To expand on this definition in the event it is not clear, this extension should represent all of the individuals on the plan and their corresponding member identifiers as they would be printed on the physical insurance card. If there is only one individual being covered and represented on the card, that person's information would be included in this extension once and repeated in the Coverage.beneficiary and the Coverage.subscriber fields. If there are two individuals on the plan and printed on the card, both would be represented in the extension and in either or both of the .subscriber and .beneficiary fields as relevant. If there are 5 inviduals covered by the plan and printed on the card, there would be 5 individuals in the extension.

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      The definition of the C4DIC-PlanBeneficiaries-extension outlines the expectation of its use: "This extension allows for the representation of all of the members on the plan with corresponding Names and MemberIDs. This enables health plans to pass this information along with the Coverage resources to align with how this content is printed on physical insurance cards." To expand on this definition in the event it is not clear, this extension should represent all of the individuals on the plan and their corresponding member identifiers as they would be printed on the physical insurance card. If there is only one individual being covered and represented on the card, that person's information would be included in this extension once and repeated in the Coverage.beneficiary and the Coverage.subscriber fields. If there are two individuals on the plan and printed on the card, both would be represented in the extension and in either or both of the .subscriber and .beneficiary fields as relevant. If there are 5 inviduals covered by the plan and printed on the card, there would be 5 individuals in the extension.
    • Mark Roberts/Durwin Day: 14-0-0

    Description

      Are there any expectations on how the PlanBeneficiaries extension will be used (specifically, relative to how Coverage.subscriber and Coverage.beneficiary are populated)? If the extension is used, should there always be an iteration of the extension for the individual in .beneficiary? Or is that considered redundant and should be avoided? If the extension is used, is it valid to use the extension to include just a subset of the plan beneficiaries or should it always be a complete list of beneficiaries. If the IG places no expectations on the use of the extension, then at least saying this explicitly will help implementers to understand that there may be multiple ways to use the extension.

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              craig.newman Craig Newman
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                Updated:
                Resolved: