Personal Health Record System Functional Model, Release 2
0.1.0 - CI Build

Personal Health Record System Functional Model, Release 2 - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

## Example Requirements: S.2.2 Manage Health Insurance Plan Benefit Information (Function)

Active as of 2024-01-31

S.2.2#01 | SHOULD | The system SHOULD provide the ability to capture selected insurance benefit information that is pertinent to the PHR Account Holder's needs. Satisfied by: https://www.hl7.org/fhir/insuranceplan.html
S.2.2#02 | SHOULD | The system SHOULD provide the ability to maintain the selected health insurance benefit information.
S.2.2#03 | SHOULD | The system SHOULD provide the ability for the PHR Account Holder to capture and render updates made to selected insurance plan benefit information that is pertinent to the PHR Account Holder's needs. For example, the PHR Account Holder might receive information regarding changes in deductible amounts, categories of coverage (e.g., new medicines or new therapies being covered), terms-of-coverage (e.g., changes in co-pay amounts), prior authorization requirements, and updates to the list of health care providers that are within the insurance carrier's network (including specific facilities and providers).
S.2.2#04 | SHOULD | The system SHOULD provide the ability to manage health insurance benefit information from multiple payer sources.
S.2.2#05 | MAY | The system MAY provide the ability to link to the health insurance benefit PHR-S as the source for multiple categories of account distributions which may be related to the varied financial implications of funds usage in accounts (such as Consumer-Directed Health Plans).
S.2.2#06 | MAY | The system MAY provide the ability to manage multiple categories of account distributions which may be related to the varied financial implications of funds usage in accounts (such as Consumer-Directed Health Plans).
S.2.2#07 | MAY | The system MAY provide the ability to capture preauthorization requirements for medications and health services specific to the PHR Account Holder’s policies.
S.2.2#08 | MAY | The system MAY provide the ability to capture, store, and render referral requirements. Note: Referral requirements are those requirements that must be met by a healthcare provider as specified by the healthcare payer or a care-coordinating entity. A care-coordinating entity consists of a group of healthcare professionals who have formally agreed to manage the healthcare of a patient.
S.2.2#09 | MAY | The system MAY provide the ability to capture and present an indication that an insurance coverage / benefit / deductible-amount / co-pay amount has changed (e.g., by receiving a notice from an insurance providers of the existence of a new benefit, an expired benefit, or a changed benefit.)