Guide d'implémentation du GT Standards et Interopérabilité pour les EDS
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Logical Model: OMOPPayerPlanPeriod - Detailed Descriptions

Draft as of 2024-10-08

Definitions for the OMOPPayerPlanPeriod logical model.

Guidance on how to interpret the contents of this table can be found here

0. OMOPPayerPlanPeriod
Definition

The PAYER_PLAN_PERIOD table captures details of the period of time that a Person is continuously enrolled under a specific health Plan benefit structure from a given Payer. Each Person receiving healthcare is typically covered by a health benefit plan, which pays for (fully or partially), or directly provides, the care. These benefit plans are provided by payers, such as health insurances or state or government agencies. In each plan the details of the health benefits are defined for the Person or her family, and the health benefit Plan might change over time typically with increasing utilization (reaching certain cost thresholds such as deductibles), plan availability and purchasing choices of the Person. The unique combinations of Payer organizations, health benefit Plans and time periods in which they are valid for a Person are recorded in this table.

ShortPayer Plan Period OMOP Table
Logical ModelInstances of this logical model are not marked to be the target of a Reference
2. OMOPPayerPlanPeriod.payer-plan-period-id
Definition

Payer Plan Period Identifier

ShortPayer Plan Period Identifier
Control1..1
Typeinteger
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
4. OMOPPayerPlanPeriod.person-id
Definition

The Person covered by the Plan.

ShortPerson
Control1..1
TypeReference(Person OMOP Table)
6. OMOPPayerPlanPeriod.payer-plan-period-start-date
Definition

Start date of Plan coverage.

ShortPayer Plan Period Start Date
Control1..1
Typedate
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
8. OMOPPayerPlanPeriod.payer-plan-period-end-date
Definition

End date of Plan coverage.

ShortPayer Plan Period End Date
Control1..1
Typedate
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
10. OMOPPayerPlanPeriod.payer-concept-id
Definition

This field represents the organization who reimburses the provider which administers care to the Person.

ShortPayer
Control0..1
TypeReference(Concept OMOP Table)
12. OMOPPayerPlanPeriod.payer-source-value
Definition

This is the Payer as it appears in the source data.

ShortPayer Source Value
Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
14. OMOPPayerPlanPeriod.payer-source-concept-id
Definition

Payer Source

ShortPayer Source
Control0..1
TypeReference(Concept OMOP Table)
16. OMOPPayerPlanPeriod.plan-concept-id
Definition

This field represents the specific health benefit Plan the Person is enrolled in.

ShortPlan
Control0..1
TypeReference(Concept OMOP Table)
18. OMOPPayerPlanPeriod.plan-source-value
Definition

This is the health benefit Plan of the Person as it appears in the source data.

ShortPlan Source Value
Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
20. OMOPPayerPlanPeriod.plan-source-concept-id
Definition

Plan Source

ShortPlan Source
Control0..1
TypeReference(Concept OMOP Table)
22. OMOPPayerPlanPeriod.sponsor-concept-id
Definition

This field represents the sponsor of the Plan who finances the Plan. This includes self-insured, small group health plan and large group health plan.

ShortSponsor
Control0..1
TypeReference(Concept OMOP Table)
24. OMOPPayerPlanPeriod.sponsor-source-value
Definition

The Plan sponsor as it appears in the source data.

ShortSponsor Source Value
Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
26. OMOPPayerPlanPeriod.sponsor-source-concept-id
Definition

Sponsor Source

ShortSponsor Source
Control0..1
TypeReference(Concept OMOP Table)
28. OMOPPayerPlanPeriod.family-source-value
Definition

The common identifier for all people (often a family) that covered by the same policy.

ShortFamily Source Value
Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
30. OMOPPayerPlanPeriod.stop-reason-concept-id
Definition

This field represents the reason the Person left the Plan, if known.

ShortStop Reason
Control0..1
TypeReference(Concept OMOP Table)
32. OMOPPayerPlanPeriod.stop-reason-source-value
Definition

The Plan stop reason as it appears in the source data.

ShortStop Reason Source Value
Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
34. OMOPPayerPlanPeriod.stop-reason-source-concept-id
Definition

Stop Reason Source

ShortStop Reason Source
Control0..1
TypeReference(Concept OMOP Table)

Guidance on how to interpret the contents of this table can be found here

0. OMOPPayerPlanPeriod
Definition

The PAYER_PLAN_PERIOD table captures details of the period of time that a Person is continuously enrolled under a specific health Plan benefit structure from a given Payer. Each Person receiving healthcare is typically covered by a health benefit plan, which pays for (fully or partially), or directly provides, the care. These benefit plans are provided by payers, such as health insurances or state or government agencies. In each plan the details of the health benefits are defined for the Person or her family, and the health benefit Plan might change over time typically with increasing utilization (reaching certain cost thresholds such as deductibles), plan availability and purchasing choices of the Person. The unique combinations of Payer organizations, health benefit Plans and time periods in which they are valid for a Person are recorded in this table.

ShortPayer Plan Period OMOP Table
Control0..*
Is Modifierfalse
Logical ModelInstances of this logical model are not marked to be the target of a Reference
2. OMOPPayerPlanPeriod.payer-plan-period-id
Definition

Payer Plan Period Identifier

ShortPayer Plan Period Identifier
Control1..1
Typeinteger
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
4. OMOPPayerPlanPeriod.person-id
Definition

The Person covered by the Plan.

ShortPerson
Control1..1
TypeReference(Person OMOP Table)
6. OMOPPayerPlanPeriod.payer-plan-period-start-date
Definition

Start date of Plan coverage.

ShortPayer Plan Period Start Date
Control1..1
Typedate
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
8. OMOPPayerPlanPeriod.payer-plan-period-end-date
Definition

End date of Plan coverage.

ShortPayer Plan Period End Date
Control1..1
Typedate
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
10. OMOPPayerPlanPeriod.payer-concept-id
Definition

This field represents the organization who reimburses the provider which administers care to the Person.

ShortPayer
Control0..1
TypeReference(Concept OMOP Table)
12. OMOPPayerPlanPeriod.payer-source-value
Definition

This is the Payer as it appears in the source data.

ShortPayer Source Value
Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
14. OMOPPayerPlanPeriod.payer-source-concept-id
Definition

Payer Source

ShortPayer Source
Control0..1
TypeReference(Concept OMOP Table)
16. OMOPPayerPlanPeriod.plan-concept-id
Definition

This field represents the specific health benefit Plan the Person is enrolled in.

ShortPlan
Control0..1
TypeReference(Concept OMOP Table)
18. OMOPPayerPlanPeriod.plan-source-value
Definition

This is the health benefit Plan of the Person as it appears in the source data.

ShortPlan Source Value
Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
20. OMOPPayerPlanPeriod.plan-source-concept-id
Definition

Plan Source

ShortPlan Source
Control0..1
TypeReference(Concept OMOP Table)
22. OMOPPayerPlanPeriod.sponsor-concept-id
Definition

This field represents the sponsor of the Plan who finances the Plan. This includes self-insured, small group health plan and large group health plan.

ShortSponsor
Control0..1
TypeReference(Concept OMOP Table)
24. OMOPPayerPlanPeriod.sponsor-source-value
Definition

The Plan sponsor as it appears in the source data.

ShortSponsor Source Value
Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
26. OMOPPayerPlanPeriod.sponsor-source-concept-id
Definition

Sponsor Source

ShortSponsor Source
Control0..1
TypeReference(Concept OMOP Table)
28. OMOPPayerPlanPeriod.family-source-value
Definition

The common identifier for all people (often a family) that covered by the same policy.

ShortFamily Source Value
Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
30. OMOPPayerPlanPeriod.stop-reason-concept-id
Definition

This field represents the reason the Person left the Plan, if known.

ShortStop Reason
Control0..1
TypeReference(Concept OMOP Table)
32. OMOPPayerPlanPeriod.stop-reason-source-value
Definition

The Plan stop reason as it appears in the source data.

ShortStop Reason Source Value
Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
34. OMOPPayerPlanPeriod.stop-reason-source-concept-id
Definition

Stop Reason Source

ShortStop Reason Source
Control0..1
TypeReference(Concept OMOP Table)

Guidance on how to interpret the contents of this table can be found here

0. OMOPPayerPlanPeriod
Definition

The PAYER_PLAN_PERIOD table captures details of the period of time that a Person is continuously enrolled under a specific health Plan benefit structure from a given Payer. Each Person receiving healthcare is typically covered by a health benefit plan, which pays for (fully or partially), or directly provides, the care. These benefit plans are provided by payers, such as health insurances or state or government agencies. In each plan the details of the health benefits are defined for the Person or her family, and the health benefit Plan might change over time typically with increasing utilization (reaching certain cost thresholds such as deductibles), plan availability and purchasing choices of the Person. The unique combinations of Payer organizations, health benefit Plans and time periods in which they are valid for a Person are recorded in this table.

ShortPayer Plan Period OMOP Table
Control0..*
Is Modifierfalse
Logical ModelInstances of this logical model are not marked to be the target of a Reference
2. OMOPPayerPlanPeriod.payer-plan-period-id
Definition

Payer Plan Period Identifier

ShortPayer Plan Period Identifier
Control1..1
Typeinteger
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
4. OMOPPayerPlanPeriod.person-id
Definition

The Person covered by the Plan.

ShortPerson
Control1..1
TypeReference(Person OMOP Table)
6. OMOPPayerPlanPeriod.payer-plan-period-start-date
Definition

Start date of Plan coverage.

ShortPayer Plan Period Start Date
Control1..1
Typedate
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
8. OMOPPayerPlanPeriod.payer-plan-period-end-date
Definition

End date of Plan coverage.

ShortPayer Plan Period End Date
Control1..1
Typedate
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
10. OMOPPayerPlanPeriod.payer-concept-id
Definition

This field represents the organization who reimburses the provider which administers care to the Person.

ShortPayer
Control0..1
TypeReference(Concept OMOP Table)
12. OMOPPayerPlanPeriod.payer-source-value
Definition

This is the Payer as it appears in the source data.

ShortPayer Source Value
Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
14. OMOPPayerPlanPeriod.payer-source-concept-id
Definition

Payer Source

ShortPayer Source
Control0..1
TypeReference(Concept OMOP Table)
16. OMOPPayerPlanPeriod.plan-concept-id
Definition

This field represents the specific health benefit Plan the Person is enrolled in.

ShortPlan
Control0..1
TypeReference(Concept OMOP Table)
18. OMOPPayerPlanPeriod.plan-source-value
Definition

This is the health benefit Plan of the Person as it appears in the source data.

ShortPlan Source Value
Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
20. OMOPPayerPlanPeriod.plan-source-concept-id
Definition

Plan Source

ShortPlan Source
Control0..1
TypeReference(Concept OMOP Table)
22. OMOPPayerPlanPeriod.sponsor-concept-id
Definition

This field represents the sponsor of the Plan who finances the Plan. This includes self-insured, small group health plan and large group health plan.

ShortSponsor
Control0..1
TypeReference(Concept OMOP Table)
24. OMOPPayerPlanPeriod.sponsor-source-value
Definition

The Plan sponsor as it appears in the source data.

ShortSponsor Source Value
Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
26. OMOPPayerPlanPeriod.sponsor-source-concept-id
Definition

Sponsor Source

ShortSponsor Source
Control0..1
TypeReference(Concept OMOP Table)
28. OMOPPayerPlanPeriod.family-source-value
Definition

The common identifier for all people (often a family) that covered by the same policy.

ShortFamily Source Value
Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
30. OMOPPayerPlanPeriod.stop-reason-concept-id
Definition

This field represents the reason the Person left the Plan, if known.

ShortStop Reason
Control0..1
TypeReference(Concept OMOP Table)
32. OMOPPayerPlanPeriod.stop-reason-source-value
Definition

The Plan stop reason as it appears in the source data.

ShortStop Reason Source Value
Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
34. OMOPPayerPlanPeriod.stop-reason-source-concept-id
Definition

Stop Reason Source

ShortStop Reason Source
Control0..1
TypeReference(Concept OMOP Table)