documentation:cdm:payer_plan

PAYER_PLAN_PERIOD table

THIS IS OUTDATED. All documentation is now on the github wiki. Please refer there or to the CDM working group for more information

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.

Field	Required	Type	Description
payer_plan_period_id	Yes	integer	A identifier for each unique combination of payer, plan, family code and time span.
person_id	Yes	integer	A foreign key identifier to the Person covered by the payer. The demographic details of that Person are stored in the PERSON table.
payer_plan_period_start_date	Yes	date	The start date of the payer plan period.
payer_plan_period_end_date	Yes	date	The end date of the payer plan period.
payer_source_value	No	varchar(50)	The source code for the payer as it appears in the source data.
plan_source_value	No	varchar(50)	The source code for the Person's health benefit plan as it appears in the source data.
family_source_value	No	varchar(50)	The source code for the Person's family as it appears in the source data.

Conventions

Different Payers have different designs for their health benefit Plans. The PAYER_PLAN_PERIOD table does not capture all details of the plan design or the relationship between Plans or the cost of healthcare triggering a change from one Plan to another. However, it allows identifying the unique combination of Payer (insurer), Plan (determining healthcare benefits and limits) and Person. Typically, depending on healthcare utilization, a Person may have one or many subsequent Plans during coverage by a single Payer.
Payer or Plan information is not normalized or recorded as part of the Standard Vocabularies. Instead, they are referred to only by their source_value.
Typically, family members are covered under the same Plan as the Person. In those cases, the payer_source_value, plan_source_value and family_source_value are identical.