PAYER_PLAN_PERIOD

Table Description

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.

User Guide

A Person can have multiple, overlapping, Payer_Plan_Periods in this table. For example, medical and drug coverage in the US can be represented by two Payer_Plan_Periods. The details of the benefit structure of the Plan is rarely known, the idea is just to identify that the Plans are different.

CDM Field	User Guide	ETL Conventions	Datatype	Required	Primary Key	Foreign Key	FK Table	FK Domain
payer_plan_period_id	A unique identifier for each unique combination of a Person, Payer, Plan, and Period of time.		integer	Yes	Yes	No
person_id	The Person covered by the Plan.	A single Person can have multiple, overlapping, PAYER_PLAN_PERIOD records	integer	Yes	No	Yes	PERSON
payer_plan_period_start_date	Start date of Plan coverage.		date	Yes	No	No
payer_plan_period_end_date	End date of Plan coverage.		date	Yes	No	No
payer_concept_id	This field represents the organization who reimburses the provider which administers care to the Person.	Map the Payer directly to a standard CONCEPT_ID. If one does not exists please contact the vocabulary team. There is no global controlled vocabulary available for this information. The point is to stratify on this information and identify if Persons have the same payer, though the name of the Payer is not necessary. Accepted Concepts.	integer	No	No	Yes	CONCEPT
payer_source_value	This is the Payer as it appears in the source data.		varchar(50)	No	No	No
payer_source_concept_id		If the source data codes the Payer in an OMOP supported vocabulary store the concept_id here.	integer	No	No	Yes	CONCEPT
plan_concept_id	This field represents the specific health benefit Plan the Person is enrolled in.	Map the Plan directly to a standard CONCEPT_ID. If one does not exists please contact the vocabulary team. There is no global controlled vocabulary available for this information. The point is to stratify on this information and identify if Persons have the same health benefit Plan though the name of the Plan is not necessary. Accepted Concepts.	integer	No	No	Yes	CONCEPT
plan_source_value	This is the health benefit Plan of the Person as it appears in the source data.		varchar(50)	No	No	No
plan_source_concept_id		If the source data codes the Plan in an OMOP supported vocabulary store the concept_id here.	integer	No	No	Yes	CONCEPT
sponsor_concept_id	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.	Map the sponsor directly to a standard CONCEPT_ID. If one does not exists please contact the vocabulary team. There is no global controlled vocabulary available for this information. The point is to stratify on this information and identify if Persons have the same sponsor though the name of the sponsor is not necessary. Accepted Concepts.	integer	No	No	Yes	CONCEPT
sponsor_source_value	The Plan sponsor as it appears in the source data.		varchar(50)	No	No	No
sponsor_source_concept_id		If the source data codes the sponsor in an OMOP supported vocabulary store the concept_id here.	integer	No	No	Yes	CONCEPT
family_source_value	The common identifier for all people (often a family) that covered by the same policy.	Often these are the common digits of the enrollment id of the policy members.	varchar(50)	No	No	No
stop_reason_concept_id	This field represents the reason the Person left the Plan, if known.	Map the stop reason directly to a standard CONCEPT_ID. If one does not exists please contact the vocabulary team. There is no global controlled vocabulary available for this information. Accepted Concepts.	integer	No	No	Yes	CONCEPT
stop_reason_source_value	The Plan stop reason as it appears in the source data.		varchar(50)	No	No	No
stop_reason_source_concept_id		If the source data codes the stop reason in an OMOP supported vocabulary store the concept_id here.	integer	No	No	Yes	CONCEPT