http://hl7.org/fhir/StructureDefinition/Coverage|4.0.1

description: Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment.
derivation: specialization
name: Coverage
type: Coverage
elements:
  policyHolder: {short: Owner of the policy, isSummary: true, index: 3}
  beneficiary: {short: Plan beneficiary, isSummary: true, index: 6}
  contract: {short: Contract details, array: true, index: 25}
  relationship:
    short: Beneficiary relationship to the subscriber
    binding: {strength: extensible, valueSet: 'http://hl7.org/fhir/ValueSet/subscriber-relationship'}
    index: 8
  type:
    short: Coverage category such as medical or accident
    binding: {strength: preferred, valueSet: 'http://hl7.org/fhir/ValueSet/coverage-type'}
    isSummary: true
    index: 2
  costToBeneficiary:
    short: Patient payments for services/products
    array: true
    index: 17
    elements:
      type:
        short: Cost category
        binding: {strength: extensible, valueSet: 'http://hl7.org/fhir/ValueSet/coverage-copay-type'}
        isSummary: true
        index: 18
      value:
        short: The amount or percentage due from the beneficiary
        choices: []
        isSummary: true
        index: 20
      exception:
        short: Exceptions for patient payments
        array: true
        index: 21
        elements:
          type:
            short: Exception category
            binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/coverage-financial-exception'}
            isSummary: true
            index: 22
          period: {short: The effective period of the exception, isSummary: true, index: 23}
        required: [type]
    required: [value]
  subrogation: {short: Reimbursement to insurer, index: 24}
  subscriber: {short: Subscriber to the policy, isSummary: true, index: 4}
  payor: {min: 1, short: Issuer of the policy, array: true, isSummary: true, index: 10}
  status:
    isModifier: true
    short: active | cancelled | draft | entered-in-error
    binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/fm-status|4.0.1'}
    isModifierReason: This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
    isSummary: true
    index: 1
  class:
    short: Additional coverage classifications
    array: true
    index: 11
    elements:
      type:
        short: Type of class such as 'group' or 'plan'
        binding: {strength: extensible, valueSet: 'http://hl7.org/fhir/ValueSet/coverage-class'}
        isSummary: true
        index: 12
      value: {short: Value associated with the type, isSummary: true, index: 13}
      name: {short: Human readable description of the type and value, isSummary: true, index: 14}
    required: [value, type]
  identifier: {short: Business Identifier for the coverage, array: true, isSummary: true, index: 0}
  order: {short: Relative order of the coverage, isSummary: true, index: 15}
  network: {short: Insurer network, isSummary: true, index: 16}
  period: {short: Coverage start and end dates, isSummary: true, index: 9}
  dependent: {short: Dependent number, isSummary: true, index: 7}
  subscriberId: {short: ID assigned to the subscriber, isSummary: true, index: 5}
class: resource
kind: resource
url: http://hl7.org/fhir/StructureDefinition/Coverage
base: http://hl7.org/fhir/StructureDefinition/DomainResource
version: 4.0.1
required: [beneficiary, status, payor]