http://hl7.org/fhir/StructureDefinition/Coverage|4.0.1
Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment.
| Name | Flags | Card | Type | Description & Constraints |
|---|---|---|---|---|
Coverage | 0..* | Insurance or medical plan or a payment agreement | ||
Σ | 0..* | Identifier | Business Identifier for the coverage | |
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error CoverageStatus (required) | |
Σ | 0..1 | CodeableConcept | Coverage category such as medical or accident CoverageType (preferred) | |
Σ | 0..1 | Reference | Owner of the policy | |
Σ | 0..1 | Reference | Subscriber to the policy | |
Σ | 0..1 | string | ID assigned to the subscriber | |
Σ | 1..1 | Reference | Plan beneficiary | |
Σ | 0..1 | string | Dependent number | |
| 0..1 | CodeableConcept | Beneficiary relationship to the subscriber Relationship (extensible) | ||
Σ | 0..1 | Period | Coverage start and end dates | |
Σ | 1..* | Reference | Issuer of the policy | |
| 0..* | BackboneElement | Additional coverage classifications | ||
Σ | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' CoverageClass (extensible) | |
Σ | 1..1 | string | Value associated with the type | |
Σ | 0..1 | string | Human readable description of the type and value | |
Σ | 0..1 | positiveInt | Relative order of the coverage | |
Σ | 0..1 | string | Insurer network | |
| 0..* | BackboneElement | Patient payments for services/products | ||
Σ | 0..1 | CodeableConcept | Cost category CopayTypes (extensible) | |
Σ | 1..1 | The amount or percentage due from the beneficiary | ||
Σ | 1..1 | Quantity | ||
Σ | 1..1 | Money | ||
| 0..* | BackboneElement | Exceptions for patient payments | ||
Σ | 1..1 | CodeableConcept | Exception category CoverageFinancialException (example) | |
Σ | 0..1 | Period | The effective period of the exception | |
| 0..1 | boolean | Reimbursement to insurer | ||
| 0..* | Reference | Contract details |