http://hl7.org/fhir/StructureDefinition/Coverage|5.0.0

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: {isModifier: false, short: Owner of the policy, mustSupport: false, isSummary: true, index: 7}
  insurancePlan: {isModifier: false, short: Insurance plan details, mustSupport: false, isSummary: false, index: 34}
  beneficiary: {isModifier: false, short: Plan beneficiary, mustSupport: false, isSummary: true, index: 10}
  contract: {isModifier: false, short: Contract details, mustSupport: false, array: true, isSummary: false, index: 33}
  relationship:
    isModifier: false
    short: Beneficiary relationship to the subscriber
    mustSupport: false
    binding: {strength: extensible, valueSet: 'http://hl7.org/fhir/ValueSet/subscriber-relationship'}
    isSummary: false
    index: 12
  type:
    isModifier: false
    short: Coverage category such as medical or accident
    mustSupport: false
    binding: {strength: preferred, valueSet: 'http://hl7.org/fhir/ValueSet/coverage-type'}
    isSummary: true
    index: 6
  costToBeneficiary:
    isModifier: false
    short: Patient payments for services/products
    mustSupport: false
    array: true
    isSummary: false
    index: 21
    elements:
      type:
        isModifier: false
        short: Cost category
        mustSupport: false
        binding: {strength: extensible, valueSet: 'http://hl7.org/fhir/ValueSet/coverage-copay-type'}
        isSummary: true
        index: 22
      category:
        isModifier: false
        short: Benefit classification
        mustSupport: false
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-benefitcategory'}
        isSummary: false
        index: 23
      network:
        isModifier: false
        short: In or out of network
        mustSupport: false
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/benefit-network'}
        isSummary: false
        index: 24
      unit:
        isModifier: false
        short: Individual or family
        mustSupport: false
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/benefit-unit'}
        isSummary: false
        index: 25
      term:
        isModifier: false
        short: Annual or lifetime
        mustSupport: false
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/benefit-term'}
        isSummary: false
        index: 26
      value:
        isModifier: false
        short: The amount or percentage due from the beneficiary
        mustSupport: false
        choices: []
        isSummary: true
        index: 28
      exception:
        isModifier: false
        short: Exceptions for patient payments
        mustSupport: false
        array: true
        isSummary: false
        index: 29
        elements:
          type:
            isModifier: false
            short: Exception category
            mustSupport: false
            binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/coverage-financial-exception'}
            isSummary: true
            index: 30
          period: {isModifier: false, short: The effective period of the exception, mustSupport: false, isSummary: true, index: 31}
        required: [type]
  insurer: {isModifier: false, short: Issuer of the policy, mustSupport: false, isSummary: true, index: 14}
  subrogation: {isModifier: false, short: Reimbursement to insurer, mustSupport: false, isSummary: false, index: 32}
  subscriber: {isModifier: false, short: Subscriber to the policy, mustSupport: false, isSummary: true, index: 8}
  status:
    isModifier: true
    short: active | cancelled | draft | entered-in-error
    mustSupport: false
    binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/fm-status|5.0.0'}
    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:
    isModifier: false
    short: Additional coverage classifications
    mustSupport: false
    array: true
    isSummary: false
    index: 15
    elements:
      type:
        isModifier: false
        short: Type of class such as 'group' or 'plan'
        mustSupport: false
        binding: {strength: extensible, valueSet: 'http://hl7.org/fhir/ValueSet/coverage-class'}
        isSummary: true
        index: 16
      value: {isModifier: false, short: Value associated with the type, mustSupport: false, isSummary: true, index: 17}
      name: {isModifier: false, short: Human readable description of the type and value, mustSupport: false, isSummary: true, index: 18}
    required: [value, type]
  kind:
    isModifier: false
    short: insurance | self-pay | other
    mustSupport: false
    binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/coverage-kind|5.0.0'}
    isSummary: true
    index: 2
  identifier: {isModifier: false, short: Business identifier(s) for this coverage, mustSupport: false, array: true, isSummary: true, index: 0}
  order: {isModifier: false, short: Relative order of the coverage, mustSupport: false, isSummary: true, index: 19}
  network: {isModifier: false, short: Insurer network, mustSupport: false, isSummary: true, index: 20}
  period: {isModifier: false, short: Coverage start and end dates, mustSupport: false, isSummary: true, index: 13}
  dependent: {isModifier: false, short: Dependent number, mustSupport: false, isSummary: true, index: 11}
  paymentBy:
    isModifier: false
    short: Self-pay parties and responsibility
    mustSupport: false
    array: true
    isSummary: false
    index: 3
    elements:
      party: {isModifier: false, short: Parties performing self-payment, mustSupport: false, isSummary: true, index: 4}
      responsibility: {isModifier: false, short: Party's responsibility, mustSupport: false, isSummary: true, index: 5}
    required: [party]
  subscriberId: {isModifier: false, short: ID assigned to the subscriber, mustSupport: false, array: true, isSummary: true, index: 9}
class: resource
kind: resource
url: http://hl7.org/fhir/StructureDefinition/Coverage
base: http://hl7.org/fhir/StructureDefinition/DomainResource
version: 5.0.0
required: [beneficiary, status, kind]