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StructureDefinitionsCoverage

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

Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment.
StructureJSONDependenciesFHIRSchemaOther VersionsDependant (0)ElementsSummary
NameFlagsCardTypeDescription & Constraints
Coverage
0..*Insurance or medical plan or a payment agreement
 
identifier
Σ
0..*IdentifierBusiness identifier(s) for this coverage
 
status *
?!Σ
1..1codeactive | cancelled | draft | entered-in-error CoverageStatus (required)
 
kind *
Σ
1..1codeinsurance | self-pay | other CoverageKind (required)
 
paymentBy
0..*BackboneElementSelf-pay parties and responsibility
 
 
party *
Σ
1..1ReferenceParties performing self-payment
 
 
responsibility
Σ
0..1stringParty's responsibility
 
type
Σ
0..1CodeableConceptCoverage category such as medical or accident CoverageType (preferred)
 
policyHolder
Σ
0..1ReferenceOwner of the policy
 
subscriber
Σ
0..1ReferenceSubscriber to the policy
 
subscriberId
Σ
0..*IdentifierID assigned to the subscriber
 
beneficiary *
Σ
1..1ReferencePlan beneficiary
 
dependent
Σ
0..1stringDependent number
 
relationship
0..1CodeableConceptBeneficiary relationship to the subscriber Relationship (extensible)
 
period
Σ
0..1PeriodCoverage start and end dates
 
insurer
Σ
0..1ReferenceIssuer of the policy
 
class
0..*BackboneElementAdditional coverage classifications
 
 
type *
Σ
1..1CodeableConceptType of class such as 'group' or 'plan' CoverageClass (extensible)
 
 
value *
Σ
1..1IdentifierValue associated with the type
 
 
name
Σ
0..1stringHuman readable description of the type and value
 
order
Σ
0..1positiveIntRelative order of the coverage
 
network
Σ
0..1stringInsurer network
 
costToBeneficiary
0..*BackboneElementPatient payments for services/products
 
 
type
Σ
0..1CodeableConceptCost category CopayTypes (extensible)
 
 
category
0..1CodeableConceptBenefit classification BenefitCategory (example)
 
 
network
0..1CodeableConceptIn or out of network BenefitNetwork (example)
 
 
unit
0..1CodeableConceptIndividual or family BenefitUnit (example)
 
 
term
0..1CodeableConceptAnnual or lifetime BenefitTerm (example)
 
 
value[x]
Σ
0..1The amount or percentage due from the beneficiary
 
 
 
valueQuantity
Σ
0..1Quantity
 
 
 
valueMoney
Σ
0..1Money
 
 
exception
0..*BackboneElementExceptions for patient payments
 
 
 
type *
Σ
1..1CodeableConceptException category CoverageFinancialException (example)
 
 
 
period
Σ
0..1PeriodThe effective period of the exception
 
subrogation
0..1booleanReimbursement to insurer
 
contract
0..*ReferenceContract details
 
insurancePlan
0..1ReferenceInsurance plan details