Coverage
Coverage
draftResource55 elementsv5.0.0
Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment.
Metadata
hl7.org/fhir- Canonical URL
- http://hl7.org/fhir/StructureDefinition/Coverage
- ID
- Coverage
- Type
- Base Definition
- Derivation
- specialization
- Publisher
- Health Level Seven International (Financial Management)
- Version
- 5.0.0
- Purpose
- Coverage provides a link between covered parties (patients) and the payors of their healthcare costs (both insurance and self-pay).
| Path | Card. | Type | Description |
|---|---|---|---|
Coverage | 0..* | Insurance or medical plan or a payment agreement | |
id | 0..1 | string | Logical id of this artifact |
meta | 0..1 | Metadata about the resource | |
implicitRules | 0..1 | uri | A set of rules under which this content was created |
language | 0..1 | code | Language of the resource contentrequired: all-languages |
text | 0..1 | Text summary of the resource, for human interpretation | |
contained | 0..* | Resource | Contained, inline Resources |
extension | 0..* | Additional content defined by implementations | |
modifierExtension | 0..* | Extensions that cannot be ignored | |
identifier | 0..* | Business identifier(s) for this coverage | |
status | 1..1 | code | active | cancelled | draft | entered-in-errorrequired: fm-status |
kind | 1..1 | code | insurance | self-pay | otherrequired: coverage-kind |
paymentBy | 0..* | BackboneElement | Self-pay parties and responsibility |
type | 0..1 | Coverage category such as medical or accidentpreferred: coverage-type | |
policyHolder | 0..1 | Owner of the policy | |
subscriber | 0..1 | Subscriber to the policy | |
subscriberId | 0..* | ID assigned to the subscriber | |
beneficiary | 1..1 | Plan beneficiary | |
dependent | 0..1 | string | Dependent number |
relationship | 0..1 | Beneficiary relationship to the subscriberextensible: subscriber-relationship | |
period | 0..1 | Coverage start and end dates | |
insurer | 0..1 | Issuer of the policy | |
class | 0..* | BackboneElement | Additional coverage classifications |
order | 0..1 | positiveInt | Relative order of the coverage |
network | 0..1 | string | Insurer network |
costToBeneficiary | 0..* | BackboneElement | Patient payments for services/products |
subrogation | 0..1 | boolean | Reimbursement to insurer |
contract | 0..* | Contract details | |
insurancePlan | 0..1 | Insurance plan details |