Coverage
FinancialFinancial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment.
| Path | Card. | Type | Description & Constraints |
|---|---|---|---|
| Coverage | 0..* | — | Insurance or medical plan or a payment agreement |
| .idΣ | 0..1 | String | Logical id of this artifact |
| .metaΣ | 0..1 | Meta | Metadata about the resource |
| .implicitRules?!Σ | 0..1 | uri | A set of rules under which this content was created |
| .language | 0..1 | code | Language of the resource content Bindinglanguages(preferred) |
| .text | 0..1 | Narrative | Text summary of the resource, for human interpretation |
| .contained | 0..* | Resource | Contained, inline Resources |
| .extension | 0..* | Extension | Additional content defined by implementations |
| .modifierExtension?! | 0..* | Extension | Extensions that cannot be ignored |
| .identifierΣ | 0..* | Identifier | Business Identifier for the coverage |
| .status?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Bindingfm-status(required) |
| .typeΣ | 0..1 | CodeableConcept | Coverage category such as medical or accident Bindingcoverage-type(preferred) |
| .policyHolderΣ | 0..1 | Reference(Patient | RelatedPerson | Organization) | Owner of the policy |
| .subscriberΣ | 0..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy |
| .subscriberIdΣ | 0..1 | string | ID assigned to the subscriber |
| .beneficiaryΣ | 1..1 | Reference(Patient) | Plan beneficiary |
| .dependentΣ | 0..1 | string | Dependent number |
| .relationship | 0..1 | CodeableConcept | Beneficiary relationship to the subscriber Bindingsubscriber-relationship(extensible) |
| .periodΣ | 0..1 | Period | Coverage start and end dates |
| .payorΣ | 1..* | Reference(Organization | Patient | RelatedPerson) | Issuer of the policy |
| .class | 0..* | BackboneElement | Additional coverage classifications |
| .id | 0..1 | String | Unique id for inter-element referencing |
| .extension | 0..* | Extension | Additional content defined by implementations |
| .modifierExtension?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| .typeΣ | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Bindingcoverage-class(extensible) |
| .valueΣ | 1..1 | string | Value associated with the type |
| .nameΣ | 0..1 | string | Human readable description of the type and value |
| .orderΣ | 0..1 | positiveInt | Relative order of the coverage |
| .networkΣ | 0..1 | string | Insurer network |
| .costToBeneficiary | 0..* | BackboneElement | Patient payments for services/products |
| .id | 0..1 | String | Unique id for inter-element referencing |
| .extension | 0..* | Extension | Additional content defined by implementations |
| .modifierExtension?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| .typeΣ | 0..1 | CodeableConcept | Cost category Bindingcoverage-copay-type(extensible) |
| .value[x]Σ | 1..1 | Quantity | Money | The amount or percentage due from the beneficiary |
| .exception | 0..* | BackboneElement | Exceptions for patient payments |
| .id | 0..1 | String | Unique id for inter-element referencing |
| .extension | 0..* | Extension | Additional content defined by implementations |
| .modifierExtension?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| .typeΣ | 1..1 | CodeableConcept | Exception category Bindingcoverage-financial-exception(example) |
| .periodΣ | 0..1 | Period | The effective period of the exception |
| .subrogation | 0..1 | boolean | Reimbursement to insurer |
| .contract | 0..* | Reference(Contract) | Contract details |