<?xml version="1.0" encoding="UTF-8"?>
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/*
  Copyright (c) 2011+, HL7, Inc.
  All rights reserved.
  
  Redistribution and use in source and binary forms, with or without modification, 
  are permitted provided that the following conditions are met:
  
   * Redistributions of source code must retain the above copyright notice, this 
     list of conditions and the following disclaimer.
   * Redistributions in binary form must reproduce the above copyright notice, 
     this list of conditions and the following disclaimer in the documentation 
     and/or other materials provided with the distribution.
   * Neither the name of HL7 nor the names of its contributors may be used to 
     endorse or promote products derived from this software without specific 
     prior written permission.
  
  THIS SOFTWARE IS PROVIDED BY THE COPYRIGHT HOLDERS AND CONTRIBUTORS "AS IS" AND 
  ANY EXPRESS OR IMPLIED WARRANTIES, INCLUDING, BUT NOT LIMITED TO, THE IMPLIED 
  WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE ARE DISCLAIMED. 
  IN NO EVENT SHALL THE COPYRIGHT HOLDER OR CONTRIBUTORS BE LIABLE FOR ANY DIRECT, 
  INDIRECT, INCIDENTAL, SPECIAL, EXEMPLARY, OR CONSEQUENTIAL DAMAGES (INCLUDING, BUT 
  NOT LIMITED TO, PROCUREMENT OF SUBSTITUTE GOODS OR SERVICES; LOSS OF USE, DATA, OR 
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  ARISING IN ANY WAY OUT OF THE USE OF THIS SOFTWARE, EVEN IF ADVISED OF THE 
  POSSIBILITY OF SUCH DAMAGE.
  

  Generated on Mon, Mar 9, 2026 22:30+0000 for FHIR v6.0.0-ballot4 

  Note: the schemas &amp; schematrons do not contain all of the rules about what makes resources
  valid. Implementers will still need to be familiar with the content of the specification and with
  any profiles that apply to the resources in order to make a conformant implementation.

-->
<xs:schema xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns="http://hl7.org/fhir" xmlns:xhtml="http://www.w3.org/1999/xhtml" targetNamespace="http://hl7.org/fhir" elementFormDefault="qualified" version="1.0">
  <xs:include schemaLocation="fhir-base.xsd"/>
  <xs:element name="Coverage" type="Coverage">
    <xs:annotation>
      <xs:documentation xml:lang="en">Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment.</xs:documentation>
    </xs:annotation>
  </xs:element>
  <xs:complexType name="Coverage">
    <xs:annotation>
      <xs:documentation xml:lang="en">Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment.</xs:documentation>
      <xs:documentation xml:lang="en">If the element is present, it must have either a @value, an @id, or extensions</xs:documentation>
    </xs:annotation>
    <xs:complexContent>
      <xs:extension base="DomainResource">
        <xs:sequence>
          <xs:element name="identifier" minOccurs="0" maxOccurs="unbounded" type="Identifier">
            <xs:annotation>
              <xs:documentation xml:lang="en">The identifier of the coverage as issued by the insurer.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="status" minOccurs="1" maxOccurs="1" type="FinancialResourceStatusCodes">
            <xs:annotation>
              <xs:documentation xml:lang="en">The status of the resource instance. The status element does not indicate whether the policy reflected in the instance is in-force at any particular point in time, that would be conveyed via the 'period' element.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="statusReason" minOccurs="0" maxOccurs="1" type="string">
            <xs:annotation>
              <xs:documentation xml:lang="en">Used to indicate why the status has changed.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="kind" minOccurs="1" maxOccurs="1" type="Kind">
            <xs:annotation>
              <xs:documentation xml:lang="en">The nature of the coverage be it insurance, or cash payment such as self-pay.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="paymentBy" type="Coverage.PaymentBy" minOccurs="0" maxOccurs="unbounded">
            <xs:annotation>
              <xs:documentation xml:lang="en">Link to the paying party and optionally what specifically they will be responsible to pay.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="type" minOccurs="0" maxOccurs="1" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health or payment by an individual or organization.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="policyHolder" minOccurs="0" maxOccurs="1" type="Reference">
            <xs:annotation>
              <xs:documentation xml:lang="en">The party who 'owns' the insurance policy.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="subscriber" minOccurs="0" maxOccurs="1" type="Reference">
            <xs:annotation>
              <xs:documentation xml:lang="en">The party who has signed-up for or 'owns' the contractual relationship to the policy or to whom the benefit of the policy for services rendered to them or their family is due.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="subscriberId" minOccurs="0" maxOccurs="unbounded" type="Identifier">
            <xs:annotation>
              <xs:documentation xml:lang="en">The insurer assigned ID for the Subscriber.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="beneficiary" minOccurs="1" maxOccurs="1" type="Reference">
            <xs:annotation>
              <xs:documentation xml:lang="en">The party who benefits from the insurance coverage; the patient when products and/or services are provided.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="dependent" minOccurs="0" maxOccurs="1" type="string">
            <xs:annotation>
              <xs:documentation xml:lang="en">A designator for a dependent under the coverage.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="relationship" minOccurs="0" maxOccurs="1" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">The relationship of beneficiary (patient) to the subscriber.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="period" minOccurs="0" maxOccurs="1" type="Period">
            <xs:annotation>
              <xs:documentation xml:lang="en">Time period during which the coverage is in force. A missing start date indicates the start date isn't known, a missing end date means the coverage is continuing to be in force. When non-contiguous periods of coverage need to be documented it is recommended that this is accomplished through the use of an extension,rather than complicating coverage period calculations for many users of the Coverage resource.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="insurer" minOccurs="0" maxOccurs="1" type="Reference">
            <xs:annotation>
              <xs:documentation xml:lang="en">The program or plan underwriter, payor, insurance company.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="class" type="Coverage.Class" minOccurs="0" maxOccurs="unbounded">
            <xs:annotation>
              <xs:documentation xml:lang="en">A suite of underwriter specific classifiers.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="order" minOccurs="0" maxOccurs="1" type="positiveInt">
            <xs:annotation>
              <xs:documentation xml:lang="en">The order of applicability of this coverage relative to other coverages which are currently in force. Note, there may be gaps in the numbering and this does not imply primary, secondary etc. as the specific positioning of coverages depends upon the episode of care. For example; a patient might have (0) auto insurance (1) their own health insurance and (2) spouse's health insurance. When claiming for treatments which were not the result of an auto accident then only coverages (1) and (2) above would be applicable and would apply in the order specified in parenthesis. Coverage.order conveys the Coordination of Benefit (COB) ordering of coverage independent of use-case, for a use-case dependent set of Coverages see Account.coverage.priority.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="network" minOccurs="0" maxOccurs="1" type="string">
            <xs:annotation>
              <xs:documentation xml:lang="en">The insurer-specific identifier for the insurer-defined network of providers to which the beneficiary may seek treatment which will be covered at the 'in-network' rate, otherwise 'out of network' terms and conditions apply.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="costToBeneficiary" type="Coverage.CostToBeneficiary" minOccurs="0" maxOccurs="unbounded">
            <xs:annotation>
              <xs:documentation xml:lang="en">A suite of codes indicating the cost category and associated amount which have been detailed in the policy and may have been  included on the health card.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="subrogation" minOccurs="0" maxOccurs="1" type="boolean">
            <xs:annotation>
              <xs:documentation xml:lang="en">When 'subrogation=true' this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="contract" minOccurs="0" maxOccurs="unbounded" type="Reference">
            <xs:annotation>
              <xs:documentation xml:lang="en">The policy(s) which constitute this insurance coverage.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="insurancePlan" minOccurs="0" maxOccurs="1" type="Reference">
            <xs:annotation>
              <xs:documentation xml:lang="en">The insurance plan details, benefits and costs, which constitute this insurance coverage.</xs:documentation>
           </xs:annotation>
          </xs:element>
        </xs:sequence>
      </xs:extension>
    </xs:complexContent>
  </xs:complexType>
  <xs:complexType name="Coverage.PaymentBy">
    <xs:annotation>
      <xs:documentation xml:lang="en">Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment.</xs:documentation>
    </xs:annotation>
    <xs:complexContent>
      <xs:extension base="BackboneElement">
        <xs:sequence>
          <xs:element name="party" minOccurs="1" maxOccurs="1" type="Reference">
            <xs:annotation>
              <xs:documentation xml:lang="en">The list of parties providing non-insurance payment for the treatment costs.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="responsibility" minOccurs="0" maxOccurs="1" type="string">
            <xs:annotation>
              <xs:documentation xml:lang="en"> Description of the financial responsibility.</xs:documentation>
           </xs:annotation>
          </xs:element>
        </xs:sequence>
      </xs:extension>
    </xs:complexContent>
  </xs:complexType>
  <xs:complexType name="Coverage.Class">
    <xs:annotation>
      <xs:documentation xml:lang="en">Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment.</xs:documentation>
    </xs:annotation>
    <xs:complexContent>
      <xs:extension base="BackboneElement">
        <xs:sequence>
          <xs:element name="type" minOccurs="1" maxOccurs="1" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">The type of classification for which an insurer-specific class label or number and optional name is provided.  For example, type may be used to identify a class of coverage or employer group, policy, or plan.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="value" minOccurs="1" maxOccurs="1" type="Identifier">
            <xs:annotation>
              <xs:documentation xml:lang="en">The alphanumeric identifier associated with the insurer issued label.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="name" minOccurs="0" maxOccurs="1" type="string">
            <xs:annotation>
              <xs:documentation xml:lang="en">A short description for the class.</xs:documentation>
           </xs:annotation>
          </xs:element>
        </xs:sequence>
      </xs:extension>
    </xs:complexContent>
  </xs:complexType>
  <xs:complexType name="Coverage.CostToBeneficiary">
    <xs:annotation>
      <xs:documentation xml:lang="en">Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment.</xs:documentation>
    </xs:annotation>
    <xs:complexContent>
      <xs:extension base="BackboneElement">
        <xs:sequence>
          <xs:element name="type" minOccurs="0" maxOccurs="1" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">The category of patient centric costs associated with treatment.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="category" minOccurs="0" maxOccurs="1" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">Code to identify the general type of benefits under which products and services are provided.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="network" minOccurs="0" maxOccurs="1" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">Is a flag to indicate whether the benefits refer to in-network providers or out-of-network providers.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="unit" minOccurs="0" maxOccurs="1" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">Indicates if the benefits apply to an individual or to the family.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="term" minOccurs="0" maxOccurs="1" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">The term or period of the values such as 'maximum lifetime benefit' or 'maximum annual visits'.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:choice minOccurs="0" maxOccurs="1" >
            <xs:annotation>
              <xs:documentation xml:lang="en">The amount due from the patient for the cost category.</xs:documentation>
            </xs:annotation>
            <xs:element name="valueQuantity" type="Quantity"/>
            <xs:element name="valueMoney" type="Money"/>
          </xs:choice>
          <xs:element name="exception" type="Coverage.Exception" minOccurs="0" maxOccurs="unbounded">
            <xs:annotation>
              <xs:documentation xml:lang="en">A suite of codes indicating exceptions or reductions to patient costs and their effective periods.</xs:documentation>
           </xs:annotation>
          </xs:element>
        </xs:sequence>
      </xs:extension>
    </xs:complexContent>
  </xs:complexType>
  <xs:complexType name="Coverage.Exception">
    <xs:annotation>
      <xs:documentation xml:lang="en">Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment.</xs:documentation>
    </xs:annotation>
    <xs:complexContent>
      <xs:extension base="BackboneElement">
        <xs:sequence>
          <xs:element name="type" minOccurs="1" maxOccurs="1" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">The code for the specific exception.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="period" minOccurs="0" maxOccurs="1" type="Period">
            <xs:annotation>
              <xs:documentation xml:lang="en">The timeframe the exception is in force.</xs:documentation>
           </xs:annotation>
          </xs:element>
        </xs:sequence>
      </xs:extension>
    </xs:complexContent>
  </xs:complexType>
  <xs:simpleType name="KindEnum">
    <xs:restriction base="code-primitive">
      <xs:enumeration value="insurance">
        <xs:annotation>
          <xs:documentation xml:lang="en">Insurance</xs:documentation>
        </xs:annotation>
      </xs:enumeration>
      <xs:enumeration value="self-pay">
        <xs:annotation>
          <xs:documentation xml:lang="en">Self-pay</xs:documentation>
        </xs:annotation>
      </xs:enumeration>
      <xs:enumeration value="other">
        <xs:annotation>
          <xs:documentation xml:lang="en">Other</xs:documentation>
        </xs:annotation>
      </xs:enumeration>
    </xs:restriction>
  </xs:simpleType>
  <xs:complexType name="Kind">
    <xs:annotation>
      <xs:documentation xml:lang="en"></xs:documentation>
      <xs:documentation xml:lang="en">If the element is present, it must have either a @value, an @id, or extensions</xs:documentation>
    </xs:annotation>
    <xs:complexContent>
      <xs:extension base="Element">
        <xs:attribute name="value" type="KindEnum" use="optional"/>
      </xs:extension>
    </xs:complexContent>
  </xs:complexType>
</xs:schema>
