Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Coverage | TU | DomainResource | Insurance or medical plan or a payment agreement Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension | |
identifier | Σ | 0..* | Identifier | Business identifier(s) for this coverage |
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: Financial Resource Status Codes (Required) |
kind | Σ | 1..1 | code | insurance | self-pay | other Binding: Kind (Required) |
paymentBy | 0..* | BackboneElement | Self-pay parties and responsibility | |
party | Σ | 1..1 | Reference(Patient | RelatedPerson | Organization) | Parties performing self-payment |
responsibility | Σ | 0..1 | string | Party's responsibility |
type | Σ | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: Coverage Type and Self-Pay Codes (Preferred) |
policyHolder | Σ | 0..1 | Reference(Patient | RelatedPerson | Organization) | Owner of the policy |
subscriber | Σ | 0..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy |
subscriberId | Σ | 0..* | Identifier | ID assigned to the subscriber |
beneficiary | Σ | 1..1 | Reference(Patient) | Plan beneficiary |
dependent | Σ | 0..1 | string | Dependent number |
relationship | 0..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: SubscriberPolicyholder Relationship Codes (Extensible) | |
period | Σ | 0..1 | Period | Coverage start and end dates |
insurer | Σ | 0..1 | Reference(Organization) | Issuer of the policy |
class | 0..* | BackboneElement | Additional coverage classifications | |
type | Σ | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: Coverage Class Codes (Extensible) |
value | Σ | 1..1 | Identifier | Value associated with the type |
name | Σ | 0..1 | string | Human readable description of the type and value |
order | Σ | 0..1 | positiveInt | Relative order of the coverage |
network | Σ | 0..1 | string | Insurer network |
costToBeneficiary | 0..* | BackboneElement | Patient payments for services/products | |
type | Σ | 0..1 | CodeableConcept | Cost category Binding: Coverage Copay Type Codes (Extensible) |
category | 0..1 | CodeableConcept | Benefit classification Binding: Benefit Category Codes (Example) | |
network | 0..1 | CodeableConcept | In or out of network Binding: Network Type Codes (Example) | |
unit | 0..1 | CodeableConcept | Individual or family Binding: Unit Type Codes (Example) | |
term | 0..1 | CodeableConcept | Annual or lifetime Binding: Benefit Term Codes (Example) | |
value[x] | Σ | 0..1 | The amount or percentage due from the beneficiary | |
valueQuantity | SimpleQuantity | |||
valueMoney | Money | |||
exception | 0..* | BackboneElement | Exceptions for patient payments | |
type | Σ | 1..1 | CodeableConcept | Exception category Binding: Example Coverage Financial Exception Codes (Example) |
period | Σ | 0..1 | Period | The effective period of the exception |
subrogation | 0..1 | boolean | Reimbursement to insurer | |
contract | 0..* | Reference(Contract) | Contract details | |
insurancePlan | 0..1 | Reference(InsurancePlan) | Insurance plan details | |
Documentation for this format |