## Union of http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage and http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage

This is the set of resources that conform to either of the profiles US Core Coverage Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage) and HRex Member Match Coverage Profile (http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage). E.g. what you have to deal with if you get resources conforming to one of them

### Structure

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Coverage | C | 0..* |  | Insurance or medical plan or a payment agreement dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management us-core-15: Member Id in Coverage.identifier or Coverage.subscriberId SHALL be present
meta | Σ | 0..1 | Meta | Metadata about the resource ele-1: All FHIR elements must have a @value or children
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
language |  | 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language. ele-1: All FHIR elements must have a @value or children
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation ele-1: All FHIR elements must have a @value or children
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
identifier | S Σ | 0..* | Identifier | Member ID and other identifiers ele-1: All FHIR elements must have a @value or children
status | ?!S Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. ele-1: All FHIR elements must have a @value or children
type | S Σ | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: ?? (extensible): US Public Health Data Consortium Source of Payment Codes ele-1: All FHIR elements must have a @value or children
policyHolder | S Σ | 0..1 | Reference(Patient | RelatedPerson | Organization) | Owner of the policy ele-1: All FHIR elements must have a @value or children
subscriber | Σ | 0..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy ele-1: All FHIR elements must have a @value or children
subscriberId | S Σ | 0..1 | string | left: ID assigned to the subscriber; right: Subscriber ID ele-1: All FHIR elements must have a @value or children
beneficiary | S Σ | 1..1 | Reference(US Core Patient Profile(7.0.0) | #sd-us-core-patient-hrex-patient-demographics) | Plan beneficiary ele-1: All FHIR elements must have a @value or children
dependent | S Σ | 0..1 | string | Dependent number ele-1: All FHIR elements must have a @value or children
relationship | S | 1..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: ?? (extensible) ele-1: All FHIR elements must have a @value or children
period | S Σ | 0..1 | Period | Coverage start and end dates ele-1: All FHIR elements must have a @value or children
payor | S Σ | 1..1 | Reference(US Core Organization Profile(7.0.0) S | US Core Patient Profile(7.0.0) | US Core RelatedPerson Profile(7.0.0) | #sd-us-core-organization-hrex-organization) | Issuer of the policy ele-1: All FHIR elements must have a @value or children
class | S | 0..* | BackboneElement | Additional coverage classifications ele-1: All FHIR elements must have a @value or children
extension |  | 0..* | Extension | Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
type | Σ | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: ?? (extensible): The policy classifications, eg. Group, Plan, Class, etc. ele-1: All FHIR elements must have a @value or children
value | Σ | 1..1 | string | Value associated with the type ele-1: All FHIR elements must have a @value or children
name | Σ | 0..1 | string | Human readable description of the type and value ele-1: All FHIR elements must have a @value or children
order | Σ | 0..1 | positiveInt | Relative order of the coverage ele-1: All FHIR elements must have a @value or children
network | Σ | 0..1 | string | Insurer network ele-1: All FHIR elements must have a @value or children
costToBeneficiary |  | 0..* | BackboneElement | Patient payments for services/products ele-1: All FHIR elements must have a @value or children
extension |  | 0..* | Extension | Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
type | Σ | 0..1 | CodeableConcept | Cost category Binding: ?? (extensible): The types of services to which patient copayments are specified. ele-1: All FHIR elements must have a @value or children
value[x] | Σ | 1..1 |  | The amount or percentage due from the beneficiary ele-1: All FHIR elements must have a @value or children
valueQuantity |  |  | Quantity(SimpleQuantity) |
valueMoney |  |  | Money |
exception |  | 0..* | BackboneElement | Exceptions for patient payments ele-1: All FHIR elements must have a @value or children
extension |  | 0..* | Extension | Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
type | Σ | 1..1 | CodeableConcept | Exception category Binding: ?? (example): The types of exceptions from the part or full value of financial obligations such as copays. ele-1: All FHIR elements must have a @value or children
period | Σ | 0..1 | Period | The effective period of the exception ele-1: All FHIR elements must have a @value or children
subrogation |  | 0..1 | boolean | Reimbursement to insurer ele-1: All FHIR elements must have a @value or children
contract |  | 0..* | Reference(Contract) | Contract details ele-1: All FHIR elements must have a @value or children
Documentation for this format