Union of http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage and http://hl7.org/fhir/us/bfdr/StructureDefinition/Coverage-principal-payer-delivery

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 Coverage - Principal Payer for Delivery (http://hl7.org/fhir/us/bfdr/StructureDefinition/Coverage-principal-payer-delivery). E.g. what you have to deal with if you get resources conforming to one of them

Structure

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage	C	0..*		Insurance or medical plan or a payment agreement Constraints: us-core-15
meta	Σ	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 Binding: ?? (preferred): A human language.
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	0..*	Identifier	left: Member ID and other identifiers; right: Business Identifier for the coverage
status	?!SΣ	1..1	code	active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance.
type	SΣ	0..1	CodeableConcept	left: Coverage category such as medical or accident; right: The value set contains the list of values used to indicate the principle source of payment for the labor and delivery (from codesystem https://nahdo.org/sopt). Binding: ?? (extensible): left: US Public Health Data Consortium Source of Payment Codes; right: Birth and Fetal Death Financial Class (NCHS)
policyHolder	Σ	0..1	Reference(Patient | RelatedPerson | Organization)	Owner of the policy
subscriber	Σ	0..1	Reference(Patient | RelatedPerson)	Subscriber to the policy
subscriberId	SΣ	0..1	string	ID assigned to the subscriber
beneficiary	SΣ	1..1	Reference(Patient)	Plan beneficiary
dependent	Σ	0..1	string	Dependent number
relationship	S	0..1	CodeableConcept	Beneficiary relationship to the subscriber Binding: ?? (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
period	SΣ	0..1	Period	Coverage start and end dates
payor	SΣ	1..*	Reference(Organization | Patient | RelatedPerson)	Issuer of the policy
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
class	S	0..*	BackboneElement	Additional coverage classifications
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: ?? (extensible): The policy classifications, eg. Group, Plan, Class, etc.
value	Σ	1..1	string	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
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	0..1	CodeableConcept	Cost category Binding: ?? (extensible): The types of services to which patient copayments are specified.
value[x]	Σ	1..1		The amount or percentage due from the beneficiary
valueQuantity			Quantity(SimpleQuantity)
valueMoney			Money
exception		0..*	BackboneElement	Exceptions for patient payments
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
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.
period	Σ	0..1	Period	The effective period of the exception
subrogation		0..1	boolean	Reimbursement to insurer
contract		0..*	Reference(Contract)	Contract details
Documentation for this format