HL7® FHIR® New Zealand Base Implementation Guide
1.1.0 - CI Build
HL7® FHIR® New Zealand Base Implementation Guide, published by HL7 New Zealand. This is not an authorized publication; it is the continuous build for version 1.1.0). This version is based on the current content of https://github.com/HL7NZ/nzbase/ and changes regularly. See the Directory of published versions
Official URL: http://hl7.org.nz/fhir/StructureDefinition/NzCoverage | Version: 1.1.0 | |||
Standards status: Trial-use |
Realm: |
Computable Name: NzCoverage |
Coverage resource for use in NZ
Profile on Coverage for NZ use. Primarily changing the type valueset
Usage:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from Coverage
This structure is derived from Coverage
Name | Flags | Card. | Type | Description & Constraints![]() |
---|---|---|---|---|
![]() ![]() | 0..* | Coverage | Insurance or medical plan or a payment agreement | |
![]() ![]() ![]() | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: CoverageType type VS (preferred) | |
![]() ![]() ![]() | ||||
![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: https://nzhts.digital.health.nz/fhir/ValueSet/coverage-category-code (extensible) | |
![]() |
Name | Flags | Card. | Type | Description & Constraints![]() | ||||
---|---|---|---|---|---|---|---|---|
![]() ![]() | 0..* | Coverage | Insurance or medical plan or a payment agreement | |||||
![]() ![]() ![]() | Σ | 0..1 | string | Logical id of this artifact | ||||
![]() ![]() ![]() | Σ | 0..1 | Meta | Metadata about the resource | ||||
![]() ![]() ![]() | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
![]() ![]() ![]() | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
![]() ![]() ![]() | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
![]() ![]() ![]() | 0..* | Resource | Contained, inline Resources | |||||
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() | ?! | 0..* | Extension | Extensions that cannot be ignored | ||||
![]() ![]() ![]() | Σ | 0..* | Identifier | Business Identifier for the coverage | ||||
![]() ![]() ![]() | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | ||||
![]() ![]() ![]() | Σ | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: CoverageType type VS (preferred) | ||||
![]() ![]() ![]() | Σ | 0..1 | Reference(Patient | RelatedPerson | Organization) | Owner of the policy | ||||
![]() ![]() ![]() | Σ | 0..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy | ||||
![]() ![]() ![]() | Σ | 0..1 | string | ID assigned to the subscriber | ||||
![]() ![]() ![]() | Σ | 1..1 | Reference(Patient) | Plan beneficiary | ||||
![]() ![]() ![]() | Σ | 0..1 | string | Dependent number | ||||
![]() ![]() ![]() | 0..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). | |||||
![]() ![]() ![]() | Σ | 0..1 | Period | Coverage start and end dates | ||||
![]() ![]() ![]() | Σ | 1..* | Reference(Organization | Patient | RelatedPerson) | Issuer of the policy | ||||
![]() ![]() ![]() | 0..* | BackboneElement | Additional coverage classifications | |||||
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() | Σ | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: https://nzhts.digital.health.nz/fhir/ValueSet/coverage-category-code (extensible) | ||||
![]() ![]() ![]() ![]() | Σ | 1..1 | string | Value associated with the type | ||||
![]() ![]() ![]() ![]() | Σ | 0..1 | string | Human readable description of the type and value | ||||
![]() ![]() ![]() | Σ | 0..1 | positiveInt | Relative order of the coverage | ||||
![]() ![]() ![]() | Σ | 0..1 | string | Insurer network | ||||
![]() ![]() ![]() | 0..* | BackboneElement | Patient payments for services/products | |||||
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() | Σ | 0..1 | CodeableConcept | Cost category Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified. | ||||
![]() ![]() ![]() ![]() | Σ | 1..1 | The amount or percentage due from the beneficiary | |||||
![]() ![]() ![]() ![]() ![]() | Quantity(SimpleQuantity) | |||||||
![]() ![]() ![]() ![]() ![]() | Money | |||||||
![]() ![]() ![]() ![]() | 0..* | BackboneElement | Exceptions for patient payments | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() | Σ | 1..1 | CodeableConcept | Exception category Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays. | ||||
![]() ![]() ![]() ![]() ![]() | Σ | 0..1 | Period | The effective period of the exception | ||||
![]() ![]() ![]() | 0..1 | boolean | Reimbursement to insurer | |||||
![]() ![]() ![]() | 0..* | Reference(Contract) | Contract details | |||||
![]() |
Name | Flags | Card. | Type | Description & Constraints![]() |
---|---|---|---|---|
![]() ![]() | 0..* | Coverage | Insurance or medical plan or a payment agreement | |
![]() |
This structure is derived from Coverage
Differential View
This structure is derived from Coverage
Name | Flags | Card. | Type | Description & Constraints![]() |
---|---|---|---|---|
![]() ![]() | 0..* | Coverage | Insurance or medical plan or a payment agreement | |
![]() ![]() ![]() | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: CoverageType type VS (preferred) | |
![]() ![]() ![]() | ||||
![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: https://nzhts.digital.health.nz/fhir/ValueSet/coverage-category-code (extensible) | |
![]() |
Snapshot View
Name | Flags | Card. | Type | Description & Constraints![]() | ||||
---|---|---|---|---|---|---|---|---|
![]() ![]() | 0..* | Coverage | Insurance or medical plan or a payment agreement | |||||
![]() ![]() ![]() | Σ | 0..1 | string | Logical id of this artifact | ||||
![]() ![]() ![]() | Σ | 0..1 | Meta | Metadata about the resource | ||||
![]() ![]() ![]() | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
![]() ![]() ![]() | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
![]() ![]() ![]() | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
![]() ![]() ![]() | 0..* | Resource | Contained, inline Resources | |||||
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() | ?! | 0..* | Extension | Extensions that cannot be ignored | ||||
![]() ![]() ![]() | Σ | 0..* | Identifier | Business Identifier for the coverage | ||||
![]() ![]() ![]() | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | ||||
![]() ![]() ![]() | Σ | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: CoverageType type VS (preferred) | ||||
![]() ![]() ![]() | Σ | 0..1 | Reference(Patient | RelatedPerson | Organization) | Owner of the policy | ||||
![]() ![]() ![]() | Σ | 0..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy | ||||
![]() ![]() ![]() | Σ | 0..1 | string | ID assigned to the subscriber | ||||
![]() ![]() ![]() | Σ | 1..1 | Reference(Patient) | Plan beneficiary | ||||
![]() ![]() ![]() | Σ | 0..1 | string | Dependent number | ||||
![]() ![]() ![]() | 0..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). | |||||
![]() ![]() ![]() | Σ | 0..1 | Period | Coverage start and end dates | ||||
![]() ![]() ![]() | Σ | 1..* | Reference(Organization | Patient | RelatedPerson) | Issuer of the policy | ||||
![]() ![]() ![]() | 0..* | BackboneElement | Additional coverage classifications | |||||
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() | Σ | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: https://nzhts.digital.health.nz/fhir/ValueSet/coverage-category-code (extensible) | ||||
![]() ![]() ![]() ![]() | Σ | 1..1 | string | Value associated with the type | ||||
![]() ![]() ![]() ![]() | Σ | 0..1 | string | Human readable description of the type and value | ||||
![]() ![]() ![]() | Σ | 0..1 | positiveInt | Relative order of the coverage | ||||
![]() ![]() ![]() | Σ | 0..1 | string | Insurer network | ||||
![]() ![]() ![]() | 0..* | BackboneElement | Patient payments for services/products | |||||
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() | Σ | 0..1 | CodeableConcept | Cost category Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified. | ||||
![]() ![]() ![]() ![]() | Σ | 1..1 | The amount or percentage due from the beneficiary | |||||
![]() ![]() ![]() ![]() ![]() | Quantity(SimpleQuantity) | |||||||
![]() ![]() ![]() ![]() ![]() | Money | |||||||
![]() ![]() ![]() ![]() | 0..* | BackboneElement | Exceptions for patient payments | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() | Σ | 1..1 | CodeableConcept | Exception category Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays. | ||||
![]() ![]() ![]() ![]() ![]() | Σ | 0..1 | Period | The effective period of the exception | ||||
![]() ![]() ![]() | 0..1 | boolean | Reimbursement to insurer | |||||
![]() ![]() ![]() | 0..* | Reference(Contract) | Contract details | |||||
![]() |
Other representations of profile: CSV, Excel, Schematron
Path | Conformance | ValueSet |
Coverage.language | preferred | CommonLanguages Max Binding: AllLanguages |
Coverage.status | required | FinancialResourceStatusCodes |
Coverage.type | preferred | CoverageType |
Coverage.relationship | extensible | SubscriberRelationshipCodes |
Coverage.class.type | extensible | https://nzhts.digital.health.nz/fhir/ValueSet/coverage-category-code |
Coverage.costToBeneficiary.type | extensible | CoverageCopayTypeCodes |
Coverage.costToBeneficiary.exception.type | example | ExampleCoverageFinancialExceptionCodes |