Definice profilu

Tento profil představuje požadavky na resource Coverage (dále Úhrada) v rámci českého národního projektu interoperability. Úhrada je určena k poskytování identifikátorů informací, které by se objevily na kartě pojištěnce, kterou lze použít k částečné nebo úplné úhradě za poskytování produktů a služeb zdravotní péče. Zároveň tento zdroj lze také použít k registraci „Samoplátce“, kde jednotlivec nebo organizace jsou jiní než pojistitel a přebírají odpovědnost za platbu části či celých nákladů na zdravotní péči.

Důležité atributy

Následuje popis důležitých prvků profilu a jejich použití.

Identifikátor platby

Bussiness identifikátor v rámci pojistného krytí, v případě platby pojišťovnou vyplňte číslo pojistné smlouvy.

Plátce

Informace o plátci léčby. Může se jednat o pojišťovnu, pacienta, osobu blízkou pacientovi nebo jinou organizaci.

Číslo předplatitele (pojištěnce)

Identifikátor předplatitele (pacienta nebo příbuzné osoby), v případě platby pojišťovnou vyplňte číslo pojištěnce.

Náklady pro plátce

Informace o krytí dodatečných nákladů plátcem (tzv. Samoplátce).

Definition of profile

This profile presents the requirements for the Coverage resource within the Czech national interoperability project. Coverage is intended to provide identifiers for information that would appear on an insured person's card, which can be used for partial or full reimbursement for the provision of healthcare products and services. At the same time, this resource can also be used to register "self-payers," where the individual or organization are different from the insurer and assumes responsibility for paying some or all of the health care costs.

Important elements

The following is a description of the most important profile elements and how they are used.

Identifier

Business identifier of the coverage. In the event of payment by an insurance company, enter the insurance assignment number (also known as Číslo pojistné smlouvy).

Payor

Information about the payor of the treatment. This could be an insurance company, a patient, a related person of patient or an another organisation.

SubscriberID

Identifier of the subscriber (patient or related person). In the event of payment by an insurance company, enter the insured person's number (also known as Číslo pojištěnce).

CostToBeneficiary

Information about the extra costs that are paid for by the payor (also known as Samoplátce).

• Key Elements Table
• Differential Table
• Snapshot Table
• Statistics/References
• All

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage		0..*	Coverage	Czech coverage
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business identifier of the coverage. In the event of payment by an insurance company, enter the insurance assignment number (also known as Číslo pojistné smlouvy).
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	SΣ	0..1	CodeableConcept	Coverage category such as medical or accident Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
coding	Σ	0..*	Coding	Code defined by a terminology system Binding: CoverageTypeAndSelf-PayCodes (required)
policyHolder	Σ	0..1	Reference(Patient (CZ core) | Related Person (CZ core) | Organization (CZ core))	Owner of the policy
subscriber	Σ	0..1	Reference(Patient (CZ core) | Related Person (CZ core))	Subscriber to the policy
subscriberId	Σ	0..1	string	Identifier of the subscriber (patient or related person). In the event of payment by an insurance company, enter the insured person's number (also known as Číslo pojištěnce).
beneficiary	Σ	1..1	Reference(Patient (CZ core))	Plan beneficiary
payor	Σ	1..*	Reference(Patient (CZ core) | Organization (CZ core) | Related Person (CZ core))	Information about the payor of the treatment. This could be an insurance company, a patient, a related person of patient or an another organisation.
costToBeneficiary		0..*	BackboneElement	Information about the extra costs that are paid for by the payor (also known as Samoplátce).
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
value[x]	Σ	1..1		The amount or percentage due from the beneficiary
valueQuantity			Quantity(SimpleQuantity)
valueMoney			Money
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Coverage.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.0.1 From the FHIR Standard
Coverage.type	preferred	CoverageTypeAndSelf-PayCodes http://hl7.org/fhir/ValueSet/coverage-type|4.0.1 From the FHIR Standard
Coverage.type.coding	required	CoverageTypeAndSelf-PayCodes http://hl7.org/fhir/ValueSet/coverage-type From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Coverage	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Coverage	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 : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Coverage	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Coverage	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Coverage	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from Coverage

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage		0..*	Coverage	Czech coverage
identifier		0..*	Identifier	Business identifier of the coverage. In the event of payment by an insurance company, enter the insurance assignment number (also known as Číslo pojistné smlouvy).
type	S	0..1	CodeableConcept	Coverage category such as medical or accident
coding		0..*	Coding	Code defined by a terminology system Binding: CoverageTypeAndSelf-PayCodes (required)
policyHolder		0..1	Reference(Patient (CZ core) | Related Person (CZ core) | Organization (CZ core))	Owner of the policy
subscriber		0..1	Reference(Patient (CZ core) | Related Person (CZ core))	Subscriber to the policy
subscriberId		0..1	string	Identifier of the subscriber (patient or related person). In the event of payment by an insurance company, enter the insured person's number (also known as Číslo pojištěnce).
beneficiary		1..1	Reference(Patient (CZ core))	Plan beneficiary
payor		1..*	Reference(Patient (CZ core) | Organization (CZ core) | Related Person (CZ core))	Information about the payor of the treatment. This could be an insurance company, a patient, a related person of patient or an another organisation.
costToBeneficiary		0..*	BackboneElement	Information about the extra costs that are paid for by the payor (also known as Samoplátce).
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Coverage.type.coding	required	CoverageTypeAndSelf-PayCodes http://hl7.org/fhir/ValueSet/coverage-type From the FHIR Standard

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage		0..*	Coverage	Czech coverage
id	Σ	0..1	id	Logical id of this artifact
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: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
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	Σ	0..*	Identifier	Business identifier of the coverage. In the event of payment by an insurance company, enter the insurance assignment number (also known as Číslo pojistné smlouvy).
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	SΣ	0..1	CodeableConcept	Coverage category such as medical or accident Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system Binding: CoverageTypeAndSelf-PayCodes (required)
text	Σ	0..1	string	Plain text representation of the concept
policyHolder	Σ	0..1	Reference(Patient (CZ core) | Related Person (CZ core) | Organization (CZ core))	Owner of the policy
subscriber	Σ	0..1	Reference(Patient (CZ core) | Related Person (CZ core))	Subscriber to the policy
subscriberId	Σ	0..1	string	Identifier of the subscriber (patient or related person). In the event of payment by an insurance company, enter the insured person's number (also known as Číslo pojištěnce).
beneficiary	Σ	1..1	Reference(Patient (CZ core))	Plan beneficiary
dependent	Σ	0..1	string	Dependent number
relationship		0..1	CodeableConcept	Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
period	Σ	0..1	Period	Coverage start and end dates
payor	Σ	1..*	Reference(Patient (CZ core) | Organization (CZ core) | Related Person (CZ core))	Information about the payor of the treatment. This could be an insurance company, a patient, a related person of patient or an another organisation.
class		0..*	BackboneElement	Additional coverage classifications
id		0..1	string	Unique id for inter-element referencing
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: CoverageClassCodes (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	Information about the extra costs that are paid for by the payor (also known as Samoplátce).
id		0..1	string	Unique id for inter-element referencing
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: CoverageCopayTypeCodes (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
id		0..1	string	Unique id for inter-element referencing
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: ExampleCoverageFinancialExceptionCodes (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

Terminology Bindings

Path	Conformance	ValueSet	URI
Coverage.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages|4.0.1 From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Coverage.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.0.1 From the FHIR Standard
Coverage.type	preferred	CoverageTypeAndSelf-PayCodes http://hl7.org/fhir/ValueSet/coverage-type|4.0.1 From the FHIR Standard
Coverage.type.coding	required	CoverageTypeAndSelf-PayCodes http://hl7.org/fhir/ValueSet/coverage-type From the FHIR Standard
Coverage.relationship	extensible	SubscriberRelationshipCodes http://hl7.org/fhir/ValueSet/subscriber-relationship|4.0.1 From the FHIR Standard
Coverage.class.type	extensible	CoverageClassCodes http://hl7.org/fhir/ValueSet/coverage-class|4.0.1 From the FHIR Standard
Coverage.costToBeneficiary.type	extensible	CoverageCopayTypeCodes http://hl7.org/fhir/ValueSet/coverage-copay-type|4.0.1 From the FHIR Standard
Coverage.costToBeneficiary.exception.type	example	ExampleCoverageFinancialExceptionCodes http://hl7.org/fhir/ValueSet/coverage-financial-exception|4.0.1 From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Coverage	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Coverage	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 : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Coverage	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Coverage	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Coverage	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage		0..*	Coverage	Czech coverage
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business identifier of the coverage. In the event of payment by an insurance company, enter the insurance assignment number (also known as Číslo pojistné smlouvy).
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	SΣ	0..1	CodeableConcept	Coverage category such as medical or accident Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
coding	Σ	0..*	Coding	Code defined by a terminology system Binding: CoverageTypeAndSelf-PayCodes (required)
policyHolder	Σ	0..1	Reference(Patient (CZ core) | Related Person (CZ core) | Organization (CZ core))	Owner of the policy
subscriber	Σ	0..1	Reference(Patient (CZ core) | Related Person (CZ core))	Subscriber to the policy
subscriberId	Σ	0..1	string	Identifier of the subscriber (patient or related person). In the event of payment by an insurance company, enter the insured person's number (also known as Číslo pojištěnce).
beneficiary	Σ	1..1	Reference(Patient (CZ core))	Plan beneficiary
payor	Σ	1..*	Reference(Patient (CZ core) | Organization (CZ core) | Related Person (CZ core))	Information about the payor of the treatment. This could be an insurance company, a patient, a related person of patient or an another organisation.
costToBeneficiary		0..*	BackboneElement	Information about the extra costs that are paid for by the payor (also known as Samoplátce).
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
value[x]	Σ	1..1		The amount or percentage due from the beneficiary
valueQuantity			Quantity(SimpleQuantity)
valueMoney			Money
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Coverage.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.0.1 From the FHIR Standard
Coverage.type	preferred	CoverageTypeAndSelf-PayCodes http://hl7.org/fhir/ValueSet/coverage-type|4.0.1 From the FHIR Standard
Coverage.type.coding	required	CoverageTypeAndSelf-PayCodes http://hl7.org/fhir/ValueSet/coverage-type From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Coverage	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Coverage	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 : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Coverage	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Coverage	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Coverage	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Differential View

This structure is derived from Coverage

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage		0..*	Coverage	Czech coverage
identifier		0..*	Identifier	Business identifier of the coverage. In the event of payment by an insurance company, enter the insurance assignment number (also known as Číslo pojistné smlouvy).
type	S	0..1	CodeableConcept	Coverage category such as medical or accident
coding		0..*	Coding	Code defined by a terminology system Binding: CoverageTypeAndSelf-PayCodes (required)
policyHolder		0..1	Reference(Patient (CZ core) | Related Person (CZ core) | Organization (CZ core))	Owner of the policy
subscriber		0..1	Reference(Patient (CZ core) | Related Person (CZ core))	Subscriber to the policy
subscriberId		0..1	string	Identifier of the subscriber (patient or related person). In the event of payment by an insurance company, enter the insured person's number (also known as Číslo pojištěnce).
beneficiary		1..1	Reference(Patient (CZ core))	Plan beneficiary
payor		1..*	Reference(Patient (CZ core) | Organization (CZ core) | Related Person (CZ core))	Information about the payor of the treatment. This could be an insurance company, a patient, a related person of patient or an another organisation.
costToBeneficiary		0..*	BackboneElement	Information about the extra costs that are paid for by the payor (also known as Samoplátce).
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Coverage.type.coding	required	CoverageTypeAndSelf-PayCodes http://hl7.org/fhir/ValueSet/coverage-type From the FHIR Standard

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage		0..*	Coverage	Czech coverage
id	Σ	0..1	id	Logical id of this artifact
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: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
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	Σ	0..*	Identifier	Business identifier of the coverage. In the event of payment by an insurance company, enter the insurance assignment number (also known as Číslo pojistné smlouvy).
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	SΣ	0..1	CodeableConcept	Coverage category such as medical or accident Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system Binding: CoverageTypeAndSelf-PayCodes (required)
text	Σ	0..1	string	Plain text representation of the concept
policyHolder	Σ	0..1	Reference(Patient (CZ core) | Related Person (CZ core) | Organization (CZ core))	Owner of the policy
subscriber	Σ	0..1	Reference(Patient (CZ core) | Related Person (CZ core))	Subscriber to the policy
subscriberId	Σ	0..1	string	Identifier of the subscriber (patient or related person). In the event of payment by an insurance company, enter the insured person's number (also known as Číslo pojištěnce).
beneficiary	Σ	1..1	Reference(Patient (CZ core))	Plan beneficiary
dependent	Σ	0..1	string	Dependent number
relationship		0..1	CodeableConcept	Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
period	Σ	0..1	Period	Coverage start and end dates
payor	Σ	1..*	Reference(Patient (CZ core) | Organization (CZ core) | Related Person (CZ core))	Information about the payor of the treatment. This could be an insurance company, a patient, a related person of patient or an another organisation.
class		0..*	BackboneElement	Additional coverage classifications
id		0..1	string	Unique id for inter-element referencing
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: CoverageClassCodes (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	Information about the extra costs that are paid for by the payor (also known as Samoplátce).
id		0..1	string	Unique id for inter-element referencing
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: CoverageCopayTypeCodes (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
id		0..1	string	Unique id for inter-element referencing
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: ExampleCoverageFinancialExceptionCodes (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

Terminology Bindings

Path	Conformance	ValueSet	URI
Coverage.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages|4.0.1 From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Coverage.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.0.1 From the FHIR Standard
Coverage.type	preferred	CoverageTypeAndSelf-PayCodes http://hl7.org/fhir/ValueSet/coverage-type|4.0.1 From the FHIR Standard
Coverage.type.coding	required	CoverageTypeAndSelf-PayCodes http://hl7.org/fhir/ValueSet/coverage-type From the FHIR Standard
Coverage.relationship	extensible	SubscriberRelationshipCodes http://hl7.org/fhir/ValueSet/subscriber-relationship|4.0.1 From the FHIR Standard
Coverage.class.type	extensible	CoverageClassCodes http://hl7.org/fhir/ValueSet/coverage-class|4.0.1 From the FHIR Standard
Coverage.costToBeneficiary.type	extensible	CoverageCopayTypeCodes http://hl7.org/fhir/ValueSet/coverage-copay-type|4.0.1 From the FHIR Standard
Coverage.costToBeneficiary.exception.type	example	ExampleCoverageFinancialExceptionCodes http://hl7.org/fhir/ValueSet/coverage-financial-exception|4.0.1 From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Coverage	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Coverage	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 : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Coverage	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Coverage	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Coverage	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from Coverage

Summary

Must-Support: 1 element

Structures

This structure refers to these other structures:

• Patient (CZ core) (https://hl7.cz/fhir/core/StructureDefinition/cz-patient-core)
• Related Person (CZ core) (https://hl7.cz/fhir/core/StructureDefinition/cz-relatedPerson-core)
• Organization (CZ core) (https://hl7.cz/fhir/core/StructureDefinition/cz-organization-core)

Maturity: 0