HL7® FHIR® New Zealand Base Implementation Guide
3.2.0-ci-build - Draft

HL7® FHIR® New Zealand Base Implementation Guide, published by HL7 New Zealand. This guide is not an authorized publication; it is the continuous build for version 3.2.0-ci-build built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7NZ/nzbase/ and changes regularly. See the Directory of published versions

Resource Profile: Coverage resource for use in NZ (Trial use)

Official URL: http://hl7.org.nz/fhir/StructureDefinition/NzCoverage Version: 1.0.0
Draft as of 2026-10-15 Computable Name: NzCoverage

Coverage resource for use in NZ (Trial use)

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description Differentials, Snapshots, and other representations.

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Coverage 0..* Coverage Insurance or medical plan or a payment agreement
Coverage.implicitRules This element is a modifier element. This element is included in summaries. 0..1 uri A set of rules under which this content was created
Coverage.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored
Coverage.status This element is a modifier element. This element is included in summaries. 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Coverage.type This element is included in summaries. 0..1 CodeableConcept Coverage category such as medical or accident
Binding: Coverage Type (extensible)
Coverage.beneficiary This element is included in summaries. 1..1 Reference(Patient) Plan beneficiary
Coverage.payor This element is included in summaries. 1..* Reference(Organization | Patient | RelatedPerson) Issuer of the policy

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Coverage.type Base extensible Coverage Type 📦1.1.0 This IG

Constraints

Id Grade Path(s) Description Expression

This structure is derived from Coverage

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Coverage 0..* Coverage Insurance or medical plan or a payment agreement
Coverage.type 0..1 CodeableConcept Coverage category such as medical or accident
Binding: Coverage Type (extensible)
Coverage.class
Coverage.class.type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: Coverage Category (extensible)

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Coverage.type Base extensible Coverage Type 📦1.1.0 This IG
Coverage.class.type Base extensible Coverage Category 📦1.0.0 This IG
NameFlagsCard.TypeDescription & Constraints    Filter: doco
Coverage 0..* Coverage Insurance or medical plan or a payment agreement
Coverage.id This element is included in summaries. 0..1 id Logical id of this artifact
Coverage.meta This element is included in summaries. 0..1 Meta Metadata about the resource
Coverage.implicitRules This element is a modifier element. This element is included in summaries. 0..1 uri A set of rules under which this content was created
Coverage.language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
Coverage.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
Coverage.contained 0..* Resource Contained, inline Resources
Coverage.extension 0..* Extension Additional content defined by implementations
Coverage.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored
Coverage.identifier This element is included in summaries. 0..* Identifier Business Identifier for the coverage
Coverage.status This element is a modifier element. This element is included in summaries. 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Coverage.type This element is included in summaries. 0..1 CodeableConcept Coverage category such as medical or accident
Binding: Coverage Type (extensible)
Coverage.policyHolder This element is included in summaries. 0..1 Reference(Patient | RelatedPerson | Organization) Owner of the policy
Coverage.subscriber This element is included in summaries. 0..1 Reference(Patient | RelatedPerson) Subscriber to the policy
Coverage.subscriberId This element is included in summaries. 0..1 string ID assigned to the subscriber
Coverage.beneficiary This element is included in summaries. 1..1 Reference(Patient) Plan beneficiary
Coverage.dependent This element is included in summaries. 0..1 string Dependent number
Coverage.relationship 0..1 CodeableConcept Beneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
Coverage.period This element is included in summaries. 0..1 Period Coverage start and end dates
Coverage.payor This element is included in summaries. 1..* Reference(Organization | Patient | RelatedPerson) Issuer of the policy
Coverage.class 0..* BackboneElement Additional coverage classifications
Coverage.class.id 0..1 string Unique id for inter-element referencing
Coverage.class.extension 0..* Extension Additional content defined by implementations
Coverage.class.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Coverage.class.type This element is included in summaries. 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: Coverage Category (extensible)
Coverage.class.value This element is included in summaries. 1..1 string Value associated with the type
Coverage.class.name This element is included in summaries. 0..1 string Human readable description of the type and value
Coverage.order This element is included in summaries. 0..1 positiveInt Relative order of the coverage
Coverage.network This element is included in summaries. 0..1 string Insurer network
Coverage.costToBeneficiary 0..* BackboneElement Patient payments for services/products
Coverage.costToBeneficiary.id 0..1 string Unique id for inter-element referencing
Coverage.costToBeneficiary.extension 0..* Extension Additional content defined by implementations
Coverage.costToBeneficiary.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Coverage.costToBeneficiary.type This element is included in summaries. 0..1 CodeableConcept Cost category
Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
Coverage.costToBeneficiary.value[x] This element is included in summaries. 1..1 The amount or percentage due from the beneficiary
Coverage.costToBeneficiary.value[x].valueQuantity Quantity(SimpleQuantity)
Coverage.costToBeneficiary.value[x].valueMoney Money
Coverage.costToBeneficiary.exception 0..* BackboneElement Exceptions for patient payments
Coverage.costToBeneficiary.exception.id 0..1 string Unique id for inter-element referencing
Coverage.costToBeneficiary.exception.extension 0..* Extension Additional content defined by implementations
Coverage.costToBeneficiary.exception.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Coverage.costToBeneficiary.exception.type This element is included in summaries. 1..1 CodeableConcept Exception category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
Coverage.costToBeneficiary.exception.period This element is included in summaries. 0..1 Period The effective period of the exception
Coverage.subrogation 0..1 boolean Reimbursement to insurer
Coverage.contract 0..* Reference(Contract) Contract details

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.language Base preferred Common Languages 📍4.0.1 FHIR Std.
Coverage.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Coverage.type Base extensible Coverage Type 📦1.1.0 This IG
Coverage.relationship Base extensible SubscriberPolicyholder Relationship Codes 📍4.0.1 FHIR Std.
Coverage.class.type Base extensible Coverage Category 📦1.0.0 This IG
Coverage.costToBeneficiary.​type Base extensible Coverage Copay Type Codes 📍4.0.1 FHIR Std.
Coverage.costToBeneficiary.​exception.type Base example Example Coverage Financial Exception Codes 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression

This structure is derived from Coverage

Summary

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Coverage 0..* Coverage Insurance or medical plan or a payment agreement
Coverage.implicitRules This element is a modifier element. This element is included in summaries. 0..1 uri A set of rules under which this content was created
Coverage.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored
Coverage.status This element is a modifier element. This element is included in summaries. 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Coverage.type This element is included in summaries. 0..1 CodeableConcept Coverage category such as medical or accident
Binding: Coverage Type (extensible)
Coverage.beneficiary This element is included in summaries. 1..1 Reference(Patient) Plan beneficiary
Coverage.payor This element is included in summaries. 1..* Reference(Organization | Patient | RelatedPerson) Issuer of the policy

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Coverage.type Base extensible Coverage Type 📦1.1.0 This IG

Constraints

Id Grade Path(s) Description Expression

Differential View

This structure is derived from Coverage

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Coverage 0..* Coverage Insurance or medical plan or a payment agreement
Coverage.type 0..1 CodeableConcept Coverage category such as medical or accident
Binding: Coverage Type (extensible)
Coverage.class
Coverage.class.type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: Coverage Category (extensible)

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Coverage.type Base extensible Coverage Type 📦1.1.0 This IG
Coverage.class.type Base extensible Coverage Category 📦1.0.0 This IG

Snapshot ViewView

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Coverage 0..* Coverage Insurance or medical plan or a payment agreement
Coverage.id This element is included in summaries. 0..1 id Logical id of this artifact
Coverage.meta This element is included in summaries. 0..1 Meta Metadata about the resource
Coverage.implicitRules This element is a modifier element. This element is included in summaries. 0..1 uri A set of rules under which this content was created
Coverage.language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
Coverage.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
Coverage.contained 0..* Resource Contained, inline Resources
Coverage.extension 0..* Extension Additional content defined by implementations
Coverage.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored
Coverage.identifier This element is included in summaries. 0..* Identifier Business Identifier for the coverage
Coverage.status This element is a modifier element. This element is included in summaries. 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Coverage.type This element is included in summaries. 0..1 CodeableConcept Coverage category such as medical or accident
Binding: Coverage Type (extensible)
Coverage.policyHolder This element is included in summaries. 0..1 Reference(Patient | RelatedPerson | Organization) Owner of the policy
Coverage.subscriber This element is included in summaries. 0..1 Reference(Patient | RelatedPerson) Subscriber to the policy
Coverage.subscriberId This element is included in summaries. 0..1 string ID assigned to the subscriber
Coverage.beneficiary This element is included in summaries. 1..1 Reference(Patient) Plan beneficiary
Coverage.dependent This element is included in summaries. 0..1 string Dependent number
Coverage.relationship 0..1 CodeableConcept Beneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
Coverage.period This element is included in summaries. 0..1 Period Coverage start and end dates
Coverage.payor This element is included in summaries. 1..* Reference(Organization | Patient | RelatedPerson) Issuer of the policy
Coverage.class 0..* BackboneElement Additional coverage classifications
Coverage.class.id 0..1 string Unique id for inter-element referencing
Coverage.class.extension 0..* Extension Additional content defined by implementations
Coverage.class.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Coverage.class.type This element is included in summaries. 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: Coverage Category (extensible)
Coverage.class.value This element is included in summaries. 1..1 string Value associated with the type
Coverage.class.name This element is included in summaries. 0..1 string Human readable description of the type and value
Coverage.order This element is included in summaries. 0..1 positiveInt Relative order of the coverage
Coverage.network This element is included in summaries. 0..1 string Insurer network
Coverage.costToBeneficiary 0..* BackboneElement Patient payments for services/products
Coverage.costToBeneficiary.id 0..1 string Unique id for inter-element referencing
Coverage.costToBeneficiary.extension 0..* Extension Additional content defined by implementations
Coverage.costToBeneficiary.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Coverage.costToBeneficiary.type This element is included in summaries. 0..1 CodeableConcept Cost category
Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
Coverage.costToBeneficiary.value[x] This element is included in summaries. 1..1 The amount or percentage due from the beneficiary
Coverage.costToBeneficiary.value[x].valueQuantity Quantity(SimpleQuantity)
Coverage.costToBeneficiary.value[x].valueMoney Money
Coverage.costToBeneficiary.exception 0..* BackboneElement Exceptions for patient payments
Coverage.costToBeneficiary.exception.id 0..1 string Unique id for inter-element referencing
Coverage.costToBeneficiary.exception.extension 0..* Extension Additional content defined by implementations
Coverage.costToBeneficiary.exception.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Coverage.costToBeneficiary.exception.type This element is included in summaries. 1..1 CodeableConcept Exception category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
Coverage.costToBeneficiary.exception.period This element is included in summaries. 0..1 Period The effective period of the exception
Coverage.subrogation 0..1 boolean Reimbursement to insurer
Coverage.contract 0..* Reference(Contract) Contract details

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.language Base preferred Common Languages 📍4.0.1 FHIR Std.
Coverage.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Coverage.type Base extensible Coverage Type 📦1.1.0 This IG
Coverage.relationship Base extensible SubscriberPolicyholder Relationship Codes 📍4.0.1 FHIR Std.
Coverage.class.type Base extensible Coverage Category 📦1.0.0 This IG
Coverage.costToBeneficiary.​type Base extensible Coverage Copay Type Codes 📍4.0.1 FHIR Std.
Coverage.costToBeneficiary.​exception.type Base example Example Coverage Financial Exception Codes 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression

This structure is derived from Coverage

Summary

 

Other representations of profile: CSV, Excel, Schematron