VRIS - Viljatusravi infosüsteem
0.1.0 - draft

VRIS - Viljatusravi infosüsteem, published by TEHIK. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/TEHIK-EE/ig-ee-vris/ and changes regularly. See the Directory of published versions

## Resource Profile: Coverage: EE VRIS Coverage

Official URL: https://fhir.ee/vris/StructureDefinition/ee-vris-coverage | Version: 0.1.0
Draft as of 2026-07-16 | Computable Name: EEVRISCoverage

Coverage profile for fertility treatment in Estonian VRIS. Identifies the payer of treatment (Health Insurance Fund or self-pay). (ee Viljatusravi rahastamise allikas, Tervisekassa või omaosalus. KAS teeme selle profiiliga või lihtsa extensioni?)

Usages:

- This Profile is not used by any profiles in this Specification

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

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

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Coverage |  | 0..* | Coverage | Insurance or medical plan or a payment agreement
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
contained |  | 0..* | Resource | Contained, inline Resources
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | (ee Kindlustuse identifikaator)
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
kind | Σ | 1..1 | code | (ee Kindlustuse liik insurance / self-pay / other) Binding: Kind (required)
paymentBy |  | 0..* | BackboneElement | (ee Kes maksab, kas patsient ise või kolmas osapool)
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
party | Σ | 1..1 | Reference(Patient | RelatedPerson | Organization) | (ee Maksja viide. Siia Tervisekassa)
beneficiary | Σ | 1..1 | Reference(Patient: EE VRIS Recipient | EE MPI Patient Verified) | (ee Kindlustushüvitise saaja on patsient, kes ravi saab)
period | Σ | 0..1 | Period | (ee Kindlustuse kehtivuse periood)
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Coverage.status | Base | required | Financial Resource Status Codes | 📍5.0.0 | FHIR Std.
Coverage.kind | Base | required | Kind | 📍5.0.0 | FHIR Std.
Coverage.class.type | Base | extensible | Coverage Class Codes | 📍5.0.0 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(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 | Insurance or medical plan or a payment agreement
identifier |  | 0..* | Identifier | (ee Kindlustuse identifikaator)
kind |  | 1..1 | code | (ee Kindlustuse liik insurance / self-pay / other)
paymentBy |  | 0..* | BackboneElement | (ee Kes maksab, kas patsient ise või kolmas osapool)
party |  | 1..1 | Reference(Patient | RelatedPerson | Organization) | (ee Maksja viide. Siia Tervisekassa)
type |  | 0..0 |  | Coverage category such as medical or accident
policyHolder |  | 0..0 |  | Owner of the policy
subscriber |  | 0..0 |  | Subscriber to the policy
subscriberId |  | 0..0 |  | ID assigned to the subscriber
beneficiary |  | 1..1 | Reference(Patient: EE VRIS Recipient | EE MPI Patient Verified) | (ee Kindlustushüvitise saaja on patsient, kes ravi saab)
dependent |  | 0..0 |  | Dependent number
relationship |  | 0..0 |  | Beneficiary relationship to the subscriber
period |  | 0..1 | Period | (ee Kindlustuse kehtivuse periood)
insurer |  | 0..0 |  | Issuer of the policy
class |  | 0..0 |  | Additional coverage classifications
order |  | 0..0 |  | Relative order of the coverage
network |  | 0..0 |  | Insurer network
costToBeneficiary |  | 0..0 |  | Patient payments for services/products
subrogation |  | 0..0 |  | Reimbursement to insurer
contract |  | 0..0 |  | Contract details
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Coverage |  | 0..* | Coverage | Insurance or medical plan or a payment agreement
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: AllLanguages (required): IETF language tag for a human language
Additional Bindings | Purpose
CommonLanguages | Starter
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 | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | (ee Kindlustuse identifikaator)
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
kind | Σ | 1..1 | code | (ee Kindlustuse liik insurance / self-pay / other) Binding: Kind (required)
paymentBy |  | 0..* | BackboneElement | (ee Kes maksab, kas patsient ise või kolmas osapool)
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
party | Σ | 1..1 | Reference(Patient | RelatedPerson | Organization) | (ee Maksja viide. Siia Tervisekassa)
responsibility | Σ | 0..1 | string | Party's responsibility
beneficiary | Σ | 1..1 | Reference(Patient: EE VRIS Recipient | EE MPI Patient Verified) | (ee Kindlustushüvitise saaja on patsient, kes ravi saab)
period | Σ | 0..1 | Period | (ee Kindlustuse kehtivuse periood)
insurancePlan |  | 0..1 | Reference(InsurancePlan) | Insurance plan details
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Coverage.language | Base | required | All Languages | 📍5.0.0 | FHIR Std.
Coverage.status | Base | required | Financial Resource Status Codes | 📍5.0.0 | FHIR Std.
Coverage.kind | Base | required | Kind | 📍5.0.0 | FHIR Std.
Coverage.class.type | Base | extensible | Coverage Class Codes | 📍5.0.0 | FHIR Std.
Coverage.costToBeneficiary.​type | Base | extensible | Coverage Copay Type Codes | 📍5.0.0 | FHIR Std.
Coverage.costToBeneficiary.​category | Base | example | Benefit Category Codes | 📍5.0.0 | FHIR Std.
Coverage.costToBeneficiary.​network | Base | example | Network Type Codes | 📍5.0.0 | FHIR Std.
Coverage.costToBeneficiary.​unit | Base | example | Unit Type Codes | 📍5.0.0 | FHIR Std.
Coverage.costToBeneficiary.​term | Base | example | Benefit Term Codes | 📍5.0.0 | FHIR Std.
Coverage.costToBeneficiary.​exception.type | Base | example | Example Coverage Financial Exception Codes | 📍5.0.0 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(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

Prohibited: 13 elements

Structures

This structure refers to these other structures:

- Patient: EE VRIS Recipient (https://fhir.ee/vris/StructureDefinition/ee-vris-recipient)
- EE MPI Patient Verified (https://fhir.ee/mpi/StructureDefinition/ee-mpi-patient-verified)

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Coverage |  | 0..* | Coverage | Insurance or medical plan or a payment agreement
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
contained |  | 0..* | Resource | Contained, inline Resources
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | (ee Kindlustuse identifikaator)
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
kind | Σ | 1..1 | code | (ee Kindlustuse liik insurance / self-pay / other) Binding: Kind (required)
paymentBy |  | 0..* | BackboneElement | (ee Kes maksab, kas patsient ise või kolmas osapool)
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
party | Σ | 1..1 | Reference(Patient | RelatedPerson | Organization) | (ee Maksja viide. Siia Tervisekassa)
beneficiary | Σ | 1..1 | Reference(Patient: EE VRIS Recipient | EE MPI Patient Verified) | (ee Kindlustushüvitise saaja on patsient, kes ravi saab)
period | Σ | 0..1 | Period | (ee Kindlustuse kehtivuse periood)
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Coverage.status | Base | required | Financial Resource Status Codes | 📍5.0.0 | FHIR Std.
Coverage.kind | Base | required | Kind | 📍5.0.0 | FHIR Std.
Coverage.class.type | Base | extensible | Coverage Class Codes | 📍5.0.0 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(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 | Insurance or medical plan or a payment agreement
identifier |  | 0..* | Identifier | (ee Kindlustuse identifikaator)
kind |  | 1..1 | code | (ee Kindlustuse liik insurance / self-pay / other)
paymentBy |  | 0..* | BackboneElement | (ee Kes maksab, kas patsient ise või kolmas osapool)
party |  | 1..1 | Reference(Patient | RelatedPerson | Organization) | (ee Maksja viide. Siia Tervisekassa)
type |  | 0..0 |  | Coverage category such as medical or accident
policyHolder |  | 0..0 |  | Owner of the policy
subscriber |  | 0..0 |  | Subscriber to the policy
subscriberId |  | 0..0 |  | ID assigned to the subscriber
beneficiary |  | 1..1 | Reference(Patient: EE VRIS Recipient | EE MPI Patient Verified) | (ee Kindlustushüvitise saaja on patsient, kes ravi saab)
dependent |  | 0..0 |  | Dependent number
relationship |  | 0..0 |  | Beneficiary relationship to the subscriber
period |  | 0..1 | Period | (ee Kindlustuse kehtivuse periood)
insurer |  | 0..0 |  | Issuer of the policy
class |  | 0..0 |  | Additional coverage classifications
order |  | 0..0 |  | Relative order of the coverage
network |  | 0..0 |  | Insurer network
costToBeneficiary |  | 0..0 |  | Patient payments for services/products
subrogation |  | 0..0 |  | Reimbursement to insurer
contract |  | 0..0 |  | Contract details
Documentation for this format

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Coverage |  | 0..* | Coverage | Insurance or medical plan or a payment agreement
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: AllLanguages (required): IETF language tag for a human language
Additional Bindings | Purpose
CommonLanguages | Starter
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 | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | (ee Kindlustuse identifikaator)
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
kind | Σ | 1..1 | code | (ee Kindlustuse liik insurance / self-pay / other) Binding: Kind (required)
paymentBy |  | 0..* | BackboneElement | (ee Kes maksab, kas patsient ise või kolmas osapool)
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
party | Σ | 1..1 | Reference(Patient | RelatedPerson | Organization) | (ee Maksja viide. Siia Tervisekassa)
responsibility | Σ | 0..1 | string | Party's responsibility
beneficiary | Σ | 1..1 | Reference(Patient: EE VRIS Recipient | EE MPI Patient Verified) | (ee Kindlustushüvitise saaja on patsient, kes ravi saab)
period | Σ | 0..1 | Period | (ee Kindlustuse kehtivuse periood)
insurancePlan |  | 0..1 | Reference(InsurancePlan) | Insurance plan details
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Coverage.language | Base | required | All Languages | 📍5.0.0 | FHIR Std.
Coverage.status | Base | required | Financial Resource Status Codes | 📍5.0.0 | FHIR Std.
Coverage.kind | Base | required | Kind | 📍5.0.0 | FHIR Std.
Coverage.class.type | Base | extensible | Coverage Class Codes | 📍5.0.0 | FHIR Std.
Coverage.costToBeneficiary.​type | Base | extensible | Coverage Copay Type Codes | 📍5.0.0 | FHIR Std.
Coverage.costToBeneficiary.​category | Base | example | Benefit Category Codes | 📍5.0.0 | FHIR Std.
Coverage.costToBeneficiary.​network | Base | example | Network Type Codes | 📍5.0.0 | FHIR Std.
Coverage.costToBeneficiary.​unit | Base | example | Unit Type Codes | 📍5.0.0 | FHIR Std.
Coverage.costToBeneficiary.​term | Base | example | Benefit Term Codes | 📍5.0.0 | FHIR Std.
Coverage.costToBeneficiary.​exception.type | Base | example | Example Coverage Financial Exception Codes | 📍5.0.0 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(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

Prohibited: 13 elements

Structures

This structure refers to these other structures:

- Patient: EE VRIS Recipient (https://fhir.ee/vris/StructureDefinition/ee-vris-recipient)
- EE MPI Patient Verified (https://fhir.ee/mpi/StructureDefinition/ee-mpi-patient-verified)

Other representations of profile: CSV, Excel, Schematron