Profile Specific Implementation Guidance

• See guidance on the construction of identifiers in each Identifier profile and the section on Business Identifiers in AU Base.
• See guidance on populating Coverage.type in AU Base Coverage Profile Specific Implementation Guidance.
• When using one of the below Coverage types, at least one of the corresponding identifiers SHOULD be populated:

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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage		0..*	AUBaseCoverage	Insurance or medical plan or a payment agreement
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SOΣ	0..*	Identifier, AUMedicareCardNumber, AUDVANumber, AUInsuranceMemberNumber, AUPensionerConcessionCardNumber, AUCwlthSeniorsHealthCardNumber, AUHealthCareCardNumber	Business Identifier for the coverage Obligations Actor SHALL:populate-if-known AU eRequesting Placer SHALL:handle AU eRequesting Filler SHALL:handle AU eRequesting Server SHALL:able-to-populate AU eRequesting Server SHALL:no-error AU eRequesting Patient
status	?!SOΣ	1..1	code	Status of the coverage Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Fixed Value: active Obligations Actor SHALL:populate AU eRequesting Placer SHALL:handle AU eRequesting Filler SHALL:handle AU eRequesting Server SHALL:able-to-populate AU eRequesting Server SHALL:no-error AU eRequesting Patient
type	SOΣ	1..1	CodeableConcept	Coverage category such as medical or accident Binding: Coverage Type and Self-Pay Codes - AU Extended (preferred) Additional Bindings Purpose AU eRequesting Coverage Type and Self-Pay Codes Min Binding Obligations Actor SHALL:populate AU eRequesting Placer SHALL:handle AU eRequesting Filler SHALL:handle AU eRequesting Server SHALL:able-to-populate AU eRequesting Server SHALL:no-error AU eRequesting Patient
beneficiary	SOΣ	1..1	Reference(AU eRequesting Patient)	Plan beneficiary Obligations Actor SHALL:populate AU eRequesting Placer SHALL:handle AU eRequesting Filler SHALL:handle AU eRequesting Server SHALL:able-to-populate AU eRequesting Server SHALL:no-error AU eRequesting Patient
payor	SOΣ	1..*	Reference(AU eRequesting Patient | AU eRequesting Organization | AU Core RelatedPerson)	Issuer of the policy Obligations Actor SHALL:populate AU eRequesting Placer SHALL:handle AU eRequesting Filler SHALL:handle AU eRequesting Server SHALL:able-to-populate AU eRequesting Server SHALL:no-error AU eRequesting Patient
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	preferred	Coverage Type and Self-Pay Codes - AU Extended	📦6.0.1-ci-build	AU Base Implementation Guide vnull

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().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 AUBaseCoverage

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage		0..*	AUBaseCoverage	Insurance or medical plan or a payment agreement
identifier	SO	0..*	Identifier, AUMedicareCardNumber, AUDVANumber, AUInsuranceMemberNumber, AUPensionerConcessionCardNumber, AUCwlthSeniorsHealthCardNumber, AUHealthCareCardNumber	Business Identifier for the coverage Obligations Actor SHALL:populate-if-known AU eRequesting Placer SHALL:handle AU eRequesting Filler SHALL:handle AU eRequesting Server SHALL:able-to-populate AU eRequesting Server SHALL:no-error AU eRequesting Patient
status	SO	1..1	code	Status of the coverage Fixed Value: active Obligations Actor SHALL:populate AU eRequesting Placer SHALL:handle AU eRequesting Filler SHALL:handle AU eRequesting Server SHALL:able-to-populate AU eRequesting Server SHALL:no-error AU eRequesting Patient
type	SO	1..1	CodeableConcept	Coverage category such as medical or accident Binding: Coverage Type and Self-Pay Codes - AU Extended (preferred) Additional Bindings Purpose AU eRequesting Coverage Type and Self-Pay Codes Min Binding Obligations Actor SHALL:populate AU eRequesting Placer SHALL:handle AU eRequesting Filler SHALL:handle AU eRequesting Server SHALL:able-to-populate AU eRequesting Server SHALL:no-error AU eRequesting Patient
beneficiary	SO	1..1	Reference(AU eRequesting Patient)	Plan beneficiary Obligations Actor SHALL:populate AU eRequesting Placer SHALL:handle AU eRequesting Filler SHALL:handle AU eRequesting Server SHALL:able-to-populate AU eRequesting Server SHALL:no-error AU eRequesting Patient
payor	SO	1..*	Reference(AU eRequesting Patient | AU eRequesting Organization | AU Core RelatedPerson)	Issuer of the policy Obligations Actor SHALL:populate AU eRequesting Placer SHALL:handle AU eRequesting Filler SHALL:handle AU eRequesting Server SHALL:able-to-populate AU eRequesting Server SHALL:no-error AU eRequesting Patient
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Coverage.type	Base	preferred	Coverage Type and Self-Pay Codes - AU Extended	📦6.0.1-ci-build	AU Base Implementation Guide vnull

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage		0..*	AUBaseCoverage	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: 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	SOΣ	0..*	Identifier, AUMedicareCardNumber, AUDVANumber, AUInsuranceMemberNumber, AUPensionerConcessionCardNumber, AUCwlthSeniorsHealthCardNumber, AUHealthCareCardNumber	Business Identifier for the coverage Obligations Actor SHALL:populate-if-known AU eRequesting Placer SHALL:handle AU eRequesting Filler SHALL:handle AU eRequesting Server SHALL:able-to-populate AU eRequesting Server SHALL:no-error AU eRequesting Patient
status	?!SOΣ	1..1	code	Status of the coverage Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Fixed Value: active Obligations Actor SHALL:populate AU eRequesting Placer SHALL:handle AU eRequesting Filler SHALL:handle AU eRequesting Server SHALL:able-to-populate AU eRequesting Server SHALL:no-error AU eRequesting Patient
type	SOΣ	1..1	CodeableConcept	Coverage category such as medical or accident Binding: Coverage Type and Self-Pay Codes - AU Extended (preferred) Additional Bindings Purpose AU eRequesting Coverage Type and Self-Pay Codes Min Binding Obligations Actor SHALL:populate AU eRequesting Placer SHALL:handle AU eRequesting Filler SHALL:handle AU eRequesting Server SHALL:able-to-populate AU eRequesting Server SHALL:no-error AU eRequesting Patient
policyHolder	Σ	0..1	Reference(Patient | RelatedPerson | Organization)	Owner of the policy
subscriber	Σ	0..1	Reference(Patient | RelatedPerson)	Subscriber to the policy
subscriberId	Σ	0..1	string	ID assigned to the subscriber
beneficiary	SOΣ	1..1	Reference(AU eRequesting Patient)	Plan beneficiary Obligations Actor SHALL:populate AU eRequesting Placer SHALL:handle AU eRequesting Filler SHALL:handle AU eRequesting Server SHALL:able-to-populate AU eRequesting Server SHALL:no-error AU eRequesting Patient
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	SOΣ	1..*	Reference(AU eRequesting Patient | AU eRequesting Organization | AU Core RelatedPerson)	Issuer of the policy Obligations Actor SHALL:populate AU eRequesting Placer SHALL:handle AU eRequesting Filler SHALL:handle AU eRequesting Server SHALL:able-to-populate AU eRequesting Server SHALL:no-error AU eRequesting Patient
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	Patient payments for services/products
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	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	preferred	Coverage Type and Self-Pay Codes - AU Extended	📦6.0.1-ci-build	AU Base Implementation Guide vnull
Coverage.relationship	Base	extensible	SubscriberPolicyholder Relationship Codes	📍4.0.1	FHIR Std.
Coverage.class.type	Base	extensible	Coverage Class Codes	📍4.0.1	FHIR Std.
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
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..*	AUBaseCoverage	Insurance or medical plan or a payment agreement
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SOΣ	0..*	Identifier, AUMedicareCardNumber, AUDVANumber, AUInsuranceMemberNumber, AUPensionerConcessionCardNumber, AUCwlthSeniorsHealthCardNumber, AUHealthCareCardNumber	Business Identifier for the coverage Obligations Actor SHALL:populate-if-known AU eRequesting Placer SHALL:handle AU eRequesting Filler SHALL:handle AU eRequesting Server SHALL:able-to-populate AU eRequesting Server SHALL:no-error AU eRequesting Patient
status	?!SOΣ	1..1	code	Status of the coverage Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Fixed Value: active Obligations Actor SHALL:populate AU eRequesting Placer SHALL:handle AU eRequesting Filler SHALL:handle AU eRequesting Server SHALL:able-to-populate AU eRequesting Server SHALL:no-error AU eRequesting Patient
type	SOΣ	1..1	CodeableConcept	Coverage category such as medical or accident Binding: Coverage Type and Self-Pay Codes - AU Extended (preferred) Additional Bindings Purpose AU eRequesting Coverage Type and Self-Pay Codes Min Binding Obligations Actor SHALL:populate AU eRequesting Placer SHALL:handle AU eRequesting Filler SHALL:handle AU eRequesting Server SHALL:able-to-populate AU eRequesting Server SHALL:no-error AU eRequesting Patient
beneficiary	SOΣ	1..1	Reference(AU eRequesting Patient)	Plan beneficiary Obligations Actor SHALL:populate AU eRequesting Placer SHALL:handle AU eRequesting Filler SHALL:handle AU eRequesting Server SHALL:able-to-populate AU eRequesting Server SHALL:no-error AU eRequesting Patient
payor	SOΣ	1..*	Reference(AU eRequesting Patient | AU eRequesting Organization | AU Core RelatedPerson)	Issuer of the policy Obligations Actor SHALL:populate AU eRequesting Placer SHALL:handle AU eRequesting Filler SHALL:handle AU eRequesting Server SHALL:able-to-populate AU eRequesting Server SHALL:no-error AU eRequesting Patient
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	preferred	Coverage Type and Self-Pay Codes - AU Extended	📦6.0.1-ci-build	AU Base Implementation Guide vnull

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().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 AUBaseCoverage

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage		0..*	AUBaseCoverage	Insurance or medical plan or a payment agreement
identifier	SO	0..*	Identifier, AUMedicareCardNumber, AUDVANumber, AUInsuranceMemberNumber, AUPensionerConcessionCardNumber, AUCwlthSeniorsHealthCardNumber, AUHealthCareCardNumber	Business Identifier for the coverage Obligations Actor SHALL:populate-if-known AU eRequesting Placer SHALL:handle AU eRequesting Filler SHALL:handle AU eRequesting Server SHALL:able-to-populate AU eRequesting Server SHALL:no-error AU eRequesting Patient
status	SO	1..1	code	Status of the coverage Fixed Value: active Obligations Actor SHALL:populate AU eRequesting Placer SHALL:handle AU eRequesting Filler SHALL:handle AU eRequesting Server SHALL:able-to-populate AU eRequesting Server SHALL:no-error AU eRequesting Patient
type	SO	1..1	CodeableConcept	Coverage category such as medical or accident Binding: Coverage Type and Self-Pay Codes - AU Extended (preferred) Additional Bindings Purpose AU eRequesting Coverage Type and Self-Pay Codes Min Binding Obligations Actor SHALL:populate AU eRequesting Placer SHALL:handle AU eRequesting Filler SHALL:handle AU eRequesting Server SHALL:able-to-populate AU eRequesting Server SHALL:no-error AU eRequesting Patient
beneficiary	SO	1..1	Reference(AU eRequesting Patient)	Plan beneficiary Obligations Actor SHALL:populate AU eRequesting Placer SHALL:handle AU eRequesting Filler SHALL:handle AU eRequesting Server SHALL:able-to-populate AU eRequesting Server SHALL:no-error AU eRequesting Patient
payor	SO	1..*	Reference(AU eRequesting Patient | AU eRequesting Organization | AU Core RelatedPerson)	Issuer of the policy Obligations Actor SHALL:populate AU eRequesting Placer SHALL:handle AU eRequesting Filler SHALL:handle AU eRequesting Server SHALL:able-to-populate AU eRequesting Server SHALL:no-error AU eRequesting Patient
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Coverage.type	Base	preferred	Coverage Type and Self-Pay Codes - AU Extended	📦6.0.1-ci-build	AU Base Implementation Guide vnull

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage		0..*	AUBaseCoverage	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: 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	SOΣ	0..*	Identifier, AUMedicareCardNumber, AUDVANumber, AUInsuranceMemberNumber, AUPensionerConcessionCardNumber, AUCwlthSeniorsHealthCardNumber, AUHealthCareCardNumber	Business Identifier for the coverage Obligations Actor SHALL:populate-if-known AU eRequesting Placer SHALL:handle AU eRequesting Filler SHALL:handle AU eRequesting Server SHALL:able-to-populate AU eRequesting Server SHALL:no-error AU eRequesting Patient
status	?!SOΣ	1..1	code	Status of the coverage Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Fixed Value: active Obligations Actor SHALL:populate AU eRequesting Placer SHALL:handle AU eRequesting Filler SHALL:handle AU eRequesting Server SHALL:able-to-populate AU eRequesting Server SHALL:no-error AU eRequesting Patient
type	SOΣ	1..1	CodeableConcept	Coverage category such as medical or accident Binding: Coverage Type and Self-Pay Codes - AU Extended (preferred) Additional Bindings Purpose AU eRequesting Coverage Type and Self-Pay Codes Min Binding Obligations Actor SHALL:populate AU eRequesting Placer SHALL:handle AU eRequesting Filler SHALL:handle AU eRequesting Server SHALL:able-to-populate AU eRequesting Server SHALL:no-error AU eRequesting Patient
policyHolder	Σ	0..1	Reference(Patient | RelatedPerson | Organization)	Owner of the policy
subscriber	Σ	0..1	Reference(Patient | RelatedPerson)	Subscriber to the policy
subscriberId	Σ	0..1	string	ID assigned to the subscriber
beneficiary	SOΣ	1..1	Reference(AU eRequesting Patient)	Plan beneficiary Obligations Actor SHALL:populate AU eRequesting Placer SHALL:handle AU eRequesting Filler SHALL:handle AU eRequesting Server SHALL:able-to-populate AU eRequesting Server SHALL:no-error AU eRequesting Patient
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	SOΣ	1..*	Reference(AU eRequesting Patient | AU eRequesting Organization | AU Core RelatedPerson)	Issuer of the policy Obligations Actor SHALL:populate AU eRequesting Placer SHALL:handle AU eRequesting Filler SHALL:handle AU eRequesting Server SHALL:able-to-populate AU eRequesting Server SHALL:no-error AU eRequesting Patient
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	Patient payments for services/products
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	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	preferred	Coverage Type and Self-Pay Codes - AU Extended	📦6.0.1-ci-build	AU Base Implementation Guide vnull
Coverage.relationship	Base	extensible	SubscriberPolicyholder Relationship Codes	📍4.0.1	FHIR Std.
Coverage.class.type	Base	extensible	Coverage Class Codes	📍4.0.1	FHIR Std.
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
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 AUBaseCoverage

Summary

Mandatory: 1 element
Must-Support: 5 elements
Fixed: 1 element

Structures

This structure refers to these other structures:

• AU eRequesting Patient (http://hl7.org.au/fhir/ereq/StructureDefinition/au-erequesting-patient)
• AU eRequesting Organization (http://hl7.org.au/fhir/ereq/StructureDefinition/au-erequesting-organization)
• AU Core RelatedPerson (http://hl7.org.au/fhir/core/StructureDefinition/au-core-relatedperson)

Maturity: 1

Below is an overview of the mandatory and optional search parameters and combined search parameters. See the AU eRequesting CapabilityStatements for a complete list of supported RESTful interactions for this IG.

FHIR search operations are described here and the syntax used to describe AU eRequesting interactions is defined here.

Any search parameter defined in FHIR may be 'allowed' by the system unless explicitly marked as "SHALL NOT".

Search Parameters:

The following search parameters and search parameter combinations are supported. Conformance obligations are detailed in the table above.

1. _id search parameter

   GET [base]/Coverage?_id=[id]

   Example:

   1. GET [base]/Coverage?_id=10045786

Implementation Notes: Fetches a bundle with the requested Coverage, instead of just the resource itself, and allows for the inclusion of additional search parameters such as _include, _revinclude, or _lastUpdated (how to search by id of the resource)