CH ORF (R4)
1.1.0 - CI Build Switzerland flag

CH ORF (R4), published by HL7 Switzerland. This is not an authorized publication; it is the continuous build for version 1.1.0). This version is based on the current content of https://github.com/hl7ch/ch-orf/ and changes regularly. See the Directory of published versions

Resource Profile: CH ORF Coverage

Official URL: http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage Version: 1.1.0
Active as of 2023-01-06 Computable Name: ChOrfCoverage

Copyright/Legal: CC-BY-SA-4.0

Profile to specify how the coverage is represented. This provides an organization or the individual, which will pay for services requested.

Usage:

Formal Views of Profile Content

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

This structure is derived from Coverage

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..*CoverageCH ORF Coverage
... contained S0..*ResourceContained, inline Resources
... identifier S0..*IdentifierBusiness Identifier for the coverage
.... type S1..1CodeableConceptDescription of identifier
Binding: Coverage Identifier Type (required)
..... coding S1..*CodingCode defined by a terminology system
...... system S1..1uriIdentity of the terminology system
...... code S1..1codeSymbol in syntax defined by the system
..... text S0..1stringPlain text representation of the concept
.... value S1..1stringThe value that is unique
... status S1..1codeactive | cancelled | draft | entered-in-error
... beneficiary S1..1Reference(CH Core Patient)Plan beneficiary
... payor S1..*Reference(CH Core Organization | CH Core Patient | RelatedPerson)Issuer of the policy

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet
Coverage.identifier.typerequiredChOrfCoverageIdentifierType (a valid code from Coverage Identifier Type)
Coverage.typerequiredChOrfCoverageType (a valid code from Coverage Type)
NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..*CoverageCH ORF Coverage
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... contained S0..*ResourceContained, inline Resources
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
.... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

.... type SΣ1..1CodeableConceptDescription of identifier
Binding: Coverage Identifier Type (required)
..... coding SΣ1..*CodingCode defined by a terminology system
...... system SΣ1..1uriIdentity of the terminology system
...... code SΣ1..1codeSymbol in syntax defined by the system
..... text SΣ0..1stringPlain text representation of the concept
.... value SΣ1..1stringThe value that is unique
Example General: 123456
... status ?!SΣ1..1codeactive | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type SΣ0..1CodeableConceptCoverage category such as medical or accident
Binding: Coverage Type (required)
... beneficiary SΣ1..1Reference(CH Core Patient)Plan beneficiary
... payor SΣ1..*Reference(CH Core Organization | CH Core Patient | RelatedPerson)Issuer of the policy

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
Coverage.identifier.userequiredIdentifierUse
Coverage.identifier.typerequiredChOrfCoverageIdentifierType (a valid code from Coverage Identifier Type)
Coverage.statusrequiredFinancialResourceStatusCodes
Coverage.typerequiredChOrfCoverageType (a valid code from Coverage Type)

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorCoverageIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorCoverageIf 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-4errorCoverageIf 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-5errorCoverageIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceCoverageA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..*CoverageCH ORF Coverage
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained S0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier SΣ0..*IdentifierBusiness Identifier for the coverage
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

.... type SΣ1..1CodeableConceptDescription of identifier
Binding: Coverage Identifier Type (required)
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ1..*CodingCode defined by a terminology system
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ1..1uriIdentity of the terminology system
...... version Σ0..1stringVersion of the system - if relevant
...... code SΣ1..1codeSymbol in syntax defined by the system
...... display Σ0..1stringRepresentation defined by the system
...... userSelected Σ0..1booleanIf this coding was chosen directly by the user
..... text SΣ0..1stringPlain text representation of the concept
.... system Σ0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value SΣ1..1stringThe value that is unique
Example General: 123456
.... period Σ0..1PeriodTime period when id is/was valid for use
.... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
... status ?!SΣ1..1codeactive | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type SΣ0..1CodeableConceptCoverage category such as medical or accident
Binding: Coverage Type (required)
... policyHolder Σ0..1Reference(Patient | RelatedPerson | Organization)Owner of the policy
... subscriber Σ0..1Reference(Patient | RelatedPerson)Subscriber to the policy
... subscriberId Σ0..1stringID assigned to the subscriber
... beneficiary SΣ1..1Reference(CH Core Patient)Plan beneficiary
... dependent Σ0..1stringDependent number
... relationship 0..1CodeableConceptBeneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).

... period Σ0..1PeriodCoverage start and end dates
... payor SΣ1..*Reference(CH Core Organization | CH Core Patient | RelatedPerson)Issuer of the policy
... class 0..*BackboneElementAdditional coverage classifications
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type Σ1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.

.... value Σ1..1stringValue associated with the type
.... name Σ0..1stringHuman readable description of the type and value
... order Σ0..1positiveIntRelative order of the coverage
... network Σ0..1stringInsurer network
... costToBeneficiary 0..*BackboneElementPatient payments for services/products
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type Σ0..1CodeableConceptCost category
Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.

.... value[x] Σ1..1The amount or percentage due from the beneficiary
..... valueQuantityQuantity(SimpleQuantity)
..... valueMoneyMoney
.... exception 0..*BackboneElementExceptions for patient payments
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type Σ1..1CodeableConceptException category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.

..... period Σ0..1PeriodThe effective period of the exception
... subrogation 0..1booleanReimbursement to insurer
... contract 0..*Reference(Contract)Contract details

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
Coverage.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
Coverage.identifier.userequiredIdentifierUse
Coverage.identifier.typerequiredChOrfCoverageIdentifierType (a valid code from Coverage Identifier Type)
Coverage.statusrequiredFinancialResourceStatusCodes
Coverage.typerequiredChOrfCoverageType (a valid code from Coverage Type)
Coverage.relationshipextensibleSubscriberRelationshipCodes
Coverage.class.typeextensibleCoverageClassCodes
Coverage.costToBeneficiary.typeextensibleCoverageCopayTypeCodes
Coverage.costToBeneficiary.exception.typeexampleExampleCoverageFinancialExceptionCodes

Constraints

IdGradePath(s)DetailsRequirements
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

This structure is derived from Coverage

Summary

Mandatory: 0 element (5 nested mandatory elements)
Must-Support: 12 elements

Structures

This structure refers to these other structures:

Differential View

This structure is derived from Coverage

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..*CoverageCH ORF Coverage
... contained S0..*ResourceContained, inline Resources
... identifier S0..*IdentifierBusiness Identifier for the coverage
.... type S1..1CodeableConceptDescription of identifier
Binding: Coverage Identifier Type (required)
..... coding S1..*CodingCode defined by a terminology system
...... system S1..1uriIdentity of the terminology system
...... code S1..1codeSymbol in syntax defined by the system
..... text S0..1stringPlain text representation of the concept
.... value S1..1stringThe value that is unique
... status S1..1codeactive | cancelled | draft | entered-in-error
... beneficiary S1..1Reference(CH Core Patient)Plan beneficiary
... payor S1..*Reference(CH Core Organization | CH Core Patient | RelatedPerson)Issuer of the policy

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet
Coverage.identifier.typerequiredChOrfCoverageIdentifierType (a valid code from Coverage Identifier Type)
Coverage.typerequiredChOrfCoverageType (a valid code from Coverage Type)

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..*CoverageCH ORF Coverage
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... contained S0..*ResourceContained, inline Resources
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
.... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

.... type SΣ1..1CodeableConceptDescription of identifier
Binding: Coverage Identifier Type (required)
..... coding SΣ1..*CodingCode defined by a terminology system
...... system SΣ1..1uriIdentity of the terminology system
...... code SΣ1..1codeSymbol in syntax defined by the system
..... text SΣ0..1stringPlain text representation of the concept
.... value SΣ1..1stringThe value that is unique
Example General: 123456
... status ?!SΣ1..1codeactive | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type SΣ0..1CodeableConceptCoverage category such as medical or accident
Binding: Coverage Type (required)
... beneficiary SΣ1..1Reference(CH Core Patient)Plan beneficiary
... payor SΣ1..*Reference(CH Core Organization | CH Core Patient | RelatedPerson)Issuer of the policy

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
Coverage.identifier.userequiredIdentifierUse
Coverage.identifier.typerequiredChOrfCoverageIdentifierType (a valid code from Coverage Identifier Type)
Coverage.statusrequiredFinancialResourceStatusCodes
Coverage.typerequiredChOrfCoverageType (a valid code from Coverage Type)

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorCoverageIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorCoverageIf 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-4errorCoverageIf 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-5errorCoverageIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceCoverageA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..*CoverageCH ORF Coverage
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained S0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier SΣ0..*IdentifierBusiness Identifier for the coverage
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

.... type SΣ1..1CodeableConceptDescription of identifier
Binding: Coverage Identifier Type (required)
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ1..*CodingCode defined by a terminology system
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ1..1uriIdentity of the terminology system
...... version Σ0..1stringVersion of the system - if relevant
...... code SΣ1..1codeSymbol in syntax defined by the system
...... display Σ0..1stringRepresentation defined by the system
...... userSelected Σ0..1booleanIf this coding was chosen directly by the user
..... text SΣ0..1stringPlain text representation of the concept
.... system Σ0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value SΣ1..1stringThe value that is unique
Example General: 123456
.... period Σ0..1PeriodTime period when id is/was valid for use
.... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
... status ?!SΣ1..1codeactive | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type SΣ0..1CodeableConceptCoverage category such as medical or accident
Binding: Coverage Type (required)
... policyHolder Σ0..1Reference(Patient | RelatedPerson | Organization)Owner of the policy
... subscriber Σ0..1Reference(Patient | RelatedPerson)Subscriber to the policy
... subscriberId Σ0..1stringID assigned to the subscriber
... beneficiary SΣ1..1Reference(CH Core Patient)Plan beneficiary
... dependent Σ0..1stringDependent number
... relationship 0..1CodeableConceptBeneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).

... period Σ0..1PeriodCoverage start and end dates
... payor SΣ1..*Reference(CH Core Organization | CH Core Patient | RelatedPerson)Issuer of the policy
... class 0..*BackboneElementAdditional coverage classifications
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type Σ1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.

.... value Σ1..1stringValue associated with the type
.... name Σ0..1stringHuman readable description of the type and value
... order Σ0..1positiveIntRelative order of the coverage
... network Σ0..1stringInsurer network
... costToBeneficiary 0..*BackboneElementPatient payments for services/products
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type Σ0..1CodeableConceptCost category
Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.

.... value[x] Σ1..1The amount or percentage due from the beneficiary
..... valueQuantityQuantity(SimpleQuantity)
..... valueMoneyMoney
.... exception 0..*BackboneElementExceptions for patient payments
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type Σ1..1CodeableConceptException category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.

..... period Σ0..1PeriodThe effective period of the exception
... subrogation 0..1booleanReimbursement to insurer
... contract 0..*Reference(Contract)Contract details

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
Coverage.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
Coverage.identifier.userequiredIdentifierUse
Coverage.identifier.typerequiredChOrfCoverageIdentifierType (a valid code from Coverage Identifier Type)
Coverage.statusrequiredFinancialResourceStatusCodes
Coverage.typerequiredChOrfCoverageType (a valid code from Coverage Type)
Coverage.relationshipextensibleSubscriberRelationshipCodes
Coverage.class.typeextensibleCoverageClassCodes
Coverage.costToBeneficiary.typeextensibleCoverageCopayTypeCodes
Coverage.costToBeneficiary.exception.typeexampleExampleCoverageFinancialExceptionCodes

Constraints

IdGradePath(s)DetailsRequirements
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

This structure is derived from Coverage

Summary

Mandatory: 0 element (5 nested mandatory elements)
Must-Support: 12 elements

Structures

This structure refers to these other structures:

 

Other representations of profile: CSV, Excel, Schematron