CH Core (R4)
5.0.0-ballot - ballot Switzerland flag

This page is part of the CH Core (R4) (v5.0.0-ballot: STU 5 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Resource Profile: CH Core Coverage

Official URL: http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-coverage Version: 5.0.0-ballot
Active as of 2024-05-16 Computable Name: CHCoreCoverage

Copyright/Legal: CC0-1.0

Base definition of the Coverage resource for use in Swiss specific use cases.

Coverage information which can be shared

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..* Coverage CH Core Coverage
... Slices for identifier 0..* Identifier Business Identifier for the coverage
Slice: Unordered, Open by pattern:$this
.... identifier:insuranceCardNumber 0..* VEKAIdentifier Insurance card number of the patient (20 digits)

Required Pattern: At least the following
..... system 1..1 uri The namespace for the identifier value
Fixed Value: urn:oid:2.16.756.5.30.1.123.100.1.1.1
... type 0..1 CodeableConcept Coverage category such as medical or accident
Binding: Main Guarantor (preferred)
... policyHolder 0..1 Reference(CH Core Patient | RelatedPerson | CH Core Organization) Owner of the policy
... beneficiary 1..1 Reference(CH Core Patient) Plan beneficiary
... payor 1..* Reference(CH Core Organization | CH Core Patient | RelatedPerson) {c, r} Issuer of the policy (if it is not the patient him/herself, represent the payor as a contained resource)
... class
.... type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: BFS Medizinische Statistik - 21 1.3.V02 - Klasse / Classe / Classe (extensible)

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
Coverage.typepreferredMainGuarantor
http://fhir.ch/ig/ch-term/ValueSet/mainguarantor
Coverage.class.typeextensibleBfsMedstats21Encountertype
http://fhir.ch/ig/ch-core/ValueSet/bfs-medstats-21-encountertype
NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..* Coverage CH Core Coverage
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... Slices for identifier Σ 0..* Identifier Business Identifier for the coverage
Slice: Unordered, Open by pattern:$this
.... identifier:insuranceCardNumber 0..* VEKAIdentifier Insurance card number of the patient (20 digits)

Required Pattern: At least the following
..... system 1..1 uri The namespace for the identifier value
Fixed Value: urn:oid:2.16.756.5.30.1.123.100.1.1.1
... type Σ 0..1 CodeableConcept Coverage category such as medical or accident
Binding: Main Guarantor (preferred)
... policyHolder Σ 0..1 Reference(CH Core Patient | RelatedPerson | CH Core Organization) Owner of the policy
... subscriber Σ 0..1 Reference(CH Core Patient | RelatedPerson) Subscriber to the policy
... beneficiary Σ 1..1 Reference(CH Core Patient) Plan beneficiary
... payor Σ 1..* Reference(CH Core Organization | CH Core Patient | RelatedPerson) {c, r} Issuer of the policy (if it is not the patient him/herself, represent the payor as a contained resource)

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Coverage.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
from the FHIR Standard
Coverage.typepreferredMainGuarantor
http://fhir.ch/ig/ch-term/ValueSet/mainguarantor

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..* Coverage CH Core 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
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... Slices for identifier Σ 0..* Identifier Business Identifier for the coverage
Slice: Unordered, Open by pattern:$this
.... identifier:insuranceCardNumber 0..* VEKAIdentifier Insurance card number of the patient (20 digits)

Required Pattern: At least the following
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... use 0..1 code usual | official | temp | secondary | old (If known)
..... type 0..1 CodeableConcept Description of identifier
..... system 1..1 uri The namespace for the identifier value
Fixed Value: urn:oid:2.16.756.5.30.1.123.100.1.1.1
..... value 0..1 string The value that is unique
..... period 0..1 Period Time period when id is/was valid for use
..... assigner 0..1 Reference(Organization) Organization that issued id (may be just text)
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type Σ 0..1 CodeableConcept Coverage category such as medical or accident
Binding: Main Guarantor (preferred)
... policyHolder Σ 0..1 Reference(CH Core Patient | RelatedPerson | CH Core Organization) Owner of the policy
... subscriber Σ 0..1 Reference(CH Core Patient | RelatedPerson) Subscriber to the policy
... subscriberId Σ 0..1 string ID assigned to the subscriber
... beneficiary Σ 1..1 Reference(CH Core Patient) 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(CH Core Organization | CH Core Patient | RelatedPerson) {c, r} Issuer of the policy (if it is not the patient him/herself, represent the payor as a contained resource)
... 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: BFS Medizinische Statistik - 21 1.3.V02 - Klasse / Classe / Classe (extensible)
.... 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

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Coverage.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
Coverage.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
from the FHIR Standard
Coverage.typepreferredMainGuarantor
http://fhir.ch/ig/ch-term/ValueSet/mainguarantor
Coverage.relationshipextensibleSubscriberRelationshipCodes
http://hl7.org/fhir/ValueSet/subscriber-relationship
from the FHIR Standard
Coverage.class.typeextensibleBfsMedstats21Encountertype
http://fhir.ch/ig/ch-core/ValueSet/bfs-medstats-21-encountertype
Coverage.costToBeneficiary.typeextensibleCoverageCopayTypeCodes
http://hl7.org/fhir/ValueSet/coverage-copay-type
from the FHIR Standard
Coverage.costToBeneficiary.exception.typeexampleExampleCoverageFinancialExceptionCodes
http://hl7.org/fhir/ValueSet/coverage-financial-exception
from the FHIR Standard

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()

This structure is derived from Coverage

Differential View

This structure is derived from Coverage

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..* Coverage CH Core Coverage
... Slices for identifier 0..* Identifier Business Identifier for the coverage
Slice: Unordered, Open by pattern:$this
.... identifier:insuranceCardNumber 0..* VEKAIdentifier Insurance card number of the patient (20 digits)

Required Pattern: At least the following
..... system 1..1 uri The namespace for the identifier value
Fixed Value: urn:oid:2.16.756.5.30.1.123.100.1.1.1
... type 0..1 CodeableConcept Coverage category such as medical or accident
Binding: Main Guarantor (preferred)
... policyHolder 0..1 Reference(CH Core Patient | RelatedPerson | CH Core Organization) Owner of the policy
... beneficiary 1..1 Reference(CH Core Patient) Plan beneficiary
... payor 1..* Reference(CH Core Organization | CH Core Patient | RelatedPerson) {c, r} Issuer of the policy (if it is not the patient him/herself, represent the payor as a contained resource)
... class
.... type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: BFS Medizinische Statistik - 21 1.3.V02 - Klasse / Classe / Classe (extensible)

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
Coverage.typepreferredMainGuarantor
http://fhir.ch/ig/ch-term/ValueSet/mainguarantor
Coverage.class.typeextensibleBfsMedstats21Encountertype
http://fhir.ch/ig/ch-core/ValueSet/bfs-medstats-21-encountertype

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..* Coverage CH Core Coverage
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... Slices for identifier Σ 0..* Identifier Business Identifier for the coverage
Slice: Unordered, Open by pattern:$this
.... identifier:insuranceCardNumber 0..* VEKAIdentifier Insurance card number of the patient (20 digits)

Required Pattern: At least the following
..... system 1..1 uri The namespace for the identifier value
Fixed Value: urn:oid:2.16.756.5.30.1.123.100.1.1.1
... type Σ 0..1 CodeableConcept Coverage category such as medical or accident
Binding: Main Guarantor (preferred)
... policyHolder Σ 0..1 Reference(CH Core Patient | RelatedPerson | CH Core Organization) Owner of the policy
... subscriber Σ 0..1 Reference(CH Core Patient | RelatedPerson) Subscriber to the policy
... beneficiary Σ 1..1 Reference(CH Core Patient) Plan beneficiary
... payor Σ 1..* Reference(CH Core Organization | CH Core Patient | RelatedPerson) {c, r} Issuer of the policy (if it is not the patient him/herself, represent the payor as a contained resource)

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Coverage.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
from the FHIR Standard
Coverage.typepreferredMainGuarantor
http://fhir.ch/ig/ch-term/ValueSet/mainguarantor

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..* Coverage CH Core 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
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... Slices for identifier Σ 0..* Identifier Business Identifier for the coverage
Slice: Unordered, Open by pattern:$this
.... identifier:insuranceCardNumber 0..* VEKAIdentifier Insurance card number of the patient (20 digits)

Required Pattern: At least the following
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... use 0..1 code usual | official | temp | secondary | old (If known)
..... type 0..1 CodeableConcept Description of identifier
..... system 1..1 uri The namespace for the identifier value
Fixed Value: urn:oid:2.16.756.5.30.1.123.100.1.1.1
..... value 0..1 string The value that is unique
..... period 0..1 Period Time period when id is/was valid for use
..... assigner 0..1 Reference(Organization) Organization that issued id (may be just text)
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type Σ 0..1 CodeableConcept Coverage category such as medical or accident
Binding: Main Guarantor (preferred)
... policyHolder Σ 0..1 Reference(CH Core Patient | RelatedPerson | CH Core Organization) Owner of the policy
... subscriber Σ 0..1 Reference(CH Core Patient | RelatedPerson) Subscriber to the policy
... subscriberId Σ 0..1 string ID assigned to the subscriber
... beneficiary Σ 1..1 Reference(CH Core Patient) 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(CH Core Organization | CH Core Patient | RelatedPerson) {c, r} Issuer of the policy (if it is not the patient him/herself, represent the payor as a contained resource)
... 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: BFS Medizinische Statistik - 21 1.3.V02 - Klasse / Classe / Classe (extensible)
.... 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

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Coverage.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
Coverage.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
from the FHIR Standard
Coverage.typepreferredMainGuarantor
http://fhir.ch/ig/ch-term/ValueSet/mainguarantor
Coverage.relationshipextensibleSubscriberRelationshipCodes
http://hl7.org/fhir/ValueSet/subscriber-relationship
from the FHIR Standard
Coverage.class.typeextensibleBfsMedstats21Encountertype
http://fhir.ch/ig/ch-core/ValueSet/bfs-medstats-21-encountertype
Coverage.costToBeneficiary.typeextensibleCoverageCopayTypeCodes
http://hl7.org/fhir/ValueSet/coverage-copay-type
from the FHIR Standard
Coverage.costToBeneficiary.exception.typeexampleExampleCoverageFinancialExceptionCodes
http://hl7.org/fhir/ValueSet/coverage-financial-exception
from the FHIR Standard

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()

This structure is derived from Coverage

 

Other representations of profile: CSV, Excel, Schematron