CH Core (R4)
2.0.0 - STU 2
This page is part of the CH Core (R4) (v2.0.0: STU 2) based on FHIR R4. . For a full list of available versions, see the Directory of published versions
Defining URL: | http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-coverage |
Version: | 2.0.0 |
Name: | CHCoreCoverage |
Title: | CH Core Coverage Profile |
Status: | Active as of 2019-05-20T00:00:00+00:00 |
Definition: | The Coverage referenced in the CH Core profiles. |
Publisher: | HL7 Switzerland |
Copyright: | CC-BY-SA-4.0 |
Source Resource: | XML / JSON / Turtle |
The official URL for this profile is:
http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-coverage
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from Coverage
Summary
Mandatory: 0 element (2 nested mandatory elements)
Fixed Value: 1 element
Structures
This structure refers to these other structures:
Slices
This structure defines the following Slices:
This structure is derived from Coverage
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Coverage | 0..* | Coverage | CH Core Coverage | |
identifier | 0..* | (Slice Definition) | Business Identifier for the coverage Slice: Unordered, Open by value:system | |
identifier:insurancecardnumber | 0..* | Identifier | insurancecardnumber | |
system | 1..1 | uri | oid of the insurance card number Fixed Value: urn:oid:2.16.756.5.30.1.123.100.1.1.1 | |
value | 1..1 | string | Insurance card number of the patient (20 digits) | |
policyHolder | 0..1 | Reference(CH Core Patient Profile | RelatedPerson | CH Core Organization Profile) | Owner of the policy | |
subscriber | 0..1 | Reference(CH Core Patient Profile | RelatedPerson) | Subscriber to the policy | |
beneficiary | 1..1 | Reference(CH Core Patient Profile) | Plan beneficiary | |
payor | 1..* | Reference(CH Core Organization Profile | CH Core Patient Profile | RelatedPerson) | Issuer of the policy | |
Documentation for this format |
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Coverage | 0..* | Coverage | CH Core Coverage | |
id | Σ | 0..1 | string | 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) Max Binding: AllLanguages: A human language. | |
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 |
identifier | Σ | 0..* | (Slice Definition) | Business Identifier for the coverage Slice: Unordered, Open by value:system |
identifier:insurancecardnumber | Σ | 0..* | Identifier | insurancecardnumber |
id | 0..1 | string | Unique id for inter-element referencing | |
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . |
type | Σ | 0..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. |
system | Σ | 1..1 | uri | oid of the insurance card number Fixed Value: urn:oid:2.16.756.5.30.1.123.100.1.1.1 |
value | Σ | 1..1 | string | Insurance card number of the patient (20 digits) Example General: 123456 |
period | Σ | 0..1 | Period | Time period when id is/was valid for use |
assigner | Σ | 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: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization. |
policyHolder | Σ | 0..1 | Reference(CH Core Patient Profile | RelatedPerson | CH Core Organization Profile) | Owner of the policy |
subscriber | Σ | 0..1 | Reference(CH Core Patient Profile | RelatedPerson) | Subscriber to the policy |
subscriberId | Σ | 0..1 | string | ID assigned to the subscriber |
beneficiary | Σ | 1..1 | Reference(CH Core Patient Profile) | 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 Profile | CH Core Patient Profile | RelatedPerson) | Issuer of the policy |
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 |
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Coverage | 0..* | Coverage | CH Core Coverage | |
Documentation for this format |
This structure is derived from Coverage
Summary
Mandatory: 0 element (2 nested mandatory elements)
Fixed Value: 1 element
Structures
This structure refers to these other structures:
Slices
This structure defines the following Slices:
Differential View
This structure is derived from Coverage
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Coverage | 0..* | Coverage | CH Core Coverage | |
identifier | 0..* | (Slice Definition) | Business Identifier for the coverage Slice: Unordered, Open by value:system | |
identifier:insurancecardnumber | 0..* | Identifier | insurancecardnumber | |
system | 1..1 | uri | oid of the insurance card number Fixed Value: urn:oid:2.16.756.5.30.1.123.100.1.1.1 | |
value | 1..1 | string | Insurance card number of the patient (20 digits) | |
policyHolder | 0..1 | Reference(CH Core Patient Profile | RelatedPerson | CH Core Organization Profile) | Owner of the policy | |
subscriber | 0..1 | Reference(CH Core Patient Profile | RelatedPerson) | Subscriber to the policy | |
beneficiary | 1..1 | Reference(CH Core Patient Profile) | Plan beneficiary | |
payor | 1..* | Reference(CH Core Organization Profile | CH Core Patient Profile | RelatedPerson) | Issuer of the policy | |
Documentation for this format |
Snapshot View
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Coverage | 0..* | Coverage | CH Core Coverage | |
id | Σ | 0..1 | string | 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) Max Binding: AllLanguages: A human language. | |
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 |
identifier | Σ | 0..* | (Slice Definition) | Business Identifier for the coverage Slice: Unordered, Open by value:system |
identifier:insurancecardnumber | Σ | 0..* | Identifier | insurancecardnumber |
id | 0..1 | string | Unique id for inter-element referencing | |
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . |
type | Σ | 0..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. |
system | Σ | 1..1 | uri | oid of the insurance card number Fixed Value: urn:oid:2.16.756.5.30.1.123.100.1.1.1 |
value | Σ | 1..1 | string | Insurance card number of the patient (20 digits) Example General: 123456 |
period | Σ | 0..1 | Period | Time period when id is/was valid for use |
assigner | Σ | 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: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization. |
policyHolder | Σ | 0..1 | Reference(CH Core Patient Profile | RelatedPerson | CH Core Organization Profile) | Owner of the policy |
subscriber | Σ | 0..1 | Reference(CH Core Patient Profile | RelatedPerson) | Subscriber to the policy |
subscriberId | Σ | 0..1 | string | ID assigned to the subscriber |
beneficiary | Σ | 1..1 | Reference(CH Core Patient Profile) | 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 Profile | CH Core Patient Profile | RelatedPerson) | Issuer of the policy |
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 |
Other representations of profile: Schematron
Path | Conformance | ValueSet |
Coverage.language | preferred | CommonLanguages Max Binding: AllLanguages |
Coverage.identifier:insurancecardnumber.use | required | IdentifierUse |
Coverage.identifier:insurancecardnumber.type | extensible | Identifier Type Codes |
Coverage.status | required | FinancialResourceStatusCodes |
Coverage.type | preferred | CoverageTypeAndSelf-PayCodes |
Coverage.relationship | extensible | SubscriberRelationshipCodes |
Coverage.class.type | extensible | CoverageClassCodes |
Coverage.costToBeneficiary.type | extensible | CoverageCopayTypeCodes |
Coverage.costToBeneficiary.exception.type | example | ExampleCoverageFinancialExceptionCodes |
Id | Path | Details | Requirements |
dom-2 | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
dom-3 | 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 | 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 | Coverage | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
dom-6 | Coverage | A resource should have narrative for robust management : text.`div`.exists() | |
ele-1 | Coverage.meta | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | Coverage.implicitRules | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | Coverage.language | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | Coverage.text | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | Coverage.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | Coverage.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | Coverage.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | Coverage.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | Coverage.identifier | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | Coverage.identifier:insurancecardnumber | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | Coverage.identifier:insurancecardnumber.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | Coverage.identifier:insurancecardnumber.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | Coverage.identifier:insurancecardnumber.use | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | Coverage.identifier:insurancecardnumber.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | Coverage.identifier:insurancecardnumber.system | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | Coverage.identifier:insurancecardnumber.value | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | Coverage.identifier:insurancecardnumber.period | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | Coverage.identifier:insurancecardnumber.assigner | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | Coverage.status | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | Coverage.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | Coverage.policyHolder | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | Coverage.subscriber | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | Coverage.subscriberId | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | Coverage.beneficiary | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | Coverage.dependent | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | Coverage.relationship | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | Coverage.period | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | Coverage.payor | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | Coverage.class | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | Coverage.class.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | Coverage.class.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | Coverage.class.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | Coverage.class.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | Coverage.class.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | Coverage.class.value | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | Coverage.class.name | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | Coverage.order | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | Coverage.network | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | Coverage.costToBeneficiary | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | Coverage.costToBeneficiary.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | Coverage.costToBeneficiary.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | Coverage.costToBeneficiary.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | Coverage.costToBeneficiary.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | Coverage.costToBeneficiary.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | Coverage.costToBeneficiary.value[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | Coverage.costToBeneficiary.exception | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | Coverage.costToBeneficiary.exception.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | Coverage.costToBeneficiary.exception.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | Coverage.costToBeneficiary.exception.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | Coverage.costToBeneficiary.exception.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | Coverage.costToBeneficiary.exception.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | Coverage.costToBeneficiary.exception.period | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | Coverage.subrogation | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | Coverage.contract | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |