This page is part of the CH ORF (R4) (v3.0.0: STU 3) 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

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Resource Profile: CH ORF Coverage

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

Usage:

• Use this Resource Profile: CH ORF Document
• Refer to this Resource Profile: CH ORF ServiceRequest
• Examples for this Resource Profile: Coverage/CoverageMusterfrau, Coverage/CoverageSelfPatient and Coverage/CoverageSelfRelatedPerson

Formal Views of Profile Content

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

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

This structure is derived from CHCoreCoverage

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	CHCoreCoverage	CH ORF Coverage
contained	S	0..*	Resource	Contained, inline Resources
identifier	S	0..*	Identifier	Business Identifier for the coverage
type	S	1..1	CodeableConcept	Description of identifier Binding: Coverage Identifier Type (required)
coding	S	1..*	Coding	Code defined by a terminology system
system	S	1..1	uri	Identity of the terminology system
code	S	1..1	code	Symbol in syntax defined by the system
text	S	0..1	string	Plain text representation of the concept
value	S	1..1	string	The value that is unique
status	S	1..1	code	active | cancelled | draft | entered-in-error
type	S	0..1	CodeableConcept	Coverage category such as medical or accident Binding: Main Guarantor (required)
beneficiary	S	1..1	Reference(CH Core Patient)	Plan beneficiary
payor	S	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)
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Coverage.identifier.type	required	ChOrfCoverageIdentifierType (a valid code from Coverage Identifier Type) http://fhir.ch/ig/ch-orf/ValueSet/ch-orf-vs-coverageidentifiertype from this IG
Coverage.type	required	MainGuarantor http://fhir.ch/ig/ch-term/ValueSet/mainguarantor

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	CHCoreCoverage	CH ORF Coverage dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
contained	S	0..*	Resource	Contained, inline Resources
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
Slices for identifier	SΣ	0..*	Identifier	Business Identifier for the coverage Slice: Unordered, Open by value:$this ele-1: All FHIR elements must have a @value or children
identifier:All Slices				Content/Rules for all slices
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
type	SΣ	1..1	CodeableConcept	Description of identifier Binding: Coverage Identifier Type (required) ele-1: All FHIR elements must have a @value or children
coding	SΣ	1..*	Coding	Code defined by a terminology system ele-1: All FHIR elements must have a @value or children
system	SΣ	1..1	uri	Identity of the terminology system ele-1: All FHIR elements must have a @value or children
code	SΣ	1..1	code	Symbol in syntax defined by the system ele-1: All FHIR elements must have a @value or children
text	SΣ	0..1	string	Plain text representation of the concept ele-1: All FHIR elements must have a @value or children
value	SΣ	1..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456
identifier:insuranceCardNumber		0..*	VEKAIdentifier	Insurance card number of the patient (20 digits) ele-1: All FHIR elements must have a @value or children 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
status	?!SΣ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. ele-1: All FHIR elements must have a @value or children
type	SΣ	0..1	CodeableConcept	Coverage category such as medical or accident Binding: Main Guarantor (required) ele-1: All FHIR elements must have a @value or children
beneficiary	SΣ	1..1	Reference(CH Core Patient)	Plan beneficiary ele-1: All FHIR elements must have a @value or children
payor	SΣ	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) ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Coverage.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Coverage.identifier.type	required	ChOrfCoverageIdentifierType (a valid code from Coverage Identifier Type) http://fhir.ch/ig/ch-orf/ValueSet/ch-orf-vs-coverageidentifiertype from this IG
Coverage.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard
Coverage.type	required	MainGuarantor http://fhir.ch/ig/ch-term/ValueSet/mainguarantor

Constraints

Id	Grade	Path(s)	Details	Requirements
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()

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	CHCoreCoverage	CH ORF 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
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
contained	S	0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣ	0..*	Identifier	Business Identifier for the coverage Slice: Unordered, Open by value:$this
identifier:All Slices				Content/Rules for all slices
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	SΣ	1..1	CodeableConcept	Description of identifier Binding: Coverage Identifier Type (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	SΣ	1..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	SΣ	0..1	string	Plain text representation of the concept
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique 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)
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	?!SΣ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	SΣ	0..1	CodeableConcept	Coverage category such as medical or accident Binding: Main Guarantor (required)
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	SΣ	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	SΣ	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
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Coverage.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Coverage.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Coverage.identifier.type	required	ChOrfCoverageIdentifierType (a valid code from Coverage Identifier Type) http://fhir.ch/ig/ch-orf/ValueSet/ch-orf-vs-coverageidentifiertype from this IG
Coverage.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard
Coverage.type	required	MainGuarantor http://fhir.ch/ig/ch-term/ValueSet/mainguarantor
Coverage.relationship	extensible	SubscriberRelationshipCodes http://hl7.org/fhir/ValueSet/subscriber-relationship from the FHIR Standard
Coverage.class.type	extensible	BfsMedstats21Encountertype http://fhir.ch/ig/ch-core/ValueSet/bfs-medstats-21-encountertype
Coverage.costToBeneficiary.type	extensible	CoverageCopayTypeCodes http://hl7.org/fhir/ValueSet/coverage-copay-type from the FHIR Standard
Coverage.costToBeneficiary.exception.type	example	ExampleCoverageFinancialExceptionCodes http://hl7.org/fhir/ValueSet/coverage-financial-exception from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
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 CHCoreCoverage

Summary

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

Differential View

This structure is derived from CHCoreCoverage

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	CHCoreCoverage	CH ORF Coverage
contained	S	0..*	Resource	Contained, inline Resources
identifier	S	0..*	Identifier	Business Identifier for the coverage
type	S	1..1	CodeableConcept	Description of identifier Binding: Coverage Identifier Type (required)
coding	S	1..*	Coding	Code defined by a terminology system
system	S	1..1	uri	Identity of the terminology system
code	S	1..1	code	Symbol in syntax defined by the system
text	S	0..1	string	Plain text representation of the concept
value	S	1..1	string	The value that is unique
status	S	1..1	code	active | cancelled | draft | entered-in-error
type	S	0..1	CodeableConcept	Coverage category such as medical or accident Binding: Main Guarantor (required)
beneficiary	S	1..1	Reference(CH Core Patient)	Plan beneficiary
payor	S	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)
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Coverage.identifier.type	required	ChOrfCoverageIdentifierType (a valid code from Coverage Identifier Type) http://fhir.ch/ig/ch-orf/ValueSet/ch-orf-vs-coverageidentifiertype from this IG
Coverage.type	required	MainGuarantor http://fhir.ch/ig/ch-term/ValueSet/mainguarantor

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	CHCoreCoverage	CH ORF Coverage dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
contained	S	0..*	Resource	Contained, inline Resources
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
Slices for identifier	SΣ	0..*	Identifier	Business Identifier for the coverage Slice: Unordered, Open by value:$this ele-1: All FHIR elements must have a @value or children
identifier:All Slices				Content/Rules for all slices
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
type	SΣ	1..1	CodeableConcept	Description of identifier Binding: Coverage Identifier Type (required) ele-1: All FHIR elements must have a @value or children
coding	SΣ	1..*	Coding	Code defined by a terminology system ele-1: All FHIR elements must have a @value or children
system	SΣ	1..1	uri	Identity of the terminology system ele-1: All FHIR elements must have a @value or children
code	SΣ	1..1	code	Symbol in syntax defined by the system ele-1: All FHIR elements must have a @value or children
text	SΣ	0..1	string	Plain text representation of the concept ele-1: All FHIR elements must have a @value or children
value	SΣ	1..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456
identifier:insuranceCardNumber		0..*	VEKAIdentifier	Insurance card number of the patient (20 digits) ele-1: All FHIR elements must have a @value or children 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
status	?!SΣ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. ele-1: All FHIR elements must have a @value or children
type	SΣ	0..1	CodeableConcept	Coverage category such as medical or accident Binding: Main Guarantor (required) ele-1: All FHIR elements must have a @value or children
beneficiary	SΣ	1..1	Reference(CH Core Patient)	Plan beneficiary ele-1: All FHIR elements must have a @value or children
payor	SΣ	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) ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Coverage.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Coverage.identifier.type	required	ChOrfCoverageIdentifierType (a valid code from Coverage Identifier Type) http://fhir.ch/ig/ch-orf/ValueSet/ch-orf-vs-coverageidentifiertype from this IG
Coverage.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard
Coverage.type	required	MainGuarantor http://fhir.ch/ig/ch-term/ValueSet/mainguarantor

Constraints

Id	Grade	Path(s)	Details	Requirements
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()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	CHCoreCoverage	CH ORF 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
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
contained	S	0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣ	0..*	Identifier	Business Identifier for the coverage Slice: Unordered, Open by value:$this
identifier:All Slices				Content/Rules for all slices
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	SΣ	1..1	CodeableConcept	Description of identifier Binding: Coverage Identifier Type (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	SΣ	1..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	SΣ	0..1	string	Plain text representation of the concept
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique 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)
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	?!SΣ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	SΣ	0..1	CodeableConcept	Coverage category such as medical or accident Binding: Main Guarantor (required)
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	SΣ	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	SΣ	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
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Coverage.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Coverage.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Coverage.identifier.type	required	ChOrfCoverageIdentifierType (a valid code from Coverage Identifier Type) http://fhir.ch/ig/ch-orf/ValueSet/ch-orf-vs-coverageidentifiertype from this IG
Coverage.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard
Coverage.type	required	MainGuarantor http://fhir.ch/ig/ch-term/ValueSet/mainguarantor
Coverage.relationship	extensible	SubscriberRelationshipCodes http://hl7.org/fhir/ValueSet/subscriber-relationship from the FHIR Standard
Coverage.class.type	extensible	BfsMedstats21Encountertype http://fhir.ch/ig/ch-core/ValueSet/bfs-medstats-21-encountertype
Coverage.costToBeneficiary.type	extensible	CoverageCopayTypeCodes http://hl7.org/fhir/ValueSet/coverage-copay-type from the FHIR Standard
Coverage.costToBeneficiary.exception.type	example	ExampleCoverageFinancialExceptionCodes http://hl7.org/fhir/ValueSet/coverage-financial-exception from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
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 CHCoreCoverage

Summary

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

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