CH ORF (R4)
3.0.0-ballot - ballot Switzerland flag

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

Official URL: http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage Version: 3.0.0-ballot
Active as of 2024-05-17 Computable Name: ChOrfCoverage

Copyright/Legal: CC0-1.0

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 CHCoreCoverage

NameFlagsCard.TypeDescription & Constraintsdoco
.. 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
... 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)

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
Coverage.identifier.typerequiredChOrfCoverageIdentifierType (a valid code from Coverage Identifier Type)
http://fhir.ch/ig/ch-orf/ValueSet/ch-orf-vs-coverageidentifiertype
from this IG
Coverage.typerequiredChOrfCoverageType (a valid code from Coverage Type)
http://fhir.ch/ig/ch-orf/ValueSet/ch-orf-vs-coveragetype
from this IG
NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..* CHCoreCoverage CH ORF Coverage
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... contained S 0..* Resource Contained, inline Resources
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
.... 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 .

..... type SΣ 1..1 CodeableConcept Description of identifier
Binding: Coverage Identifier Type (required)
...... coding SΣ 1..* Coding Code defined by a terminology system
....... system SΣ 1..1 uri Identity of the terminology system
....... code SΣ 1..1 code Symbol in syntax defined by the system
...... text SΣ 0..1 string Plain text representation of the concept
..... value SΣ 1..1 string The value that is unique
Example General: 123456
.... 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
... 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: Coverage Type (required)
... beneficiary SΣ 1..1 Reference(CH Core Patient) Plan beneficiary
... 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)

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Coverage.identifier.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
Coverage.identifier.typerequiredChOrfCoverageIdentifierType (a valid code from Coverage Identifier Type)
http://fhir.ch/ig/ch-orf/ValueSet/ch-orf-vs-coverageidentifiertype
from this IG
Coverage.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
from the FHIR Standard
Coverage.typerequiredChOrfCoverageType (a valid code from Coverage Type)
http://fhir.ch/ig/ch-orf/ValueSet/ch-orf-vs-coveragetype
from this IG

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..* 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
... 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 pattern:$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: Coverage Type (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

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.identifier.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
Coverage.identifier.typerequiredChOrfCoverageIdentifierType (a valid code from Coverage Identifier Type)
http://fhir.ch/ig/ch-orf/ValueSet/ch-orf-vs-coverageidentifiertype
from this IG
Coverage.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
from the FHIR Standard
Coverage.typerequiredChOrfCoverageType (a valid code from Coverage Type)
http://fhir.ch/ig/ch-orf/ValueSet/ch-orf-vs-coveragetype
from this IG
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 CHCoreCoverage

Summary

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

Differential View

This structure is derived from CHCoreCoverage

NameFlagsCard.TypeDescription & Constraintsdoco
.. 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
... 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)

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
Coverage.identifier.typerequiredChOrfCoverageIdentifierType (a valid code from Coverage Identifier Type)
http://fhir.ch/ig/ch-orf/ValueSet/ch-orf-vs-coverageidentifiertype
from this IG
Coverage.typerequiredChOrfCoverageType (a valid code from Coverage Type)
http://fhir.ch/ig/ch-orf/ValueSet/ch-orf-vs-coveragetype
from this IG

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..* CHCoreCoverage CH ORF Coverage
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... contained S 0..* Resource Contained, inline Resources
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
.... 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 .

..... type SΣ 1..1 CodeableConcept Description of identifier
Binding: Coverage Identifier Type (required)
...... coding SΣ 1..* Coding Code defined by a terminology system
....... system SΣ 1..1 uri Identity of the terminology system
....... code SΣ 1..1 code Symbol in syntax defined by the system
...... text SΣ 0..1 string Plain text representation of the concept
..... value SΣ 1..1 string The value that is unique
Example General: 123456
.... 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
... 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: Coverage Type (required)
... beneficiary SΣ 1..1 Reference(CH Core Patient) Plan beneficiary
... 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)

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Coverage.identifier.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
Coverage.identifier.typerequiredChOrfCoverageIdentifierType (a valid code from Coverage Identifier Type)
http://fhir.ch/ig/ch-orf/ValueSet/ch-orf-vs-coverageidentifiertype
from this IG
Coverage.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
from the FHIR Standard
Coverage.typerequiredChOrfCoverageType (a valid code from Coverage Type)
http://fhir.ch/ig/ch-orf/ValueSet/ch-orf-vs-coveragetype
from this IG

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..* 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
... 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 pattern:$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: Coverage Type (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

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.identifier.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
Coverage.identifier.typerequiredChOrfCoverageIdentifierType (a valid code from Coverage Identifier Type)
http://fhir.ch/ig/ch-orf/ValueSet/ch-orf-vs-coverageidentifiertype
from this IG
Coverage.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
from the FHIR Standard
Coverage.typerequiredChOrfCoverageType (a valid code from Coverage Type)
http://fhir.ch/ig/ch-orf/ValueSet/ch-orf-vs-coveragetype
from this IG
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 CHCoreCoverage

Summary

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

 

Other representations of profile: CSV, Excel, Schematron