Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
id		1..1	id	A unique id for the coverage resource that will be used for referencing within the bundle message.
meta		1..1	Meta	The metadata about a resource.
profile		1..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
identifier		1..*	Identifier	A unique id for the coverage resource that will be used for referencing within the bundle message.
status		1..1	code	The status of the resource instance. Required Pattern: active
type		1..1	CodeableConcept	Coverage category such as medical or accident
policyHolder		0..1	Reference(SHAPatient | Organization)	Owner of the policy. The patient
subscriber		0..1	Reference(SHAPatient)	Subscriber to the policy. A reference to the patient resource. The patient
subscriberId		0..1	string	ID assigned to the subscriber. The policy subscriber ID from the insurance company. SHA Number
beneficiary		1..1	Reference(Patient)	The party who is the subject of care and whose healthcare costs may be covered under the insurance policy. The Patient Required Pattern: At least the following
reference		1..1	string	Literal reference, Relative, internal or absolute URL Fixed Value: Patient/SHAPatientExample
dependent		0..1	string	Dependent number issued by an insurer to distinguish between multiple parties covered under the subscriber's policy.
relationship		1..1	CodeableConcept	The relationship of the beneficiary to the subscriber eg Self
period		0..1	Period	Time period during which the coverage is in force. A missing start date indicates the start date isn't known, a missing end date means the coverage is continuing to be in force
payor		1..1	Reference(Organization | Patient | RelatedPerson)	Issuer of the policy. A reference to the insurance company
class		0..*	BackboneElement	Additional coverage classifications. Plan and group
value		1..1	string	Value associated with the type. Group ID
name		1..1	string	Value associated with the type. Group display name
costToBeneficiary		0..*	BackboneElement	Patient payments for services/products. Ex: co-payment
type		0..1	CodeableConcept	Cost category. This value set includes sample Coverage Copayment Type codes.
Slices for value[x]		1..1	SimpleQuantity, Money	The amount or percentage due from the beneficiary Slice: Unordered, Open by type:$this
value[x]:valueQuantity		0..1	SimpleQuantity	The amount or percentage due from the beneficiary
value[x]:valueMoney		0..1	Money	Money value to be paid by the beneficiary
subrogation		0..1	boolean	Indicates whether this plan is just for other insurers to recover changes from, for example auto, home or workers compensation
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
id	Σ	1..1	id	A unique id for the coverage resource that will be used for referencing within the bundle message.
meta	Σ	1..1	Meta	The metadata about a resource.
profile	Σ	1..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	1..*	Identifier	A unique id for the coverage resource that will be used for referencing within the bundle message.
status	?!Σ	1..1	code	The status of the resource instance. Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active
type	Σ	1..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(SHAPatient | Organization)	Owner of the policy. The patient
subscriber	Σ	0..1	Reference(SHAPatient)	Subscriber to the policy. A reference to the patient resource. The patient
subscriberId	Σ	0..1	string	ID assigned to the subscriber. The policy subscriber ID from the insurance company. SHA Number
beneficiary	Σ	1..1	Reference(Patient)	The party who is the subject of care and whose healthcare costs may be covered under the insurance policy. The Patient Required Pattern: At least the following
reference		1..1	string	Literal reference, Relative, internal or absolute URL Fixed Value: Patient/SHAPatientExample
dependent	Σ	0..1	string	Dependent number issued by an insurer to distinguish between multiple parties covered under the subscriber's policy.
relationship		1..1	CodeableConcept	The relationship of the beneficiary to the subscriber eg Self Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
period	Σ	0..1	Period	Time period during which the coverage is in force. A missing start date indicates the start date isn't known, a missing end date means the coverage is continuing to be in force
payor	Σ	1..1	Reference(Organization | Patient | RelatedPerson)	Issuer of the policy. A reference to the insurance company
class		0..*	BackboneElement	Additional coverage classifications. Plan and group
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. Group ID
name	Σ	1..1	string	Value associated with the type. Group display name
costToBeneficiary		0..*	BackboneElement	Patient payments for services/products. Ex: co-payment
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	0..1	CodeableConcept	Cost category. This value set includes sample Coverage Copayment Type codes. Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
Slices for value[x]	Σ	1..1		The amount or percentage due from the beneficiary Slice: Unordered, Closed by type:$this
valueQuantity			Quantity(SimpleQuantity)
valueMoney			Money
value[x]:valueQuantity	Σ	0..1	SimpleQuantity	The amount or percentage due from the beneficiary
value[x]:valueMoney	Σ	0..1	Money	Money value to be paid by the beneficiary
subrogation		0..1	boolean	Indicates whether this plan is just for other insurers to recover changes from, for example auto, home or workers compensation
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Coverage.status	required	Pattern: active http://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard
Coverage.type	preferred	CoverageTypeAndSelf-PayCodes http://hl7.org/fhir/ValueSet/coverage-type from the FHIR Standard
Coverage.relationship	extensible	SubscriberRelationshipCodes http://hl7.org/fhir/ValueSet/subscriber-relationship from the FHIR Standard
Coverage.class.type	extensible	CoverageClassCodes http://hl7.org/fhir/ValueSet/coverage-class from the FHIR Standard
Coverage.costToBeneficiary.type	extensible	CoverageCopayTypeCodes http://hl7.org/fhir/ValueSet/coverage-copay-type 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()

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
id	Σ	1..1	id	A unique id for the coverage resource that will be used for referencing within the bundle message.
meta	Σ	1..1	Meta	The metadata about a resource.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	Σ	0..1	instant	When the resource version last changed
source	Σ	0..1	uri	Identifies where the resource comes from
profile	Σ	1..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
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		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	1..*	Identifier	A unique id for the coverage resource that will be used for referencing within the bundle message.
status	?!Σ	1..1	code	The status of the resource instance. Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active
type	Σ	1..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(SHAPatient | Organization)	Owner of the policy. The patient
subscriber	Σ	0..1	Reference(SHAPatient)	Subscriber to the policy. A reference to the patient resource. The patient
subscriberId	Σ	0..1	string	ID assigned to the subscriber. The policy subscriber ID from the insurance company. SHA Number
beneficiary	Σ	1..1	Reference(Patient)	The party who is the subject of care and whose healthcare costs may be covered under the insurance policy. The Patient Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
reference		1..1	string	Literal reference, Relative, internal or absolute URL Fixed Value: Patient/SHAPatientExample
type		0..1	uri	Type the reference refers to (e.g. "Patient")
identifier		0..1	Identifier	Logical reference, when literal reference is not known
display		0..1	string	Text alternative for the resource
dependent	Σ	0..1	string	Dependent number issued by an insurer to distinguish between multiple parties covered under the subscriber's policy.
relationship		1..1	CodeableConcept	The relationship of the beneficiary to the subscriber eg Self Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
period	Σ	0..1	Period	Time period during which the coverage is in force. A missing start date indicates the start date isn't known, a missing end date means the coverage is continuing to be in force
payor	Σ	1..1	Reference(Organization | Patient | RelatedPerson)	Issuer of the policy. A reference to the insurance company
class		0..*	BackboneElement	Additional coverage classifications. Plan and group
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. Group ID
name	Σ	1..1	string	Value associated with the type. Group display name
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. Ex: co-payment
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. This value set includes sample Coverage Copayment Type codes. Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
Slices for value[x]	Σ	1..1		The amount or percentage due from the beneficiary Slice: Unordered, Closed by type:$this
valueQuantity			Quantity(SimpleQuantity)
valueMoney			Money
value[x]:valueQuantity	Σ	0..1	SimpleQuantity	The amount or percentage due from the beneficiary
value[x]:valueMoney	Σ	0..1	Money	Money value to be paid by the beneficiary
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	Indicates whether this plan is just for other insurers to recover changes from, for example auto, home or workers compensation
contract		0..*	Reference(Contract)	Contract details
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Coverage.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
Coverage.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
Coverage.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
Coverage.status	required	Pattern: active http://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard
Coverage.type	preferred	CoverageTypeAndSelf-PayCodes http://hl7.org/fhir/ValueSet/coverage-type from the FHIR Standard
Coverage.relationship	extensible	SubscriberRelationshipCodes http://hl7.org/fhir/ValueSet/subscriber-relationship from the FHIR Standard
Coverage.class.type	extensible	CoverageClassCodes http://hl7.org/fhir/ValueSet/coverage-class from the FHIR Standard
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()

Summary

Mandatory: 6 elements(1 nested mandatory element)

Structures

This structure refers to these other structures:

• SHAPatient (https://shr.tiberbuapps.com/fhir/StructureDefinition/SHAPatient)
• SimpleQuantity (http://hl7.org/fhir/StructureDefinition/SimpleQuantity)

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of Coverage.costToBeneficiary.value[x]

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
id		1..1	id	A unique id for the coverage resource that will be used for referencing within the bundle message.
meta		1..1	Meta	The metadata about a resource.
profile		1..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
identifier		1..*	Identifier	A unique id for the coverage resource that will be used for referencing within the bundle message.
status		1..1	code	The status of the resource instance. Required Pattern: active
type		1..1	CodeableConcept	Coverage category such as medical or accident
policyHolder		0..1	Reference(SHAPatient | Organization)	Owner of the policy. The patient
subscriber		0..1	Reference(SHAPatient)	Subscriber to the policy. A reference to the patient resource. The patient
subscriberId		0..1	string	ID assigned to the subscriber. The policy subscriber ID from the insurance company. SHA Number
beneficiary		1..1	Reference(Patient)	The party who is the subject of care and whose healthcare costs may be covered under the insurance policy. The Patient Required Pattern: At least the following
reference		1..1	string	Literal reference, Relative, internal or absolute URL Fixed Value: Patient/SHAPatientExample
dependent		0..1	string	Dependent number issued by an insurer to distinguish between multiple parties covered under the subscriber's policy.
relationship		1..1	CodeableConcept	The relationship of the beneficiary to the subscriber eg Self
period		0..1	Period	Time period during which the coverage is in force. A missing start date indicates the start date isn't known, a missing end date means the coverage is continuing to be in force
payor		1..1	Reference(Organization | Patient | RelatedPerson)	Issuer of the policy. A reference to the insurance company
class		0..*	BackboneElement	Additional coverage classifications. Plan and group
value		1..1	string	Value associated with the type. Group ID
name		1..1	string	Value associated with the type. Group display name
costToBeneficiary		0..*	BackboneElement	Patient payments for services/products. Ex: co-payment
type		0..1	CodeableConcept	Cost category. This value set includes sample Coverage Copayment Type codes.
Slices for value[x]		1..1	SimpleQuantity, Money	The amount or percentage due from the beneficiary Slice: Unordered, Open by type:$this
value[x]:valueQuantity		0..1	SimpleQuantity	The amount or percentage due from the beneficiary
value[x]:valueMoney		0..1	Money	Money value to be paid by the beneficiary
subrogation		0..1	boolean	Indicates whether this plan is just for other insurers to recover changes from, for example auto, home or workers compensation
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
id	Σ	1..1	id	A unique id for the coverage resource that will be used for referencing within the bundle message.
meta	Σ	1..1	Meta	The metadata about a resource.
profile	Σ	1..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	1..*	Identifier	A unique id for the coverage resource that will be used for referencing within the bundle message.
status	?!Σ	1..1	code	The status of the resource instance. Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active
type	Σ	1..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(SHAPatient | Organization)	Owner of the policy. The patient
subscriber	Σ	0..1	Reference(SHAPatient)	Subscriber to the policy. A reference to the patient resource. The patient
subscriberId	Σ	0..1	string	ID assigned to the subscriber. The policy subscriber ID from the insurance company. SHA Number
beneficiary	Σ	1..1	Reference(Patient)	The party who is the subject of care and whose healthcare costs may be covered under the insurance policy. The Patient Required Pattern: At least the following
reference		1..1	string	Literal reference, Relative, internal or absolute URL Fixed Value: Patient/SHAPatientExample
dependent	Σ	0..1	string	Dependent number issued by an insurer to distinguish between multiple parties covered under the subscriber's policy.
relationship		1..1	CodeableConcept	The relationship of the beneficiary to the subscriber eg Self Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
period	Σ	0..1	Period	Time period during which the coverage is in force. A missing start date indicates the start date isn't known, a missing end date means the coverage is continuing to be in force
payor	Σ	1..1	Reference(Organization | Patient | RelatedPerson)	Issuer of the policy. A reference to the insurance company
class		0..*	BackboneElement	Additional coverage classifications. Plan and group
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. Group ID
name	Σ	1..1	string	Value associated with the type. Group display name
costToBeneficiary		0..*	BackboneElement	Patient payments for services/products. Ex: co-payment
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	0..1	CodeableConcept	Cost category. This value set includes sample Coverage Copayment Type codes. Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
Slices for value[x]	Σ	1..1		The amount or percentage due from the beneficiary Slice: Unordered, Closed by type:$this
valueQuantity			Quantity(SimpleQuantity)
valueMoney			Money
value[x]:valueQuantity	Σ	0..1	SimpleQuantity	The amount or percentage due from the beneficiary
value[x]:valueMoney	Σ	0..1	Money	Money value to be paid by the beneficiary
subrogation		0..1	boolean	Indicates whether this plan is just for other insurers to recover changes from, for example auto, home or workers compensation
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Coverage.status	required	Pattern: active http://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard
Coverage.type	preferred	CoverageTypeAndSelf-PayCodes http://hl7.org/fhir/ValueSet/coverage-type from the FHIR Standard
Coverage.relationship	extensible	SubscriberRelationshipCodes http://hl7.org/fhir/ValueSet/subscriber-relationship from the FHIR Standard
Coverage.class.type	extensible	CoverageClassCodes http://hl7.org/fhir/ValueSet/coverage-class from the FHIR Standard
Coverage.costToBeneficiary.type	extensible	CoverageCopayTypeCodes http://hl7.org/fhir/ValueSet/coverage-copay-type 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()

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
id	Σ	1..1	id	A unique id for the coverage resource that will be used for referencing within the bundle message.
meta	Σ	1..1	Meta	The metadata about a resource.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	Σ	0..1	instant	When the resource version last changed
source	Σ	0..1	uri	Identifies where the resource comes from
profile	Σ	1..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
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		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	1..*	Identifier	A unique id for the coverage resource that will be used for referencing within the bundle message.
status	?!Σ	1..1	code	The status of the resource instance. Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active
type	Σ	1..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(SHAPatient | Organization)	Owner of the policy. The patient
subscriber	Σ	0..1	Reference(SHAPatient)	Subscriber to the policy. A reference to the patient resource. The patient
subscriberId	Σ	0..1	string	ID assigned to the subscriber. The policy subscriber ID from the insurance company. SHA Number
beneficiary	Σ	1..1	Reference(Patient)	The party who is the subject of care and whose healthcare costs may be covered under the insurance policy. The Patient Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
reference		1..1	string	Literal reference, Relative, internal or absolute URL Fixed Value: Patient/SHAPatientExample
type		0..1	uri	Type the reference refers to (e.g. "Patient")
identifier		0..1	Identifier	Logical reference, when literal reference is not known
display		0..1	string	Text alternative for the resource
dependent	Σ	0..1	string	Dependent number issued by an insurer to distinguish between multiple parties covered under the subscriber's policy.
relationship		1..1	CodeableConcept	The relationship of the beneficiary to the subscriber eg Self Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
period	Σ	0..1	Period	Time period during which the coverage is in force. A missing start date indicates the start date isn't known, a missing end date means the coverage is continuing to be in force
payor	Σ	1..1	Reference(Organization | Patient | RelatedPerson)	Issuer of the policy. A reference to the insurance company
class		0..*	BackboneElement	Additional coverage classifications. Plan and group
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. Group ID
name	Σ	1..1	string	Value associated with the type. Group display name
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. Ex: co-payment
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. This value set includes sample Coverage Copayment Type codes. Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
Slices for value[x]	Σ	1..1		The amount or percentage due from the beneficiary Slice: Unordered, Closed by type:$this
valueQuantity			Quantity(SimpleQuantity)
valueMoney			Money
value[x]:valueQuantity	Σ	0..1	SimpleQuantity	The amount or percentage due from the beneficiary
value[x]:valueMoney	Σ	0..1	Money	Money value to be paid by the beneficiary
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	Indicates whether this plan is just for other insurers to recover changes from, for example auto, home or workers compensation
contract		0..*	Reference(Contract)	Contract details
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Coverage.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
Coverage.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
Coverage.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
Coverage.status	required	Pattern: active http://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard
Coverage.type	preferred	CoverageTypeAndSelf-PayCodes http://hl7.org/fhir/ValueSet/coverage-type from the FHIR Standard
Coverage.relationship	extensible	SubscriberRelationshipCodes http://hl7.org/fhir/ValueSet/subscriber-relationship from the FHIR Standard
Coverage.class.type	extensible	CoverageClassCodes http://hl7.org/fhir/ValueSet/coverage-class from the FHIR Standard
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()

Summary

Mandatory: 6 elements(1 nested mandatory element)

Structures

This structure refers to these other structures:

• SHAPatient (https://shr.tiberbuapps.com/fhir/StructureDefinition/SHAPatient)
• SimpleQuantity (http://hl7.org/fhir/StructureDefinition/SimpleQuantity)

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of Coverage.costToBeneficiary.value[x]