Universal API Implementation Guide - Local Development build (v1.1.20) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

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Resource Profile: UAPI Coverage

This profile constrains the Coverage resource

Usages:

• Use this Profile: UAPI Bundle - AS Enrollment, UAPI Bundle - Copay Enrollment and UAPI Bundle - Copay Request-Response
• Refer to this Profile: UAPI MedicationRequest

Formal Views of Profile Content

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

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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:PlanYear		0..1	string	UAPI Coverage Plan Year URL: https://fhir.developer.gene.com/StructureDefinition/PlanYear
extension:ReferenceNumber		0..1	string	UAPI Coverage Reference Number URL: https://fhir.developer.gene.com/StructureDefinition/ReferenceNumber
extension:IssuedDate		0..1	date	UAPI Coverage - Card issuance date URL: https://fhir.developer.gene.com/StructureDefinition/IssuedDate
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	SΣ	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.
subscriber	Σ	1..1	Reference(UAPI Patient | UAPI RelatedPerson)	Subscriber to the policy
reference	ΣC	0..1	string	Patient or RelatedPerson resource UUID
subscriberId	SΣ	0..1	string	ID assigned to the subscriber
beneficiary	Σ	1..1	Reference(UAPI Patient)	Plan beneficiary
reference	ΣC	0..1	string	Patient resource UUID
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible) Required Pattern: Patient
payor	Σ	1..*	Reference(UAPI Organization)	Issuer of the policy
reference	ΣC	0..1	string	Payor Orginization resource UUID
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible) Required Pattern: Organization
class	S	1..*	BackboneElement	Additional coverage classifications
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.
coding	Σ	1..1	Coding	Code defined by a terminology system
system	Σ	1..1	uri	Identity of the terminology system Required Pattern: http://terminology.hl7.org/CodeSystem/coverage-class
code	Σ	1..1	code	Symbol in syntax defined by the system
value	Σ	1..1	string	Value associated with the type
name	Σ	1..1	string	Human readable description of the type and value
order	SΣ	1..1	positiveInt	Relative order of the coverage
network	SΣ	1..1	string	Insurer network
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Coverage.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.3.0 From the FHIR Standard
Coverage.type	preferred	CoverageTypeAndSelf-PayCodes http://hl7.org/fhir/ValueSet/coverage-type From the FHIR Standard
Coverage.beneficiary.type	extensible	Pattern Value: Patient http://hl7.org/fhir/ValueSet/resource-types From the FHIR Standard
Coverage.payor.type	extensible	Pattern Value: Organization http://hl7.org/fhir/ValueSet/resource-types From the FHIR Standard
Coverage.class.type	extensible	CoverageClassCodes http://hl7.org/fhir/ValueSet/coverage-class 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.exists() and ('#'+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(uri) = '#').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 Coverage

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage			Coverage
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:PlanYear		0..1	string	UAPI Coverage Plan Year URL: https://fhir.developer.gene.com/StructureDefinition/PlanYear
extension:ReferenceNumber		0..1	string	UAPI Coverage Reference Number URL: https://fhir.developer.gene.com/StructureDefinition/ReferenceNumber
extension:IssuedDate		0..1	date	UAPI Coverage - Card issuance date URL: https://fhir.developer.gene.com/StructureDefinition/IssuedDate
type	S	1..1	CodeableConcept	Coverage category such as medical or accident
subscriber		1..1	Reference(UAPI Patient | UAPI RelatedPerson)	Subscriber to the policy
reference		0..1	string	Patient or RelatedPerson resource UUID
subscriberId	S	0..1	string	ID assigned to the subscriber
beneficiary		1..1	Reference(UAPI Patient)	Plan beneficiary
reference		0..1	string	Patient resource UUID
type		0..1	uri	Type the reference refers to (e.g. "Patient") Required Pattern: Patient
payor		1..*	Reference(UAPI Organization)	Issuer of the policy
reference		0..1	string	Payor Orginization resource UUID
type		0..1	uri	Type the reference refers to (e.g. "Patient") Required Pattern: Organization
class	S	1..*	BackboneElement	Additional coverage classifications
type
coding		1..1	Coding	Code defined by a terminology system
system		1..1	uri	Identity of the terminology system Required Pattern: http://terminology.hl7.org/CodeSystem/coverage-class
code		1..1	code	Symbol in syntax defined by the system
name		1..1	string	Human readable description of the type and value
order	S	1..1	positiveInt	Relative order of the coverage
network	S	1..1	string	Insurer network
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
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): IETF language tag Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources Constraints: dom-r4b
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:PlanYear		0..1	string	UAPI Coverage Plan Year URL: https://fhir.developer.gene.com/StructureDefinition/PlanYear
extension:ReferenceNumber		0..1	string	UAPI Coverage Reference Number URL: https://fhir.developer.gene.com/StructureDefinition/ReferenceNumber
extension:IssuedDate		0..1	date	UAPI Coverage - Card issuance date URL: https://fhir.developer.gene.com/StructureDefinition/IssuedDate
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business Identifier for the coverage
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	SΣ	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(Patient | RelatedPerson | Organization)	Owner of the policy
subscriber	Σ	1..1	Reference(UAPI Patient | UAPI RelatedPerson)	Subscriber to the policy
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Patient or RelatedPerson resource UUID
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
subscriberId	SΣ	0..1	string	ID assigned to the subscriber
beneficiary	Σ	1..1	Reference(UAPI Patient)	Plan beneficiary
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Patient resource UUID
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible) Required Pattern: Patient
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
dependent	Σ	0..1	string	Dependent number
relationship		0..1	CodeableConcept	Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
period	Σ	0..1	Period	Coverage start and end dates
payor	Σ	1..*	Reference(UAPI Organization)	Issuer of the policy
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Payor Orginization resource UUID
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible) Required Pattern: Organization
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
class	S	1..*	BackboneElement	Additional coverage classifications
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	1..1	Coding	Code defined by a terminology system
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Required Pattern: http://terminology.hl7.org/CodeSystem/coverage-class
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	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	Σ	0..1	string	Plain text representation of the concept
value	Σ	1..1	string	Value associated with the type
name	Σ	1..1	string	Human readable description of the type and value
order	SΣ	1..1	positiveInt	Relative order of the coverage
network	SΣ	1..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 / Code	URI
Coverage.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Coverage.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.3.0 From the FHIR Standard
Coverage.type	preferred	CoverageTypeAndSelf-PayCodes http://hl7.org/fhir/ValueSet/coverage-type From the FHIR Standard
Coverage.subscriber.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types From the FHIR Standard
Coverage.beneficiary.type	extensible	Pattern Value: Patient http://hl7.org/fhir/ValueSet/resource-types From the FHIR Standard
Coverage.relationship	extensible	SubscriberRelationshipCodes http://hl7.org/fhir/ValueSet/subscriber-relationship From the FHIR Standard
Coverage.payor.type	extensible	Pattern Value: Organization http://hl7.org/fhir/ValueSet/resource-types 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.exists() and ('#'+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(uri) = '#').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()
dom-r4b	warning	Coverage.contained	Containing new R4B resources within R4 resources may cause interoperability issues if instances are shared with R4 systems : ($this is Citation or $this is Evidence or $this is EvidenceReport or $this is EvidenceVariable or $this is MedicinalProductDefinition or $this is PackagedProductDefinition or $this is AdministrableProductDefinition or $this is Ingredient or $this is ClinicalUseDefinition or $this is RegulatedAuthorization or $this is SubstanceDefinition or $this is SubscriptionStatus or $this is SubscriptionTopic) implies (%resource is Citation or %resource is Evidence or %resource is EvidenceReport or %resource is EvidenceVariable or %resource is MedicinalProductDefinition or %resource is PackagedProductDefinition or %resource is AdministrableProductDefinition or %resource is Ingredient or %resource is ClinicalUseDefinition or %resource is RegulatedAuthorization or %resource is SubstanceDefinition or %resource is SubscriptionStatus or %resource is SubscriptionTopic)
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 Coverage

Summary

Mandatory: 9 elements
Must-Support: 5 elements

Structures

This structure refers to these other structures:

• UAPI Patient (https://fhir.developer.gene.com/StructureDefinition/uapi-patient)
• UAPI RelatedPerson (https://fhir.developer.gene.com/StructureDefinition/uapi-relatedPerson)
• UAPI Organization (https://fhir.developer.gene.com/StructureDefinition/uapi-organization)

Extensions

This structure refers to these extensions:

• https://fhir.developer.gene.com/StructureDefinition/PlanYear
• https://fhir.developer.gene.com/StructureDefinition/ReferenceNumber
• https://fhir.developer.gene.com/StructureDefinition/IssuedDate

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:PlanYear		0..1	string	UAPI Coverage Plan Year URL: https://fhir.developer.gene.com/StructureDefinition/PlanYear
extension:ReferenceNumber		0..1	string	UAPI Coverage Reference Number URL: https://fhir.developer.gene.com/StructureDefinition/ReferenceNumber
extension:IssuedDate		0..1	date	UAPI Coverage - Card issuance date URL: https://fhir.developer.gene.com/StructureDefinition/IssuedDate
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	SΣ	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.
subscriber	Σ	1..1	Reference(UAPI Patient | UAPI RelatedPerson)	Subscriber to the policy
reference	ΣC	0..1	string	Patient or RelatedPerson resource UUID
subscriberId	SΣ	0..1	string	ID assigned to the subscriber
beneficiary	Σ	1..1	Reference(UAPI Patient)	Plan beneficiary
reference	ΣC	0..1	string	Patient resource UUID
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible) Required Pattern: Patient
payor	Σ	1..*	Reference(UAPI Organization)	Issuer of the policy
reference	ΣC	0..1	string	Payor Orginization resource UUID
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible) Required Pattern: Organization
class	S	1..*	BackboneElement	Additional coverage classifications
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.
coding	Σ	1..1	Coding	Code defined by a terminology system
system	Σ	1..1	uri	Identity of the terminology system Required Pattern: http://terminology.hl7.org/CodeSystem/coverage-class
code	Σ	1..1	code	Symbol in syntax defined by the system
value	Σ	1..1	string	Value associated with the type
name	Σ	1..1	string	Human readable description of the type and value
order	SΣ	1..1	positiveInt	Relative order of the coverage
network	SΣ	1..1	string	Insurer network
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Coverage.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.3.0 From the FHIR Standard
Coverage.type	preferred	CoverageTypeAndSelf-PayCodes http://hl7.org/fhir/ValueSet/coverage-type From the FHIR Standard
Coverage.beneficiary.type	extensible	Pattern Value: Patient http://hl7.org/fhir/ValueSet/resource-types From the FHIR Standard
Coverage.payor.type	extensible	Pattern Value: Organization http://hl7.org/fhir/ValueSet/resource-types From the FHIR Standard
Coverage.class.type	extensible	CoverageClassCodes http://hl7.org/fhir/ValueSet/coverage-class 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.exists() and ('#'+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(uri) = '#').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()

Differential View

This structure is derived from Coverage

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage			Coverage
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:PlanYear		0..1	string	UAPI Coverage Plan Year URL: https://fhir.developer.gene.com/StructureDefinition/PlanYear
extension:ReferenceNumber		0..1	string	UAPI Coverage Reference Number URL: https://fhir.developer.gene.com/StructureDefinition/ReferenceNumber
extension:IssuedDate		0..1	date	UAPI Coverage - Card issuance date URL: https://fhir.developer.gene.com/StructureDefinition/IssuedDate
type	S	1..1	CodeableConcept	Coverage category such as medical or accident
subscriber		1..1	Reference(UAPI Patient | UAPI RelatedPerson)	Subscriber to the policy
reference		0..1	string	Patient or RelatedPerson resource UUID
subscriberId	S	0..1	string	ID assigned to the subscriber
beneficiary		1..1	Reference(UAPI Patient)	Plan beneficiary
reference		0..1	string	Patient resource UUID
type		0..1	uri	Type the reference refers to (e.g. "Patient") Required Pattern: Patient
payor		1..*	Reference(UAPI Organization)	Issuer of the policy
reference		0..1	string	Payor Orginization resource UUID
type		0..1	uri	Type the reference refers to (e.g. "Patient") Required Pattern: Organization
class	S	1..*	BackboneElement	Additional coverage classifications
type
coding		1..1	Coding	Code defined by a terminology system
system		1..1	uri	Identity of the terminology system Required Pattern: http://terminology.hl7.org/CodeSystem/coverage-class
code		1..1	code	Symbol in syntax defined by the system
name		1..1	string	Human readable description of the type and value
order	S	1..1	positiveInt	Relative order of the coverage
network	S	1..1	string	Insurer network
Documentation for this format

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
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): IETF language tag Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources Constraints: dom-r4b
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:PlanYear		0..1	string	UAPI Coverage Plan Year URL: https://fhir.developer.gene.com/StructureDefinition/PlanYear
extension:ReferenceNumber		0..1	string	UAPI Coverage Reference Number URL: https://fhir.developer.gene.com/StructureDefinition/ReferenceNumber
extension:IssuedDate		0..1	date	UAPI Coverage - Card issuance date URL: https://fhir.developer.gene.com/StructureDefinition/IssuedDate
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business Identifier for the coverage
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	SΣ	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(Patient | RelatedPerson | Organization)	Owner of the policy
subscriber	Σ	1..1	Reference(UAPI Patient | UAPI RelatedPerson)	Subscriber to the policy
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Patient or RelatedPerson resource UUID
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
subscriberId	SΣ	0..1	string	ID assigned to the subscriber
beneficiary	Σ	1..1	Reference(UAPI Patient)	Plan beneficiary
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Patient resource UUID
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible) Required Pattern: Patient
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
dependent	Σ	0..1	string	Dependent number
relationship		0..1	CodeableConcept	Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
period	Σ	0..1	Period	Coverage start and end dates
payor	Σ	1..*	Reference(UAPI Organization)	Issuer of the policy
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Payor Orginization resource UUID
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible) Required Pattern: Organization
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
class	S	1..*	BackboneElement	Additional coverage classifications
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	1..1	Coding	Code defined by a terminology system
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Required Pattern: http://terminology.hl7.org/CodeSystem/coverage-class
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	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	Σ	0..1	string	Plain text representation of the concept
value	Σ	1..1	string	Value associated with the type
name	Σ	1..1	string	Human readable description of the type and value
order	SΣ	1..1	positiveInt	Relative order of the coverage
network	SΣ	1..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 / Code	URI
Coverage.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Coverage.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.3.0 From the FHIR Standard
Coverage.type	preferred	CoverageTypeAndSelf-PayCodes http://hl7.org/fhir/ValueSet/coverage-type From the FHIR Standard
Coverage.subscriber.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types From the FHIR Standard
Coverage.beneficiary.type	extensible	Pattern Value: Patient http://hl7.org/fhir/ValueSet/resource-types From the FHIR Standard
Coverage.relationship	extensible	SubscriberRelationshipCodes http://hl7.org/fhir/ValueSet/subscriber-relationship From the FHIR Standard
Coverage.payor.type	extensible	Pattern Value: Organization http://hl7.org/fhir/ValueSet/resource-types 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.exists() and ('#'+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(uri) = '#').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()
dom-r4b	warning	Coverage.contained	Containing new R4B resources within R4 resources may cause interoperability issues if instances are shared with R4 systems : ($this is Citation or $this is Evidence or $this is EvidenceReport or $this is EvidenceVariable or $this is MedicinalProductDefinition or $this is PackagedProductDefinition or $this is AdministrableProductDefinition or $this is Ingredient or $this is ClinicalUseDefinition or $this is RegulatedAuthorization or $this is SubstanceDefinition or $this is SubscriptionStatus or $this is SubscriptionTopic) implies (%resource is Citation or %resource is Evidence or %resource is EvidenceReport or %resource is EvidenceVariable or %resource is MedicinalProductDefinition or %resource is PackagedProductDefinition or %resource is AdministrableProductDefinition or %resource is Ingredient or %resource is ClinicalUseDefinition or %resource is RegulatedAuthorization or %resource is SubstanceDefinition or %resource is SubscriptionStatus or %resource is SubscriptionTopic)
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 Coverage

Summary

Mandatory: 9 elements
Must-Support: 5 elements

Structures

This structure refers to these other structures:

• UAPI Patient (https://fhir.developer.gene.com/StructureDefinition/uapi-patient)
• UAPI RelatedPerson (https://fhir.developer.gene.com/StructureDefinition/uapi-relatedPerson)
• UAPI Organization (https://fhir.developer.gene.com/StructureDefinition/uapi-organization)

Extensions

This structure refers to these extensions:

• https://fhir.developer.gene.com/StructureDefinition/PlanYear
• https://fhir.developer.gene.com/StructureDefinition/ReferenceNumber
• https://fhir.developer.gene.com/StructureDefinition/IssuedDate

Other representations of profile: CSV, Excel, Schematron