| identifier | No | Identifier[] | Business Identifier for the coverage |
| status | Yes | code | active / cancelled / draft / entered-in-error |
| type | No | CodeableConcept | Coverage category such as medical or accident |
| policyHolder | No | Reference<Patient / RelatedPerson / Organization> | Owner of the policy |
| subscriber | No | Reference<Patient / RelatedPerson> | Subscriber to the policy |
| subscriberId | No | string | ID assigned to the subscriber |
| beneficiary | Yes | Reference<Patient> | Plan beneficiary |
| dependent | No | string | Dependent number |
| relationship | No | CodeableConcept | Beneficiary relationship to the subscriber |
| period | No | Period | Coverage start and end dates |
| payor | Yes | Reference<Organization / Patient / RelatedPerson>[] | Issuer of the policy |
| class | No | CoverageClass | Additional coverage classifications |
| - id | No | string | Unique id for inter-element referencing |
| - extension | No | Extension[] | Additional content defined by implementations |
| - modifierExtension | No | Extension[] | Extensions that cannot be ignored even if unrecognized |
| - type | Yes | CodeableConcept | Type of class such as ‘group’ or ‘plan’ |
| - value | Yes | string | Value associated with the type |
| - name | No | string | Human readable description of the type and value |
| order | No | positiveInt | Relative order of the coverage |
| network | No | string | Insurer network |
| costToBeneficiary | No | CoverageCostToBeneficiary | Patient payments for services/products |
| - id | No | string | Unique id for inter-element referencing |
| - extension | No | Extension[] | Additional content defined by implementations |
| - modifierExtension | No | Extension[] | Extensions that cannot be ignored even if unrecognized |
| - type | No | CodeableConcept | Cost category |
| - value[x] | Yes | Quantity, Money | The amount or percentage due from the beneficiary |
| - exception | No | CoverageCostToBeneficiaryException | Exceptions for patient payments |
| - id | No | string | Unique id for inter-element referencing |
| - extension | No | Extension[] | Additional content defined by implementations |
| - modifierExtension | No | Extension[] | Extensions that cannot be ignored even if unrecognized |
| - type | Yes | CodeableConcept | Exception category |
| - period | No | Period | The effective period of the exception |
| subrogation | No | boolean | Reimbursement to insurer |
| contract | No | Reference<Contract>[] | Contract details |
