Resources
Coverage
Resources
Coverage
Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment.
Properties
| Name | Required | Type | Description |
|---|---|---|---|
| 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 |
Search Parameters
| Name | Type | Description | Expression |
|---|---|---|---|
| beneficiary | reference | Covered party | Coverage.beneficiary |
| class-type | token | Coverage class (eg. plan, group) | Coverage.class.type |
| class-value | string | Value of the class (eg. Plan number, group number) | Coverage.class.value |
| dependent | string | Dependent number | Coverage.dependent |
| identifier | token | The primary identifier of the insured and the coverage | Coverage.identifier |
| patient | reference | Retrieve coverages for a patient | Coverage.beneficiary |
| payor | reference | The identity of the insurer or party paying for services | Coverage.payor |
| policy-holder | reference | Reference to the policyholder | Coverage.policyHolder |
| status | token | The status of the Coverage | Coverage.status |
| subscriber | reference | Reference to the subscriber | Coverage.subscriber |
| type | token | The kind of coverage (health plan, auto, Workers Compensation) | Coverage.type |
Inherited Properties
| Name | Required | Type | Description |
|---|---|---|---|
| id | No | string | Logical id of this artifact |
| meta | No | Meta | Metadata about the resource |
| implicitRules | No | uri | A set of rules under which this content was created |
| language | No | code | Language of the resource content |
| text | No | Narrative | Text summary of the resource, for human interpretation |
| contained | No | Resource[] | Contained, inline Resources |
| extension | No | Extension[] | Additional content defined by implementations |
| modifierExtension | No | Extension[] | Extensions that cannot be ignored |
To view the FHIR specification for this resource, see Coverage.