Data that reflect a payer’s coverage that was effective as of the date of service or the date of admission of the claim.

---

Coverage

Definition	Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment.
Control	0..*
Summary	False

Coverage.id

Definition	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Control	0..1
Summary	True
Type	http://hl7.org/fhirpath/System.String

Coverage.meta

Definition	The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
Control	1..1
Summary	True
Type	Meta

Coverage.meta.id

Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control	0..1
Summary	False
Type	http://hl7.org/fhirpath/System.String

Coverage.meta.extension

Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Control	0..*
Summary	False
Alternate Names	extensions, user content
Type	Extension

Coverage.meta.versionId

Definition	The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.
Control	0..1
Summary	True
Type	id

Coverage.meta.lastUpdated

Definition	When the resource last changed - e.g. when the version changed.
Control	1..1
Summary	True
Type	instant

Coverage.meta.source

Definition	A uri that identifies the source system of the resource. This provides a minimal amount of [Provenance](http://hl7.org/fhir/R4/provenance.html#) information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.
Control	0..1
Summary	True
Type	uri

Coverage.meta.profile

Definition	A list of profiles (references to [StructureDefinition](http://hl7.org/fhir/R4/structuredefinition.html#) resources) that this resource claims to conform to. The URL is a reference to [StructureDefinition.url](http://hl7.org/fhir/R4/structuredefinition-definitions.html#StructureDefinition.url).
Control	1..*
Summary	True
Type	canonical

Coverage.meta.security

Definition	Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.
Control	0..*
Summary	True
Type	Coding

Coverage.meta.tag

Definition	Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.
Control	0..*
Summary	True
Type	Coding

Coverage.implicitRules

Definition	A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Control	0..1
Summary	True
Type	uri

Coverage.language

Definition	The base language in which the resource is written.
Control	0..1
Summary	False
Type	code

Coverage.text

Definition	A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Control	0..1
Summary	False
Alternate Names	narrative, html, xhtml, display
Type	Narrative

Coverage.contained

Definition	These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Control	0..*
Summary	False
Alternate Names	inline resources, anonymous resources, contained resources
Type	Resource

Coverage.extension

Definition	May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Control	0..*
Summary	False
Alternate Names	extensions, user content
Type	Extension

Coverage.modifierExtension

Definition	May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Control	0..*
Summary	False
Alternate Names	extensions, user content
Type	Extension

Coverage.identifier

Definition	A unique identifier assigned to this coverage.
Control	0..*
Summary	True
Type	Identifier

Coverage.status

Definition	The status of the resource instance.
Control	1..1
Summary	True
Type	code

Coverage.type

Definition	The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health or payment by an individual or organization.
Control	0..1
Summary	True
Type	CodeableConcept

Coverage.policyHolder

Definition	The party who 'owns' the insurance policy.
Control	0..1
Summary	True
Type	Reference

Coverage.subscriber

Definition	The party who has signed-up for or 'owns' the contractual relationship to the policy or to whom the benefit of the policy for services rendered to them or their family is due.
Control	0..1
Summary	True
Type	Reference

Coverage.subscriberId

Definition	The insurer assigned ID for the Subscriber.
Control	1..1
Summary	True
Type	string

Coverage.beneficiary

Definition	The party who benefits from the insurance coverage; the patient when products and/or services are provided.
Control	1..1
Summary	True
Type	Reference

Coverage.dependent

Definition	A unique identifier for a dependent under the coverage.
Control	0..1
Summary	True
Type	string

Coverage.relationship

Definition	The relationship of beneficiary (patient) to the subscriber.
Control	1..1
Summary	False
Type	CodeableConcept

Coverage.period

Definition	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.
Control	0..1
Summary	True
Type	Period

Coverage.payor

Definition	The program or plan underwriter or payor including both insurance and non-insurance agreements, such as patient-pay agreements.
Control	1..1
Summary	True
Type	Reference

Coverage.class

Definition	A suite of underwriter specific classifiers.
Control	0..*
Summary	False
Type	BackboneElement

Coverage.class.id

Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control	0..1
Summary	False
Type	http://hl7.org/fhirpath/System.String

Coverage.class.extension

Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Control	0..*
Summary	False
Alternate Names	extensions, user content
Type	Extension

Coverage.class.modifierExtension

Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Control	0..*
Summary	True
Alternate Names	extensions, user content, modifiers
Type	Extension

Coverage.class.type

Definition	The type of classification for which an insurer-specific class label or number and optional name is provided, for example may be used to identify a class of coverage or employer group, Policy, Plan.
Control	1..1
Summary	True
Type	CodeableConcept

Coverage.class.value

Definition	The alphanumeric string value associated with the insurer issued label.
Control	1..1
Summary	True
Type	string

Coverage.class.name

Definition	A short description for the class.
Control	0..1
Summary	True
Type	string

Coverage.class:group

Definition	A suite of underwriter specific classifiers.
Control	0..1
Summary	False
Type	BackboneElement

Coverage.class:group.id

Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control	0..1
Summary	False
Type	http://hl7.org/fhirpath/System.String

Coverage.class:group.extension

Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Control	0..*
Summary	False
Alternate Names	extensions, user content
Type	Extension

Coverage.class:group.modifierExtension

Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Control	0..*
Summary	True
Alternate Names	extensions, user content, modifiers
Type	Extension

Coverage.class:group.type

Definition	The type of classification for which an insurer-specific class label or number and optional name is provided, for example may be used to identify a class of coverage or employer group, Policy, Plan.
Control	1..1
Summary	True
Type	CodeableConcept

Coverage.class:group.value

Definition	The alphanumeric string value associated with the insurer issued label.
Control	1..1
Summary	True
Type	string

Coverage.class:group.name

Definition	A short description for the class.
Control	0..1
Summary	True
Type	string

Coverage.class:plan

Definition	A suite of underwriter specific classifiers.
Control	0..1
Summary	False
Type	BackboneElement

Coverage.class:plan.id

Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control	0..1
Summary	False
Type	http://hl7.org/fhirpath/System.String

Coverage.class:plan.extension

Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Control	0..*
Summary	False
Alternate Names	extensions, user content
Type	Extension

Coverage.class:plan.modifierExtension

Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Control	0..*
Summary	True
Alternate Names	extensions, user content, modifiers
Type	Extension

Coverage.class:plan.type

Definition	The type of classification for which an insurer-specific class label or number and optional name is provided, for example may be used to identify a class of coverage or employer group, Policy, Plan.
Control	1..1
Summary	True
Type	CodeableConcept

Coverage.class:plan.value

Definition	The alphanumeric string value associated with the insurer issued label.
Control	1..1
Summary	True
Type	string

Coverage.class:plan.name

Definition	A short description for the class.
Control	0..1
Summary	True
Type	string

Coverage.order

Definition	The order of applicability of this coverage relative to other coverages which are currently in force. Note, there may be gaps in the numbering and this does not imply primary, secondary etc. as the specific positioning of coverages depends upon the episode of care.
Control	0..1
Summary	True
Type	positiveInt

Coverage.network

Definition	The insurer-specific identifier for the insurer-defined network of providers to which the beneficiary may seek treatment which will be covered at the 'in-network' rate, otherwise 'out of network' terms and conditions apply.
Control	0..1
Summary	True
Type	string

Coverage.costToBeneficiary

Definition	A suite of codes indicating the cost category and associated amount which have been detailed in the policy and may have been included on the health card.
Control	0..*
Summary	False
Alternate Names	CoPay, Deductible, Exceptions
Type	BackboneElement

Coverage.costToBeneficiary.id

Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control	0..1
Summary	False
Type	http://hl7.org/fhirpath/System.String

Coverage.costToBeneficiary.extension

Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Control	0..*
Summary	False
Alternate Names	extensions, user content
Type	Extension

Coverage.costToBeneficiary.modifierExtension

Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Control	0..*
Summary	True
Alternate Names	extensions, user content, modifiers
Type	Extension

Coverage.costToBeneficiary.type

Definition	The category of patient centric costs associated with treatment.
Control	0..1
Summary	True
Type	CodeableConcept

Coverage.costToBeneficiary.value[x]

Definition	The amount due from the patient for the cost category.
Control	1..1
Summary	True
Type	Quantity

Coverage.costToBeneficiary.exception

Definition	A suite of codes indicating exceptions or reductions to patient costs and their effective periods.
Control	0..*
Summary	False
Type	BackboneElement

Coverage.costToBeneficiary.exception.id

Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control	0..1
Summary	False
Type	http://hl7.org/fhirpath/System.String

Coverage.costToBeneficiary.exception.extension

Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Control	0..*
Summary	False
Alternate Names	extensions, user content
Type	Extension

Coverage.costToBeneficiary.exception.modifierExtension

Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Control	0..*
Summary	True
Alternate Names	extensions, user content, modifiers
Type	Extension

Coverage.costToBeneficiary.exception.type

Definition	The code for the specific exception.
Control	1..1
Summary	True
Type	CodeableConcept

Coverage.costToBeneficiary.exception.period

Definition	The timeframe during when the exception is in force.
Control	0..1
Summary	True
Type	Period

Coverage.subrogation

Definition	When 'subrogation=true' this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs.
Control	0..1
Summary	False
Type	boolean

Coverage.contract

Definition	The policy(s) which constitute this insurance coverage.
Control	0..*
Summary	False
Type	Reference