Coverage

ResourceFinancial · SupportTrial useMaturity 2

Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment.

StructureSearch parametersHL7 specificationStructureDefinition JSON

Tested supportFull test results →

Backends

PostgreSQLElasticsearch

Interactions

CreateReadUpdatePatchDelete

Search

11 of 11 parameters tested

Structure

Show inherited elements (17)

Element	Card.	Type	Description
identifierΣ	0..*	Identifier	Business Identifier for the coverage
statusRequired?!Σ	1..1	code	active | cancelled | draft | entered-in-errorBinding (required): fm-status
typeΣ	0..1	CodeableConcept	Coverage category such as medical or accidentBinding (preferred): coverage-type
policyHolderΣ	0..1	Reference(Patient | RelatedPerson | Organization)	Owner of the policy
subscriberΣ	0..1	Reference(Patient | RelatedPerson)	Subscriber to the policy
subscriberIdΣ	0..1	string	ID assigned to the subscriber
beneficiaryRequiredΣ	1..1	Reference(Patient)	Plan beneficiary
dependentΣ	0..1	string	Dependent number
relationship	0..1	CodeableConcept	Beneficiary relationship to the subscriberBinding (extensible): subscriber-relationship
periodΣ	0..1	Period	Coverage start and end dates
payorRequiredΣ	1..*	Reference(Organization | Patient | RelatedPerson)	Issuer of the policy
class	0..*	BackboneElement	Additional coverage classifications
typeRequiredΣ	1..1	CodeableConcept	Type of class such as 'group' or 'plan'Binding (extensible): coverage-class
valueRequiredΣ	1..1	string	Value associated with the type
nameΣ	0..1	string	Human readable description of the type and value
orderΣ	0..1	positiveInt	Relative order of the coverage
networkΣ	0..1	string	Insurer network
costToBeneficiary	0..*	BackboneElement	Patient payments for services/products
typeΣ	0..1	CodeableConcept	Cost categoryBinding (extensible): coverage-copay-type
value[x]RequiredΣ	1..1	Quantity | Money	The amount or percentage due from the beneficiary
exception	0..*	BackboneElement	Exceptions for patient payments
typeRequiredΣ	1..1	CodeableConcept	Exception categoryBinding (example): coverage-financial-exception
periodΣ	0..1	Period	The effective period of the exception
subrogation	0..1	boolean	Reimbursement to insurer
contract	0..*	Reference(Contract)	Contract details

Σ in _summary results · ?! modifier element · 1.. required · inherited elements in grey

Search parameters

Query with GET [base]/Coverage?[parameter]=[value]. Type decides which modifiers and prefixes apply, see search features.

Parameter	Type	Description	PG	ES
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

PG: PostgreSQL, ES: Elasticsearch. passes its TestScript checks, fails, not tested yet.

Common parameters on every resource (8)

_haste-health-author	reference	The author of the resource
_id	token	Logical id of this artifact
_lastUpdated	date	When the resource version last changed
_profile	uri	Profiles this resource claims to conform to
_security	token	Security Labels applied to this resource
_source	uri	Identifies where the resource comes from
_tag	token	Tags applied to this resource
_type	token	Derived from the R4B Definition