Financial instrument which may be used to reimburse or pay for health care products and services.

Health care programs and insurers are significant payors of health service costs.

The main (and possibly only) identifier for the coverage - often referred to as a Member Id, Certificate number, Personal Health Number or Case ID. May be constructed as the concatenation of the Coverage.SubscriberID and the Coverage.dependant.

This value may uniquely identify the coverage or it may be used in conjunction with the additional identifiers below.

The status of the resource instance.

This element is labeled as a modifier because the status contains the code entered-in-error that marks the coverage as not currently valid.

The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health or payment by an individual or organization.

The order of application of coverages is dependent on the types of coverage.

The party who 'owns' the insurance policy, may be an individual, corporation or the subscriber's employer.

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.

The insurer assigned ID for the Subscriber.

The party who benefits from the insurance coverage; the patient when services are provided.

A unique identifier for a dependent under the coverage.

For some coverage a single identifier is issued to the Subscriber and a dependent number issued to each beneficiary.

The relationship of beneficiary (patient) to the subscriber.

To determine relationship between the patient and the subscriber.

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.

The program or plan underwriter or payor including both insurance and non-insurance agreements, such as patient-pay agreements. May provide multiple identifiers such as insurance company identifier or business identifier (BIN number).

Need to identify the issuer to target for processing and for coordination of benefit processing.

A suite of underwrite specific classifiers, for example may be used to identify a class of coverage or employer group, Policy, Plan.

The type of classification for which an insurer-specific class tag or number and optional name is provided, for example may be used to identify a class of coverage or employer group, Policy, Plan.

For example, the Group or Plan number.

A short description for the class.

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.

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.

A suite of underwrite specific classifiers, for example may be used to identify a class of coverage or employer group, Policy, Plan.

Types of products or services such as visit, specialist visits, emergency, inpatient care, etc.

The amount of patient payments for various types of services/products, expressed as a percentage of the service/product cost or a fixed amount of currency.

The policy(s) which constitute this insurance coverage.