Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Davinci ATR Coverage
insuranceProductType	S	0..1	CodeableConcept	Indicates the Insurance Product Type related to the Coverage. URL: http://hl7.org/fhir/us/davinci-atr/StructureDefinition/ext-insuranceProductType Binding: Insurance Product Type VS (extensible)
Slices for identifier	S	0..*	Identifier	Business Identifier for the coverage Slice: Unordered, Open by value:type.coding.system, value:type.coding.code
identifier:MemberIdentifier	S	0..1	Identifier	Business Identifier for the coverage
type	S	1..1	CodeableConcept	Description of identifier
coding	S	1..1	Coding	Code defined by a terminology system
system	S	1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
code	S	1..1	code	Symbol in syntax defined by the system Fixed Value: MB
system	S	1..1	uri	The namespace for the identifier value
value	S	1..1	string	The value that is unique
status	S	1..1	code	active | cancelled | draft | entered-in-error Fixed Value: active
policyHolder	S	0..1	Reference(Davinci ATR Patient | Davinci ATR RelatedPerson | Davinci ATR Organization)	Owner of the policy
subscriber	S	0..1	Reference(Davinci ATR Patient | Davinci ATR RelatedPerson)	Subscriber to the policy
subscriberId	S	1..1	string	ID assigned to the subscriber
beneficiary	S	1..1	Reference(Davinci ATR Patient)	Plan beneficiary
dependent	S	0..1	string	Dependent number
relationship	S	0..1	CodeableConcept	Beneficiary relationship to the subscriber
period	S	1..1	Period	Coverage start and end dates
payor	S	1..1	Reference(Davinci ATR Patient | Davinci ATR RelatedPerson | Davinci ATR Organization)	Issuer of the policy
Slices for class	S	0..*	BackboneElement	Additional coverage classifications Slice: Unordered, Open by value:type.coding.system, value:type.coding.code
class:PlanIdentifier	S	0..1	BackboneElement	Additional coverage classifications
type	S	1..1	CodeableConcept	Type of class such as 'group' or 'plan'
coding	S	1..1	Coding	Code defined by a terminology system
system	S	1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
code	S	1..1	code	Symbol in syntax defined by the system Fixed Value: plan
value	S	1..1	string	Value associated with the type
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Davinci ATR Coverage
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
insuranceProductType	S	0..1	CodeableConcept	Indicates the Insurance Product Type related to the Coverage. URL: http://hl7.org/fhir/us/davinci-atr/StructureDefinition/ext-insuranceProductType Binding: Insurance Product Type VS (extensible)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣ	0..*	Identifier	Business Identifier for the coverage Slice: Unordered, Open by value:type.coding.system, value:type.coding.code
identifier:MemberIdentifier	SΣ	0..1	Identifier	Business Identifier for the coverage
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	SΣ	1..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
coding	SΣ	1..1	Coding	Code defined by a terminology system
system	SΣ	1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
code	SΣ	1..1	code	Symbol in syntax defined by the system Fixed Value: MB
system	SΣ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique Example General: 123456
status	?!SΣ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Fixed Value: active
policyHolder	SΣ	0..1	Reference(Davinci ATR Patient | Davinci ATR RelatedPerson | Davinci ATR Organization)	Owner of the policy
subscriber	SΣ	0..1	Reference(Davinci ATR Patient | Davinci ATR RelatedPerson)	Subscriber to the policy
subscriberId	SΣ	1..1	string	ID assigned to the subscriber
beneficiary	SΣ	1..1	Reference(Davinci ATR Patient)	Plan beneficiary
dependent	SΣ	0..1	string	Dependent number
relationship	S	0..1	CodeableConcept	Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
period	SΣ	1..1	Period	Coverage start and end dates
payor	SΣ	1..1	Reference(Davinci ATR Patient | Davinci ATR RelatedPerson | Davinci ATR Organization)	Issuer of the policy
Slices for class	S	0..*	BackboneElement	Additional coverage classifications Slice: Unordered, Open by value:type.coding.system, value:type.coding.code
class:All Slices				Content/Rules for all slices
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
value	Σ	1..1	string	Value associated with the type
class:PlanIdentifier	S	0..1	BackboneElement	Additional coverage classifications
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	SΣ	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
coding	SΣ	1..1	Coding	Code defined by a terminology system
system	SΣ	1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
code	SΣ	1..1	code	Symbol in syntax defined by the system Fixed Value: plan
value	SΣ	1..1	string	Value associated with the type
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Coverage.identifier:MemberIdentifier.use	required	IdentifierUse
Coverage.identifier:MemberIdentifier.type	extensible	Identifier Type Codes
Coverage.status	required	Fixed Value: active
Coverage.relationship	extensible	SubscriberRelationshipCodes
Coverage.class.type	extensible	CoverageClassCodes
Coverage.class:PlanIdentifier.type	extensible	CoverageClassCodes

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Coverage	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Coverage	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Coverage	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Coverage	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Coverage	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Davinci ATR Coverage
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
insuranceProductType	S	0..1	CodeableConcept	Indicates the Insurance Product Type related to the Coverage. URL: http://hl7.org/fhir/us/davinci-atr/StructureDefinition/ext-insuranceProductType Binding: Insurance Product Type VS (extensible)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣ	0..*	Identifier	Business Identifier for the coverage Slice: Unordered, Open by value:type.coding.system, value:type.coding.code
identifier:MemberIdentifier	SΣ	0..1	Identifier	Business Identifier for the coverage
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	SΣ	1..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	SΣ	1..1	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system Fixed Value: MB
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
system	SΣ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Fixed Value: active
type	Σ	0..1	CodeableConcept	Coverage category such as medical or accident Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
policyHolder	SΣ	0..1	Reference(Davinci ATR Patient | Davinci ATR RelatedPerson | Davinci ATR Organization)	Owner of the policy
subscriber	SΣ	0..1	Reference(Davinci ATR Patient | Davinci ATR RelatedPerson)	Subscriber to the policy
subscriberId	SΣ	1..1	string	ID assigned to the subscriber
beneficiary	SΣ	1..1	Reference(Davinci ATR Patient)	Plan beneficiary
dependent	SΣ	0..1	string	Dependent number
relationship	S	0..1	CodeableConcept	Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
period	SΣ	1..1	Period	Coverage start and end dates
payor	SΣ	1..1	Reference(Davinci ATR Patient | Davinci ATR RelatedPerson | Davinci ATR Organization)	Issuer of the policy
Slices for class	S	0..*	BackboneElement	Additional coverage classifications Slice: Unordered, Open by value:type.coding.system, value:type.coding.code
class:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
value	Σ	1..1	string	Value associated with the type
name	Σ	0..1	string	Human readable description of the type and value
class:PlanIdentifier	S	0..1	BackboneElement	Additional coverage classifications
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	SΣ	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	SΣ	1..1	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system Fixed Value: plan
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
value	SΣ	1..1	string	Value associated with the type
name	Σ	0..1	string	Human readable description of the type and value
order	Σ	0..1	positiveInt	Relative order of the coverage
network	Σ	0..1	string	Insurer network
costToBeneficiary		0..*	BackboneElement	Patient payments for services/products
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	0..1	CodeableConcept	Cost category Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
value[x]	Σ	1..1		The amount or percentage due from the beneficiary
valueQuantity			Quantity(SimpleQuantity)
valueMoney			Money
exception		0..*	BackboneElement	Exceptions for patient payments
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	CodeableConcept	Exception category Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
period	Σ	0..1	Period	The effective period of the exception
subrogation		0..1	boolean	Reimbursement to insurer
contract		0..*	Reference(Contract)	Contract details
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Coverage.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
Coverage.identifier:MemberIdentifier.use	required	IdentifierUse
Coverage.identifier:MemberIdentifier.type	extensible	Identifier Type Codes
Coverage.status	required	Fixed Value: active
Coverage.type	preferred	CoverageTypeAndSelf-PayCodes
Coverage.relationship	extensible	SubscriberRelationshipCodes
Coverage.class.type	extensible	CoverageClassCodes
Coverage.class:PlanIdentifier.type	extensible	CoverageClassCodes
Coverage.costToBeneficiary.type	extensible	CoverageCopayTypeCodes
Coverage.costToBeneficiary.exception.type	example	ExampleCoverageFinancialExceptionCodes

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Coverage	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Coverage	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Coverage	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Coverage	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Coverage	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Summary

Mandatory: 5 elements (11 nested mandatory elements)
Must-Support: 25 elements
Fixed Value: 5 elements

Structures

This structure refers to these other structures:

• Davinci ATR Patient (http://hl7.org/fhir/us/davinci-atr/StructureDefinition/atr-patient)
• Davinci ATR RelatedPerson (http://hl7.org/fhir/us/davinci-atr/StructureDefinition/atr-relatedperson)
• Davinci ATR Organization (http://hl7.org/fhir/us/davinci-atr/StructureDefinition/atr-organization)

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/us/davinci-atr/StructureDefinition/ext-insuranceProductType

Slices

This structure defines the following Slices:

• The element Coverage.identifier is sliced based on the values of value:type.coding.system, value:type.coding.code
• The element Coverage.class is sliced based on the values of value:type.coding.system, value:type.coding.code

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Davinci ATR Coverage
insuranceProductType	S	0..1	CodeableConcept	Indicates the Insurance Product Type related to the Coverage. URL: http://hl7.org/fhir/us/davinci-atr/StructureDefinition/ext-insuranceProductType Binding: Insurance Product Type VS (extensible)
Slices for identifier	S	0..*	Identifier	Business Identifier for the coverage Slice: Unordered, Open by value:type.coding.system, value:type.coding.code
identifier:MemberIdentifier	S	0..1	Identifier	Business Identifier for the coverage
type	S	1..1	CodeableConcept	Description of identifier
coding	S	1..1	Coding	Code defined by a terminology system
system	S	1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
code	S	1..1	code	Symbol in syntax defined by the system Fixed Value: MB
system	S	1..1	uri	The namespace for the identifier value
value	S	1..1	string	The value that is unique
status	S	1..1	code	active | cancelled | draft | entered-in-error Fixed Value: active
policyHolder	S	0..1	Reference(Davinci ATR Patient | Davinci ATR RelatedPerson | Davinci ATR Organization)	Owner of the policy
subscriber	S	0..1	Reference(Davinci ATR Patient | Davinci ATR RelatedPerson)	Subscriber to the policy
subscriberId	S	1..1	string	ID assigned to the subscriber
beneficiary	S	1..1	Reference(Davinci ATR Patient)	Plan beneficiary
dependent	S	0..1	string	Dependent number
relationship	S	0..1	CodeableConcept	Beneficiary relationship to the subscriber
period	S	1..1	Period	Coverage start and end dates
payor	S	1..1	Reference(Davinci ATR Patient | Davinci ATR RelatedPerson | Davinci ATR Organization)	Issuer of the policy
Slices for class	S	0..*	BackboneElement	Additional coverage classifications Slice: Unordered, Open by value:type.coding.system, value:type.coding.code
class:PlanIdentifier	S	0..1	BackboneElement	Additional coverage classifications
type	S	1..1	CodeableConcept	Type of class such as 'group' or 'plan'
coding	S	1..1	Coding	Code defined by a terminology system
system	S	1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
code	S	1..1	code	Symbol in syntax defined by the system Fixed Value: plan
value	S	1..1	string	Value associated with the type
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Davinci ATR Coverage
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
insuranceProductType	S	0..1	CodeableConcept	Indicates the Insurance Product Type related to the Coverage. URL: http://hl7.org/fhir/us/davinci-atr/StructureDefinition/ext-insuranceProductType Binding: Insurance Product Type VS (extensible)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣ	0..*	Identifier	Business Identifier for the coverage Slice: Unordered, Open by value:type.coding.system, value:type.coding.code
identifier:MemberIdentifier	SΣ	0..1	Identifier	Business Identifier for the coverage
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	SΣ	1..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
coding	SΣ	1..1	Coding	Code defined by a terminology system
system	SΣ	1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
code	SΣ	1..1	code	Symbol in syntax defined by the system Fixed Value: MB
system	SΣ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique Example General: 123456
status	?!SΣ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Fixed Value: active
policyHolder	SΣ	0..1	Reference(Davinci ATR Patient | Davinci ATR RelatedPerson | Davinci ATR Organization)	Owner of the policy
subscriber	SΣ	0..1	Reference(Davinci ATR Patient | Davinci ATR RelatedPerson)	Subscriber to the policy
subscriberId	SΣ	1..1	string	ID assigned to the subscriber
beneficiary	SΣ	1..1	Reference(Davinci ATR Patient)	Plan beneficiary
dependent	SΣ	0..1	string	Dependent number
relationship	S	0..1	CodeableConcept	Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
period	SΣ	1..1	Period	Coverage start and end dates
payor	SΣ	1..1	Reference(Davinci ATR Patient | Davinci ATR RelatedPerson | Davinci ATR Organization)	Issuer of the policy
Slices for class	S	0..*	BackboneElement	Additional coverage classifications Slice: Unordered, Open by value:type.coding.system, value:type.coding.code
class:All Slices				Content/Rules for all slices
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
value	Σ	1..1	string	Value associated with the type
class:PlanIdentifier	S	0..1	BackboneElement	Additional coverage classifications
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	SΣ	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
coding	SΣ	1..1	Coding	Code defined by a terminology system
system	SΣ	1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
code	SΣ	1..1	code	Symbol in syntax defined by the system Fixed Value: plan
value	SΣ	1..1	string	Value associated with the type
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Coverage.identifier:MemberIdentifier.use	required	IdentifierUse
Coverage.identifier:MemberIdentifier.type	extensible	Identifier Type Codes
Coverage.status	required	Fixed Value: active
Coverage.relationship	extensible	SubscriberRelationshipCodes
Coverage.class.type	extensible	CoverageClassCodes
Coverage.class:PlanIdentifier.type	extensible	CoverageClassCodes

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Coverage	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Coverage	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Coverage	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Coverage	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Coverage	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Davinci ATR Coverage
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
insuranceProductType	S	0..1	CodeableConcept	Indicates the Insurance Product Type related to the Coverage. URL: http://hl7.org/fhir/us/davinci-atr/StructureDefinition/ext-insuranceProductType Binding: Insurance Product Type VS (extensible)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣ	0..*	Identifier	Business Identifier for the coverage Slice: Unordered, Open by value:type.coding.system, value:type.coding.code
identifier:MemberIdentifier	SΣ	0..1	Identifier	Business Identifier for the coverage
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	SΣ	1..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	SΣ	1..1	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system Fixed Value: MB
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
system	SΣ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Fixed Value: active
type	Σ	0..1	CodeableConcept	Coverage category such as medical or accident Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
policyHolder	SΣ	0..1	Reference(Davinci ATR Patient | Davinci ATR RelatedPerson | Davinci ATR Organization)	Owner of the policy
subscriber	SΣ	0..1	Reference(Davinci ATR Patient | Davinci ATR RelatedPerson)	Subscriber to the policy
subscriberId	SΣ	1..1	string	ID assigned to the subscriber
beneficiary	SΣ	1..1	Reference(Davinci ATR Patient)	Plan beneficiary
dependent	SΣ	0..1	string	Dependent number
relationship	S	0..1	CodeableConcept	Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
period	SΣ	1..1	Period	Coverage start and end dates
payor	SΣ	1..1	Reference(Davinci ATR Patient | Davinci ATR RelatedPerson | Davinci ATR Organization)	Issuer of the policy
Slices for class	S	0..*	BackboneElement	Additional coverage classifications Slice: Unordered, Open by value:type.coding.system, value:type.coding.code
class:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
value	Σ	1..1	string	Value associated with the type
name	Σ	0..1	string	Human readable description of the type and value
class:PlanIdentifier	S	0..1	BackboneElement	Additional coverage classifications
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	SΣ	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	SΣ	1..1	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system Fixed Value: plan
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
value	SΣ	1..1	string	Value associated with the type
name	Σ	0..1	string	Human readable description of the type and value
order	Σ	0..1	positiveInt	Relative order of the coverage
network	Σ	0..1	string	Insurer network
costToBeneficiary		0..*	BackboneElement	Patient payments for services/products
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	0..1	CodeableConcept	Cost category Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
value[x]	Σ	1..1		The amount or percentage due from the beneficiary
valueQuantity			Quantity(SimpleQuantity)
valueMoney			Money
exception		0..*	BackboneElement	Exceptions for patient payments
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	CodeableConcept	Exception category Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
period	Σ	0..1	Period	The effective period of the exception
subrogation		0..1	boolean	Reimbursement to insurer
contract		0..*	Reference(Contract)	Contract details
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Coverage.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
Coverage.identifier:MemberIdentifier.use	required	IdentifierUse
Coverage.identifier:MemberIdentifier.type	extensible	Identifier Type Codes
Coverage.status	required	Fixed Value: active
Coverage.type	preferred	CoverageTypeAndSelf-PayCodes
Coverage.relationship	extensible	SubscriberRelationshipCodes
Coverage.class.type	extensible	CoverageClassCodes
Coverage.class:PlanIdentifier.type	extensible	CoverageClassCodes
Coverage.costToBeneficiary.type	extensible	CoverageCopayTypeCodes
Coverage.costToBeneficiary.exception.type	example	ExampleCoverageFinancialExceptionCodes

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Coverage	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Coverage	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Coverage	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Coverage	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Coverage	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Summary

Mandatory: 5 elements (11 nested mandatory elements)
Must-Support: 25 elements
Fixed Value: 5 elements

Structures

This structure refers to these other structures:

• Davinci ATR Patient (http://hl7.org/fhir/us/davinci-atr/StructureDefinition/atr-patient)
• Davinci ATR RelatedPerson (http://hl7.org/fhir/us/davinci-atr/StructureDefinition/atr-relatedperson)
• Davinci ATR Organization (http://hl7.org/fhir/us/davinci-atr/StructureDefinition/atr-organization)

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/us/davinci-atr/StructureDefinition/ext-insuranceProductType

Slices

This structure defines the following Slices:

• The element Coverage.identifier is sliced based on the values of value:type.coding.system, value:type.coding.code
• The element Coverage.class is sliced based on the values of value:type.coding.system, value:type.coding.code