This page is part of the Pharmacist Care Plan FHIR IG (v0.2.0: STU 1 Draft) based on FHIR v3.1.0. The current version which supercedes this version is 1.0.0. For a full list of available versions, see the Directory of published versions 
SD.2 StructureDefinition-PhCP-Coverage
title: StructureDefinition-PhCP-Coverage-intro layout: default active: StructureDefinition-PhCP-Coverage-intro —
The Coverage profile groups the policy and authorization acts within a Payers Section to order the payment sources. The Coverage.identifier is the ID from the patient’s insurance card.
SD.2.1 Formal Views of Profile Content
Description of Profiles, Differentials, and Snapshots.
The official URL for this profile is: http://hl7.org/fhir/us/phcp/StructureDefinition/PhCP-Coverage
Published on Sat Jul 22 06:02:00 AEST 2017 as a draft by .
This profile builds on Coverage
Differential View
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  Coverage | I | 1..* | Insurance or medical plan or a payment agreement | |
  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) Max Binding: AllLanguages | |
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |
 contained | 0..* | Resource | Contained, inline Resources | |
 extension | 0..* | Extension | Additional content defined by implementations | |
 modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
| identifier | SΣ | 0..* | Identifier | Business Identifier for the coverage |
| status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required) |
| type | SΣ | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: CoverageTypeAndSelf-PayCodes (preferred) |
 policyHolder | Σ | 0..1 | Reference(Patient | RelatedPerson | Organization) | Owner of the policy |
| subscriber | SΣ | 0..1 | Reference(US Core Patient Profile) | Subscriber to the policy |
| subscriberId | SΣ | 1..1 | string | ID assigned to the subscriber |
| beneficiary | Σ | 1..1 | Reference(Patient) | Plan beneficiary |
| dependent | Σ | 0..1 | string | Dependent number |
| relationship | S | 0..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible) |
| period | Σ | 0..1 | Period | Coverage start and end dates |
| payor | SΣ | 1..* | Reference(US Core Organization Profile | US Core Patient Profile | RelatedPerson) | Issuer of the policy |
| class | I | 0..* | 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 | Σ | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible) |
| value | Σ | 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 | I | 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) |
 value[x] | Σ | 1..1 | SimpleQuantity, Money | The amount or percentage due from the beneficiary |
| exception | I | 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) |
| 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 | ||||
Downloads: StructureDefinition: (XML, JSON), Schema: XML Schematron
TODO - Search
