CARIN Digital Insurance Card
1.0.0 - STU 1 US

This page is part of the CARIN Digital Insurance Card (v1.0.0: STU 1) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Resource Profile: C4DIC Coverage

Official URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Coverage Version: 1.0.0
Active as of 2022-07-13 Computable Name: C4DICCoverage

Data that reflect a payer’s coverage of the member.

Usage:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from Coverage

Summary

Mandatory: 16 elements (2 nested mandatory elements)
Must-Support: 34 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

  • The element Coverage.meta.profile is sliced based on the value of pattern:$this
  • The element Coverage.identifier is sliced based on the value of pattern:type
  • The element Coverage.class is sliced based on the value of pattern:type
  • The element Coverage.costToBeneficiary.value[x] is sliced based on the value of type:$this

This structure is derived from Coverage

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..*CoverageInsurance or medical plan or a payment agreement
... meta S1..1MetaMetadata about the resource
.... lastUpdated S1..1instantWhen the resource version last changed
.... Slices for profile 1..*canonical(StructureDefinition)Profiles this resource claims to conform to
Slice: Unordered, Open by pattern:$this
..... profile:supportedProfile 1..1canonical(StructureDefinition)Profiles this resource claims to conform to
Required Pattern: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Coverage
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... C4DIC-PlanBeneficiaries-extension 0..*(Complex)Plan Beneficiaries
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension
... C4DIC-BackgroundColor-extension 0..1CodeableConceptBackground Color
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BackgroundColor-extension
Binding: C4DIC ISO Color (required)
... C4DIC-HighlightColor-extension 0..1CodeableConceptHighlight Color
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-HighlightColor-extension
Binding: C4DIC ISO Color (required)
... C4DIC-Logo-extension 0..1(Complex)Logo
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Logo-extension
... C4DIC-QRCode-extension 0..*(Complex)QR Code
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-QRCode-extension
... C4DIC-Barcode-extension 0..*(Complex)Barcode
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Barcode-extension
... C4DIC-SupportingImage-extension 0..*(Complex)Supporting image
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-SupportingImage-extension
... C4DIC-CardIssueDate-extension 0..1dateCard Issue Date
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-CardIssueDate-extension
... Slices for identifier S1..*IdentifierBusiness Identifier for the coverage
Slice: Unordered, Open by pattern:type
.... identifier:All Slices Content/Rules for all slices
..... type 0..1CodeableConceptDescription of identifier
Binding: C4DIC Coverage Identifier Type (extensible)
.... identifier:memberid S1..1IdentifierMember ID
..... type 1..1CodeableConceptDescription of identifier
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: MB
..... system S1..1uriThe namespace for the identifier value
..... value S1..1stringThe value that is unique
..... assigner S1..1Reference(Organization)Organization that issued id (may be just text)
... status S1..1codeactive | cancelled | draft | entered-in-error
... type S1..1CodeableConceptCoverage category such as medical or accident
... subscriber S1..1Reference(Patient | RelatedPerson)Subscriber to the policy
.... reference S1..1stringLiteral reference, Relative, internal or absolute URL
... subscriberId S1..1stringID assigned to the subscriber
... beneficiary S1..1Reference(C4DIC Patient)Plan beneficiary
.... reference S1..1stringLiteral reference, Relative, internal or absolute URL
... dependent S0..1stringDependent number
... relationship S1..1CodeableConceptBeneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (required)
... period S0..1PeriodCoverage start and end dates
... payor S1..1Reference(C4DIC Organization)Issuer of the policy
... Slices for class S0..*BackboneElementAdditional coverage classifications
Slice: Unordered, Open by pattern:type
.... class:All Slices Content/Rules for all slices
..... type 1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: C4DIC Coverage Class (required)
.... class:group S0..1BackboneElementAdditional coverage classifications
..... type 1..1CodeableConceptType of class such as 'group' or 'plan'
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: group
..... value 1..1stringValue associated with the type
..... name 0..1stringHuman readable description of the type and value
.... class:plan S0..1BackboneElementAdditional coverage classifications
..... type 1..1CodeableConceptType of class such as 'group' or 'plan'
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: plan
..... value 1..1stringValue associated with the type
..... name 0..1stringHuman readable description of the type and value
.... class:division S0..1BackboneElementAdditional coverage classifications
..... type 1..1CodeableConceptType of class such as 'group' or 'plan'
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: division
.... class:network S0..1BackboneElementAdditional coverage classifications
..... type 1..1CodeableConceptType of class such as 'group' or 'plan'
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: network
.... class:rxbin S0..1BackboneElementAdditional coverage classifications
..... type 1..1CodeableConceptType of class such as 'group' or 'plan'
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: rxbin
.... class:rxpcn S0..1BackboneElementAdditional coverage classifications
..... type 1..1CodeableConceptType of class such as 'group' or 'plan'
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: rxpcn
.... class:rxgroup S0..1BackboneElementAdditional coverage classifications
..... type 1..1CodeableConceptType of class such as 'group' or 'plan'
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: rxgroup
.... class:rxid S0..1BackboneElementAdditional coverage classifications
..... type 1..1CodeableConceptType of class such as 'group' or 'plan'
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: rxid
.... class:rxiin S0..1BackboneElementAdditional coverage classifications
..... type 1..1CodeableConceptType of class such as 'group' or 'plan'
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: rxiin
... costToBeneficiary S0..*BackboneElementPatient payments for services/products
.... type S1..1CodeableConceptCost category
Binding: C4DIC Copay Type (extensible)
.... value[x] 1..1MoneyThe amount or percentage due from the beneficiary
Slice: Unordered, Open by type:$this
.... valueMoney SI1..1MoneyThe amount or percentage due from the beneficiary
ValueMoney-details-or-extension: costToBeneficiary SHALL have (value AND currency) OR Beneficiary Cost String extension, but not both
..... C4DIC-BeneficiaryCostString-extension S0..1stringBeneficiary Cost as String
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension
..... value S0..1decimalNumerical value (with implicit precision)
..... currency S0..1codeISO 4217 Currency Code

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..*CoverageInsurance or medical plan or a payment agreement
... id Σ0..1stringLogical id of this artifact
... meta SΣ1..1MetaMetadata about the resource
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... versionId Σ0..1idVersion specific identifier
.... lastUpdated SΣ1..1instantWhen the resource version last changed
.... source Σ0..1uriIdentifies where the resource comes from
.... Slices for profile Σ1..*canonical(StructureDefinition)Profiles this resource claims to conform to
Slice: Unordered, Open by pattern:$this
..... profile:supportedProfile Σ1..1canonical(StructureDefinition)Profiles this resource claims to conform to

Required Pattern: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Coverage
.... security Σ0..*CodingSecurity Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.


.... tag Σ0..*CodingTags applied to this resource
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".


... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... C4DIC-PlanBeneficiaries-extension 0..*(Complex)Plan Beneficiaries
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension
... C4DIC-AdditionalCardInformation-extension 0..*AnnotationAdditional Insurance Card Information
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-AdditionalCardInformation-extension
... C4DIC-BackgroundColor-extension 0..1CodeableConceptBackground Color
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BackgroundColor-extension
Binding: C4DIC ISO Color (required)
... C4DIC-HighlightColor-extension 0..1CodeableConceptHighlight Color
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-HighlightColor-extension
Binding: C4DIC ISO Color (required)
... C4DIC-Logo-extension 0..1(Complex)Logo
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Logo-extension
... C4DIC-QRCode-extension 0..*(Complex)QR Code
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-QRCode-extension
... C4DIC-Barcode-extension 0..*(Complex)Barcode
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Barcode-extension
... C4DIC-SupportingImage-extension 0..*(Complex)Supporting image
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-SupportingImage-extension
... C4DIC-CardIssueDate-extension 0..1dateCard Issue Date
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-CardIssueDate-extension
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... Slices for identifier SΣ1..*IdentifierBusiness Identifier for the coverage
Slice: Unordered, Open by pattern:type
.... identifier:All Slices Content/Rules for all slices
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type Σ0..1CodeableConceptDescription of identifier
Binding: C4DIC Coverage Identifier Type (extensible)
..... system Σ0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value Σ0..1stringThe value that is unique
Example General: 123456
..... period Σ0..1PeriodTime period when id is/was valid for use
..... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
.... identifier:memberid SΣ1..1IdentifierMember ID
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type Σ1..1CodeableConceptDescription 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.


Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: MB
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... system SΣ1..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value SΣ1..1stringThe value that is unique
Example General: 123456
..... period Σ0..1PeriodTime period when id is/was valid for use
..... assigner SΣ1..1Reference(Organization)Organization that issued id (may be just text)
... status ?!SΣ1..1codeactive | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type SΣ1..1CodeableConceptCoverage 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 Σ0..1Reference(Patient | RelatedPerson | Organization)Owner of the policy
... subscriber SΣ1..1Reference(Patient | RelatedPerson)Subscriber to the policy
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣI1..1stringLiteral reference, Relative, internal or absolute URL
.... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
.... display Σ0..1stringText alternative for the resource
... subscriberId SΣ1..1stringID assigned to the subscriber
... beneficiary SΣ1..1Reference(C4DIC Patient)Plan beneficiary
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣI1..1stringLiteral reference, Relative, internal or absolute URL
.... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
.... display Σ0..1stringText alternative for the resource
... dependent SΣ0..1stringDependent number
... relationship S1..1CodeableConceptBeneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (required)
... period SΣ0..1PeriodCoverage start and end dates
... payor SΣ1..1Reference(C4DIC Organization)Issuer of the policy
... Slices for class S0..*BackboneElementAdditional coverage classifications
Slice: Unordered, Open by pattern:type
.... class:All Slices Content/Rules for all slices
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type Σ1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: C4DIC Coverage Class (required)
..... value Σ1..1stringValue associated with the type
..... name Σ0..1stringHuman readable description of the type and value
.... class:group S0..1BackboneElementAdditional coverage classifications
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type Σ1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.


Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: group
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... value Σ1..1stringValue associated with the type
..... name Σ0..1stringHuman readable description of the type and value
.... class:plan S0..1BackboneElementAdditional coverage classifications
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type Σ1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.


Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: plan
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... value Σ1..1stringValue associated with the type
..... name Σ0..1stringHuman readable description of the type and value
.... class:division S0..1BackboneElementAdditional coverage classifications
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type Σ1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.


Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: division
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... value Σ1..1stringValue associated with the type
..... name Σ0..1stringHuman readable description of the type and value
.... class:network S0..1BackboneElementAdditional coverage classifications
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type Σ1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.


Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: network
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... value Σ1..1stringValue associated with the type
..... name Σ0..1stringHuman readable description of the type and value
.... class:rxbin S0..1BackboneElementAdditional coverage classifications
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type Σ1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.


Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: rxbin
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... value Σ1..1stringValue associated with the type
..... name Σ0..1stringHuman readable description of the type and value
.... class:rxpcn S0..1BackboneElementAdditional coverage classifications
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type Σ1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.


Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: rxpcn
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... value Σ1..1stringValue associated with the type
..... name Σ0..1stringHuman readable description of the type and value
.... class:rxgroup S0..1BackboneElementAdditional coverage classifications
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type Σ1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.


Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: rxgroup
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... value Σ1..1stringValue associated with the type
..... name Σ0..1stringHuman readable description of the type and value
.... class:rxid S0..1BackboneElementAdditional coverage classifications
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type Σ1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.


Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: rxid
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... value Σ1..1stringValue associated with the type
..... name Σ0..1stringHuman readable description of the type and value
.... class:rxiin S0..1BackboneElementAdditional coverage classifications
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type Σ1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.


Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: rxiin
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... value Σ1..1stringValue associated with the type
..... name Σ0..1stringHuman readable description of the type and value
... order Σ0..1positiveIntRelative order of the coverage
... network Σ0..1stringInsurer network
... costToBeneficiary S0..*BackboneElementPatient payments for services/products
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type SΣ1..1CodeableConceptCost category
Binding: C4DIC Copay Type (extensible)
.... Slices for value[x] Σ1..1MoneyThe amount or percentage due from the beneficiary
Slice: Unordered, Closed by type:$this
..... value[x]:valueMoney SΣI1..1MoneyThe amount or percentage due from the beneficiary
ValueMoney-details-or-extension: costToBeneficiary SHALL have (value AND currency) OR Beneficiary Cost String extension, but not both
...... id 0..1stringUnique id for inter-element referencing
...... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... C4DIC-BeneficiaryCostString-extension S0..1stringBeneficiary Cost as String
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension
...... value SΣ0..1decimalNumerical value (with implicit precision)
...... currency SΣ0..1codeISO 4217 Currency Code
Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.

.... exception 0..*BackboneElementExceptions for patient payments
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type Σ1..1CodeableConceptException category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.

..... period Σ0..1PeriodThe effective period of the exception
... subrogation 0..1booleanReimbursement to insurer
... contract 0..*Reference(Contract)Contract details

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..*CoverageInsurance or medical plan or a payment agreement
... meta Σ1..1MetaMetadata about the resource
.... lastUpdated Σ1..1instantWhen the resource version last changed
... Slices for identifier Σ1..*IdentifierBusiness Identifier for the coverage
Slice: Unordered, Open by pattern:type
.... identifier:memberid Σ1..1IdentifierMember ID
..... system Σ1..1uriThe namespace for the identifier value
..... value Σ1..1stringThe value that is unique
..... assigner Σ1..1Reference(Organization)Organization that issued id (may be just text)
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... subscriber Σ1..1Reference(Patient | RelatedPerson)Subscriber to the policy
.... reference ΣI1..1stringLiteral reference, Relative, internal or absolute URL
... subscriberId Σ1..1stringID assigned to the subscriber
... beneficiary Σ1..1Reference(C4DIC Patient)Plan beneficiary
.... reference ΣI1..1stringLiteral reference, Relative, internal or absolute URL
... dependent Σ0..1stringDependent number
... relationship 1..1CodeableConceptBeneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (required)
... period Σ0..1PeriodCoverage start and end dates
... payor Σ1..1Reference(C4DIC Organization)Issuer of the policy
... Slices for class 0..*BackboneElementAdditional coverage classifications
Slice: Unordered, Open by pattern:type
.... class:group 0..1BackboneElementAdditional coverage classifications
.... class:plan 0..1BackboneElementAdditional coverage classifications
.... class:division 0..1BackboneElementAdditional coverage classifications
.... class:network 0..1BackboneElementAdditional coverage classifications
.... class:rxbin 0..1BackboneElementAdditional coverage classifications
.... class:rxpcn 0..1BackboneElementAdditional coverage classifications
.... class:rxgroup 0..1BackboneElementAdditional coverage classifications
.... class:rxid 0..1BackboneElementAdditional coverage classifications
.... class:rxiin 0..1BackboneElementAdditional coverage classifications
... costToBeneficiary 0..*BackboneElementPatient payments for services/products
.... type Σ1..1CodeableConceptCost category
Binding: C4DIC Copay Type (extensible)
.... value[x]:valueMoney ΣI1..1MoneyThe amount or percentage due from the beneficiary
ValueMoney-details-or-extension: costToBeneficiary SHALL have (value AND currency) OR Beneficiary Cost String extension, but not both
..... C4DIC-BeneficiaryCostString-extension 0..1stringBeneficiary Cost as String
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension
..... value Σ0..1decimalNumerical value (with implicit precision)
..... currency Σ0..1codeISO 4217 Currency Code
Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.


doco Documentation for this format

This structure is derived from Coverage

Summary

Mandatory: 16 elements (2 nested mandatory elements)
Must-Support: 34 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

  • The element Coverage.meta.profile is sliced based on the value of pattern:$this
  • The element Coverage.identifier is sliced based on the value of pattern:type
  • The element Coverage.class is sliced based on the value of pattern:type
  • The element Coverage.costToBeneficiary.value[x] is sliced based on the value of type:$this

Differential View

This structure is derived from Coverage

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..*CoverageInsurance or medical plan or a payment agreement
... meta S1..1MetaMetadata about the resource
.... lastUpdated S1..1instantWhen the resource version last changed
.... Slices for profile 1..*canonical(StructureDefinition)Profiles this resource claims to conform to
Slice: Unordered, Open by pattern:$this
..... profile:supportedProfile 1..1canonical(StructureDefinition)Profiles this resource claims to conform to
Required Pattern: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Coverage
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... C4DIC-PlanBeneficiaries-extension 0..*(Complex)Plan Beneficiaries
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension
... C4DIC-BackgroundColor-extension 0..1CodeableConceptBackground Color
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BackgroundColor-extension
Binding: C4DIC ISO Color (required)
... C4DIC-HighlightColor-extension 0..1CodeableConceptHighlight Color
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-HighlightColor-extension
Binding: C4DIC ISO Color (required)
... C4DIC-Logo-extension 0..1(Complex)Logo
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Logo-extension
... C4DIC-QRCode-extension 0..*(Complex)QR Code
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-QRCode-extension
... C4DIC-Barcode-extension 0..*(Complex)Barcode
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Barcode-extension
... C4DIC-SupportingImage-extension 0..*(Complex)Supporting image
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-SupportingImage-extension
... C4DIC-CardIssueDate-extension 0..1dateCard Issue Date
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-CardIssueDate-extension
... Slices for identifier S1..*IdentifierBusiness Identifier for the coverage
Slice: Unordered, Open by pattern:type
.... identifier:All Slices Content/Rules for all slices
..... type 0..1CodeableConceptDescription of identifier
Binding: C4DIC Coverage Identifier Type (extensible)
.... identifier:memberid S1..1IdentifierMember ID
..... type 1..1CodeableConceptDescription of identifier
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: MB
..... system S1..1uriThe namespace for the identifier value
..... value S1..1stringThe value that is unique
..... assigner S1..1Reference(Organization)Organization that issued id (may be just text)
... status S1..1codeactive | cancelled | draft | entered-in-error
... type S1..1CodeableConceptCoverage category such as medical or accident
... subscriber S1..1Reference(Patient | RelatedPerson)Subscriber to the policy
.... reference S1..1stringLiteral reference, Relative, internal or absolute URL
... subscriberId S1..1stringID assigned to the subscriber
... beneficiary S1..1Reference(C4DIC Patient)Plan beneficiary
.... reference S1..1stringLiteral reference, Relative, internal or absolute URL
... dependent S0..1stringDependent number
... relationship S1..1CodeableConceptBeneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (required)
... period S0..1PeriodCoverage start and end dates
... payor S1..1Reference(C4DIC Organization)Issuer of the policy
... Slices for class S0..*BackboneElementAdditional coverage classifications
Slice: Unordered, Open by pattern:type
.... class:All Slices Content/Rules for all slices
..... type 1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: C4DIC Coverage Class (required)
.... class:group S0..1BackboneElementAdditional coverage classifications
..... type 1..1CodeableConceptType of class such as 'group' or 'plan'
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: group
..... value 1..1stringValue associated with the type
..... name 0..1stringHuman readable description of the type and value
.... class:plan S0..1BackboneElementAdditional coverage classifications
..... type 1..1CodeableConceptType of class such as 'group' or 'plan'
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: plan
..... value 1..1stringValue associated with the type
..... name 0..1stringHuman readable description of the type and value
.... class:division S0..1BackboneElementAdditional coverage classifications
..... type 1..1CodeableConceptType of class such as 'group' or 'plan'
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: division
.... class:network S0..1BackboneElementAdditional coverage classifications
..... type 1..1CodeableConceptType of class such as 'group' or 'plan'
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: network
.... class:rxbin S0..1BackboneElementAdditional coverage classifications
..... type 1..1CodeableConceptType of class such as 'group' or 'plan'
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: rxbin
.... class:rxpcn S0..1BackboneElementAdditional coverage classifications
..... type 1..1CodeableConceptType of class such as 'group' or 'plan'
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: rxpcn
.... class:rxgroup S0..1BackboneElementAdditional coverage classifications
..... type 1..1CodeableConceptType of class such as 'group' or 'plan'
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: rxgroup
.... class:rxid S0..1BackboneElementAdditional coverage classifications
..... type 1..1CodeableConceptType of class such as 'group' or 'plan'
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: rxid
.... class:rxiin S0..1BackboneElementAdditional coverage classifications
..... type 1..1CodeableConceptType of class such as 'group' or 'plan'
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: rxiin
... costToBeneficiary S0..*BackboneElementPatient payments for services/products
.... type S1..1CodeableConceptCost category
Binding: C4DIC Copay Type (extensible)
.... value[x] 1..1MoneyThe amount or percentage due from the beneficiary
Slice: Unordered, Open by type:$this
.... valueMoney SI1..1MoneyThe amount or percentage due from the beneficiary
ValueMoney-details-or-extension: costToBeneficiary SHALL have (value AND currency) OR Beneficiary Cost String extension, but not both
..... C4DIC-BeneficiaryCostString-extension S0..1stringBeneficiary Cost as String
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension
..... value S0..1decimalNumerical value (with implicit precision)
..... currency S0..1codeISO 4217 Currency Code

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..*CoverageInsurance or medical plan or a payment agreement
... id Σ0..1stringLogical id of this artifact
... meta SΣ1..1MetaMetadata about the resource
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... versionId Σ0..1idVersion specific identifier
.... lastUpdated SΣ1..1instantWhen the resource version last changed
.... source Σ0..1uriIdentifies where the resource comes from
.... Slices for profile Σ1..*canonical(StructureDefinition)Profiles this resource claims to conform to
Slice: Unordered, Open by pattern:$this
..... profile:supportedProfile Σ1..1canonical(StructureDefinition)Profiles this resource claims to conform to

Required Pattern: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Coverage
.... security Σ0..*CodingSecurity Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.


.... tag Σ0..*CodingTags applied to this resource
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".


... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... C4DIC-PlanBeneficiaries-extension 0..*(Complex)Plan Beneficiaries
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension
... C4DIC-AdditionalCardInformation-extension 0..*AnnotationAdditional Insurance Card Information
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-AdditionalCardInformation-extension
... C4DIC-BackgroundColor-extension 0..1CodeableConceptBackground Color
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BackgroundColor-extension
Binding: C4DIC ISO Color (required)
... C4DIC-HighlightColor-extension 0..1CodeableConceptHighlight Color
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-HighlightColor-extension
Binding: C4DIC ISO Color (required)
... C4DIC-Logo-extension 0..1(Complex)Logo
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Logo-extension
... C4DIC-QRCode-extension 0..*(Complex)QR Code
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-QRCode-extension
... C4DIC-Barcode-extension 0..*(Complex)Barcode
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Barcode-extension
... C4DIC-SupportingImage-extension 0..*(Complex)Supporting image
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-SupportingImage-extension
... C4DIC-CardIssueDate-extension 0..1dateCard Issue Date
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-CardIssueDate-extension
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... Slices for identifier SΣ1..*IdentifierBusiness Identifier for the coverage
Slice: Unordered, Open by pattern:type
.... identifier:All Slices Content/Rules for all slices
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type Σ0..1CodeableConceptDescription of identifier
Binding: C4DIC Coverage Identifier Type (extensible)
..... system Σ0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value Σ0..1stringThe value that is unique
Example General: 123456
..... period Σ0..1PeriodTime period when id is/was valid for use
..... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
.... identifier:memberid SΣ1..1IdentifierMember ID
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type Σ1..1CodeableConceptDescription 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.


Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: MB
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... system SΣ1..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value SΣ1..1stringThe value that is unique
Example General: 123456
..... period Σ0..1PeriodTime period when id is/was valid for use
..... assigner SΣ1..1Reference(Organization)Organization that issued id (may be just text)
... status ?!SΣ1..1codeactive | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type SΣ1..1CodeableConceptCoverage 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 Σ0..1Reference(Patient | RelatedPerson | Organization)Owner of the policy
... subscriber SΣ1..1Reference(Patient | RelatedPerson)Subscriber to the policy
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣI1..1stringLiteral reference, Relative, internal or absolute URL
.... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
.... display Σ0..1stringText alternative for the resource
... subscriberId SΣ1..1stringID assigned to the subscriber
... beneficiary SΣ1..1Reference(C4DIC Patient)Plan beneficiary
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣI1..1stringLiteral reference, Relative, internal or absolute URL
.... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
.... display Σ0..1stringText alternative for the resource
... dependent SΣ0..1stringDependent number
... relationship S1..1CodeableConceptBeneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (required)
... period SΣ0..1PeriodCoverage start and end dates
... payor SΣ1..1Reference(C4DIC Organization)Issuer of the policy
... Slices for class S0..*BackboneElementAdditional coverage classifications
Slice: Unordered, Open by pattern:type
.... class:All Slices Content/Rules for all slices
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type Σ1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: C4DIC Coverage Class (required)
..... value Σ1..1stringValue associated with the type
..... name Σ0..1stringHuman readable description of the type and value
.... class:group S0..1BackboneElementAdditional coverage classifications
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type Σ1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.


Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: group
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... value Σ1..1stringValue associated with the type
..... name Σ0..1stringHuman readable description of the type and value
.... class:plan S0..1BackboneElementAdditional coverage classifications
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type Σ1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.


Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: plan
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... value Σ1..1stringValue associated with the type
..... name Σ0..1stringHuman readable description of the type and value
.... class:division S0..1BackboneElementAdditional coverage classifications
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type Σ1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.


Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: division
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... value Σ1..1stringValue associated with the type
..... name Σ0..1stringHuman readable description of the type and value
.... class:network S0..1BackboneElementAdditional coverage classifications
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type Σ1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.


Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: network
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... value Σ1..1stringValue associated with the type
..... name Σ0..1stringHuman readable description of the type and value
.... class:rxbin S0..1BackboneElementAdditional coverage classifications
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type Σ1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.


Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: rxbin
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... value Σ1..1stringValue associated with the type
..... name Σ0..1stringHuman readable description of the type and value
.... class:rxpcn S0..1BackboneElementAdditional coverage classifications
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type Σ1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.


Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: rxpcn
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... value Σ1..1stringValue associated with the type
..... name Σ0..1stringHuman readable description of the type and value
.... class:rxgroup S0..1BackboneElementAdditional coverage classifications
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type Σ1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.


Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: rxgroup
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... value Σ1..1stringValue associated with the type
..... name Σ0..1stringHuman readable description of the type and value
.... class:rxid S0..1BackboneElementAdditional coverage classifications
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type Σ1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.


Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: rxid
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... value Σ1..1stringValue associated with the type
..... name Σ0..1stringHuman readable description of the type and value
.... class:rxiin S0..1BackboneElementAdditional coverage classifications
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type Σ1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.


Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: rxiin
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... value Σ1..1stringValue associated with the type
..... name Σ0..1stringHuman readable description of the type and value
... order Σ0..1positiveIntRelative order of the coverage
... network Σ0..1stringInsurer network
... costToBeneficiary S0..*BackboneElementPatient payments for services/products
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type SΣ1..1CodeableConceptCost category
Binding: C4DIC Copay Type (extensible)
.... Slices for value[x] Σ1..1MoneyThe amount or percentage due from the beneficiary
Slice: Unordered, Closed by type:$this
..... value[x]:valueMoney SΣI1..1MoneyThe amount or percentage due from the beneficiary
ValueMoney-details-or-extension: costToBeneficiary SHALL have (value AND currency) OR Beneficiary Cost String extension, but not both
...... id 0..1stringUnique id for inter-element referencing
...... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... C4DIC-BeneficiaryCostString-extension S0..1stringBeneficiary Cost as String
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension
...... value SΣ0..1decimalNumerical value (with implicit precision)
...... currency SΣ0..1codeISO 4217 Currency Code
Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.

.... exception 0..*BackboneElementExceptions for patient payments
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type Σ1..1CodeableConceptException category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.

..... period Σ0..1PeriodThe effective period of the exception
... subrogation 0..1booleanReimbursement to insurer
... contract 0..*Reference(Contract)Contract details

doco Documentation for this format

 

Other representations of profile: CSV, Excel, Schematron

Terminology Bindings

PathConformanceValueSet / Code
Coverage.meta.securityextensibleAll Security Labels
Coverage.meta.tagexampleCommonTags
Coverage.languagepreferredCommonLanguages
Max Binding: AllLanguages
Coverage.identifier.userequiredIdentifierUse
Coverage.identifier.typeextensibleC4DICCoverageIdentifierType
Coverage.identifier:memberid.userequiredIdentifierUse
Coverage.identifier:memberid.typeextensiblePattern: MB
Coverage.statusrequiredFinancialResourceStatusCodes
Coverage.typepreferredCoverageTypeAndSelf-PayCodes
Coverage.subscriber.typeextensibleResourceType
Coverage.beneficiary.typeextensibleResourceType
Coverage.relationshiprequiredSubscriberRelationshipCodes
Coverage.class.typerequiredC4DICCoverageClassVS
Coverage.class:group.typeextensiblePattern: group
Coverage.class:plan.typeextensiblePattern: plan
Coverage.class:division.typeextensiblePattern: division
Coverage.class:network.typeextensiblePattern: network
Coverage.class:rxbin.typeextensiblePattern: rxbin
Coverage.class:rxpcn.typeextensiblePattern: rxpcn
Coverage.class:rxgroup.typeextensiblePattern: rxgroup
Coverage.class:rxid.typeextensiblePattern: rxid
Coverage.class:rxiin.typeextensiblePattern: rxiin
Coverage.costToBeneficiary.typeextensibleC4DICCopayTypeVS
Coverage.costToBeneficiary.value[x]:valueMoney.currencyrequiredCurrencies
Coverage.costToBeneficiary.exception.typeexampleExampleCoverageFinancialExceptionCodes

Constraints

IdGradePathDetailsRequirements
ValueMoney-details-or-extensionerrorCoverage.costToBeneficiary.value[x]:valueMoneycostToBeneficiary SHALL have (value AND currency) OR Beneficiary Cost String extension, but not both
: ((value.exists() and currency.exists()) xor extension.where(url='http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension').exists()) and ((value.exists() xor currency.exists())).not()