XealthIG - Local Development build (vv1.42.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

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Resource Profile: Xealth Coverage

Defines Xealth constraints on Coverage.

Usage:

• Examples for this Resource Profile: Coverage/123

Formal Views of Profile Content

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

• Key Elements Table
• Differential Table
• Snapshot Table
• Statistics/References
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Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management
id	SΣ	1..1	id	Logical id of this artifact
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
identifier	SΣ	1..*	Identifier	Business Identifier for the coverage ele-1: All FHIR elements must have a @value or children
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: Xealth Coverage Status Value Set (required) ele-1: All FHIR elements must have a @value or children
type	SΣ	1..1	CodeableConcept	Coverage category such as medical or accident Binding: Xealth Coverage Type Value Set (required) ele-1: All FHIR elements must have a @value or children
subscriber	Σ	0..1	Reference(Patient | RelatedPerson)	ID assigned to the subscriber. Subscriber will only be populated if the relationship of the patient to the subscriber is 'self' ele-1: All FHIR elements must have a @value or children
subscriberId	Σ	0..1	string	Subscriber to the policy. SubscriberId will only be populated if the relationship of the patient to the subscriber is 'self' ele-1: All FHIR elements must have a @value or children
beneficiary	Σ	1..1	Reference(Patient)	Plan beneficiary ele-1: All FHIR elements must have a @value or children
payor	Σ	1..*	Reference(Organization | Patient | RelatedPerson)	Issuer of the policy ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Coverage.status	required	XealthCoverageStatusVS https://fhir.xealth.io/ValueSet/xealth-coverage-status-vs from this IG
Coverage.type	required	XealthCoverageTypeVS https://fhir.xealth.io/ValueSet/xealth-coverage-type-vs from this IG

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()

This structure is derived from Coverage

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
id	S	1..1	id	Logical id of this artifact
identifier	S	1..*	Identifier	Business Identifier for the coverage
status		1..1	code	active | cancelled | draft | entered-in-error Binding: Xealth Coverage Status Value Set (required)
type	S	1..1	CodeableConcept	Coverage category such as medical or accident Binding: Xealth Coverage Type Value Set (required)
subscriber		0..1	Reference(Patient | RelatedPerson)	ID assigned to the subscriber. Subscriber will only be populated if the relationship of the patient to the subscriber is 'self'
subscriberId		0..1	string	Subscriber to the policy. SubscriberId will only be populated if the relationship of the patient to the subscriber is 'self'
class
type		1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: Xealth Coverage Class Type Status Value Set (required)
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Coverage.status	required	XealthCoverageStatusVS https://fhir.xealth.io/ValueSet/xealth-coverage-status-vs from this IG
Coverage.type	required	XealthCoverageTypeVS https://fhir.xealth.io/ValueSet/xealth-coverage-type-vs from this IG
Coverage.class.type	required	XealthCoverageClassTypeStatusVS https://fhir.xealth.io/ValueSet/xealth-coverage-class-type-status-vs from this IG

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
id	SΣ	1..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
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	1..*	Identifier	Business Identifier for the coverage
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: Xealth Coverage Status Value Set (required)
type	SΣ	1..1	CodeableConcept	Coverage category such as medical or accident Binding: Xealth Coverage Type Value Set (required)
policyHolder	Σ	0..1	Reference(Patient | RelatedPerson | Organization)	Owner of the policy
subscriber	Σ	0..1	Reference(Patient | RelatedPerson)	ID assigned to the subscriber. Subscriber will only be populated if the relationship of the patient to the subscriber is 'self'
subscriberId	Σ	0..1	string	Subscriber to the policy. SubscriberId will only be populated if the relationship of the patient to the subscriber is 'self'
beneficiary	Σ	1..1	Reference(Patient)	Plan beneficiary
dependent	Σ	0..1	string	Dependent number
relationship		0..1	CodeableConcept	Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
period	Σ	0..1	Period	Coverage start and end dates
payor	Σ	1..*	Reference(Organization | Patient | RelatedPerson)	Issuer of the policy
class		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: Xealth Coverage Class Type Status Value Set (required)
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		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	URI
Coverage.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Coverage.status	required	XealthCoverageStatusVS https://fhir.xealth.io/ValueSet/xealth-coverage-status-vs from this IG
Coverage.type	required	XealthCoverageTypeVS https://fhir.xealth.io/ValueSet/xealth-coverage-type-vs from this IG
Coverage.relationship	extensible	SubscriberRelationshipCodes http://hl7.org/fhir/ValueSet/subscriber-relationship from the FHIR Standard
Coverage.class.type	required	XealthCoverageClassTypeStatusVS https://fhir.xealth.io/ValueSet/xealth-coverage-class-type-status-vs from this IG
Coverage.costToBeneficiary.type	extensible	CoverageCopayTypeCodes http://hl7.org/fhir/ValueSet/coverage-copay-type from the FHIR Standard
Coverage.costToBeneficiary.exception.type	example	ExampleCoverageFinancialExceptionCodes http://hl7.org/fhir/ValueSet/coverage-financial-exception from the FHIR Standard

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()

This structure is derived from Coverage

Summary

Mandatory: 3 elements
Must-Support: 3 elements

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management
id	SΣ	1..1	id	Logical id of this artifact
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
identifier	SΣ	1..*	Identifier	Business Identifier for the coverage ele-1: All FHIR elements must have a @value or children
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: Xealth Coverage Status Value Set (required) ele-1: All FHIR elements must have a @value or children
type	SΣ	1..1	CodeableConcept	Coverage category such as medical or accident Binding: Xealth Coverage Type Value Set (required) ele-1: All FHIR elements must have a @value or children
subscriber	Σ	0..1	Reference(Patient | RelatedPerson)	ID assigned to the subscriber. Subscriber will only be populated if the relationship of the patient to the subscriber is 'self' ele-1: All FHIR elements must have a @value or children
subscriberId	Σ	0..1	string	Subscriber to the policy. SubscriberId will only be populated if the relationship of the patient to the subscriber is 'self' ele-1: All FHIR elements must have a @value or children
beneficiary	Σ	1..1	Reference(Patient)	Plan beneficiary ele-1: All FHIR elements must have a @value or children
payor	Σ	1..*	Reference(Organization | Patient | RelatedPerson)	Issuer of the policy ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Coverage.status	required	XealthCoverageStatusVS https://fhir.xealth.io/ValueSet/xealth-coverage-status-vs from this IG
Coverage.type	required	XealthCoverageTypeVS https://fhir.xealth.io/ValueSet/xealth-coverage-type-vs from this IG

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()

Differential View

This structure is derived from Coverage

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
id	S	1..1	id	Logical id of this artifact
identifier	S	1..*	Identifier	Business Identifier for the coverage
status		1..1	code	active | cancelled | draft | entered-in-error Binding: Xealth Coverage Status Value Set (required)
type	S	1..1	CodeableConcept	Coverage category such as medical or accident Binding: Xealth Coverage Type Value Set (required)
subscriber		0..1	Reference(Patient | RelatedPerson)	ID assigned to the subscriber. Subscriber will only be populated if the relationship of the patient to the subscriber is 'self'
subscriberId		0..1	string	Subscriber to the policy. SubscriberId will only be populated if the relationship of the patient to the subscriber is 'self'
class
type		1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: Xealth Coverage Class Type Status Value Set (required)
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Coverage.status	required	XealthCoverageStatusVS https://fhir.xealth.io/ValueSet/xealth-coverage-status-vs from this IG
Coverage.type	required	XealthCoverageTypeVS https://fhir.xealth.io/ValueSet/xealth-coverage-type-vs from this IG
Coverage.class.type	required	XealthCoverageClassTypeStatusVS https://fhir.xealth.io/ValueSet/xealth-coverage-class-type-status-vs from this IG

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
id	SΣ	1..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
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	1..*	Identifier	Business Identifier for the coverage
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: Xealth Coverage Status Value Set (required)
type	SΣ	1..1	CodeableConcept	Coverage category such as medical or accident Binding: Xealth Coverage Type Value Set (required)
policyHolder	Σ	0..1	Reference(Patient | RelatedPerson | Organization)	Owner of the policy
subscriber	Σ	0..1	Reference(Patient | RelatedPerson)	ID assigned to the subscriber. Subscriber will only be populated if the relationship of the patient to the subscriber is 'self'
subscriberId	Σ	0..1	string	Subscriber to the policy. SubscriberId will only be populated if the relationship of the patient to the subscriber is 'self'
beneficiary	Σ	1..1	Reference(Patient)	Plan beneficiary
dependent	Σ	0..1	string	Dependent number
relationship		0..1	CodeableConcept	Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
period	Σ	0..1	Period	Coverage start and end dates
payor	Σ	1..*	Reference(Organization | Patient | RelatedPerson)	Issuer of the policy
class		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: Xealth Coverage Class Type Status Value Set (required)
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		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	URI
Coverage.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Coverage.status	required	XealthCoverageStatusVS https://fhir.xealth.io/ValueSet/xealth-coverage-status-vs from this IG
Coverage.type	required	XealthCoverageTypeVS https://fhir.xealth.io/ValueSet/xealth-coverage-type-vs from this IG
Coverage.relationship	extensible	SubscriberRelationshipCodes http://hl7.org/fhir/ValueSet/subscriber-relationship from the FHIR Standard
Coverage.class.type	required	XealthCoverageClassTypeStatusVS https://fhir.xealth.io/ValueSet/xealth-coverage-class-type-status-vs from this IG
Coverage.costToBeneficiary.type	extensible	CoverageCopayTypeCodes http://hl7.org/fhir/ValueSet/coverage-copay-type from the FHIR Standard
Coverage.costToBeneficiary.exception.type	example	ExampleCoverageFinancialExceptionCodes http://hl7.org/fhir/ValueSet/coverage-financial-exception from the FHIR Standard

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()

This structure is derived from Coverage

Summary

Mandatory: 3 elements
Must-Support: 3 elements

Other representations of profile: CSV, Excel, Schematron