XealthIG
v1.52.0 - release

XealthIG - Local Development build (vv1.52.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: Xealth Coverage

Official URL: https://fhir.xealth.io/StructureDefinition/xealth-coverage Version: v1.52.0
Active as of 2026-10-26 Computable Name: XealthCoverage

Defines Xealth constraints on Coverage.

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

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

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Coverage 0..* Coverage Insurance or medical plan or a payment agreement
Coverage.id This element must be supported. This element is included in summaries. 1..1 id Logical id of this artifact
Coverage.implicitRules This element is a modifier element. This element is included in summaries. 0..1 uri A set of rules under which this content was created
Coverage.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored
Coverage.identifier This element must be supported. This element is included in summaries. 1..* Identifier Business Identifier for the coverage
Coverage.status This element is a modifier element. This element is included in summaries. 1..1 code active | cancelled | draft | entered-in-error
Binding: Xealth Coverage Status Value Set (required)
Coverage.type This element must be supported. This element is included in summaries. 1..1 CodeableConcept Coverage category such as medical or accident
Binding: Xealth Coverage Type Value Set (required)
Coverage.subscriber This element is included in summaries. 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'
Coverage.subscriberId This element is included in summaries. 0..1 string Subscriber to the policy. SubscriberId will only be populated if the relationship of the patient to the subscriber is 'self'
Coverage.beneficiary This element is included in summaries. 1..1 Reference(Patient) Plan beneficiary
Coverage.payor This element is included in summaries. 1..* Reference(Organization | Patient | RelatedPerson) Issuer of the policy

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.status Base required Xealth Coverage Status Value Set 📦v1.52.0 This IG
Coverage.type Base required Xealth Coverage Type Value Set 📦v1.52.0 This IG

Constraints

Id Grade Path(s) Description Expression
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

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Coverage 0..* Coverage Insurance or medical plan or a payment agreement
Coverage.id This element must be supported. 1..1 id Logical id of this artifact
Coverage.identifier This element must be supported. 1..* Identifier Business Identifier for the coverage
Coverage.status 1..1 code active | cancelled | draft | entered-in-error
Binding: Xealth Coverage Status Value Set (required)
Coverage.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'
Coverage.subscriberId 0..1 string Subscriber to the policy. SubscriberId will only be populated if the relationship of the patient to the subscriber is 'self'
Coverage.class
Coverage.class.type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: Xealth Coverage Class Type Status Value Set (required)

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Coverage.status Base required Xealth Coverage Status Value Set 📦v1.52.0 This IG
Coverage.type Base required Xealth Coverage Type Value Set 📦v1.52.0 This IG
Coverage.class.type Base required Xealth Coverage Class Type Status Value Set 📦v1.52.0 This IG
NameFlagsCard.TypeDescription & Constraints    Filter: doco
Coverage 0..* Coverage Insurance or medical plan or a payment agreement
Coverage.id This element must be supported. This element is included in summaries. 1..1 id Logical id of this artifact
Coverage.meta This element is included in summaries. 0..1 Meta Metadata about the resource
Coverage.implicitRules This element is a modifier element. This element is included in summaries. 0..1 uri A set of rules under which this content was created
Coverage.language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
Coverage.text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
Coverage.contained 0..* Resource Contained, inline Resources
Coverage.extension 0..* Extension Additional content defined by implementations
Coverage.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored
Coverage.identifier This element must be supported. This element is included in summaries. 1..* Identifier Business Identifier for the coverage
Coverage.status This element is a modifier element. This element is included in summaries. 1..1 code active | cancelled | draft | entered-in-error
Binding: Xealth Coverage Status Value Set (required)
Coverage.type This element must be supported. This element is included in summaries. 1..1 CodeableConcept Coverage category such as medical or accident
Binding: Xealth Coverage Type Value Set (required)
Coverage.policyHolder This element is included in summaries. 0..1 Reference(Patient | RelatedPerson | Organization) Owner of the policy
Coverage.subscriber This element is included in summaries. 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'
Coverage.subscriberId This element is included in summaries. 0..1 string Subscriber to the policy. SubscriberId will only be populated if the relationship of the patient to the subscriber is 'self'
Coverage.beneficiary This element is included in summaries. 1..1 Reference(Patient) Plan beneficiary
Coverage.dependent This element is included in summaries. 0..1 string Dependent number
Coverage.relationship 0..1 CodeableConcept Beneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
Coverage.period This element is included in summaries. 0..1 Period Coverage start and end dates
Coverage.payor This element is included in summaries. 1..* Reference(Organization | Patient | RelatedPerson) Issuer of the policy
Coverage.class 0..* BackboneElement Additional coverage classifications
Coverage.class.id 0..1 string Unique id for inter-element referencing
Coverage.class.extension 0..* Extension Additional content defined by implementations
Coverage.class.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Coverage.class.type This element is included in summaries. 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: Xealth Coverage Class Type Status Value Set (required)
Coverage.class.value This element is included in summaries. 1..1 string Value associated with the type
Coverage.class.name This element is included in summaries. 0..1 string Human readable description of the type and value
Coverage.order This element is included in summaries. 0..1 positiveInt Relative order of the coverage
Coverage.network This element is included in summaries. 0..1 string Insurer network
Coverage.costToBeneficiary 0..* BackboneElement Patient payments for services/products
Coverage.costToBeneficiary.id 0..1 string Unique id for inter-element referencing
Coverage.costToBeneficiary.extension 0..* Extension Additional content defined by implementations
Coverage.costToBeneficiary.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Coverage.costToBeneficiary.type This element is included in summaries. 0..1 CodeableConcept Cost category
Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
Coverage.costToBeneficiary.value[x] This element is included in summaries. 1..1 The amount or percentage due from the beneficiary
Coverage.costToBeneficiary.value[x].valueQuantity Quantity(SimpleQuantity)
Coverage.costToBeneficiary.value[x].valueMoney Money
Coverage.costToBeneficiary.exception 0..* BackboneElement Exceptions for patient payments
Coverage.costToBeneficiary.exception.id 0..1 string Unique id for inter-element referencing
Coverage.costToBeneficiary.exception.extension 0..* Extension Additional content defined by implementations
Coverage.costToBeneficiary.exception.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Coverage.costToBeneficiary.exception.type This element is included in summaries. 1..1 CodeableConcept Exception category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
Coverage.costToBeneficiary.exception.period This element is included in summaries. 0..1 Period The effective period of the exception
Coverage.subrogation 0..1 boolean Reimbursement to insurer
Coverage.contract 0..* Reference(Contract) Contract details

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.language Base preferred Common Languages 📍4.0.1 FHIR Std.
Coverage.status Base required Xealth Coverage Status Value Set 📦v1.52.0 This IG
Coverage.type Base required Xealth Coverage Type Value Set 📦v1.52.0 This IG
Coverage.relationship Base extensible SubscriberPolicyholder Relationship Codes 📍4.0.1 FHIR Std.
Coverage.class.type Base required Xealth Coverage Class Type Status Value Set 📦v1.52.0 This IG
Coverage.costToBeneficiary.​type Base extensible Coverage Copay Type Codes 📍4.0.1 FHIR Std.
Coverage.costToBeneficiary.​exception.type Base example Example Coverage Financial Exception Codes 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
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

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Coverage 0..* Coverage Insurance or medical plan or a payment agreement
Coverage.id This element must be supported. This element is included in summaries. 1..1 id Logical id of this artifact
Coverage.implicitRules This element is a modifier element. This element is included in summaries. 0..1 uri A set of rules under which this content was created
Coverage.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored
Coverage.identifier This element must be supported. This element is included in summaries. 1..* Identifier Business Identifier for the coverage
Coverage.status This element is a modifier element. This element is included in summaries. 1..1 code active | cancelled | draft | entered-in-error
Binding: Xealth Coverage Status Value Set (required)
Coverage.type This element must be supported. This element is included in summaries. 1..1 CodeableConcept Coverage category such as medical or accident
Binding: Xealth Coverage Type Value Set (required)
Coverage.subscriber This element is included in summaries. 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'
Coverage.subscriberId This element is included in summaries. 0..1 string Subscriber to the policy. SubscriberId will only be populated if the relationship of the patient to the subscriber is 'self'
Coverage.beneficiary This element is included in summaries. 1..1 Reference(Patient) Plan beneficiary
Coverage.payor This element is included in summaries. 1..* Reference(Organization | Patient | RelatedPerson) Issuer of the policy

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.status Base required Xealth Coverage Status Value Set 📦v1.52.0 This IG
Coverage.type Base required Xealth Coverage Type Value Set 📦v1.52.0 This IG

Constraints

Id Grade Path(s) Description Expression
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

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Coverage 0..* Coverage Insurance or medical plan or a payment agreement
Coverage.id This element must be supported. 1..1 id Logical id of this artifact
Coverage.identifier This element must be supported. 1..* Identifier Business Identifier for the coverage
Coverage.status 1..1 code active | cancelled | draft | entered-in-error
Binding: Xealth Coverage Status Value Set (required)
Coverage.type This element must be supported. 1..1 CodeableConcept Coverage category such as medical or accident
Binding: Xealth Coverage Type Value Set (required)
Coverage.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'
Coverage.subscriberId 0..1 string Subscriber to the policy. SubscriberId will only be populated if the relationship of the patient to the subscriber is 'self'
Coverage.class
Coverage.class.type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: Xealth Coverage Class Type Status Value Set (required)

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Coverage.status Base required Xealth Coverage Status Value Set 📦v1.52.0 This IG
Coverage.type Base required Xealth Coverage Type Value Set 📦v1.52.0 This IG
Coverage.class.type Base required Xealth Coverage Class Type Status Value Set 📦v1.52.0 This IG

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Coverage 0..* Coverage Insurance or medical plan or a payment agreement
Coverage.id This element must be supported. This element is included in summaries. 1..1 id Logical id of this artifact
Coverage.meta This element is included in summaries. 0..1 Meta Metadata about the resource
Coverage.implicitRules This element is a modifier element. This element is included in summaries. 0..1 uri A set of rules under which this content was created
Coverage.language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
Coverage.text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
Coverage.contained 0..* Resource Contained, inline Resources
Coverage.extension 0..* Extension Additional content defined by implementations
Coverage.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored
Coverage.identifier This element must be supported. This element is included in summaries. 1..* Identifier Business Identifier for the coverage
Coverage.status This element is a modifier element. This element is included in summaries. 1..1 code active | cancelled | draft | entered-in-error
Binding: Xealth Coverage Status Value Set (required)
Coverage.type This element must be supported. This element is included in summaries. 1..1 CodeableConcept Coverage category such as medical or accident
Binding: Xealth Coverage Type Value Set (required)
Coverage.policyHolder This element is included in summaries. 0..1 Reference(Patient | RelatedPerson | Organization) Owner of the policy
Coverage.subscriber This element is included in summaries. 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'
Coverage.subscriberId This element is included in summaries. 0..1 string Subscriber to the policy. SubscriberId will only be populated if the relationship of the patient to the subscriber is 'self'
Coverage.beneficiary This element is included in summaries. 1..1 Reference(Patient) Plan beneficiary
Coverage.dependent This element is included in summaries. 0..1 string Dependent number
Coverage.relationship 0..1 CodeableConcept Beneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
Coverage.period This element is included in summaries. 0..1 Period Coverage start and end dates
Coverage.payor This element is included in summaries. 1..* Reference(Organization | Patient | RelatedPerson) Issuer of the policy
Coverage.class 0..* BackboneElement Additional coverage classifications
Coverage.class.id 0..1 string Unique id for inter-element referencing
Coverage.class.extension 0..* Extension Additional content defined by implementations
Coverage.class.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Coverage.class.type This element is included in summaries. 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: Xealth Coverage Class Type Status Value Set (required)
Coverage.class.value This element is included in summaries. 1..1 string Value associated with the type
Coverage.class.name This element is included in summaries. 0..1 string Human readable description of the type and value
Coverage.order This element is included in summaries. 0..1 positiveInt Relative order of the coverage
Coverage.network This element is included in summaries. 0..1 string Insurer network
Coverage.costToBeneficiary 0..* BackboneElement Patient payments for services/products
Coverage.costToBeneficiary.id 0..1 string Unique id for inter-element referencing
Coverage.costToBeneficiary.extension 0..* Extension Additional content defined by implementations
Coverage.costToBeneficiary.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Coverage.costToBeneficiary.type This element is included in summaries. 0..1 CodeableConcept Cost category
Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
Coverage.costToBeneficiary.value[x] This element is included in summaries. 1..1 The amount or percentage due from the beneficiary
Coverage.costToBeneficiary.value[x].valueQuantity Quantity(SimpleQuantity)
Coverage.costToBeneficiary.value[x].valueMoney Money
Coverage.costToBeneficiary.exception 0..* BackboneElement Exceptions for patient payments
Coverage.costToBeneficiary.exception.id 0..1 string Unique id for inter-element referencing
Coverage.costToBeneficiary.exception.extension 0..* Extension Additional content defined by implementations
Coverage.costToBeneficiary.exception.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Coverage.costToBeneficiary.exception.type This element is included in summaries. 1..1 CodeableConcept Exception category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
Coverage.costToBeneficiary.exception.period This element is included in summaries. 0..1 Period The effective period of the exception
Coverage.subrogation 0..1 boolean Reimbursement to insurer
Coverage.contract 0..* Reference(Contract) Contract details

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.language Base preferred Common Languages 📍4.0.1 FHIR Std.
Coverage.status Base required Xealth Coverage Status Value Set 📦v1.52.0 This IG
Coverage.type Base required Xealth Coverage Type Value Set 📦v1.52.0 This IG
Coverage.relationship Base extensible SubscriberPolicyholder Relationship Codes 📍4.0.1 FHIR Std.
Coverage.class.type Base required Xealth Coverage Class Type Status Value Set 📦v1.52.0 This IG
Coverage.costToBeneficiary.​type Base extensible Coverage Copay Type Codes 📍4.0.1 FHIR Std.
Coverage.costToBeneficiary.​exception.type Base example Example Coverage Financial Exception Codes 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
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