Canonical URL: http://fhir.de/StructureDefinition/coverage-de-sel/0.2
| Coverage | 0..* | Coverage | Short description Versicherungsdaten DefinitionAngaben zur Versicherung oder zur Kostenübernahme durch den Patienten selbst oder durch Dritte
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| identifier | Σ | 0..* | Identifier | Short description The primary coverage ID DefinitionThe main (and possibly only) identifier for the coverage - often referred to as a Member Id, Certificate number, Personal Health Number or Case ID. May be constructed as the concatination of the Coverage.SubscriberID and the Coverage.dependant. This value may uniquely identify the coverage or it may be used in conjunction with the additional identifiers below.
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| status | Σ ?! | 1..1 | codeBinding | Short description active | cancelled | draft | entered-in-error DefinitionThe status of the resource instance. This element is labeled as a modifier because the status contains the code entered-in-error that marks the coverage as not currently valid.
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| type | Σ | 0..1 | CodeableConceptBinding | Short description Versicherungsart DefinitionArt der Versicherung: Selbstzahler, gesetzliche/private Versicherung, Berufsgenossenschaft oder Sozialamt The order of application of coverages is dependent on the types of coverage. 28.07.2017 (zulip): TC Konsens bzgl. Verwendung eines eigenen ValueSets anstelle des im Standrad definierten preferred bindings, da die dort igen Codes nicht passen. versicherungsart-de-basis (required) Constraints
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| coding | Σ | 0..* | Coding | Short description Code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings. Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
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| system | Σ | 0..1 | uriFixed Value | Short description Identity of the terminology system DefinitionThe identification of the code system that defines the meaning of the symbol in the code. Need to be unambiguous about the source of the definition of the symbol. The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.
http://fhir.de/CodeSystem/versicherungsart-de-basis
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| version | Σ | 0..1 | string | Short description Version of the system - if relevant DefinitionThe version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.
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| code | Σ | 0..1 | codeFixed Value | Short description Symbol in syntax defined by the system DefinitionA symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). Need to refer to a particular code in the system. Note that FHIR strings may not exceed 1MB in size
SEL
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| display | Σ | 0..1 | string | Short description Representation defined by the system DefinitionA representation of the meaning of the code in the system, following the rules of the system. Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Note that FHIR strings may not exceed 1MB in size
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| userSelected | Σ | 0..1 | boolean | Short description If this coding was chosen directly by the user DefinitionIndicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays). This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.
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| text | Σ | 0..1 | string | Short description Plain text representation of the concept DefinitionA human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. Very often the text is the same as a displayName of one of the codings.
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| policyHolder | Σ | 0..0 | Reference(Patient | RelatedPerson | Organization) | Short description Owner of the policy DefinitionThe party who 'owns' the insurance policy, may be an individual, corporation or the subscriber's employer. Es gibt derzeit in DE keine Verwendung für dieses Attribut (Konsens Interop-Forum 12.6.2017) Falls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org Reference(Patient | RelatedPerson | Organization) Constraints
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| subscriber | Σ | 0..1 | Reference(RelatedPerson | Patient, deutsches Basisprofil (Version 0.2)) | Short description Unterzeichner der Kostenübernahme DefinitionPerson, die dies Kostenübernahme zusichert (entweder der Patient selbst oder eine andere Person, z.B. ein Elternteil) References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(RelatedPerson | Patient, deutsches Basisprofil (Version 0.2)) Constraints
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| subscriberId | Σ | 0..0 | string | Short description ID assigned to the Subscriber DefinitionThe insurer assigned ID for the Subscriber. Note that FHIR strings may not exceed 1MB in size
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| beneficiary | Σ | 1..1 | Reference(Patient, deutsches Basisprofil (Version 0.2)) | Short description Begünstigte Person DefinitionPerson, auf die sich die Kostenübernahme bezieht (der Patient) References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Patient, deutsches Basisprofil (Version 0.2)) Constraints
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| relationship | 0..1 | CodeableConcept | Short description Beneficiary relationship to the Subscriber DefinitionThe relationship of beneficiary (patient) to the subscriber. To determine relationship between the patient and the subscriber. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. policyholder-relationship (example) Constraints
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| period | Σ | 0..1 | Period | Short description Coverage start and end dates DefinitionTime period during which the coverage is in force. A missing start date indicates the start date isn't known, a missing end date means the coverage is continuing to be in force. This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). If duration is required, specify the type as Interval|Duration.
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| payor | Σ | 1..* | Reference(Organisation, deutsches Basisprofil (Version 0.2) | RelatedPerson | Patient, deutsches Basisprofil (Version 0.2)) | Short description Kostenübernehmer DefinitionPerson, die die Kosten übernimmt (beim Selbstzahlerverhältnis i.d.R. identisch mit subscriber) Sonderfall: Die Kostenübernahme wird von einer Person (subscriber) erklärt, die Übernahme erfolgt jedoch durch eine Organisation Need to identify the issuer to target for processing and for coordination of benefit processing. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Organisation, deutsches Basisprofil (Version 0.2) | RelatedPerson | Patient, deutsches Basisprofil (Version 0.2)) Constraints
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| grouping | 0..0 | BackboneElement | Short description Additional coverage classifications DefinitionA suite of underwrite specific classifiers, for example may be used to identify a class of coverage or employer group, Policy, Plan. Es gibt derzeit in DE keine Verwendung für dieses Attribut (Konsens Interop-Forum 12.6.2017) Falls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org
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| dependent | Σ | 0..0 | string | Short description Dependent number DefinitionIdentifikation einer unter dieser Police versicherten Partei Bsp: eine Familie ist mit der Police mit dem Identifier "12345" versichert Vater 12345a Mutter 12345b Kind 12345c a, b und c wären dann jeweils die "dependents" For some coverage a single identifier is issued to the Subscriber and a dependent number issued to each beneficiary. Es gibt derzeit in DE keine Verwendung für dieses Attribut (Konsens Interop-Forum 12.6.2017) Falls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org
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| sequence | Σ | 0..0 | string | Short description The plan instance or sequence counter DefinitionAn optional counter for a particular instance of the identified coverage which increments upon each renewal. Some coverage, for example social plans, may be offered in short time increments, for example for a week or a month at a time, so while the rest of the plan details and identifiers may remain constant over time, the instance is incremented with each renewal and provided to the covered party on their 'card'. Es gibt derzeit in DE keine Verwendung für dieses Attribut (Konsens Interop-Forum 12.6.2017) Falls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org
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| order | Σ | 0..0 | positiveInt | Short description Relative order of the coverage DefinitionThe order of applicability of this coverage relative to other coverages which are currently inforce. Note, there may be gaps in the numbering and this does not imply primary, secondard etc. as the specific positioning of coverages depends upon the episode of care. Es git derzeit in DE keine Verwendung für dieses Attribut (Konsens Interop-Forum 12.6.2017) Für die Priorisierung der Versicherungsverhältnisse sollte statt dessen Account.coverage.priority verwendet werden, da die Priorisierung abhängig von Fall- und Abrechnungsart unterschiedlich sein kann. Falls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org
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| network | Σ | 0..0 | string | Short description Insurer network DefinitionDie Versicherungsleistungen sind an ein bestimmtes Netzwerk von Gesundheitsdienstleistern gebunden Es gibt derzeit in DE keine Verwendung für dieses Attribut (Konsens Interop-Forum 12.6.2017) Falls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org
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| contract | 0..* | Reference(Contract) | Short description Contract details DefinitionThe policy(s) which constitute this insurance coverage. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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<Coverage> <meta> <profile value="http://fhir.de/StructureDefinition/coverage-de-sel/0.2" /> </meta> <status value="active" /> <type> <coding> <system value="http://fhir.de/CodeSystem/versicherungsart-de-basis" /> <code value="SEL" /> </coding> </type> <subscriber> <reference value="RelatedPerson/22334" /> <display value="Zahlemann, Heinz" /> </subscriber> <beneficiary> <reference value="Patient/12345" /> <display value="Zahlemann, Jeanette" /> </beneficiary> <payor> <reference value="RelatedPerson/22334" /> <display value="Zahlemann, Heinz" /> </payor> </Coverage>
{ "resourceType":"Coverage", "meta":{ "profile": [ "http://fhir.de/StructureDefinition/coverage-de-sel/0.2" ] }, "status":"active", "type":{ "coding": [ { "system":"http://fhir.de/CodeSystem/versicherungsart-de-basis", "code":"SEL" } ] }, "subscriber":{ "reference":"RelatedPerson/22334", "display":"Zahlemann, Heinz" }, "beneficiary":{ "reference":"Patient/12345", "display":"Zahlemann, Jeanette" }, "payor": [ { "reference":"RelatedPerson/22334", "display":"Zahlemann, Heinz" } ] }
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