A unique identifier assigned to this coverage.

Allows coverages to be distinguished and referenced.

The 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 concatenation of the Coverage.SubscriberID and the Coverage.dependant.

The status of the resource instance.

Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.

This element is labeled as a modifier because the status contains the code entered-in-error that marks the coverage as not currently valid.

The 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.

A 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 SHALL NOT exceed 1MB in size

Indicates that this coding was chosen by a user directly - e.g. 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.

A 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.

Person, auf die sich die Kostenübernahme bezieht (der Patient)

This is the party who receives treatment for which the costs are reimbursed under the 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.

A unique identifier for a dependent under the coverage.

For some coverages a single identifier is issued to the Subscriber and then a unique dependent number is issued to each beneficiary.

Periodically the member number is constructed from the subscriberId and the dependant number.

The relationship of beneficiary (patient) to the subscriber.

To determine relationship between the patient and the subscriber to determine coordination of benefits.

Typically, an individual uses policies which are theirs (relationship='self') before policies owned by others.

Time 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.

Some insurers require the submission of the coverage term.

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").

Period is not used for a duration (a measure of elapsed time). See Duration.

The type of classification for which an insurer-specific class label or number and optional name is provided, for example may be used to identify a class of coverage or employer group, Policy, Plan.

The insurer issued label for a specific health card value.

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.

The alphanumeric string value associated with the insurer issued label.

The insurer issued label and value are necessary to identify the specific policy.

For example, the Group or Plan number.

A short description for the class.

Used to provide a meaningful description in correspondence to the patient.

Note that FHIR strings SHALL NOT exceed 1MB in size

The category of patient centric costs associated with treatment.

Needed to identify the category associated with the amount for the patient.

For example visit, specialist visits, emergency, inpatient care, etc.

The code for the specific exception.

Needed to identify the exception associated with the amount for the patient.

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.

The timeframe during when the exception is in force.

Needed to identify the applicable timeframe for the exception for the correct calculation of patient costs.

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").

Period is not used for a duration (a measure of elapsed time). See Duration.

When 'subrogation=true' this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs.

See definition for when to be used.

Typically, automotive and worker's compensation policies would be flagged with 'subrogation=true' to enable healthcare payors to collect against accident claims.

The policy(s) which constitute this insurance coverage.

To reference the legally binding contract between the policy holder and the insurer.

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.