HL7 FHIR Implementation Guide: Simplify Health Equity Application Reviews IG Release 1 - US Realm | STU1 - Local Development build (v0.1.0). See the Directory of published versions

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Resource Profile: SHEAR Coverage

Data that reflect a payer’s coverage of the member, with links to Insurance products and Services that are provided via the coverage plan.

Usage:

• This Resource Profile is not used by any profiles in this Implementation Guide

Formal Views of Profile Content

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

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from C4DICCoverage

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	C4DICCoverage	Insurance or medical plan or a payment agreement
meta
profile	S	1..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
SHEAR-InsuranceProduct-extension		0..*	(Complex)	Covered Insurance Products or Services URL: https://ig.fhir.safhir.io/ig/shear/StructureDefinition/SHEAR-InsuranceProduct-extension
SHEAR-AdvanceDirective-extension		0..1	(Complex)	Link to Advance Directive URL: https://ig.fhir.safhir.io/ig/shear/StructureDefinition/SHEAR-AdvanceDirective-extension
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	C4DICCoverage	Insurance or medical plan or a payment agreement
meta	SΣ	1..1	Meta	Metadata about the resource
lastUpdated	SΣ	1..1	instant	When the resource version last changed
Slices for profile	SΣ	1..*	canonical(StructureDefinition)	Profiles this resource claims to conform to Slice: Unordered, Open by pattern:$this
profile:supportedProfile	Σ	1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to Required Pattern: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Coverage
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
C4DIC-PlanBeneficiaries-extension		0..*	(Complex)	Plan Beneficiaries URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension
C4DIC-AdditionalCardInformation-extension		0..*	Annotation	Additional Insurance Card Information URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-AdditionalCardInformation-extension
C4DIC-BackgroundColor-extension		0..1	CodeableConcept	Background Color URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BackgroundColor-extension Binding: C4DIC ISO Color (required)
C4DIC-HighlightColor-extension		0..1	CodeableConcept	Highlight 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..1	date	Card Issue Date URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-CardIssueDate-extension
SHEAR-InsuranceProduct-extension		0..*	(Complex)	Covered Insurance Products or Services URL: https://ig.fhir.safhir.io/ig/shear/StructureDefinition/SHEAR-InsuranceProduct-extension
SHEAR-AdvanceDirective-extension		0..1	(Complex)	Link to Advance Directive URL: https://ig.fhir.safhir.io/ig/shear/StructureDefinition/SHEAR-AdvanceDirective-extension
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣ	1..*	Identifier	Business Identifier for the coverage Slice: Unordered, Open by pattern:type
identifier:All Slices				Content/Rules for all slices
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
identifier:memberid	SΣ	1..1	Identifier	Member ID
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	1..1	CodeableConcept	Description 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
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
code		1..1	code	Symbol in syntax defined by the system Fixed Value: MB
system	SΣ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique Example General: 123456
assigner	SΣ	1..1	Reference(Organization)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	SΣ	1..1	CodeableConcept	Coverage 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.
subscriber	SΣ	1..1	Reference(Patient | RelatedPerson)	Subscriber to the policy
reference	SΣC	1..1	string	Literal reference, Relative, internal or absolute URL
subscriberId	SΣ	1..1	string	ID assigned to the subscriber
beneficiary	SΣ	1..1	Reference(C4DIC Patient)	Plan beneficiary
reference	SΣC	1..1	string	Literal reference, Relative, internal or absolute URL
dependent	SΣ	0..1	string	Dependent number
relationship	S	1..1	CodeableConcept	Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (required)
period	SΣ	0..1	Period	Coverage start and end dates
payor	SΣ	1..1	Reference(C4DIC Organization)	Issuer of the policy
Slices for class	S	0..*	BackboneElement	Additional coverage classifications Slice: Unordered, Open by pattern:type
class:All Slices				Content/Rules for all slices
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: C4DIC Coverage Class (required)
value	Σ	1..1	string	Value associated with the type
class:group	S	0..1	BackboneElement	Additional coverage classifications
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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
code		1..1	code	Symbol in syntax defined by the system Fixed Value: group
value	Σ	1..1	string	Value associated with the type
class:plan	S	0..1	BackboneElement	Additional coverage classifications
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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
code		1..1	code	Symbol in syntax defined by the system Fixed Value: plan
value	Σ	1..1	string	Value associated with the type
class:division	S	0..1	BackboneElement	Additional coverage classifications
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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS
code		1..1	code	Symbol in syntax defined by the system Fixed Value: division
value	Σ	1..1	string	Value associated with the type
class:network	S	0..1	BackboneElement	Additional coverage classifications
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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS
code		1..1	code	Symbol in syntax defined by the system Fixed Value: network
value	Σ	1..1	string	Value associated with the type
class:rxbin	S	0..1	BackboneElement	Additional coverage classifications
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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
code		1..1	code	Symbol in syntax defined by the system Fixed Value: rxbin
value	Σ	1..1	string	Value associated with the type
class:rxpcn	S	0..1	BackboneElement	Additional coverage classifications
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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
code		1..1	code	Symbol in syntax defined by the system Fixed Value: rxpcn
value	Σ	1..1	string	Value associated with the type
class:rxgroup	S	0..1	BackboneElement	Additional coverage classifications
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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
code		1..1	code	Symbol in syntax defined by the system Fixed Value: rxgroup
value	Σ	1..1	string	Value associated with the type
class:rxid	S	0..1	BackboneElement	Additional coverage classifications
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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
code		1..1	code	Symbol in syntax defined by the system Fixed Value: rxid
value	Σ	1..1	string	Value associated with the type
class:rxiin	S	0..1	BackboneElement	Additional coverage classifications
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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS
code		1..1	code	Symbol in syntax defined by the system Fixed Value: rxiin
value	Σ	1..1	string	Value associated with the type
costToBeneficiary	S	0..*	BackboneElement	Patient payments for services/products
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	SΣ	1..1	CodeableConcept	Cost category Binding: C4DIC Copay Type (extensible)
Slices for value[x]	Σ	1..1	Money	The amount or percentage due from the beneficiary Slice: Unordered, Closed by type:$this
value[x]:valueMoney	SΣC	1..1	Money	The amount or percentage due from the beneficiary
C4DIC-BeneficiaryCostString-extension	S	0..1	string	Beneficiary Cost as String URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension
value	SΣ	0..1	decimal	Numerical value (with implicit precision)
currency	SΣ	0..1	code	ISO 4217 Currency Code Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Coverage.identifier.use	required	IdentifierUse
Coverage.identifier:memberid.use	required	IdentifierUse
Coverage.identifier:memberid.type	extensible	Pattern: MB
Coverage.status	required	FinancialResourceStatusCodes
Coverage.type	preferred	CoverageTypeAndSelf-PayCodes
Coverage.relationship	required	SubscriberRelationshipCodes
Coverage.class.type	required	C4DICCoverageClassVS
Coverage.class:group.type	extensible	Pattern: group
Coverage.class:plan.type	extensible	Pattern: plan
Coverage.class:division.type	extensible	Pattern: division
Coverage.class:network.type	extensible	Pattern: network
Coverage.class:rxbin.type	extensible	Pattern: rxbin
Coverage.class:rxpcn.type	extensible	Pattern: rxpcn
Coverage.class:rxgroup.type	extensible	Pattern: rxgroup
Coverage.class:rxid.type	extensible	Pattern: rxid
Coverage.class:rxiin.type	extensible	Pattern: rxiin
Coverage.costToBeneficiary.type	extensible	C4DICCopayTypeVS
Coverage.costToBeneficiary.value[x]:valueMoney.currency	required	Currencies (a valid code from urn:iso:std:iso:4217)

Constraints

Id	Grade	Path(s)	Details	Requirements
ValueMoney-details-or-extension	error	Coverage.costToBeneficiary.value[x]:valueMoney	costToBeneficiary 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()
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()

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	C4DICCoverage	Insurance or medical plan or a payment agreement
id	Σ	0..1	id	Logical id of this artifact
meta	SΣ	1..1	Meta	Metadata about the resource
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	SΣ	1..1	instant	When the resource version last changed
source	Σ	0..1	uri	Identifies where the resource comes from
Slices for profile	SΣ	1..*	canonical(StructureDefinition)	Profiles this resource claims to conform to Slice: Unordered, Open by pattern:$this
profile:supportedProfile	Σ	1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to Required Pattern: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Coverage
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags 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	?!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
Slices for extension		0..*	Extension	Extension 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..*	Annotation	Additional Insurance Card Information URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-AdditionalCardInformation-extension
C4DIC-BackgroundColor-extension		0..1	CodeableConcept	Background Color URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BackgroundColor-extension Binding: C4DIC ISO Color (required)
C4DIC-HighlightColor-extension		0..1	CodeableConcept	Highlight 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..1	date	Card Issue Date URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-CardIssueDate-extension
SHEAR-InsuranceProduct-extension		0..*	(Complex)	Covered Insurance Products or Services URL: https://ig.fhir.safhir.io/ig/shear/StructureDefinition/SHEAR-InsuranceProduct-extension
SHEAR-AdvanceDirective-extension		0..1	(Complex)	Link to Advance Directive URL: https://ig.fhir.safhir.io/ig/shear/StructureDefinition/SHEAR-AdvanceDirective-extension
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣ	1..*	Identifier	Business Identifier for the coverage Slice: Unordered, Open by pattern:type
identifier:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: C4DIC Coverage Identifier Type (extensible)
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	0..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:memberid	SΣ	1..1	Identifier	Member ID
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	1..1	CodeableConcept	Description 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
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: MB
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
system	SΣ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	SΣ	1..1	Reference(Organization)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	SΣ	1..1	CodeableConcept	Coverage 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	Σ	0..1	Reference(Patient | RelatedPerson | Organization)	Owner of the policy
subscriber	SΣ	1..1	Reference(Patient | RelatedPerson)	Subscriber to the policy
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	SΣC	1..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
subscriberId	SΣ	1..1	string	ID assigned to the subscriber
beneficiary	SΣ	1..1	Reference(C4DIC Patient)	Plan beneficiary
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	SΣC	1..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
dependent	SΣ	0..1	string	Dependent number
relationship	S	1..1	CodeableConcept	Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (required)
period	SΣ	0..1	Period	Coverage start and end dates
payor	SΣ	1..1	Reference(C4DIC Organization)	Issuer of the policy
Slices for class	S	0..*	BackboneElement	Additional coverage classifications Slice: Unordered, Open by pattern:type
class:All Slices				Content/Rules for all slices
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: C4DIC Coverage Class (required)
value	Σ	1..1	string	Value associated with the type
name	Σ	0..1	string	Human readable description of the type and value
class:group	S	0..1	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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: group
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
value	Σ	1..1	string	Value associated with the type
name	Σ	0..1	string	Human readable description of the type and value
class:plan	S	0..1	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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: plan
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
value	Σ	1..1	string	Value associated with the type
name	Σ	0..1	string	Human readable description of the type and value
class:division	S	0..1	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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: division
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
value	Σ	1..1	string	Value associated with the type
name	Σ	0..1	string	Human readable description of the type and value
class:network	S	0..1	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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: network
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
value	Σ	1..1	string	Value associated with the type
name	Σ	0..1	string	Human readable description of the type and value
class:rxbin	S	0..1	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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: rxbin
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
value	Σ	1..1	string	Value associated with the type
name	Σ	0..1	string	Human readable description of the type and value
class:rxpcn	S	0..1	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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: rxpcn
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
value	Σ	1..1	string	Value associated with the type
name	Σ	0..1	string	Human readable description of the type and value
class:rxgroup	S	0..1	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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: rxgroup
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
value	Σ	1..1	string	Value associated with the type
name	Σ	0..1	string	Human readable description of the type and value
class:rxid	S	0..1	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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: rxid
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
value	Σ	1..1	string	Value associated with the type
name	Σ	0..1	string	Human readable description of the type and value
class:rxiin	S	0..1	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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: rxiin
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
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	S	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	SΣ	1..1	CodeableConcept	Cost category Binding: C4DIC Copay Type (extensible)
Slices for value[x]	Σ	1..1	Money	The amount or percentage due from the beneficiary Slice: Unordered, Closed by type:$this
value[x]:valueMoney	SΣC	1..1	Money	The amount or percentage due from the beneficiary
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
C4DIC-BeneficiaryCostString-extension	S	0..1	string	Beneficiary Cost as String URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension
value	SΣ	0..1	decimal	Numerical value (with implicit precision)
currency	SΣ	0..1	code	ISO 4217 Currency Code Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.
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 / Code
Coverage.meta.security	extensible	All Security Labels
Coverage.meta.tag	example	CommonTags
Coverage.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
Coverage.identifier.use	required	IdentifierUse
Coverage.identifier.type	extensible	C4DICCoverageIdentifierType
Coverage.identifier:memberid.use	required	IdentifierUse
Coverage.identifier:memberid.type	extensible	Pattern: MB
Coverage.status	required	FinancialResourceStatusCodes
Coverage.type	preferred	CoverageTypeAndSelf-PayCodes
Coverage.subscriber.type	extensible	ResourceType
Coverage.beneficiary.type	extensible	ResourceType
Coverage.relationship	required	SubscriberRelationshipCodes
Coverage.class.type	required	C4DICCoverageClassVS
Coverage.class:group.type	extensible	Pattern: group
Coverage.class:plan.type	extensible	Pattern: plan
Coverage.class:division.type	extensible	Pattern: division
Coverage.class:network.type	extensible	Pattern: network
Coverage.class:rxbin.type	extensible	Pattern: rxbin
Coverage.class:rxpcn.type	extensible	Pattern: rxpcn
Coverage.class:rxgroup.type	extensible	Pattern: rxgroup
Coverage.class:rxid.type	extensible	Pattern: rxid
Coverage.class:rxiin.type	extensible	Pattern: rxiin
Coverage.costToBeneficiary.type	extensible	C4DICCopayTypeVS
Coverage.costToBeneficiary.value[x]:valueMoney.currency	required	Currencies (a valid code from urn:iso:std:iso:4217)
Coverage.costToBeneficiary.exception.type	example	ExampleCoverageFinancialExceptionCodes

Constraints

Id	Grade	Path(s)	Details	Requirements
ValueMoney-details-or-extension	error	Coverage.costToBeneficiary.value[x]:valueMoney	costToBeneficiary 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()
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 C4DICCoverage

Summary

Must-Support: 1 element

Extensions

This structure refers to these extensions:

• https://ig.fhir.safhir.io/ig/shear/StructureDefinition/SHEAR-InsuranceProduct-extension
• https://ig.fhir.safhir.io/ig/shear/StructureDefinition/SHEAR-AdvanceDirective-extension

Differential View

This structure is derived from C4DICCoverage

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	C4DICCoverage	Insurance or medical plan or a payment agreement
meta
profile	S	1..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
SHEAR-InsuranceProduct-extension		0..*	(Complex)	Covered Insurance Products or Services URL: https://ig.fhir.safhir.io/ig/shear/StructureDefinition/SHEAR-InsuranceProduct-extension
SHEAR-AdvanceDirective-extension		0..1	(Complex)	Link to Advance Directive URL: https://ig.fhir.safhir.io/ig/shear/StructureDefinition/SHEAR-AdvanceDirective-extension
Documentation for this format

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	C4DICCoverage	Insurance or medical plan or a payment agreement
meta	SΣ	1..1	Meta	Metadata about the resource
lastUpdated	SΣ	1..1	instant	When the resource version last changed
Slices for profile	SΣ	1..*	canonical(StructureDefinition)	Profiles this resource claims to conform to Slice: Unordered, Open by pattern:$this
profile:supportedProfile	Σ	1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to Required Pattern: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Coverage
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
C4DIC-PlanBeneficiaries-extension		0..*	(Complex)	Plan Beneficiaries URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension
C4DIC-AdditionalCardInformation-extension		0..*	Annotation	Additional Insurance Card Information URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-AdditionalCardInformation-extension
C4DIC-BackgroundColor-extension		0..1	CodeableConcept	Background Color URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BackgroundColor-extension Binding: C4DIC ISO Color (required)
C4DIC-HighlightColor-extension		0..1	CodeableConcept	Highlight 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..1	date	Card Issue Date URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-CardIssueDate-extension
SHEAR-InsuranceProduct-extension		0..*	(Complex)	Covered Insurance Products or Services URL: https://ig.fhir.safhir.io/ig/shear/StructureDefinition/SHEAR-InsuranceProduct-extension
SHEAR-AdvanceDirective-extension		0..1	(Complex)	Link to Advance Directive URL: https://ig.fhir.safhir.io/ig/shear/StructureDefinition/SHEAR-AdvanceDirective-extension
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣ	1..*	Identifier	Business Identifier for the coverage Slice: Unordered, Open by pattern:type
identifier:All Slices				Content/Rules for all slices
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
identifier:memberid	SΣ	1..1	Identifier	Member ID
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	1..1	CodeableConcept	Description 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
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
code		1..1	code	Symbol in syntax defined by the system Fixed Value: MB
system	SΣ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique Example General: 123456
assigner	SΣ	1..1	Reference(Organization)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	SΣ	1..1	CodeableConcept	Coverage 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.
subscriber	SΣ	1..1	Reference(Patient | RelatedPerson)	Subscriber to the policy
reference	SΣC	1..1	string	Literal reference, Relative, internal or absolute URL
subscriberId	SΣ	1..1	string	ID assigned to the subscriber
beneficiary	SΣ	1..1	Reference(C4DIC Patient)	Plan beneficiary
reference	SΣC	1..1	string	Literal reference, Relative, internal or absolute URL
dependent	SΣ	0..1	string	Dependent number
relationship	S	1..1	CodeableConcept	Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (required)
period	SΣ	0..1	Period	Coverage start and end dates
payor	SΣ	1..1	Reference(C4DIC Organization)	Issuer of the policy
Slices for class	S	0..*	BackboneElement	Additional coverage classifications Slice: Unordered, Open by pattern:type
class:All Slices				Content/Rules for all slices
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: C4DIC Coverage Class (required)
value	Σ	1..1	string	Value associated with the type
class:group	S	0..1	BackboneElement	Additional coverage classifications
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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
code		1..1	code	Symbol in syntax defined by the system Fixed Value: group
value	Σ	1..1	string	Value associated with the type
class:plan	S	0..1	BackboneElement	Additional coverage classifications
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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
code		1..1	code	Symbol in syntax defined by the system Fixed Value: plan
value	Σ	1..1	string	Value associated with the type
class:division	S	0..1	BackboneElement	Additional coverage classifications
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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS
code		1..1	code	Symbol in syntax defined by the system Fixed Value: division
value	Σ	1..1	string	Value associated with the type
class:network	S	0..1	BackboneElement	Additional coverage classifications
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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS
code		1..1	code	Symbol in syntax defined by the system Fixed Value: network
value	Σ	1..1	string	Value associated with the type
class:rxbin	S	0..1	BackboneElement	Additional coverage classifications
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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
code		1..1	code	Symbol in syntax defined by the system Fixed Value: rxbin
value	Σ	1..1	string	Value associated with the type
class:rxpcn	S	0..1	BackboneElement	Additional coverage classifications
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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
code		1..1	code	Symbol in syntax defined by the system Fixed Value: rxpcn
value	Σ	1..1	string	Value associated with the type
class:rxgroup	S	0..1	BackboneElement	Additional coverage classifications
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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
code		1..1	code	Symbol in syntax defined by the system Fixed Value: rxgroup
value	Σ	1..1	string	Value associated with the type
class:rxid	S	0..1	BackboneElement	Additional coverage classifications
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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
code		1..1	code	Symbol in syntax defined by the system Fixed Value: rxid
value	Σ	1..1	string	Value associated with the type
class:rxiin	S	0..1	BackboneElement	Additional coverage classifications
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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS
code		1..1	code	Symbol in syntax defined by the system Fixed Value: rxiin
value	Σ	1..1	string	Value associated with the type
costToBeneficiary	S	0..*	BackboneElement	Patient payments for services/products
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	SΣ	1..1	CodeableConcept	Cost category Binding: C4DIC Copay Type (extensible)
Slices for value[x]	Σ	1..1	Money	The amount or percentage due from the beneficiary Slice: Unordered, Closed by type:$this
value[x]:valueMoney	SΣC	1..1	Money	The amount or percentage due from the beneficiary
C4DIC-BeneficiaryCostString-extension	S	0..1	string	Beneficiary Cost as String URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension
value	SΣ	0..1	decimal	Numerical value (with implicit precision)
currency	SΣ	0..1	code	ISO 4217 Currency Code Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Coverage.identifier.use	required	IdentifierUse
Coverage.identifier:memberid.use	required	IdentifierUse
Coverage.identifier:memberid.type	extensible	Pattern: MB
Coverage.status	required	FinancialResourceStatusCodes
Coverage.type	preferred	CoverageTypeAndSelf-PayCodes
Coverage.relationship	required	SubscriberRelationshipCodes
Coverage.class.type	required	C4DICCoverageClassVS
Coverage.class:group.type	extensible	Pattern: group
Coverage.class:plan.type	extensible	Pattern: plan
Coverage.class:division.type	extensible	Pattern: division
Coverage.class:network.type	extensible	Pattern: network
Coverage.class:rxbin.type	extensible	Pattern: rxbin
Coverage.class:rxpcn.type	extensible	Pattern: rxpcn
Coverage.class:rxgroup.type	extensible	Pattern: rxgroup
Coverage.class:rxid.type	extensible	Pattern: rxid
Coverage.class:rxiin.type	extensible	Pattern: rxiin
Coverage.costToBeneficiary.type	extensible	C4DICCopayTypeVS
Coverage.costToBeneficiary.value[x]:valueMoney.currency	required	Currencies (a valid code from urn:iso:std:iso:4217)

Constraints

Id	Grade	Path(s)	Details	Requirements
ValueMoney-details-or-extension	error	Coverage.costToBeneficiary.value[x]:valueMoney	costToBeneficiary 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()
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()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	C4DICCoverage	Insurance or medical plan or a payment agreement
id	Σ	0..1	id	Logical id of this artifact
meta	SΣ	1..1	Meta	Metadata about the resource
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	SΣ	1..1	instant	When the resource version last changed
source	Σ	0..1	uri	Identifies where the resource comes from
Slices for profile	SΣ	1..*	canonical(StructureDefinition)	Profiles this resource claims to conform to Slice: Unordered, Open by pattern:$this
profile:supportedProfile	Σ	1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to Required Pattern: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Coverage
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags 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	?!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
Slices for extension		0..*	Extension	Extension 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..*	Annotation	Additional Insurance Card Information URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-AdditionalCardInformation-extension
C4DIC-BackgroundColor-extension		0..1	CodeableConcept	Background Color URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BackgroundColor-extension Binding: C4DIC ISO Color (required)
C4DIC-HighlightColor-extension		0..1	CodeableConcept	Highlight 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..1	date	Card Issue Date URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-CardIssueDate-extension
SHEAR-InsuranceProduct-extension		0..*	(Complex)	Covered Insurance Products or Services URL: https://ig.fhir.safhir.io/ig/shear/StructureDefinition/SHEAR-InsuranceProduct-extension
SHEAR-AdvanceDirective-extension		0..1	(Complex)	Link to Advance Directive URL: https://ig.fhir.safhir.io/ig/shear/StructureDefinition/SHEAR-AdvanceDirective-extension
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣ	1..*	Identifier	Business Identifier for the coverage Slice: Unordered, Open by pattern:type
identifier:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: C4DIC Coverage Identifier Type (extensible)
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	0..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:memberid	SΣ	1..1	Identifier	Member ID
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	1..1	CodeableConcept	Description 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
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: MB
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
system	SΣ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	SΣ	1..1	Reference(Organization)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	SΣ	1..1	CodeableConcept	Coverage 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	Σ	0..1	Reference(Patient | RelatedPerson | Organization)	Owner of the policy
subscriber	SΣ	1..1	Reference(Patient | RelatedPerson)	Subscriber to the policy
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	SΣC	1..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
subscriberId	SΣ	1..1	string	ID assigned to the subscriber
beneficiary	SΣ	1..1	Reference(C4DIC Patient)	Plan beneficiary
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	SΣC	1..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
dependent	SΣ	0..1	string	Dependent number
relationship	S	1..1	CodeableConcept	Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (required)
period	SΣ	0..1	Period	Coverage start and end dates
payor	SΣ	1..1	Reference(C4DIC Organization)	Issuer of the policy
Slices for class	S	0..*	BackboneElement	Additional coverage classifications Slice: Unordered, Open by pattern:type
class:All Slices				Content/Rules for all slices
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: C4DIC Coverage Class (required)
value	Σ	1..1	string	Value associated with the type
name	Σ	0..1	string	Human readable description of the type and value
class:group	S	0..1	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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: group
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
value	Σ	1..1	string	Value associated with the type
name	Σ	0..1	string	Human readable description of the type and value
class:plan	S	0..1	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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: plan
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
value	Σ	1..1	string	Value associated with the type
name	Σ	0..1	string	Human readable description of the type and value
class:division	S	0..1	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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: division
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
value	Σ	1..1	string	Value associated with the type
name	Σ	0..1	string	Human readable description of the type and value
class:network	S	0..1	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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: network
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
value	Σ	1..1	string	Value associated with the type
name	Σ	0..1	string	Human readable description of the type and value
class:rxbin	S	0..1	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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: rxbin
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
value	Σ	1..1	string	Value associated with the type
name	Σ	0..1	string	Human readable description of the type and value
class:rxpcn	S	0..1	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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: rxpcn
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
value	Σ	1..1	string	Value associated with the type
name	Σ	0..1	string	Human readable description of the type and value
class:rxgroup	S	0..1	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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: rxgroup
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
value	Σ	1..1	string	Value associated with the type
name	Σ	0..1	string	Human readable description of the type and value
class:rxid	S	0..1	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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: rxid
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
value	Σ	1..1	string	Value associated with the type
name	Σ	0..1	string	Human readable description of the type and value
class:rxiin	S	0..1	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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: rxiin
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
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	S	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	SΣ	1..1	CodeableConcept	Cost category Binding: C4DIC Copay Type (extensible)
Slices for value[x]	Σ	1..1	Money	The amount or percentage due from the beneficiary Slice: Unordered, Closed by type:$this
value[x]:valueMoney	SΣC	1..1	Money	The amount or percentage due from the beneficiary
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
C4DIC-BeneficiaryCostString-extension	S	0..1	string	Beneficiary Cost as String URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension
value	SΣ	0..1	decimal	Numerical value (with implicit precision)
currency	SΣ	0..1	code	ISO 4217 Currency Code Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.
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 / Code
Coverage.meta.security	extensible	All Security Labels
Coverage.meta.tag	example	CommonTags
Coverage.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
Coverage.identifier.use	required	IdentifierUse
Coverage.identifier.type	extensible	C4DICCoverageIdentifierType
Coverage.identifier:memberid.use	required	IdentifierUse
Coverage.identifier:memberid.type	extensible	Pattern: MB
Coverage.status	required	FinancialResourceStatusCodes
Coverage.type	preferred	CoverageTypeAndSelf-PayCodes
Coverage.subscriber.type	extensible	ResourceType
Coverage.beneficiary.type	extensible	ResourceType
Coverage.relationship	required	SubscriberRelationshipCodes
Coverage.class.type	required	C4DICCoverageClassVS
Coverage.class:group.type	extensible	Pattern: group
Coverage.class:plan.type	extensible	Pattern: plan
Coverage.class:division.type	extensible	Pattern: division
Coverage.class:network.type	extensible	Pattern: network
Coverage.class:rxbin.type	extensible	Pattern: rxbin
Coverage.class:rxpcn.type	extensible	Pattern: rxpcn
Coverage.class:rxgroup.type	extensible	Pattern: rxgroup
Coverage.class:rxid.type	extensible	Pattern: rxid
Coverage.class:rxiin.type	extensible	Pattern: rxiin
Coverage.costToBeneficiary.type	extensible	C4DICCopayTypeVS
Coverage.costToBeneficiary.value[x]:valueMoney.currency	required	Currencies (a valid code from urn:iso:std:iso:4217)
Coverage.costToBeneficiary.exception.type	example	ExampleCoverageFinancialExceptionCodes

Constraints

Id	Grade	Path(s)	Details	Requirements
ValueMoney-details-or-extension	error	Coverage.costToBeneficiary.value[x]:valueMoney	costToBeneficiary 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()
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 C4DICCoverage

Summary

Must-Support: 1 element

Extensions

This structure refers to these extensions:

• https://ig.fhir.safhir.io/ig/shear/StructureDefinition/SHEAR-InsuranceProduct-extension
• https://ig.fhir.safhir.io/ig/shear/StructureDefinition/SHEAR-AdvanceDirective-extension